Estradiol = 39. Low Libido, Low Temp. Lab Results Posted

Pharma / TRT Testosterone Replacement
1

Hey guys. I wanted to start off by saying that I have spent 2 weeks reading all of the stickies (well done KSMAN, I appreciate all of your hard work) and have ordered a majority of the recommended blood work and would like to present my partial results today for any feedback. I am going to be very concise here as to not waste anyones time reading unneeded, superfluous commentary.

My Symptoms. I am 35. 10-12% body fat (visible six pack). I workout 5-6 days a week lifting weights. Little or no cardio. 6 feet tall 196 pounds.

I have low libido, low ejaculate, ED with no morning erections unless I take a PDE-5 inhibitor, very introverted with social phobia (more of a lack of a desire to go out, I am just content staying home by myself all the time), mild depression and a persistent brain fog/sluggish cognitive tempo/AHDH/PI thing going on. My morning temperatures have been a slow as 95.9 but normally are around 96.1. My normal afternoon body temp was 97.1-97.3.

I have NEVER salted my foods in my life, so I almost certainly have an iodine deficiency.
I was eating a very low fat and low calorie diet with intermittent fasting.
About a month ago I dropped the IF, started adding 3 tablespoons of coconut oil to my diet and added more starches and I added 400-500 mcg a day of iodine from kelp to my diet. I gained 8 pounds and my afternoon temperatures are now averaging 97.6-97.8. I tried the Iodoral but I felt horrible and got massive skin eruptions. I know that this is purportedly from bromide detox but I am wondering if this that this could be overt iodine toxicity. Either way, I cant deal with the red bumps and rash all over my face so I am choosing to go slow with IR.

Labs from a couple of years ago have shown high estradiol and low ferritin (9). I tried arimidex and I crashed (E2 went to 6) and felt horrible so I just gave up on it. I am an over responder it seems.
So now I am fed up with feeling like crap and I decided to order the labs and move on this. Here is what I have back so far. All labs are from Quest:
CBC and CMP has everything in range. I can post specifics if needed.
ESTRADIOL 39 pg/ml (RR <or=39)
TOTAL CHOLESTEROL 171
HDL 61
TRIGLYCERIDES 65
LDL 97
CHOL/HDLC RATIO 2.8
NON HDL CHOL 110

TOTAL T3 106 (76-181)
FREE T3 3.3 (2.3-4.2)
TOTAL T4 8.7 (4.5-12.0)
FREE T4 1.4 (0.8-1.8)
TSH 2.14 (0.40-4.50)

All other labs are pending.
So, my estradiol at 39 is enough to be symptomatic and, according to the forums, could be causing my shyness, lack of motivation, and libido issues. I have liquid adex and will start on a VERY low dose and titrate up or down based on labs. I am going to do more research on KSMANS posts to try and find out when I should retest estradiol and total and free test.

My temperature increase due to my caloric and iodine increase is encouraging but I still have not made to to 98 degrees yet. I am still early in my IR and, as I said earlier, I am going low dose because of the side effects. My thyroid labs seem smack dab in the middle. Does anyone have any opinion on this? Should I test for rT3?
Thanks for taking the time to read this. Any help would be appreciated.

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But T3 should be nearer to midrange 130, you are 1.06

TSH=2.14 is indicating a problem and that is consistent with ID.

Your body temperatures are low and consistent with TSH and ID.

fT3 is what gets the job done. That is right at midrange. But with low body temperatures, you still have functional hypothyroidism. The simple answer is that rT3 is blocking fT3. You need rT3 labs to know.

I hope that you have LH/FSH done.

No one is allergic to iodine or its salts [it is a mineral]. It is misnomer for fish or shell fish sensitivities.

I assume that you understand that it takes 1500 0.5mg doses to get a .75 gram IR and you would never get there.

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Thank you for the reply. Yes, I suppose I should just man up and do the full on IR and put of with a week or so of misery and take comfort that I am displacing and eliminating bromide.

I did order LH/FSH as well. I ordered everything that was listed in the stickies.

I can order a rT3 lab, but what would this information do for me? I am skeptical of the high T3 dose protocol for Wilsons temperature syndrome that purports to lower rT3 and I do not know of any other reliable way to do so. I have heard selenium can work but it is purely anecdotal.

This is not highly relevant but I have a MTHFR mutation which means I can not convert dietary folates into the 5-methyltetrahydrofolate which is a major player in all methylation pathways, including phase II hepatic detoxification. This may have implications for estradiol conjugation and also hepatic metabolism of arimidex.

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If rT3 is elevated, then you need to be looking at the causes and possible life-style changes.

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[quote]KSman wrote:
If rT3 is elevated, then you need to be looking at the causes and possible life-style changes.[/quote]

Okay I will look in to that. A few more labs are back today and the only thing pending in the total and free testosterone.

FSH 5.4 (1.6-8.0)
LH 3.4 (1.5-9.3)

FERRITIN: 31 (20-343)

Vit D,25-OH,D3 49 (30-100)

Okay so, it appears my E2 of 39 is causing HPTA suppression in part by decreasing LH so I’d be amazed if my TT and FT aren’t low. I started on .125 mg (1 drop EOD my research chem anastrolzole 30 drops =1.0 mg). The reason I am going so low is because I crashed hard on .5 mg a week of arimidex previously. i’m going to slowly titrate based on E2 labs. KSMAN, how often should I check E2 to dial in my anastrozole dose. I have unlimited access to labs.

Also my ferritin is low enough to cause thyroid issues and brain fog/depression/ADHD. The only thing is I always get horrible joint pains about 4 days into low dose (25 mg) iron supplementation. Usually iron overload takes a long time to deposit in to the joints AND you wouldn’t normally see a low serum ferritin with serum iron high enough to cause joint problems so there must be something else. I may need to try a different form of iron? this is very perplexing to me.

I will post TT and FT labs as soon as they come back. Thank you.

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Hot off the press:

Total Testosterone 605 (250-1100)
Free Test 130.4 (35.0-155.0)

So even with an E2 of 39 I have a free test of 130.4 which puts it in the upper quadrant. That’s good news I guess. So hopefully once I get my E2 down to around 22 or so I should feel better. Also I will work on IR and monitor my thyroid labs and temperatures. I will also work on inching up my ferritin.

7

Tune up your E2 and things will be better yet.

Are you avoiding iron rich foods, red meat? Breakfast cereals are typically iron fortified, a problem for some males.

Serum iron is available blood work. I don’t know what to do with that data because I have seen wild swings in serum iron that can make one do supplements or seek iron loss. I don’t trust the numbers as something that is reliably actionable.

Low ferritin is associated with poor fT4–>fT3 conversion. Your fT3 seems good, hence the focus on fT3. So ferritin does not at first glance look like a QOL issue for you. From here, the focus is then on possible iron loss typically suspected to be a GI bleed. To investigate that, you look at CBC hematocrit, RBC and hemoglobin. Those may not be really low, still in range, but may be low enough to be suggestive. So one then asks about digestive problems and food sensitivities. To detect a GI bleed, one then gets a test kit from doc that you take home and smear poop on a card and return for analysis.

If you take a antacids, that can limit absorption of dietary iron as well as other minerals and vitamin B12.

So now you see why we ask to see all labs. There can be a lot of useful info hiding within the normal ranges.

Your sensitivity to iron supplements seems odd. You can try different types or fractional doses, perhaps not every day. Also possible some kind of abnormal processing of high amounts. You take with a meal or empty stomach? Your reaction to iron might be disclosing a hidden pathology or condition.

Do not take iron supplements with your vitamins as odd things can happen. Example, any vitamin E is disabled with iron supplements.

This is a good article: http://www.hematology.org/patients/blood-disorders/anemia/5263.aspx
“”“Severe side effects other than allergic reactions are rare and include urticaria (hives), pruritus (itching), and muscle and joint pain.”“”

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Thanks. Is 2 weeks enough time to retest E2 levels to dial in my dosing?

For misguided reasons, I quit eating red meat 20 years ago and i never got back into the habit. This seems to be causing my low ferritin levels and I need to objectively reevaluate my aversions to red meat. It seems a steak or 2 per week may go far in raising my ferritin levels. i had to cut out all breakfast cereals due to my MTHFR mutation because the synthetic folic acid was building up to very high levels in my bloodstream and interfering with the action of methyfolate (the biologically active form) at the tissue level.

Anyway it seems a lifetime of low iron and almost zero iodine has taken its toll.

Yeah, I will run a full iron workup and see if anything is off.

HCT 44.6 (35-55)
RBC 4.66 (4.0-6.2)
HGB 15.1 (11.0-18.8)

I haven’t noticed any sensitivities from the likely culprits, (i.e. dairy, gluten, eggs, etc) but I’ve never done an elimination diet. I’m very regular and haven’t noticed any gas or bloating postprandial. No antacids.

I do bleed a lot from my gums (every time I brush my teeth) and I’m wondering if that, while not necessarily enough to cause blood loss and subsequent iron depletion, isn’t an indication of some inflammatory issue which could be cause rT3 problems.

The iron reaction is odd and I’ve noticed in on 3 separate occasions. What’s weird is it is only 25 mgs and it occurs whether I take it with food or on an empty stomach. I’m going to switch forms and see what happens.

thanks for the link; it was informative.

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So I identified myself as an over-responder to adex years ago, so this time around I started by taking 1 DROP of adex EOD first thing in the AM. I have been on 1 drop EOD since Christmas and here are the results of my most recent E2.
12/21/13 Estradiol 39
1/15/14 Estradiol 22

So I’m right at the target but the problem is I can feel my levels fluctuate and my serum E2 doesn’t feel like it’s “locked in”. This is evidenced by changing mood through the day and noticeable changes in libido towards the evening prior to my next dose. I’m thinking that I need to dilute it in alcohol and lower the dose and repeat. I’m not sure. I wonder if over-responders have a hard time dialing in steady state levels of arimidex and have E2 fluctuations more than normal responders.

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If you’re dosing EOD, your blood levels of the drug should be fine.

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I wonder if it is really the E2 you are feeling or perhaps just the circadian variation of something else (e.g., T drops significantly from morning to evening in young men).

But for more stable levels of E2 you could perhaps try aromasin, which destroys aromatase enzymes (as opposed to arimidex that just temporarily binds them). Since it takes a number of days for the body to replace aromatase enzymes, you get more stable levels of E2 with the same dosing frequency.

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[quote]seekonk wrote:
I wonder if it is really the E2 you are feeling or perhaps just the circadian variation of something else (e.g., T drops significantly from morning to evening in young men).

But for more stable levels of E2 you could perhaps try aromasin, which destroys aromatase enzymes (as opposed to arimidex that just temporarily binds them). Since it takes a number of days for the body to replace aromatase enzymes, you get more stable levels of E2 with the same dosing frequency. [/quote]

If you had stable blood levels of arimidex, it should provide just as stable E2 levels as aromasin. If there are really random E2 fluctuations, it’s something else. Could be E2 clearance issues? Even when dialed in, I can get high E2 sides after a night of drinking. I assume this is because my liver is too busy with other activities to properly dispose of circulating E2.

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I’ve been reading that for thyroid labs, the curves are skewed, so median and mode aren’t midpoint. Optimal TSH is around 1.5 but will obviously change if you are taking thyroid hormones. Really you wan’t to be around the the 75% percentile on free levels to get rid of symptoms. One person I’ve seen argue persuasively that Total T4 and Free T3 levels are the two best indicators of symptoms.

As for me when I did high dosing of iodine it shot my TSH up 230%(it started at a super low .6) and my T4 up 20%(didnt know to test for T3 or free levels at that time). But I also has some negative side effects. After reading more I think 1mg is probably the most people should take daily (making sure to supplemente with selenium).

You might want to check for thyroid antibodies, the TPO antibodies means your body is attacking the enzymes that make T3 and T4 and the anti thyroglobulin means your body is directly attacking thyroglobulin that is where thyroid hormones are stored(and so T4 and T3 are being released in an abnormal way). For me taking armour thyroid and T3 seemed to have a therapeutic effect- after easing off it my heart rate and body temp remained at a higher rate. It sounds like other doctors use a protocol like this, and it often lowers antibody levels in people who have them after a time.