Estradiol vs Total Estrogen

Pharma Testosterone Replacement
1

I am new to TRT and need advice. I am a 55 year old male. I consume alcohol much too often.
Two years ago my urologist suggested I try TRT after checking my levels. At that time, my Test was 225, she did not check estrogen initially. She prescribed 200mg test cypionate every two weeks. After 8 weeks, my test moved to 351. Total estrogen was 111. During this first period of time, I felt great. Sex was great.

My Doctor prescribed Anastrozole 1mg every 72 hours. Thats when the problems began with ED. Three months later my test number was 847 and total Estrogem 142.
ED continued, I got frustrated and stopped all test and AI. In a few months, I was back to normal.

Last month I decided to give it another try after reading about this topic here. My doctor agreed and prescribed the same test dosage. She ran labs that day also. Five days later, her nurse called and said do not take any test cypionate. That my estrogen is too high (Estrogens, Total 02 431 High pg/mL 56-213) and to begin Anastrozole. I began .25mg every 72 hours. That estrogen level worried me.

I could not understand how my total estrogen could be double the high range having not taken any test in over a year! I told the nurse I wanted to have labs ran again, that there has to be a mistake. This time, I asked the nurse to check Estradiol along with total E. My Estradiol was (Estradiol 01 <5.0 Low pg/mL 7.6-42.6)
Total E of the chart! (Estrogens, Total 02 432 High pg/mL 56-213)
I think this explains the ED before. No Estradiol present.
How can this be? Should I worry about total E if my estradiol is okay? Any advise is greatly appreciated.
First lab below is initial after one year test free.

Age: 55

Ordered Items: Testosterone; Prolactin; Estrogens, Total
Date Collected: 12/12/2022 Date Received: 12/12/2022 Date Reported: 12/15/2022
Testosterone
Test Current Result and Flag Previous Result and Date Units Reference Interval
Testosterone 01 251 Low ng/dL 264-916

Prolactin
Test Current Result and Flag Previous Result and Date Units Reference Interval
Prolactin 01 4.4 ng/mL 4.0-15.2

Estrogens, Total
Test Current Result and Flag Previous Result and Date Units Reference Interval
Estrogens, Total 02 431 High pg/mL 56-213

Labs below are after a total of 300 mg test cypionate and 1mg of AI divided into .25 doses.
Ordered Items: Estradiol; Estrogens, Total
Date Collected: 12/29/2022 Date Received: 12/29/2022 Date Reported: 01/02/2023

Estradiol

Estradiol 01. <5.0 Low pg/mL 7.6-42.6
Roche ECLIA methodology

Estrogens, Total

Estrogens, Total 02 432 High pg/mL 56-213

3

Total estrogen is all the different types of estrogen’s in your body, the only one that you should be concerned with is (E2) estrogen. Dim supplement can change the balance between good and bad estrogen.

All these tests indicate is that your estrogen balance is off, as you have other types of estrogen and your E2 is extremely low!

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4

Your doctor is out to lunch! Basically what your doctor has done is, prescribed you a bad protocol that shoots your androgens into the stratosphere, shooting up your estrogen, and now you need a drug to counter it.

Now that drug is crushing your estrogen!

This is actually quite common because the guidelines are outdated and that’s all the doctors have to go by, and it usually ends in misery. It takes a good doctor to recognize this and do what’s best for the patient.

All of the short-acting agents are plagued by a “roller coaster” effect by achieving supraphysiologic levels within 2–4 days after injection followed by sub-therapeutic levels by 10–14 days. A rapid decline in serum levels around 10–14 days has been called “testosterone crash” and is associated with sudden recurrence of TD symptoms. To minimize these effects, more frequent dosing from once to twice weekly has been suggested as is preferred by these authors.

I would talk to your doctor about changing your protocol or find a new doctor ASAP!

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5

Your doc is completely lost.

I would advise finding a new one. Immediately.

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6

When, relative to your injection, was you blood drawn? That 351 level would be much higher within days of the injection.

Nope. Total estrogen is practically irrelevant, and estrone and estriol are very weak estrogens. Estradiol is the one you want to check, and unless you have an illness and/or inflammatory condition, the regular test is fine. You can run the LC/MS/MS if you’d like to do so, but no need to spend the extra money.

It should, it’s too low.

Is that 300mg every two weeks? Ask if you could take 150mg per week. No anastrozole. Get your blood test on injection day, first thing, take your dose later.

Good luck!

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7

How can total estrogen be sooooo high, with E2 less than 5? This is pre TRT!

8

200mg per two weeks. That was the total I had injected for the second lab test.

9

200 mg of test cypionate every two weeks doesn’t sound extreme. I asked if I could administer 100 mg per week and she was good with that. I listed 300 mg, but that was over a three week period.
My concern is how does an individual have a total estrogen level of 432 without doing TRT?
This with a estradiol level of <5???

10

This is what is listed. I’m not sure???
Roche ECLIA methodology

12

There’s such a thing as hormonal imbalances and that could be why your E2 is low, because your body can’t balance all the estrogens correctly.

A member on another forum has a similar issue, his total estrogens was very high and E2 was on the low side. He started taking Dim and retested and found E2 high at 74 (previously 17) even after dropping his T dosage by 50 mg!

His total estrogens came down too. It’s obvious he probably took too much dim and swing things too far the other way.

The protocol isn’t an optimal way to replace testosterone. Sure it works for a small percentage of men, but mostly it causes problems with estrogen, hematocrit and hemoglobin.

You won’t find anyone on it on T-Nation or Excelmale or on most other forums because anyone visiting these forums soon figure things out.

That’s great your doctor is open minded! We need more doctors like that.

Not if you have elevated C-reactive proteins, if not it’s perfectly fine and more reliable than the sensitive assay which is overly reliant on technician skill.

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13

So smart in these matters.

14

The credit should go to @highpull. Now you know who taught me this bit of info.

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