High E2 induced hypogonadism

Pharma
1

Long time low T with symptoms and here are my latest labs:

Total testosterone: 9.9 mmol/l (9.2-31.8)
SHBG: 17 nmol/l (18-54)
Free testosterone (calculated): 194 pmol/l
(220-800)
Estradiol (sensitive): 0.13 nmol/l (<0.13)
LH: 0.93 U/I (1-9)
Prolactin: 95.3 mU/I (<350)
Cortisol: 322 nmol/l (133-540)

So I think it’s clear that abnormal aromatase activity is suppressing my T production.

However, I have explanation for this and I’m nowhere near overweight/overfat.

Terrible T/E2 so probably AI before SERM. I guess exogenous T would make no sense at this point without knowing whether the excess aromatization is happening the testes or adipose tissue.

2

Through which mechanism does borderline high estrogen levels suppress testosterone production?

3

By binding to the estrogen receptors in the hypothalamus. This basically tells that there’s enough testosterone, which is somewhat correct, as E2 would go way overboard if there was more T to be converted to E2.

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4

Have you talked to an endo about this? There doesn’t seem to be a question in your post.
If you have been a longtime suffer why haven’t you done anything about it?

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5

It’s complicated, but let’s just say that sensitive E2 was never taken before, which was crucial; I always thought that my E2 was low, as so was everything else. Obviously will be discussing this with my urologist, but I was interested about broctors thoughts here (about taking AI only route, or whether SERMs could also improve T/E2 ratio).

6

Let us know what he says. You are in the US?

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7

Finland actually. There are probably only handful of MDs that would even consider prescribing AIs or SERMs (even injectable T options are rather lackluster Sustanon and Nebido). Thankfully, I’ve managed to find one that’s really open-minded.

What I find interesting is that despite lurking in various forums and after seeing a ton of bloodwork, I don’t think I’ve ever seen one that is close to mine.

8

I think you have a classic case of hypogonadism and lowering your e2 will do little to nothing to raise your testosterone levels. Both your TT and FT are below the threshold. You will probably need to go the TRT route.

If you want to try an ai first before commiting to pinning test for the rest of your life, I can see why that would be appealing. However, don’t get your hopes up. Good luck.

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