High Total Test, High DHT, Right E2 but Low Free Test

Pharma TRT
1

Hi everyone, I am new to this forum and first of all I wanted to apologize if my english is not so good but I am from Spain (Europe) and I need to work on improving it.

I am 43 years old, my weight is 196.21lbs (89kg), my height is 1.88m and I am more or less in shape with a 16% of body fat. I have been on TRT for almost 2 years, here in Europe it is something that it is starting now, so you can imagine how terrible it is to find a good doctor with knowledge on what he is doing.

I was diagnosed by the same TRT doctor with subclinical hypothyroidism (TSH=10) and I am on Levothyroxine only treatment from then (here in Europe there is no legal possibility of obtaining any type of T3).

My last thyroid test results are (100mcg of levothyroxine/day):
-TSH=1.19mU/L [0.3 to 4.2]
-T4=7.5ug/dL [4.6 to 10.5]
-FT4=1.27ng/dL [0.78 to 1.53]
-T3=1ug/L [0.7 to 2]
-FT3=3.04ng/L [2.1 to 4.4]
-RT3=0.43ng/mL [0.09 to 0.35]
-Anti-TPO= NEGATIVE
-Antithyroglobulin= NEGATIVE

I have no record of morning oral temperatures but I can tell you that I am not the person I used to be before started treatment with levothyroxine. Some problems such as dry skin, intolerance to cold have improved but on the other hand I still feel lack of energy almost every day, as well as difficulty to get rid of excess body fat.

My problem is that after several cycles of 3 months each (with its corresponding blood work) and several changes in the protocol in order to find the right dose of Test, Arimidex, number of injections… I am in the situation described in the lastest blood work results:

a) TRT protocol
• 250mg test cypionate / 10 days divided in 3 SC pins
• 1 HMG 75ui / 10 days
• 5.25mg arimidex/10 days in divided doses

b) Blood work results from this July (2018)

  • TOTAL TESTOSTERONE= 1205.51ng/dL; [ 241 - 827 ]  (above normal range)

  • FREE TESTOSTERONE=16.6pg/mL;
    Up to 20 years [0.2 - 42.5]
    20 - 39 years [8.9 - 42.5]
    40 - 59 years [6.6 - 30.0]

  • E2 (ESTRADIOL)=20.86pg/mL; [Up to 62.0]

  • DHT=128ng/dL; [Men 0.25 - 0.99] (above the normal range)

  • SHBG=40.1

  • LH basal <0.10 mUI/ml

  • CBC->

  • WHITE CELL 4.82 1000/mm3 [ 4.5 - 10.5 ]

  • RED CELL 5.06 mill/mm3 [ 4.2 - 5.8 ]

  • HEMOGLOBIN 14.6 g/dl [ 13 - 18 ]

  • HEMATOCRIT 44.8 % [ 40 - 51 ]

  • MEAN CORPUSCULAR VOLUME 88.6 fl [ 78 - 100 ]

  • MEAN CORPUSCULAR HEMOGLOBIN 28.9 pg [ 26 - 36 ]

  • MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION 32.6 g/dl [ 30 - 38 ]

  • PLATELETS 191 1000/mm3 [ 140 - 450 ]

  • RDW-S (DS) 48.9 fl [ 33 - 56 ]

  • RDW-C (CV) 14.3 % [ 10.5 - 16.6 ]

  • WHITE CELL FORMULA->

  • LYMPHOCYTES % 42 % [ 24 - 44 ]

  • MONOCYTES % 7 % [ 2 - 9 ]

  • BANDS % 2 % [ 0 - 4 ]

  • SEGS % 45 % [ 41 - 71 ]

  • EOSINOPHILS % 4 % [ 1 - 4 ]

  • BASOPHILS % 0 % [ 0 - 2 ]

  • BIOCHEMISTRY–>

  • UREA 0.47 g/l [ 0.15 - 0.55 ]

  • GLUCOSE 0.81 g/l [ 0.6 - 1.1 ]

  • URIC ACID 60.4 mg/l [ 30 - 70 ]

  • CREATININE * 12.7 mg/l [ 5 - 12 ]

  • LIPID PANEL–>

  • TRIGLYCERIDES 0.41 g/l (Normal)
     Normal <1.50 g/l; above normal 1.50-1.99 g/l; High 2.00-4.99 g/l; Very high >5.00 g/l.

  • TOTAL CHOLESTEROL 0.90 g/l (Normal)
     Normal <2.0 g/l; above normal 2.0-2.39 g/l; High.>2.40 g/l

  • HDL - CHOLESTEROL 0.41 g/l (Normal)
     low <0.4 g/l; Normal 0.4-0.6 g/l; High >0.6 g/l

  • LDL - CHOLESTEROL 0.41 g/l (Normal)
     Normal <1.0 g/l; above normal 1.00-1.59 g/l; High 1.60-1.89 g/l; Very high >1.90 g/l

  • VLDL - CHOLESTEROL 0.08 g/l [ 0.07 - 0.55 ]

  • CHOLESTEROL RATIO/HDL 2.20 [ 0 - 5 ]

  • ENZYMES–>

  • GAMMA - GT 15 UI/l [ 4 - 49 ]

  • SEROLOGICAL MARKERS–>

  • PSA 1.28 ng/ml [ 0 - 4 ]

The results show that I have reached a total testosterone level above the normal range however the level of free testosterone is still low. In the past, E2 levels were high (one of the reasons that would explain the low FT level would be that the aromatase was converting too much testosterone to E2), but now the level of E2 is under control within the healthy range, then the question is. Why is my free testosterone still very low given the amount of total testosterone in my system? I think that a lot of testosterone is becoming DHT due to the high activity of 5α – reductase, in fact my levels are above normal range so now I am at a blocking point and I need some advice, if possible, to increase the levels of free testosterone and at the same time to place the level of DHT within normal range, which I suppose is quite recommendable due to the side effects.

I have been reading a bit of 5α – reductase blockers as Finasterine, but side effects seem to be worse than the possible benefits.

Unfortunately, it seems that I have a body with too much aromatase and 5α – reductase, so everything is a problem to have under control testosterone level.

2

My man, your English is outstanding. It’s better than half the people I work with, frankly.

1 Like
3

First off that is a LOT of anastrozole. I would consider cutting back on that and letting your E2 come up a bit since its borderline low. Your symptoms might be due to that.

What are your SHBG ranges?

4

Hi NH_Watts,

Answering the first part of your advice I would say yes it is a lot of anastrozole I am working in rise just a bit the E2 level to E2=22 but I have tested over myself throught this two years and I am on the opposite side of an anastrozole over responder. Maybe I have to loose some body fat to mitigate the extra T to E2 convertion as part of the global solution.

About SHBG rages → nmol/L → men → [12 - 75]
Perhaps, having high SHBG, do I need to change my injection protocol?

5

No. Don’t go by that. You need e2. If your total t is 1200 ur e2 can be higher. Especially if shbg is not low. I have e2 30 and feel very good with a total t of about 650. Once I stopped ai and being obsessed about getting to 22 I felt much better.

2 Likes
6

Have you always taken the AI? If not what did your levels get to that required the AI? Estradiol of 20 is borderline-low/low and your anastrozole dose is very high. I would drop it by at least a couple of mg and see how you feel over the next 4-6 weeks and then get more blood work.

The legacy thinking here on AIs was 1mg per 100mg of Testosterone. Progressive thinking is NO AI at all unless you have symptoms that merit its use.

7

You could use a little more thyroid medicine, Free T3 is almost midrange and some need to be higher to feel good. You must likely don’t have the correct estrogen test and estrogen may be lower than stated, you AI dosages is too high. Low estrogen causes fatigue.

I don’t see ferritin or cortisol, both are required for thyroid hormone production.

8

Thanks to all of you guys! I will try to summarize a little bit the historic that explains why I take that big amount of anastrozole.

  1. Data before TRT →
    Total T=278.21ng/dL; Free T=4.21pg/mL; E2=29.11/mL; SHBG=49.1 (Testoterone levels were extremely low, so it’s clear that now I am in a much better situation).

  2. First cycles of TRT (3 months each; anastrozole=2.5mg/10 days in divided doses; 250mg test cypionate/10 days IM in one shot) →
    Total T=1249.81ng/dL; Free T=22.01pg/mL; E2=57pg/mL (I felt sensitivity in my nipples and night sweats).

  • At the beginning without anatrozole at all just tamoxifen at 10mg/day my E2 rise to the peak of 69.38pg/mL.
  1. Cycle right before the latest one I’ve already posted (3 months; anastrozole=4.75mg/10 days; 250mg test cypionate/10days SC divided in three pins) →
    Total T=879.02ng/dL; Free T=18.6pg/mL; E2=33.22pg/mL (I felt OK and recovering morning woods but I was looking to optimize each parameter following some data I have learned reading this forum).

Now with E2 a 20.86pg/mL I still have good morning woods but maybe I am a little bit lack of energy. The lack of energy confuse me because there are so many factors in the game (E2, FT3, RT3, FTest and maybe as you pointed out Cortisol levels,…), so I think the way to follow is fix parameter by parameter changing things slowly.

Next time I will test cortisol and ferritin in order to have more data and a better global picture of my situation.

Talking about taking more levothyroxine in order to increase FT3, I am not sure if that would e a good idea. The last increase in the dose, results showed that all levels remained more or less the same but RT3 increase proportionally which is not good at all and as I already said, here in Europe there is no possibility to buy legal T3 medicine so I am afraid of rise my RT3 and feel even worse than now.

9

Please tell me you’re not cycling on and off TRT every couple of months, cycling is a term used by those who abuse testosterone. You go on and stay on TRT, it’s for life.

10

The approach it is not doing cycles as a bodybuilder but every 3 months my doctor do blood work and make changes if it is necessary. In any case I have to deal with the limitations with the doctors here, I have learned a lot reading this forum but it is extremely difficult to change the mind of a doctor here because of all this is new and there are a lot of miscomceptions. That is the reason why I am now asking you guys in order to be healthy and get the best of the treatment.

11

Any advice about how could I improve my free testosterone level and at the same time lower DHT to normal level?

Are really dangerous the DHT level of my last blood work taking into account the rest of values?

From what it has been said so far I have to decrease anastrozol dose, trying to improve FT3 level (I will try to rise levothyroxine dose and we will see what happens…), check ferritin and cortisol levels.

So any other idea about how to optimize my actual protocol beside those already said?

12

A normal DHT level for you could be higher than most, careful with the word normal. DHT is converted from testosterone, generally the more testosterone you have, the more DHT.

13

You are right systemlord, my DHT level seems to be above most of people, so I planned to reduce the testosterone dose in order to reduce total testosterone and DHT leves within the range but I am worried of have low free testosterone level. I don’t know if I have to do nothing living as it is or if there is something i could do to compensate and have higher free testosterone and lower dht (values from where I am now).

14

Serum DHT and the levels of DHT level in your tissues are different, you need not concern yourself when you can only see one side of the coin. It’s similar to serum magnesium, cell magnesium could be depleted or lower within the cells.

I don’t understand why you are so worried about serum DHT when you have no idea about DHT levels in the tissue.

15

OK, that’s something I have not considered. I simply saw that the level of serum DHT was pretty above the range and after reading a bit about it seems to have some relation to prostate cancer along with a high level of E2 and low testosterone level. On the other side I am not worried about baldness I am bald from long time ago and It is something I don’t care about.

In any case, I would prefer to have a higher free testosterone, the level of serum DHT within the range (although it will be in the upper side of the range, for sure) and the level of E2 controlled. I insist that I am a bit surprised by the low serum level of free testosterone considering that I am on TRT, that total testosterone is above the normal range and E2 is a bit low.