My Adex Experience

mobiuskoan · December 2, 2007, 3:59am

First off: thanks to everybody on this forum. Y’all make this place an invaluable resource.

To get the ball rolling, here are my stats:

			7/27	10/31

T - Total 736 742 241-827
T - Free 127 140 34-194
T - Free and weakly bound 268 300 84-402
SHBG 53 47 8-46
E 57 <2 < OR = 29

I’m 43, fit, and had been experiencing a range of low T symptoms: low libido, low energy, and loss of body hair being the most noticeable.

Anyway, saw my Bodylogic M. D. doc a couple days ago to go over my numbers. She had initially prescribed a supplement called indole 3 carbonyl. After about six weeks, I decided to ditch the supplement and started taking Adex. Though I noticed an immediate improvement, it was minimal and short-lived. As you can see from my E, I think I passed through the sweet spot level pretty quickly.

After my first 13 days on a 1 mg/week dosage, I bumped it up to a half milligram EOD with the goal of getting my blood level up to 1 mg (it seemed like a good idea!). On day 43, I found out that I had managed to knock my E into the toilet, so i brought my dosage back down to 1 mg/week.

That was two weeks ago. Since I’m still not feeling all that great, I decided to drop down to one half milligram per week. Just started this and it will take about two weeks for my blood level to stabilize. We’ll see if that’s the Goldilocks dosage I need.

As I mentioned, I did see the Doc a couple days ago. She was also concerned that my SHBG was still pretty high. She said we might want to consider hCG or Clomid.

Right now I just want to get my E levels right and see how much a difference that makes. And I want to make sure they are where they should be before tinkering anymore with my innards and glands!

If anybody can share any insights into SHGB, I’d really love to hear them.

TIA, Mike

Dr_PowerClean · December 2, 2007, 11:00pm

Damn, Mike, nobody replied to you in over a day, that’s not right.
Interesting story and certainly valid topic given many here have been in similar circumstances with high E2, either with or without HRT. It truly is the pits. I just found out my E2 was 155, and I was already acting and feeling like a PMS ridden woman.
I had been taking Nolvadex since it was the only available drug where I live, but it doesnt really lower E2, just prevents gyno apparently. I finally got some Adex three days ago and I already feel somewhat better. I want to take about 4mg a day but I’m being a good boy and taking the .5mg per week for now. KSman has written extensively on the virtues of controlling your E2 but not putting it in the toilet, as you described.
I did a fair amount of research into SHBG as a result of gswork’s thread. It is not widely agreed upon. Many here have read and believed the articles that implicate it as the smoking gun which, as it rises with age, is the culprit in coverting total t into more E2 instead of free T. I recently ran across articles contradicting this and stating SHBG is merely a “marker” for rising E2. Right now, I am not convinced that they have it figured out yet.
I think the overall premise that many here on T-Nation advocate is valid, that if one receives HRT, E2 levels should be kept in the range of a normal twenty to thirty year old, which is where the HRT should be taking your T levels as well. This would amount to an E2 level about 20-25. Happydog has written extensively on the importance of the T to E2 ratio, and feels that is a useful tool in finding the “sweet spot”. I am nowhere near a sweet spot, so when I get to one, I’ll let you know what T/E combo works for me. Doc

Raw_Power · December 3, 2007, 4:23am

Yeah, it’s real easy to overdue it on Adex. I was taking liquid exemestane (Aromasin) at a pretty hefty daily dose and my E2 only went down slightly. I switched over to anastrozole (Arimidex) and used the same dosing that I had done with exemestane and my E2 dropped off the lab chart down to nothing. Needless to say, the symptoms were almost identical to having elevated E2.

After experimenting around with anastrozole for a few weeks I finally figured out that 1mg/week is plenty sufficient…at least for me. It’s much stronger than exemestane. At 1mg/week I got my E2 level to 20 which is ideal. I sure feel a lot better as well.

This stuff can get very tricky especially if one is doing it on their own when doctors refuse to help those on TRT with high E2 levels.

happydog48 · December 3, 2007, 8:51am

I’m not a fan of your doctor. She needs to do her homework and since she isn’t, you definitely need to.

The IC3 was a mistake. IC3 is converted to DIM by stomach acid and if do a search at pubmed for DIM you’ll find numerous articles that show DIM to be an androgen receptor antagonist.

There’s a good T-Nation article about IC3 and DIM here:

http://www.T-Nation.com/readArticle.do?id=462263

My suspicion is that your symptoms have little or nothing to do with testosterone and estradiol. Your E was a little high to begin with but since lowering it (even before you went crazy with the dosage) didn’t really help, I’d say that was valuable information and would make me want to look elsewhere for possible problems. I’d want to know about thyroid levels. KSMan can tell you more about thyroid. I’m afraid I haven’t studied it much, yet. Did you have a thyroid panel as part of your blood work?

Clomid is a SERM and isn’t going to lower your estradiol levels. It can also have estrogenic effects on mood, which in your case I would think is not such a good idea so I’d want to know her reasoning on why she thinks you should take Clomid. I’d also want to know her exact reasons for recommending hCG since everything she’s said so far sounds pretty off the wall. It sounds like she’s trying to raise your testosterone, but with your numbers that doesn’t make much sense.

What other supplements or meds are you taking? It just seems to me that there is more going on here than what you’ve posted so far.

mobiuskoan · December 4, 2007, 4:08am

[quote]Dr.PowerClean wrote:
Damn, Mike, nobody replied to you in over a day, that’s not right.
[/quote]
Hey Doc,

Thanks for rescuing the thread! Heck, I have a hard time keeping up with all the helpful replies. Can you point me to any helpful articles you’ve read on SHBG and perhaps hCG and/or Clomid?

Happydog: just to make sure we’re on the same page, you did see that my original estradiol was at 57, right? (My stats don’t want to format right when I post.) So I thought my doctor was on the right track with making getting that down to a normal level the first point of attack.

I do agree with you that the IC3 was at best a waste of time and money, at worst the wrong treatment. She is a BodyLogic M. D. doctor and I actually sought her out after somebody on this forum linked to the BodyLogic website. She seems very thoughtful, smart, concerned, and open-minded. But I am a little leery that these BodyLogic docs are encouraged to push supplements. They do sell them through their offices.

On the other hand, she did say that if the IC3 didn’t work, that the next step would be Arimidex. And then when I told her that I had gone and gotten it on my own and began my own treatment, she had no problem with that. And she was happy to write me a script to make it all legal.

Re: Clomid and hCG, her reasons for suggesting them were that even though the Adex clearly had its intended effect of inhibiting the aromatase activity, my SHBG is still quite elevated. So she said that even when I get my estradiol in the sweet spot, I still may not have an ideal hormonal balance due to the activity of the SHBG binding to and bringing down my free testosterone. She said that Clomid and/or hCG helps boost my own production of testosterone and so, by bringing the total up, I could overcome at least to a certain extent my elevated SHBG problem.

She did do a thyroid panel with the original blood work and said that it was fine. Here are some of the numbers: FSH 7.7, insulin 3, LH 2.6, progesterone 0.6, prolactin 11.3, TSH 2.83, a.m. cortisol 19.1. Hemoglobin A1c 5.1.

Re: other supplements and meds: nothing except vitamins. And though I’ve been tempted by things like REZ-V, I haven’t tried any of them.

So right now the only thing I’m doing is trying to zero in on the right Adex dosage. Then I will reevaluate based on how I’m feeling and where my ongoing learning and research takes me (most of which starts right here!).

Mike

Dr_PowerClean · December 4, 2007, 5:39am

Mike, first, Happydog is correct to guide you away from Clomid. It is a SERM, just like the Nolvadex I tried prior to Adex. These drugs help lower E2 very little, if at all, and have unwanted side effects on mood which I can vouch for. The gear using bodybuilders use Nolvadex only because it has an anti-gyno usefulness for guys with mega levels of T aboard.
HCG is a useful drug, but I agree with KSman there is a useful lifetime to the drug and the younger you are the more effective it is (also you develop a diminishing rate of return with it over time. I do think it works great at first for rescuing testicular function, I attribute having a son to taking HCG when I was 35 and beginning to have primary testicular failure.
The data on SHBG is conflicting and it may not be the overt culprit as thought in screwing up the process of coverting total T to free T instead of Estradiol. At least one study suggests it is simply a “marker” for rising E2. I left referecnes for this on gsworks thread.
You’re on the right track just trying to dial in that E2 number and then seeing where your total and free T’s are at, and of course seeing how you feel and function. Doc

bigdawg011 · December 4, 2007, 6:40pm

mobiuskoan,

If it goes to Arimidex, before they send you to Medaus pharmacy (or whichever she may be partnering with), call your local pharmacies and ask their price, and see if you can find out if your insurance will cover it.

Back when I was a BodyLogicMD client, I didn’t know better. I paid a ton for 8 1mg tablets. I didn’t even know that my insurance would cover it for a $25 copay.

Learn from my mistake.

Good luck.

KSman · December 4, 2007, 6:47pm

SHBG increase seems to occur with age. But T and DHEA are also going down and E increases or at least the E:T ratio becomes more adverse. Hard to know if the increase of SHBG has its own reason to progress independent of E changes.

%BF or absolute fat mass also increase. That is more aromatase to convert T–>E. The relative amount of aromatase [per unit of fat] might also be increasing.

More E means more fat, more fat means more E. All of these things are interconnected.

I think that it is safe to say that SHBG does not directly do any T–>E conversion. But with a different spin on the above:

More E means more fat, higher SHBG, more SHBG means less FT, less FT allows any amount of E to have greater effects as the E is then unopposed by FT. This can lead to estrogen dominance in some men, most of which might appear to be fat. But older men who are hypogonadic and untreated, might be estrogen dominant even if not obviously fat. This can be seen as muscle loss and gaining fat on the abdomen even while otherwise appearing to be of a lean build.

Totally off topic:

I have suggested that TRT/HRT is like a tripod, with the three legs being T, AI and hCG. Note that hCG also restores the pregnenolone production that the testes were producing prior to HPTA shutdown.

As for hCG not been effective as one gets old; that is in part a result of tissue aging. One can avoid some of that with supplements. Some of the reports of hCG not working any longer, may be from some who used too much for years. There is not any good data that tracks use of hCG in proper (low) doses for years. Dosing was done without any supporting research until a paper was published in May 2005.

happydog48 · December 4, 2007, 3:59pm

Upon further reflection, I think we should also consider that estradiol down regulates androgen receptors and if mobiuskoan’s estradiol has been high for a long time, it may be that two weeks of lowered estradiol simply wasn’t long enough to effect the changes necessary to feel better. It isn’t just a numbers game. There is also gene expression, receptor activity and brain function to consider, none of which are measured in blood tests.

KNB · December 5, 2007, 6:10am

[quote]mobiuskoan wrote:
Dr.PowerClean wrote:
Damn, Mike, nobody replied to you in over a day, that’s not right.

Hey Doc,