E2 lower than normal but FT high and TT decent. How do raise E2?

[kruno1970]

I posted earlier this week but haven't really got good answers regarding my lower E2 (Estradiol, Sensitive 12 pg/mL 3-70). I feel this is reason for my low libido, aches and pains, etc. I was going to do TRT but my TT and FT seem pretty good (bw below). Would like to increase E2 and test at same time but keep testies functioning properly.

Any advice and suggestions would be great.


CBC With Differential/Platelet
WBC 5.2 x10E3/uL 4.0-10.5 01
RBC 5.07 x10E6/uL 4.14-5.80 01
Hemoglobin 15.7 g/dL 12.6-17.7 01
Hematocrit 46.3 % 37.5-51.0 01
MCV 91 fL 79-97 01
MCH 31.0 pg 26.6-33.0
MCHC 33.9 g/dL 31.5-35.7
RDW 12.9 % 12.3-15.4
Platelets 255 x10E3/uL 140-415
Neutrophils 38 Low % 40-74
Lymphs 51 High % 14-46
Monocytes 9 % 4-13
Eos 2 % 0-7
Basos 0 % 0-3
Neutrophils (Absolute) 2.0 x10E3/uL 1.8-7.8
Lymphs (Absolute) 2.6 x10E3/uL 0.7-4.5
Monocytes(Absolute) 0.5 x10E3/uL 0.1-1.0
Eos (Absolute) 0.1 x10E3/uL 0.0-0.4
Baso (Absolute) 0.0 x10E3/uL 0.0-0.2
Immature Granulocytes 0 % 0-2
Immature Grans (Abs) 0.0 x10E3/uL 0.0-0.1
Comp. Metabolic Panel (14)
Glucose, Serum 86 mg/dL 65-99
BUN 19 mg/dL 6-24
Creatinine, Serum 1.03 mg/dL 0.76-1.27
eGFR If NonAfricn Am 89 mL/min/1.73 >59
eGFR If Africn Am 103 mL/min/1.73 >59
BUN/Creatinine Ratio 18 9-20
Sodium, Serum 138 mmol/L 134-144
Potassium, Serum 4.4 mmol/L 3.5-5.2
Chloride, Serum 101 mmol/L 97-108
Carbon Dioxide, Total 25 mmol/L 20-32
Calcium, Serum 9.4 mg/dL 8.7-10.2
Protein, Total, Serum 6.8 g/dL 6.0-8.5
Albumin, Serum 4.5 g/dL 3.5-5.5
Globulin, Total 2.3 g/dL 1.5-4.5
A/G Ratio 2.0 1.1-2.5
Bilirubin, Total 0.7 mg/dL 0.0-1.2
Alkaline Phosphatase, S 84 IU/L 25-150
AST (SGOT) 24 IU/L 0-40
ALT (SGPT) 20 IU/L 0-55
Lipid Panel
Cholesterol, Total 177 mg/dL 100-199
Triglycerides 77 mg/dL 0-149
HDL Cholesterol 48 mg/dL >39
According to ATP-III Guidelines, HDL-C >59 mg/dL is considered a
negative risk factor for CHD.
VLDL Cholesterol Cal 15 mg/dL 5-40
LDL Cholesterol Calc 114 High mg/dL 0-99
Thyroid Panel With TSH
TSH 2.670 uIU/mL 0.450-4.500
Thyroxine (T4) 6.4 ug/dL 4.5-12.0
T3 Uptake 38 % 24-39
Free Thyroxine Index 2.4 1.2-4.9
Testosterone , Free/Tot Equilib
Testosterone, Serum 700 ng/dL 348-1197
Testosterone,Free 25.13 High ng/dL 5.00-21.00
% Free Testosterone 3.59 % 1.50-4.20
Prostate Specific Ag, Serum 1.8 ng/mL 0.0-4.0
IGF -1 Insulin -Like Growth Factor I 170 ng/mL 64-210
Estradiol, Sensitive 12 pg/mL 3-70

[reporich]

Im also in the same situation, whats your HRT protocol?

[kruno1970]

Haven't started anything yet. Since my TT and FT are pretty good but E2 low not sure what to do. HCG mono-therapy might me the way to go with me as it supposedly increases E2 and test at the same time. Looking for some directions from the vets or anyone who's been in my shoes regarding to low E2 but good test.

[reporich]

That may work. It will be interesting to hear what the "vets" say.

[lovbyts]

I'm not a E2 or hormone specialist by any means. I'm still learning and using everyone questions as a tool to research. This is what I found so far for normal test range and low E2 levels possibilities.
If estrogen is an accelerator of mineral uptake into the body, it can have opposite effects. Zinc accelerates thyroidal function and copper slows it down. When copper gets deficient, the thyroid produces excessive hormone and hyperthyroidism results. The balance of zinc and copper is important in maintaining normal thyroid function and the proper ratio seems to be about 5:1 for females and 10:1 or higher for males.

If the diet has a zinc/copper ratio which is too high, which is pretty much characteristic of some diets, estrogen can have an accelerative effect of causing this zn/cu imbalance in the body to get too high and causing hyperthyroidism. If the zinc/copper ratio is too low, then estrogen can have the opposite effect, of causing the body to incorporate too much copper and not enough zinc and thereby slowing the thyroid too much. This may be the most prevalent situation since there are more people with hypothyroidism than hyperthyroidism.

[Vettester]

Haven't started anything yet. Since my TT and FT are pretty good but E2 low not sure what to do. HCG mono-therapy might me the way to go with me as it supposedly increases E2 and test at the same time. Looking for some directions from the vets or anyone who's been in my shoes regarding to low E2 but good test.

Yes, your total serum is very good, and your SHBG is calculated and sitting in the single digits at/around 6.4nmol/l, which is the reason for your above average free & bio test results. My suspicion is that you are seeing more conversion to DHT, via the 5-AR enzyme, which in turn is probably what is impacting the E2 conversion that you desire.

There could be some other factors here to review, including other upstream pathways to back fill, like DHEA & pregnenolone, and possibly looking closer at the thyroid panels, which some may speculate that they lean towards hypothyroidism. I think other labs are in order to draw a further assessment, including thyroid antibodies, RT3, RT4, B12, Vitamin D3 (which is a secosteroid btw), iron & ferritin, and definitely adrenals with a cortisol test.

Some of these other labs can be high or low, which in turn can effect the balance of how other variables within your hormonal pathway will function. Adrenal concerns can lead to thyroid concerns, which can lead to other issues, even hypogonadism, pathologies, and the body's ability to achieve homeostasis. Trust me, I'm a hard learner myself on the whole thyroid subject, and it's quite meticulous with getting all the aspects of it determined to not only try and get it on the right track, but to get all the other surrounding variables around it to be optimal as well. I would read the desired labs at stopthethyroidmadness.com to get a better handle on what else you need.

Lastly, on taking the HCG ... OK, here's the scoop, your serum levels are great, which is probably attributed to a decent level of LH being produced and signaled from the pituitary. HCG simply just mimics the LH analog. The pituitary works off a negative feedback loop function with the testes to pulse the LH as needed when your test serum levels start dropping. Test levels go up -> LH decreases ... Test levels go down -> LH Increases, leydigs get stimulated, the whole process repeats itself. If you add a exogenous form of LH by implementing HCG, then your natural ability to regulate the LH signal will decline steadily, eventually leading to suppression of the HPTA. The testes will respond normally to the LH signal, the pituitary will know that testosterone levels have increased, thus it will not have the need to pulse additional LH. Give that some thought prior to jumping on it, or you just may find yourself in the HRT club sooner than later.

Also, if all else fails, you could talk to your doctor about a compounded cream to optimize your E2 levels. I'd approach this and/or natural methods before ever looking at any DHT blockers.

BTW, the PSA marker seems slightly elevated, if anything just for discussion. Not sure if this has ever been a factor with the doctor, or if there's family history involving prostate issues?

[kruno1970]

Thank you Vette. I'm still so new with my journey on learning about TRT and how hormones effect the aging process that most of what you said is still over my head. I feel if I take this information to my doctor she may not really know what to do with it. I live in Canada and most physicians here are clueless when it comes to trt let alone giving advice or treatments based on bw. I had blood work with my doc prior to getting the above bw myself in Florida when I was visiting. My doc said everything was normal but I didn't trust her opinion since I don't feel right. On the other hand I have a homeopath that I see a couple times a year and every time for the last 3 years he says my system is not right (based on urinary tests). I haven't seen him in over 10 mths. All is know is my libdo is really down, my energy is low and the aches keep getting worse. Even though I have gear and access to what I need I don't want to make any unnecessary leaps into taking test or any other trt related therapies without knowing more about what is actually causing these issues. If you can please break down in more layman terms what steps i should take to get to the bottom of my issues. I understand your suggestion for more bw. Should I ask for these labs by my doc or keep doing it myself? Also is there is specific type of lab work that the suggested test fall under i.e. full male hormone panel,etc.? Any more direction and advice would be appreciated.

Yes, your total serum is very good, and your SHBG is calculated and sitting in the single digits at/around 6.4nmol/l, which is the reason for your above average free & bio test results. My suspicion is that you are seeing more conversion to DHT, via the 5-AR enzyme, which in turn is probably what is impacting the E2 conversion that you desire.

There could be some other factors here to review, including other upstream pathways to back fill, like DHEA & pregnenolone, and possibly looking closer at the thyroid panels, which some may speculate that they lean towards hypothyroidism. I think other labs are in order to draw a further assessment, including thyroid antibodies, RT3, RT4, B12, Vitamin D3 (which is a secosteroid btw), iron & ferritin, and definitely adrenals with a cortisol test.

Some of these other labs can be high or low, which in turn can effect the balance of how other variables within your hormonal pathway will function. Adrenal concerns can lead to thyroid concerns, which can lead to other issues, even hypogonadism, pathologies, and the body's ability to achieve homeostasis. Trust me, I'm a hard learner myself on the whole thyroid subject, and it's quite meticulous with getting all the aspects of it determined to not only try and get it on the right track, but to get all the other surrounding variables around it to be optimal as well. I would read the desired labs at stopthethyroidmadness.com to get a better handle on what else you need.

Lastly, on taking the HCG ... OK, here's the scoop, your serum levels are great, which is probably attributed to a decent level of LH being produced and signaled from the pituitary. HCG simply just mimics the LH analog. The pituitary works off a negative feedback loop function with the testes to pulse the LH as needed when your test serum levels start dropping. Test levels go up -> LH decreases ... Test levels go down -> LH Increases, leydigs get stimulated, the whole process repeats itself. If you add a exogenous form of LH by implementing HCG, then your natural ability to regulate the LH signal will decline steadily, eventually leading to suppression of the HPTA. The testes will respond normally to the LH signal, the pituitary will know that testosterone levels have increased, thus it will not have the need to pulse additional LH. Give that some thought prior to jumping on it, or you just may find yourself in the HRT club sooner than later.

Also, if all else fails, you could talk to your doctor about a compounded cream to optimize your E2 levels. I'd approach this and/or natural methods before ever looking at any DHT blockers.

BTW, the PSA marker seems slightly elevated, if anything just for discussion. Not sure if this has ever been a factor with the doctor, or if there's family history involving prostate issues?

[Vettester]

OP, definitely don't start self medicating. It could lead to many other problems. If things haven't changed, you have a good amount of natural test; both serum & free. The problem appears that there's not enough conversion downstream to E2. My suspicion is that you're seeing quite a bit of conversion of DHT, which would directly reflect the E2 increase.

If you can get the DHT lab, and the ones that are mentioned in the stopthethyroidmadness site, it will help us a bit more. In the meantime, I want you to stock up and start taking some soy products, including tofu, which has isoflavones compounds that not only will help promote estrogen, but will help slow down and regulate DHT production.

Yeah, Canada has it's problems from what I hear with getting responsive, good qualified physicians to help with this sort of stuff. The good news, you don't need any form of TRT (hopefully not for a long time), so quite possibly it's just some change ups and a few supplements to get things more balanced. Again, don't take anything exogenous for testosterone.

[kelkel]

Well articulated Vette. Op, consider supplementation with micronized DHEA as Vette referenced. It can elevate your estrogen level. It did for me and my E runs steadily low at 16. It brought me up to around 23. Happy with that. It was the only change in my protocol between BW so I attribute it specifically to that.

[bass]

you can also try flax seeds, flax seed oil and soy bean products to elevate E2. this is often suggested by GD, and it does work!