Lab Results - Advice on Estradiol management

[piggybank]

Long post, hopefully I've broken it up enough so it's readable.

I've been on TRT for over 6 months. I felt cold all the time (for like 6 months) and had libido issues (past 5 years or so).

Diagnosed with Hypogonadism and Hypothyroidism with blood tests and saliva. Prescribed 100mg cyp (I split this up into shots 2 x week). 35 years old. 5'11, 200 pounds. Lift weights 4 days a week. Bodyfat in high teens.

Armor thyroid has brought my temps up and i no longer have cold hands and no longer feel like I'm freezing all the time. My recovery from lifting is great. However, my libido hasn't improved.

Unfortunately, my doc prefers saliva tests for test, dhea, and estradiol; serum for everything else.

Here are my salivary results after 6 months:

Results Normal Range
Estradiol (e2) .2 <2.5 pg/ml
DHEA .10 0.09 - 1.60 pg/ml
Testosterone 53 40 - 170 pg/ml
DHT <10 <60

Doc was fine with estradiol. Wanted to bump my DHEA dosage (up to 75 mg) and bump up my Test dosage.

After suspecting that my estrogen levels were too high, rather than too low (crappy libido, gyno pain, irritability, and ED issues), I paid out of pocket for a labcorp panel that included estradiol (standard; not the sensitive one).

Here are the results:

Testosterone Total 910.6 ng/dl (range: 348-1197 ng/dL)
DHEA-Sulfate 521.3 (range: 138.5-475.2 ug/dL)
Estradiol 71.8 (range: 7.6-42.6 pg/mL)

Obviously my estradiol is high on the labcorp test. I realize that I didn't opt for the sensitive test, but with my symptoms, it likely shouldn't matter if the labcorp was sensitive or standard in this instance, correct? In the future, I will opt for the sensitive test.

DHEA is high, so I'm NOT going to add more. I imagine that the "extra" DHEA i take in was helping add to the estradiol as well. I was using 50mg oral caps a day. Should I drop down to 25mg or just lay off DHEA for a few weeks until my next test?

I put a phone call into the doctor and talked to him about addressing e2. I have spoken to him previously on using AI's and I don't feel like he's a fan of them; He likes Indoplex/DIM. I had taken 100mg DIM a night but not consistently; due to my saliva tests, I figured I was going too low on estradiol with the DIM.

Doc thankfully acknowledged the validity of the serum test and told me to keep Test at 100mg week and increase the DIM and we'll see if that helps. If there is no improvement, he said we'll look towards arimidex. Also take 30mg a night of Zinc. I was on 60mg of zinc and tested high on that, so I dropped the zinc to 30mg.

Any recommendations on DIM or Indolplex brands? I put an order in for Indolplex (Tyler Indolplex), but right now I have 100mg caps of DIM. Should I bump up the DIM to like 200-300mg until the indolplex comes in?

Thanks for your help and I can provide any additional info if you guys need it.

[jomamma007]

Long post, hopefully I've broken it up enough so it's readable.

I've been on TRT for over 6 months. I felt cold all the time (for like 6 months) and had libido issues (past 5 years or so).

Diagnosed with Hypogonadism and Hypothyroidism with blood tests and saliva. Prescribed 100mg cyp (I split this up into shots 2 x week). 35 years old. 5'11, 200 pounds. Lift weights 4 days a week. Bodyfat in high teens.

Armor thyroid has brought my temps up and i no longer have cold hands and no longer feel like I'm freezing all the time. My recovery from lifting is great. However, my libido hasn't improved.

Unfortunately, my doc prefers saliva tests for test, dhea, and estradiol; serum for everything else.

Here are my salivary results after 6 months:

Results Normal Range
Estradiol (e2) .2 <2.5 pg/ml
DHEA .10 0.09 - 1.60 pg/ml
Testosterone 53 40 - 170 pg/ml
DHT <10 <60

Doc was fine with estradiol. Wanted to bump my DHEA dosage (up to 75 mg) and bump up my Test dosage.

After suspecting that my estrogen levels were too high, rather than too low (crappy libido, gyno pain, irritability, and ED issues), I paid out of pocket for a labcorp panel that included estradiol (standard; not the sensitive one).

Here are the results:

Testosterone Total 910.6 ng/dl (range: 348-1197 ng/dL)
DHEA-Sulfate 521.3 (range: 138.5-475.2 ug/dL)
Estradiol 71.8 (range: 7.6-42.6 pg/mL)

Obviously my estradiol is high on the labcorp test. I realize that I didn't opt for the sensitive test, but with my symptoms, it likely shouldn't matter if the labcorp was sensitive or standard in this instance, correct? In the future, I will opt for the sensitive test.With levels that high, it shouldn't matter, but definitely get sensitive panel from now on

DHEA is high, so I'm NOT going to add more. I imagine that the "extra" DHEA i take in was helping add to the estradiol as well. I was using 50mg oral caps a day. Should I drop down to 25mg or just lay off DHEA for a few weeks until my next test?That's really up to you. Most likely that DHEA is increasing your estrogen a good amount. Personally I'd stop it as no one has ever commented saying they feel any different from taking it, but then again there is research showing it's beneficial. So lowering it to 25mg a day could be a good start.

I put a phone call into the doctor and talked to him about addressing e2. I have spoken to him previously on using AI's and I don't feel like he's a fan of them; He likes Indoplex/DIM. I had taken 100mg DIM a night but not consistently; due to my saliva tests, I figured I was going too low on estradiol with the DIM. Listen to your doc. Consistently take 200mg a day and retest in a month

Doc thankfully acknowledged the validity of the serum test and told me to keep Test at 100mg week and increase the DIM and we'll see if that helps. If there is no improvement, he said we'll look towards arimidex. Also take 30mg a night of Zinc. I was on 60mg of zinc and tested high on that, so I dropped the zinc to 30mg.

Any recommendations on DIM or Indolplex brands? I put an order in for Indolplex (Tyler Indolplex), but right now I have 100mg caps of DIM. Should I bump up the DIM to like 200-300mg until the indolplex comes in?

Thanks for your help and I can provide any additional info if you guys need it.

Wish you would have gotten a free test done. You could also try lowering your dosage to say 80mgs per week if all else fails to avoid arimidex. I know you're thinking no way man I don't want to have less testosterone, but accordingly to your labs 80mgs a week would ball park you around 700~ levels. Plus that's the T level of a 20 year old. Most people on these forums are around that level and feel great, and if this means you can avoid an ai I'd do it. It's a rollercoaster trying to dial in your estrgogen with an ai. Sometimes its too much, sometimes its not enough, it's a pain. But definitely first try lowering your dhea dose, adding in DIM, retest in a month. Also did you have a dhea test on trt before adding it in? You could go without it for a month and see where this puts your DHEA and E levels.

On the standard esrdaiol test i was at 45(7-42.6). But on the sensitive test i was 19(3-70). Always be sure to get blood work before adjusting anything. Sometimes you think your e is low when it's really high as nearly all the symptoms are the same. That 20-30 estrogen sweet spot everyone speaks of is for estradiol sensitive not the regular panel. Plus it's still a guideline, some guys feel great at 35, other 15.

If it were me I'd just drop the dosage to 80mgs a week, split into two injections and stop taking dhea for a month and retest. I'd bet you'd feel great and be in range for estrogen. Then from there you can choose to add dhea back in as well as possibly some DIM. Remember you aren't a number, it's about how you feel. The more crap you have to add to your protocol, the more complex things get.

[piggybank]

Wish you would have gotten a free test done.

For the blood test where I had a 910.6, here are the other values (i'm sorry I didn't include these...):

Testosterone, Total, LC/MS 910.6 ng/dl (range: 348.0 - 1197.0)
Testost., % Free+Weakly Bound 19.6% (range 9.0 -46)
Testost., F+W Bound 178.5 (range 40.0 - 250.0)

Is the F+W bound Free Test?

Also found SHBG buried in the test results...

Sex Horm Binding Glob, Serum 55.9 nmol/L (range 16.5 - 55.9)

Lipids...
Cholesterol, Total 99 L mg/dl (range 100 - 199)
Triglycerides 38 mg/dl (range 0 -149)
HDL Cholesterol 37 L mg/dl (>39)

You could also try lowering your dosage to say 80mgs per week if all else fails to avoid arimidex. I know you're thinking no way man I don't want to have less testosterone, but accordingly to your labs 80mgs a week would ball park you around 700~ levels. Plus that's the T level of a 20 year old. Most people on these forums are around that level and feel great, and if this means you can avoid an ai I'd do it.

I believe that ultimately, my doc wants me to maintain at 80mg a week. I'm not too concerned on the number, just want to feel good. Plus avoiding an AI is good in my opinion.

But definitely first try lowering your dhea dose, adding in DIM, retest in a month. Also did you have a dhea test on trt before adding it in? You could go without it for a month and see where this puts your DHEA and E levels.

I did a saliva test for the DHEA before TRT, but I have to throw that out because it was salivary and .11ng/ml (.01 ng/ml higher than the latest test!). Who knows what I really was at on serum test?

Sounds like dropping the DHEA for a month is probably a good idea. I'll retest in a month with the lowered DHEA, Test, and addition of DIM; this time I'll get the sensitive estradiol test.

Thanks for your help.

[jomamma007]

start supplementing with Vitamin D3 to get that SHBG down. Note it will also come down as your estrogen drops. Your free test will be a great place with these additions.

[piggybank]

start supplementing with Vitamin D3 to get that SHBG down. Note it will also come down as your estrogen drops. Your free test will be a great place with these additions.

Will do... Vitamin D tested at 39. That was with 6K units with Vitamin d3 a day. I'll bump it up to 10K units.