Help needed with bloodwork results

[SidVicious77]

Hi guys
Would be great to get some suggestions on understanding and deciding what to do about the following results.

Age 37years, 9months
FSH - 2.75 mIU/ml (reference range: 1.72-12.0)
LH - 3.34 mIU/ml (r.r. : 1.12-7.0)
Testosterone Total - 3.67 ng/ml (r.r :3.0-10.6) (=367ng/dl)
Testosterone Free - 10.52 pg/ml (r.r : 8.69 - 54.69)
Estradiol - 59.84 pg/ml (r.r. <39.8)
Prolactin - 4.48 ng/ml (r.r. : 3.0 - 10.6)

Cortisol (AM) - 11.72 microgram/dl (r.r. : 5-23)
TSH - 0.65 uIU/ml (r.r.: 0.25-5)

Test included a mandatory CBC, not sure it's relevant but adding it in anyway
Random Blood Sugar - 79.51 mg/dl (r.r.: 70-160)
Haemoglobin - 16.1 gm/dl (r.r.: 13-16.5)
Total WBC Count - 10000 cells/cumm (r.r.:4000-11000)
Neutrophils - 70% (r.r.: 40-70%)
Lymphocytes - 20% (r.r.: 20-45%)
Monocytes - 06% (r.r.:02-08%)
Eosinophils - 04% (r.r.: 01-06%)
Basophils - 00% (r.r.: 0-1%)
RBC Count - 5.3 mill/cumm (r.r.:4.8-6.0)
PCV - 47.1% (r.r.:40-54%)
Platelet Count -317000/cumm (r.r.:150000-400000)


Questions:
Anything worrying in the above numbers? Only thing I'm really concerned about myself is low test and high estrogen.
Am I doomed to TRT, or is there a good chance that bringing Estradiol down would raise Total and free test? I would rather stay off TRT if I can avoid it, though I'm fine with needles.
What would be the best protocol to bring Estrogen down?
LH looks to be mid-range, so why is Total Test knocking on the doors of HRT levels?
Why would FSH be low if LH is mid-range?

Some background:
EDIT: BP is high 138/96
Tests were taken at about 11 am on a totally empty stomach.
Didn't get DHT done as this was already getting too expensive for my budget this month.
Doctor was assuring me that test levels were fine for someone my age, and didn't seem remotely bothered that they look on the lower side, at least to me. Estradiol and free test results came in only today, so will email him again to see if that will change his mind.
I'd taken a year off from working out to recover from a shoulder reconstruction and finish some long-pending projects. Dropped bodyweight from 88 kilos to 74 kilos as a result. Have been working out again for the last two or three months. Regained a decent amount of size in that time, (up to 78 kilos now, and fat % is 15.3% as opposed to about 16% pre-surgery) - enough for people to comment. But feeling like shit, low on motivation, energy, appetite and libido.

Sorry for the long post. Would be great to get some inputs from knowledgeable members here.

Sid

[Chicagotarsier]

Are you on any medications?

[SidVicious77]

Thanks for the response.
Nizral 2% shampoo twice a week for dandruff and thinning hair, no other antiandrogens.
Frequent ibuprofen for spondylitis-related pain and inflammation.
5 mg Tadalafil on occasion.
That's about it.
I smoke, but rarely drink - once every two or three months and only a couple of beers at that.

[SidVicious77]

Just got an email back from the doctor. He says no medication necessary, tests to be repeated in two months at 8am on an empty stomach.
Am I wrong in thinking he's full of s***?

[bullshark99]

IMO, no. You are clearly low, nowhere near optimal, but people here always say don't treat a number, treat "symptoms". You say you have them, I don't question that, but I would dig a little deeper myself. Curious why E2 is so high??
T levels are highest first thing in the AM, I think it is "reasonable" to retest before treatment, 2 months Idk?, curious to see others chime in on E2 levels.

[Chauffeur]

Just got an email back from the doctor. He says no medication necessary, tests to be repeated in two months at 8am on an empty stomach.
Am I wrong in thinking he's full of s***?

I wouldn't want to wait another 2 months for bloodwork.

To be honest, it doesn't sound like this doctor is going to be much help. If I were you I'd seek out a doctor who specializes in male hormones and see what he thinks.

There is no doubt that your hormone levels are not where they should be. Your total T is fairly low, your free T looks terrible, and your estradiol is obviously elevated. I'm not surprised that you feel like shit.

[SidVicious77]

If I were you I'd seek out a doctor who specializes in male hormones and see what he thinks.

This guy is an endocrinologist, which was the whole point of going to see him. But you're right, seeing another doctor makes sense. Will have to hold off till next month because of finances.

Does anyone have any ideas on why E2 is so high, or answers to my questions? Any suggestions about what I could do right away to sort this out?

[Beethoven]

V

This guy is an endocrinologist, which was the whole point of going to see him. But you're right, seeing another doctor makes sense. Will have to hold off till next month because of finances.

Does anyone have any ideas on why E2 is so high, or answers to my questions? Any suggestions about what I could do right away to sort this out?

Don't get caught up in titles. There are Endocrinologists that don't know TRT, and some GP's that do. Find a Dr that does, no matter what the kind.

[SidVicious77]

So would you say I need retesting/more tests, and if so, what would I need to check for?

[SidVicious77]

Also, would be great to hear some answers to my original questions... I will of course see another doctor, but that won't be till next month, wouldn't want to wait till then to understand what's happening.
A) Why would test be so low with LH in mid range?
B) Does TRT look likely to be my future, or can I fix this by controlling E2, would that raise test to normal?
C) What would be the best protocol to bring E2 down?
D) Why might FSH be low if LH is normal? As in, aren't they released together in response to GnRH?

[kelkel]

Also, would be great to hear some answers to my original questions... I will of course see another doctor, but that won't be till next month, wouldn't want to wait till then to understand what's happening.
A) Why would test be so low with LH in mid range?
B) Does TRT look likely to be my future, or can I fix this by controlling E2, would that raise test to normal?
C) What would be the best protocol to bring E2 down?
D) Why might FSH be low if LH is normal? As in, aren't they released together in response to GnRH?

A) Your LH is not mid-range.
B) It's in everyone's future. When is the question. Reducing E2 will elevate test. How much is unknown and up to your individual metabolism. On that note, estradiol is not the proper test. An E2 Sensitive Assay is what's needed. Standard estradiol is not sensitive enough for males and actually reads higher than normal which can cause dosing issues...
C) Maybe start with 200mg DIM, 50mg zinc and 3-4 copper. Zinc and copper can be purchased combined. Also if body fat is high it contributes to estrogen conversion.
D) Because you're human and endogenous pathways are not always linear. BW is a snapshot in time.

[SidVicious77]

Thanks Kelkel. I'll try to get my hands on that. Sadly here in India, it's hard to get hold of anything but really basic supplements.
In case the sensitive E2 assay is not available here - I didn't see it in the list of available tests the doctor checked off for me - what is your suggestion? Is there a percentage of the test I did take that I should go by?

[kelkel]

Look hard as it should be available over there. Post menopausal women will need this test so it's got to be used over there as well. At least you'd think so....
If not just stick with standard estradiol. Just remember what I told you.

[Roger11]

Kelkel, id also say injecting more frequently reduces E2 also.

Hence why i do twice per week now. i use to do 250mg per week and the whole 1 shot bought my E2 to 300, doing 125mg twice per week with 0.25mg arimidex twice per week also bought my E2 to 90, JUST A THOUGHT FOR YOU OP.

[kelkel]

Kelkel, id also say injecting more frequently reduces E2 also.

It does, but he's not on TRT just yet.

[SidVicious77]

Look hard as it should be available over there. Post menopausal women will need this test so it's got to be used over there as well. At least you'd think so....

You would think... But then you'd also be surprised by how primitive most facilities here are. I will search though.
In case it isn't available, should I be looking at a certain percentage of my estradiol number, or as it is?
Thanks for taking the time to answer.

[kelkel]

I know of no formula to accomplish this. Wish there was. Just know it'll be lower than standard estradiol.

[SidVicious77]

All right, thanks a ton. I'll check in again when I've found out more about what's available here.