On TRT, Need Help - First Time Poster

[Case Manager]

Well, here we go, finally with the correct test. It looks like everything is good. And it looks like my estrogen is actually perfect. And I feel pretty good. I have much more energy than I did before going on treatment. The libido problems have definitely gone away.

I was actually kind of worried at first when I thought I was going to lower my estrogen that I was going to turn into a heartless bastard, but I've found that to be true no more than usual.

Oct 4 Lab Result_Redacted.pdf

Your thoughts?

[Youthful55guy]

Well, here we go, finally with the correct test. It looks like everything is good. And it looks like my estrogen is actually perfect. And I feel pretty good. I have much more energy than I did before going on treatment. The libido problems have definitely gone away.

I was actually kind of worried at first when I thought I was going to lower my estrogen that I was going to turn into a heartless bastard, but I've found that to be true no more than usual.

Oct 4 Lab Result_Redacted.pdf

Your thoughts?

Your labs look good. Ignore the "High" Total Testosterone , it's Free T that matters and that is about perfect.

What I find most interesting is that this is the first time I've seen someone posted E2 results from the standard ECLIA test method vs. the LC/MS/MS method. There's a huge difference in the numbers. The ECLIA method tells you that your are way high at 70.4 pg/mL (range 7.6-42.6) but the LC/MS/MS says you are just fine at 18.6 pg/mL (Range 8.0-35). I definitely would go with the LC/MS/MS test method, which is designed specifically for men and is the test recommended by the top TRT docs.

Thanks for posting!

[Case Manager]

Is there a way to tell if they ordered the correct test from looking at the lab report? I have some doubts that they ordered the correct lab as once again my estrogen is coming up over normal. This doesn't make sense as I actually decreased my testosterone to .20 mL every 3 days (.25 was actually preventing me from sleeping some) while keeping my Arimidex dosage at the same amount.

[Youthful55guy]

Is there a way to tell if they ordered the correct test from looking at the lab report? I have some doubts that they ordered the correct lab as once again my estrogen is coming up over normal. This doesn't make sense as I actually decreased my testosterone to .20 mL every 3 days (.25 was actually preventing me from sleeping some) while keeping my Arimidex dosage at the same amount.

If the high end of the normal range does not go over about 40, then I'd say the test was designed for men. My LabCorp LC/MS/MS test gives a range of 8-35 pg/mL. Also, if the test description uses the term "ECLIA", it's probably the wrong test.

[Case Manager]

Ok, I think I see what they did. They ordered their standard total estrogen test in combination with the sensitive test. The sensitive number looks great. Slightly lower than it was last time, but well within range and to be expected with a slight down titration in test while maintaining the same amount of Adex, right? So I just ignore the total estrogen, correct?

Oh, also they wanted to bring me in for a doctor visit because the hepatic ALT was out of range, high. What is this and should I be concerned?

December 17 Labs.pdf

[SwoleAnchelada]

This would be a great thread for a lot of trt people to read, great advice for both starting out and how to make adjustments faster, leading to desired results much quicker too

[Youthful55guy]

Ok, I think I see what they did. They ordered their standard total estrogen test in combination with the sensitive test. The sensitive number looks great. Slightly lower than it was last time, but well within range and to be expected with a slight down titration in test while maintaining the same amount of Adex, right? So I just ignore the total estrogen, correct?

Oh, also they wanted to bring me in for a doctor visit because the hepatic ALT was out of range, high. What is this and should I be concerned?

December 17 Labs.pdf

Correct on E, looks like they wasted your insurance money and ran both tests. Total estrogens tell you nothing.

Regarding ALT, are you taking any anabolic steroids other than the prescribed T? Oral anabolics in particular can affect the liver. Other common drugs that affect liver are NSAIDS (particularly Naproxen and Ibuprofen), Acetaminophen, many antidepressants, and some evidence that statins do in some people (e.g., Lipitor). Oh, of course, let's not forget about alcohol consumption, particularly with the fore mentioned drugs. Many other drugs affect liver function and it may not indicate liver damage, just that the liver is working harder to detoxify the drugs. Doctors get their undies in a bundle when liver enzymes go up and they can't isolate it to a cause, which could indicate various liver cancers and other liver diseases (e.g. hepatitis).

I recently went through a barrage of liver tests because my liver enzymes have been elevated for a couple years. They would go up and down with no apparent cause. Turns out that it was my use of NSAIDs, where my consumption was episodic in nature. First for chronic plantar fasciitis (which new inserts fixed) and then post-tendon surgery (I was taking a lot of Tylenol). Also unknown to my doc, I am taking very low dose Winstrol for high SHBG, which can also put stress on the liver. Turns out that eliminating the NSAIDS for a month fixed the problem, even with the very low dose Winstrol (0.25 mg 2X per day).

[Case Manager]

Correct on E, looks like they wasted your insurance money and ran both tests. Total estrogens tell you nothing.

Regarding ALT, are you taking any anabolic steroids other than the prescribed T? Oral anabolics in particular can affect the liver. Other common drugs that affect liver are NSAIDS (particularly Naproxen and Ibuprofen), Acetaminophen, many antidepressants, and some evidence that statins do in some people (e.g., Lipitor). Oh, of course, let's not forget about alcohol consumption, particularly with the fore mentioned drugs. Many other drugs affect liver function and it may not indicate liver damage, just that the liver is working harder to detoxify the drugs. Doctors get their undies in a bundle when liver enzymes go up and they can't isolate it to a cause, which could indicate various liver cancers and other liver diseases (e.g. hepatitis).

I recently went through a barrage of liver tests because my liver enzymes have been elevated for a couple years. They would go up and down with no apparent cause. Turns out that it was my use of NSAIDs, where my consumption was episodic in nature. First for chronic plantar fasciitis (which new inserts fixed) and then post-tendon surgery (I was taking a lot of Tylenol). Also unknown to my doc, I am taking very low dose Winstrol for high SHBG, which can also put stress on the liver. Turns out that eliminating the NSAIDS for a month fixed the problem, even with the very low dose Winstrol (0.25 mg 2X per day).

Absolutely not taking any anabolic steroids , nor would I. Hope that's not too faux paus to say around here. I have chronic back and neck pain and take low doses of either norco or tramadol almost nightly, depending on pain level. Any time I take either of those I'll take a 500 tylenol with it for efficacy. I also take mobic 7.5 almost daily as well for pain management. In addition to that I take Accutane and lisinopril daily. So yeh, I guess there's good reason for my liver levels to be elevated.

[kelkel]

Remember that it's normal for people who work out to have elevated ALT/AST levels. Even multiple times higher than the given range and they can stay elevated for a week or more. All due to muscular trauma.

[Youthful55guy]

Absolutely not taking any anabolic steroids, nor would I. Hope that's not too faux paus to say around here. I have chronic back and neck pain and take low doses of either norco or tramadol almost nightly, depending on pain level. Any time I take either of those I'll take a 500 tylenol with it for efficacy. I also take mobic 7.5 almost daily as well for pain management. In addition to that I take Accutane and lisinopril daily. So yeh, I guess there's good reason for my liver levels to be elevated.

I'm guessing that the Tylenol and pain meds are probably what's pushing it up. Also, as Kel mentioned, exercise is another stress on the liver that can elevate enzymes. Probably nothing to worry about.

[Case Manager]

I do a circuit training/strength/hypertrophy workout every other day. I always go to exhaustion on the second to last and last set of every body part. I always try to end up "good sore" the next day.

So here's a question. I'd like to go see the doc as little as possible. I know he's going to bring something up about total estrogen and why it's a problem that it's out of range, so why is that number not as important as he thinks it is?

[Youthful55guy]

First the test is designed to measure all of the estrogens collectively: estrone (E1), estradiol (E2), and estriol (E3). E2 (Estrodiol 17 beta to be specific) is by far the most potent and the one that is problematic for men. It is a direct metabolite of Testosterone and the conversion is irreversible in the steroid pathways. E1 and E3 are much less potent and are on a dead end pathway to excretion. See the attached image. Since E2 is the most important estrogen in both men and women, it is assigned (by convention) a receptor binding affinity (for potency) of 100. By comparison, E1 is 37 and E3 is 21. So, E1 and E2 are not much to worry about.



Secondly, and more importantly, the total estrogen test is simply not designed to measure the low levels of estrogens typically found in healthy men. Believe it or not, I actually published a paper on a E2 test assay using an older (RIA) technology many, many years ago, so I know a thing or two about hormonal assays. The Total Estrogen test is simply not designed to detect lower levels of E2 in men. It is based on an enzymatic luminescence (ECLIA) technology commercialized in the late 1980's. Since the lower end of the sensitivity of the assay is higher than the typical high end of males estrogens, it will always come back with a value that is higher than your actual estrogen level. Having this test run is worse than having no test at all because it yields erroneous data that leads to the wrong treatment. Here's an article comparing the ECLIA method to the correct LC/MS/MS. The full length paper is also available in PubMed: https://www.ncbi.nlm.nih.gov/pubmed/...Studies+in+Men

[Case Manager]

Well, this is excellent information. Thanks again for all your help. This is far more than I ever expected to get out of this starting the conversation here. If only you could prescribe medication....

[TRTdrew]

I’m late to this thread, but I thought I’d chime in. I have a friend who takes tramadol daily and says it affects his labido.