High e2 to blame?

[Krb367]

Damn it’s been a long time since I’ve been on the forum! But this is the only place I trust for advice and have been unable to come across someone with a similar situation by just searching posts..

I’ve been on TRT ~ for around a year now.
200mg a week, which is split between two pins. Not running any AI, but I do have a script for Arimidex. No HCG. All previous labs testosterone and estrogen have been in range, leaning more on the higher end of the spectrum but no major issues. Up until here recently is when I started to notice myself being super fucking emotional, and a problem with getting a full erection. I feel like the culprit is def from the elevated e2, which in turn is due to the high testosterone. Both are out of range.

Should I start running my AI? They’re 1mg, I was thinking either .5mg twice a week with my injections, or splitting them even more and trying for .25mg twice a week.

Leave the AI out, and lower my testosterone dose? My pin yesterday I only drew up and injected about 3/4 of 1/2 ml.

Or should I do both options, lower the dose and start the AI?

Past two labs below (done every 10 weeks)


01/30/2019
Testosterone, Serum
1108 ng/dL (264-916 )
Estradiol
43.0 pg/mL (7.6-42.6 )
WBC 7.1 x10E3/uL (3.4-10.8 )
RBC 5.33 x10E6/uL (4.14-5.80 )
Hemoglobin 15.8 g/dL (13.0-17.7 )
Hematocrit 47.8 % (37.5-51.0 )
MCV 90 fL (79-97 )
MCH 29.6 pg (26.6-33.0 )
MCHC 33.1 g/dL (31.5-35.7 )
Neutrophils 52 % (Not Estab. )
Immature Granulocytes 0 % (Not Estab. )
Lymphs 33 % (Not Estab. )
Monocytes 8 % (Not Estab. )
Eos 7 % (Not Estab. )
Basos 0 % (Not Estab. )
Platelets 210 x10E3/uL (150-379 )
Hematology Comments: N/A
Neutrophils (Absolute) 3.7 x10E3/uL (1.4-7.0 )
Immature Grans (Abs) 0.0 x10E3/uL (0.0-0.1 )
Lymphs (Absolute) 2.3 x10E3/uL (0.7-3.1 )
Monocytes(Absolute) 0.6 x10E3/uL (0.1-0.9 )
Eos (Absolute)
0.5 x10E3/uL (0.0-0.4 )
Baso (Absolute) 0.0 x10E3/uL (0.0-0.2 )
NRBC N/A
RDW 13.7 % (12.3-15.4 )
Immature Cells N/A
Free Testosterone(Direct) 26.3 pg/mL (8.7-25.1 )

11/21/2018
Testosterone, Serum
1329 ng/dL (264-916 )
Estradiol
46.0 pg/mL (7.6-42.6 )
WBC 5.8 x10E3/uL (3.4-10.8 )
RBC 5.34 x10E6/uL (4.14-5.80 )
Hemoglobin 15.9 g/dL (13.0-17.7 )
Hematocrit 46.6 % (37.5-51.0 )
MCV 87 fL (79-97 )
MCH 29.8 pg (26.6-33.0 )
MCHC 34.1 g/dL (31.5-35.7 )
Neutrophils 52 % (Not Estab. )
Immature Granulocytes 0 % (Not Estab. )
Lymphs 29 % (Not Estab. )
Monocytes 12 % (Not Estab. )
Eos 6 % (Not Estab. )
Basos 1 % (Not Estab. )
Platelets 203 x10E3/uL (150-379 )
Hematology Comments: N/A
Neutrophils (Absolute) 3.0 x10E3/uL (1.4-7.0 )
Immature Grans (Abs) 0.0 x10E3/uL (0.0-0.1 )
Lymphs (Absolute) 1.7 x10E3/uL (0.7-3.1 )
Monocytes(Absolute) 0.7 x10E3/uL (0.1-0.9 )
Eos (Absolute) 0.3 x10E3/uL (0.0-0.4 )
Baso (Absolute) 0.0 x10E3/uL (0.0-0.2 )
NRBC N/A
RDW 14.2 % (12.3-15.4 )
Immature Cells N/A
Free Testosterone(Direct) 31.6 pg/mL (8.7-25.1 )

[Youthful55guy]

Estradiol 43.0 pg/mL (7.6-42.6 )

Your E2 is not high. I would not mess with an AI. It will more than likely make the ED much worse. AI dosing is extremely difficult to control in such small doses you would need to trim off a few pg/mL from your E labs. I would not be concerned unless your E2 climbed over 50, and then even be cautious.

I am surprised your Total T is only 1108 ng/dL with a dose of 00 mL 2X per week (200mg/week). When during the injection the injection cycle are you pulling your labs?

[Krb367]

Estradiol 43.0 pg/mL (7.6-42.6 )

Your E2 is not high. I would not mess with an AI. It will more than likely make the ED much worse. AI dosing is extremely difficult to control in such small doses you would need to trim off a few pg/mL from your E labs. I would not be concerned unless your E2 climbed over 50, and then even be cautious.

I am surprised your Total T is only 1108 ng/dL with a dose of 00 mL 2X per week (200mg/week). When during the injection the injection cycle are you pulling your labs?

I was trying to remember while I was writing my post, because I knew that would be a question someone would ask.. anywhere from a 1-3 days after a pin. Sometimes 4, it just varies. Front desk looks up 10 weeks and we arrange it around my schedule with being in town. My next 10 week is Thursday, and I’ll have my last injection that Monday morning.

Looking from a bloodwork pov, those are the only values that have really changed since I’ve noticed the lowered libido/ed and being more emotional.. another underlying issue? For the most part my doctor listens and is willing to help, so if there is something I should bring up or ask to have added into bloodwork or prescriptions?

[Couchlockd]

Try going to EOD 50mg injections.

That's 175 a week and should lower that e2 without ai and create a less peaky and troughy blood level

[Youthful55guy]

I was trying to remember while I was writing my post, because I knew that would be a question someone would ask.. anywhere from a 1-3 days after a pin. Sometimes 4, it just varies. Front desk looks up 10 weeks and we arrange it around my schedule with being in town. My next 10 week is Thursday, and I’ll have my last injection that Monday morning.

Looking from a bloodwork pov, those are the only values that have really changed since I’ve noticed the lowered libido/ed and being more emotional.. another underlying issue? For the most part my doctor listens and is willing to help, so if there is something I should bring up or ask to have added into bloodwork or prescriptions?

I do not have an answer for an alternative cause of increased emotions. I personally find emotionality a difficult thing to measure much less pin down a source of changes. But I am certain with the labs you present that it is not ties to E2. There is debate in the TRT community about whether or not to control E2 if it goes above range. Some even argue that it is good. I just don't have enough knowledge to have an opinion.

What I do know is that unless your progesterone and/or prolactin are concurrently high, gynecomastia (the side-effect feared the most by men) is probably not going to be a problem UNLESS you are messing with certain synthetic androgens that have progestin-like activity. This is really the reason why guys get so flipped out about their E that they are willing to drive it into the ground. They listen to the bodybuilding lore. Yes, for bodybuilders stacking synthetic androgens on top of high doses of E, gynecomastia is a very real possibility and E control is essential to prevent it, but for you and I on normal TRT it should not be a problem. Guys need E too. Ironically our dicks go limp without it and we get similar symptoms as low T if E goes too low.

Regarding day of the injection cycle you pull labs. It needs to be consistent if you plan on comparing on lab draw to another, which you should to understand how changes in your protocol affect your labs. So if you are going to stick with a 2X per week protocol, you need to choose a specific day of the week (either Day 3 or Day 4) and plan your life around it. This is the primary reason I recommend an E3D protocol. The interval between injections is always constant. Therefore, you simply schedule your lab draws so that they occur on an injection day and pull the blood just prior to the injection.

[Youthful55guy]

Try going to EOD 50mg injections.

That's 175 a week and should lower that e2 without ai and create a less peaky and troughy blood level

Good suggestion. More consistency in peek to nadir T levels is always good. E2D, like E3D, provides a consistent interval between injections so you schedule labs on an injection day. However, per previous comments, I just don't think that E2 is the problem with the OP.

[almostgone]

Lower libido....wonder where the OP's DHT is at? Free T sounds low as well given the dosage, but everyone does metabolize/process differently.

[Youthful55guy]

Lower libido....wonder where the OP's DHT is at? Free T sounds low as well given the dosage, but everyone does metabolize/process differently.

Given a Total T of 1108 ng/dL (264-916) and a Free T of 26.3 pg/mL (8.7-25.1), I doubt that DHT is going to be low unless he's pushing finasteride more then 1mg/day (even that would be a bit much I suspect). But I do agree with you that DHT should become part of our normal hormone panels and that we need to start controlling it better while on TRT. This is one of my current areas of interest. High DHT = hair loss and erythrocytosis. Low DHT = poor libido and ED. Got to find that sweet spot, which I suspect is about the upper 75th percentile of the normal range.

[almostgone]

Given a Total T of 1108 ng/dL (264-916) and a Free T of 26.3 pg/mL (8.7-25.1), I doubt that DHT is going to be low unless he's pushing finasteride more then 1mg/day (even that would be a bit much I suspect). But I do agree with you that DHT should become part of our normal hormone panels and that we need to start controlling it better while on TRT. This is one of my current areas of interest. High DHT = hair loss and erythrocytosis. Low DHT = poor libido and ED. Got to find that sweet spot, which I suspect is about the upper 75th percentile of the normal range.

Yes sir, that is kind of where I was leading. With a total T of 743.1 ( range is 264-916 ng/dL) and a free T of 24.8 (top end of range is 24 pg/mL), my DHT was 95 ( range of 30-85 ng/dL). I was expecting it to be higher than that.

Kel convinced me a while back to get a good baseline DHT and then check it periodically. After doing some reading I became aware of the importance of a healthy DHT level.

Edit: I usually bite the bullet and blow some HSA $$ on DHT and SHBG at least annually since I'm an old fart.

[Youthful55guy]

YKel convinced me a while back to get a good baseline DHT and then check it periodically. After doing some reading I became aware of the importance of a healthy DHT level.

Kel is a smart man.

[almostgone]

Kel is a smart man.

Yes sir, that he is and one hell of a nice guy! It's fun to just shoot the shit with him about random topics... eventually works it's way back to lifting, hormones, or day to day stuff. But definitely a great guy!

We're lucky to have him here at the forum....you as well.

I always retain another tidbit of info or food for thought when I read y'all's posts in here!!

[Krb367]

I haven’t been so much worried about my e2 high/low, it just wasn’t under these last two labs it was actually “out of range” and it so happens I’ve noticed this ED problem (not fully hard, maybe 60-75%) over the past few months.. I understand with the non persistent timing of labs it makes things more difficult to pin point the issue.

Should I have him check my DHT and SHBG? I’m not running anything at the moment, I haven’t been since I started TRT due to my doctor making me come in every 10 weeks. Super scared for a cycle to completely throw things out of wack and raise a red flag.. I know any past cycles prior to TRT, testosterone only, I always ran a low dose of Aromasin ED, with HCG and I never had any ED before.

[Youthful55guy]

I haven’t been so much worried about my e2 high/low, it just wasn’t under these last two labs it was actually “out of range” and it so happens I’ve noticed this ED problem (not fully hard, maybe 60-75%) over the past few months.. I understand with the non persistent timing of labs it makes things more difficult to pin point the issue.

Should I have him check my DHT and SHBG? I’m not running anything at the moment, I haven’t been since I started TRT due to my doctor making me come in every 10 weeks. Super scared for a cycle to completely throw things out of wack and raise a red flag.. I know any past cycles prior to TRT, testosterone only, I always ran a low dose of Aromasin ED, with HCG and I never had any ED before.

It's always a good idea to know DHT and SHBG, but I doubt they are contributing to your ED. Your Free T is excellent with a Total T of 1108 ng/dL, so I doubt that SHBG is either high or low. With a Total T of 1108, your DHT should be slightly high unless you are taking finasteride in which case it is absolutely necessary to be monitoring DHT and adjusting the dose accordingly. Assuming you are not taking finasteride or you would have mentioned it by now, so a slightly high DHT should have the opposite effect on ED.