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Author Topic: Low estradiol- on compounded cream and DIM  (Read 722 times)

Dod1

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Low estradiol- on compounded cream and DIM
« on: April 05, 2018, 09:29:27 am »
Writing for my husband. You all seem to know more about this than anyone. Forgive me if it’s a repeat but most posts I see about low E have to do with an AI.
35 years old, about 20 pounds overweight.
Started 50mg/day compounded T cream daily 5 weeks ago for decreased (like very little) libido, lack of motivation, difficulty losing weight, trouble with memory/focus.
He had monitored for about 6-8 months- trying natural ways to increase (supplements, working out, etc), total T stayed in low-mid 300.

Labs when starting cream:
Total T 330 (264-916)
Free T 9.75 (5-21)
FSH 3.5 (1.5-12.4)
LH 3.7 (1.7-8.6)
Estradiol 21 (7.6-42.6)
IGF 250 (83-233)
Vitamin D 36 (30-100)

After 5 weeks:
Total T 447 (264-916)
Free T 15.78 (5-21)
FSH 2.7 (1.5-12.4)
LH 3.2 (1.7-8.6)
Estradiol 5.5 (7.6-42.6)
IGF 246 (83-233)
Vitamin D 39 (30-100)

Thyroid function is good. TSH is optimal range (1.5), Free T4, and Free T3 are in the top quarter. Although reverse T3 is high. But I think that’s ok since T3 is top of normal.

The testosterone seems better but the Estradiol is SO much lower. There has been zero improvement in symptoms, he really hasn’t noticed anything at all, although I think libido May even be a bit worse. Diet has been good, working out, hasn’t lost a pound.
He is taking DIM, general vitamins/mineral supplements, and Vitamin D. Really needs to lose the few pounds due to borderline BP with heart defect.

Can DIM lower E this much? Any other thoughts or advice? Any thoughts on the elevated IGF (should we worry about Pit tumor? Dr said no because of LH/FSH)

HRT Guru

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Re: Low estradiol- on compounded cream and DIM
« Reply #1 on: April 05, 2018, 10:11:51 am »
You're using the wrong Estradiol test, the only test suitable for males is the Ultra Sensitive Estradiol LC/MS/MS...any other is for females. Labcorp and Quest both print on their results the correct test for men to be using. The females test tends to overestimate levels in males and cannot be used.

For his testing after 5 weeks, was the cream applied two hours prior to his blood draw? This is the only way to test when using topicals and if applied to an arm the blood draw must be on the opposite arm. The tests would indicate that that's not how it was done.

Just reading between the lines there...get the correct test with the correct testing protocol and see what comes back. I think there's little to diagnose there with the wrong test and my assumption on testing strategy there.

Peak Testosterone Forum

Re: Low estradiol- on compounded cream and DIM
« Reply #1 on: April 05, 2018, 10:11:51 am »


Cataceous

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Re: Low estradiol- on compounded cream and DIM
« Reply #2 on: April 05, 2018, 12:33:45 pm »
Because immunoassay-based estradiol tests either tend to read high or be pretty accurate, I'd say it's a good bet that his estradiol is indeed low. DIM should not cause this, as it operates by steering estradiol metabolism more towards certain (safer) paths than others. This is pure speculation, but it may be that your husband has a relative dearth of the aromatase enzyme in his skin. In this case the exogenous testosterone has shut down natural production and supplied it in a location where less can be converted to estradiol. I would still favor a "calibration" test with a mass spectrometry-based estradiol test before proceeding. No single test should be completely trusted. It appears you're using LabCorp, so this is the LC/MS test: https://www.labcorp.com/test-menu/24871/estradiol-sensitive-lc-ms

Ideally an immunoassay test would be done simultaneously for comparison. If there is a large discrepancy, with immunoassay higher, then C-reactive protein should be measured. This inflammatory marker is one molecule that can be "accidentally" detected by the immunoassay test, and you don't want too much of it.

Some nontrivial fraction of men do not do well with transdermal testosterone due to various absorption issues. For these guys, switching to injections frequently resolves the problems that gels, etc. do not.
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 57, Ht: 5'10", Wt: 158 lbs
Protocol: 18 mg T enanthate subQ qod, 250 IU hCG subQ qod, 70 mcg anastrozole qod, 6.25 mg DHEA orally bid
7-12/2018 test results: TT: 800 ng/dL, E2: 31 pg/mL LC/MS-MS, DHEA-S: 264 ug/dL (49-344)—SHBG ~30 nmol/L

doin it

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Re: Low estradiol- on compounded cream and DIM
« Reply #3 on: April 06, 2018, 02:19:37 pm »

Creams and gels sometimes do not do much for T levels but do drive DHT (Dihydrotestosterone)  levels very high.  This does not seem to be true in your case as higher DHT generally increases libido, performance, and well-being. But he should get DHT tested as well (no matter what form of T application is used).

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Re: Low estradiol- on compounded cream and DIM
« Reply #3 on: April 06, 2018, 02:19:37 pm »


doin it

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Re: Low estradiol- on compounded cream and DIM
« Reply #4 on: April 06, 2018, 05:36:51 pm »

Creams and gels sometimes do not do much for T levels but do drive DHT (Dihydrotestosterone)  levels very high.  This does not seem to be true in your case as higher DHT generally increases libido, performance, and well-being. But he should get DHT tested as well (no matter what form of T application is used).

-------
Prolactin and Progestetone should also be tested as these can affect libido and performance.


Joe Sixpack

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Re: Low estradiol- on compounded cream and DIM
« Reply #5 on: April 06, 2018, 07:45:14 pm »
that is shockingly low estradiol for any man, but especially for one who could stand to lose 20 lbs.  Most guys are going to feel horrible at that level of estradiol, even if his testosterone is at a good level. 

The standard method of increasing estradiol is to increase the testosterone dose. 
Age: 55, Ht: 5'08", Wt: 155 lbs
Protocol: 25 mg T Cyp + 25 IU HCG M,W,F + 2 clicks T Cream + 15mg DHEA + 15mg Pregnenalone daily.
12/2018 test results: TT: 1054 ng/dL (264-916), FT: 17.2 pg/mL (7.2-24), E2: 21.6 pg/mL sensitive (8.0-35.0)

ghce

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Re: Low estradiol- on compounded cream and DIM
« Reply #6 on: April 06, 2018, 08:56:06 pm »
I would tend to say that your husband is a bad absorber of T cream though it could just be that the level of T cream (concentration or volume) is too low, His 2nd test for LH tends to indicate that his LH levels have barely shifted which given he is on TRT should not be the case.
 
A good TRT protocol would likely see his LH levels close to zero. Possibly he should up his dose or shift to injectables.
Age:57, Height 6' 3" weight 92.5KG
2014 Androderm Patches
2014-2016 Andriol 160mg
June 2016 Clomid/Serophene 12.5mg EOD
September 2016 no TRT all natural and supplements for the time being
February 2017 Testosterone cream 100mg daily

Sept 2016
Testosterone   8.2 nmol/l   9-38
Free Testosterone   239 pmol/l   L   250-800
SHBG:  14    nmol/L   9-60
Free Androgen index   586   >400
Oestradiol    112   pmol/L    <190
LH    2.6 IU/L Adult male   2 - 9 IU/L
FSH  1.4 IU/L Adult male L2 - 12 IU/L

22 November
T 6.8  nmol/L ( 9-38 ) L

March 2017
Testosterone:   45.0  nmol/L ( 9-38 ) H ( 1,323 ng/dl )
Free Testosterone:   1512  pmol/L ( 250-800 ) H
SHBG:   17  nmol/L ( 9-60 )
Plasma IGF-1:   227 ug/L ( 55-198 ) H
Plasma cortisol:   434 nmol/L ( 0600-1000 hrs 170-500 nmol/L )
HbA1c:   36 mmol/mol ( 20-40 )
LH:   <0.1 IU/L
FSH:   0.1 IU/L
DHT Plasma Dihydrotestosterone:   7455   pmol/L ( 223 ng/dl ) 

Reference Range Adult males  1000-6000 pmol/L

Peak Testosterone Forum

Re: Low estradiol- on compounded cream and DIM
« Reply #6 on: April 06, 2018, 08:56:06 pm »