Low Estrogen Crisis

[HunterPDX]

Hello.  Yes new to the forums and I've been reading a lot both here and elsewhere.  I decided to risk getting some feedback because the folks here seem decent and I already have a doctor, now two, that I'm in discussions with on this.  Often the forums I view are either about men and high estrogen, or are very hostile to new questions, or both.  I'll post lab values and dates at the end of this post.  I'm posting here because I'm (sadly) finding standard physician practice around the complexities of men and estrogen to be very dismissive.  Like many of you, I've had to fight to get testosterone tested.  And estradiol?  I've had to basically get it tested on my own initiative because the doctor's office flat out refuses.  I'm not seeking medical advice, simply perspectives and experiences.  Thinking that one is "alone" in this experience is, in and of itself, very depressing.  I'm using LabCorp for my own testing.  You'll see two different "ranges".  That's because my doctor's office uses a different lab.

HISTORY:  Started a new very serious workout regimen and diet regimen at start of year.  Very motivated, hired a trainer.  Lost 25 pounds but have had difficulty putting on muscular weight.   Protein can be difficult to get so I tend to supplement with whey isolate.  Also BCAA.  I tolerate dairy fine.   Have been on androgel TRT for about ten years now.  Usually my numbers are monitored about every year or less but this year I decided after a few months of no real growth and stubborn weight loss to check my T.  I'd been suspicious that the gel wasn't really working well anymore and I was right.  It had seriously tanked.  We switched to IM test because that is always absorbed (gel isn't I gather). 

Well--and this is MY fault--I screwed up the dosing and created a huge testosterone spike.  Did 250mg twice a week instead of over the course of a week with two injections.  I also suspected an estradiol spike but, even after an ER visit for severe edema, it was not tested.  So I checked it.  Was absurdly high.  Nothing was done so I used Letrozole for about a week.  We decided to D/C TRT for a while as I was going out of the country anyhow, get another lab of my testosterone, and then resume IM test a little more carefully.   Estrogen was also checked exactly once.  I've had to mostly do my own tests because it's been so low you cannot really measure it most of the time.  Have not even thrown an AI at it since first week in May.  I don't feel right at all but--unfortunately--I don't have a basis for comparison as the first estadiol test I ever had was April 2015 where it was stupendously high.  I might have always had low estrogens, who knows?  I probably aromatized the the initial IM tesosterone like crazy but then mysteriously stopped aromatizing at all.  Sure I crushed it with an AI at first.  But I haven't touched the stuff since having low/undetectable estradiol. 

I've got one lab with SHBG and I read here that, in some men with low estadiol, this can be correlated. 

Essentially am now working with an ND who will hopefully be able to make heads or tails of this.  The positive side is that TRT has finally gone to a more or less "normal" place with my testosterone values.  This makes me happy.  It took a while.  The negative side is I have no estrogen.  As an aside, I have always had low HDL (good cholesterol) but my LDL is usually in the normal range.  That did spike last Fall which was a motivator for all the diet and exercise.  I've also always had a very difficult time putting on good muscular weight even with very consistent weight training. 

So take a look.  If you're going to tell me to "talk to my doctor" please know that I'm talking to two doctors.  This information is not a secret though the ND has not really weighed in much yet other than to start looking closely at liver function.  All my regular liver and blood tests are normal on my labs (standard medicine is VERY good about drawing comprehensive metabolic panels and CBCs) but he thinks it might be liver problems and I don't disagree at the moment.   

I'm curious as to what peoples opinions and experiences are.  Some of these tests are not lab standardized as to values for normal, so the level with LabCorp, for instance, would not be the same as the level for the other lab whose name I do not have right now.

4/14/15
Tesosterone, Serum   45  (LOW)           NR 241 - 827  (not LabCorp)

Initiated Testosterone IM  250mg x2/week (my bad)

4/27/15
Testosterone               >1500                 NR  348 - 1197
Estradiol, Sensitive      161.2  (HIGH)     NR  8.0 - 35.0

D/Ced IM Testosterone, Initiated Letrozole for 1 week. 

5/21/15
Tesosterone, Serum   313                     NR  241 - 827 
Estradiol                     10.4                    NR   10 - 42
FSH                           10.0                     NR  1.4 - 18.1
LH                              10.8 (HIGH)        NR   1.5 - 9.3

Initiated IM Testosterone 250mg/week, split into two doses

5/26/15
Testosterone            1064  (HIGH)          NR   241 - 827

6/10/15
Testosterone             >1500  (HIGH)         NR   348 - 1197
Estradiol                    <5.0    (LOW)           NR  7.6 - 42.6
Progesterone              0.8                         NR   0.2 - 1.4
SHBG                          19.9                      NR   19.3 - 76.4

7/6/15
Testosterone                      873                       NR   348 - 1197
Test, Free+Weak Bound    328.2 (HIGH)          NR   40.0 - 250.0
Estradiol, Sensitive           <2.5   (LOW)             NR  8.0 - 35.0

7/27/15
Testosterone                    984                     NR  348 - 1197
Testosterone, Free          34.0  (HIGH)       NR    7.2 - 24.0
Estradiol                         <5.0   (LOW)         NR   7.6 - 42.6


I don't know what to think, but I have opinions.  Chiefly:

1) My estrogens were always low.  Then they got thrown up so so high that my body's homeostatis never recovered from the shock and has kept them undetectable ever since
2) My thyroid-pituitary-testes axis is messed up
3) SHBG bound up all my estrogen and I'm evacuating it from my body.  I do drink about 120oz of water a day, lol.

[PeakT]

Wow.  Sorry to hear about all the struggles.

Well, it looks like you've the testosterone side of the equation under control now, so that's good.  But I can believe those low estradiol numbers.  There was one other man on here - can't remember who - that had the same issue - beefy testosterone and near non-existent estradiol.  To be honest, it's to get my arms around, because the great majority of guys on upper range HRT struggle with high estradiol not low. 

Did you use a suicide inhibitor for the AI by any chance?  It takes a few weeks for the enzymes to build back up if that is the case.

Okay, I found the thread and he also used an AI:

http://www.peaktestosterone.com/forum/index.php?topic=7760.msg66892#msg66892

The only thing I know of that will (semi-safely) boost estradiol levels is probably grapefruit and grapefruit juice.  Be careful, though, as this can interact with many medications, so talk to your doc first if you are taking anything right now.

As far as SHBG, I don't see that as an issue if you are really still at about 27.  If you were low SHBG, it can clear out your estradiol (and T).

[HunterPDX]

Wow.  Sorry to hear about all the struggles.

Well, it looks like you've the testosterone side of the equation under control now, so that's good.  But I can believe those low estradiol numbers.  There was one other man on here - can't remember who - that had the same issue - beefy testosterone and near non-existent estradiol.  To be honest, it's to get my arms around, because the great majority of guys on upper range HRT struggle with high estradiol not low. 

Did you use a suicide inhibitor for the AI by any chance?  It takes a few weeks for the enzymes to build back up if that is the case.

Okay, I found the thread and he also used an AI:

http://www.peaktestosterone.com/forum/index.php?topic=7760.msg66892#msg66892

The only thing I know of that will (semi-safely) boost estradiol levels is probably grapefruit and grapefruit juice.  Be careful, though, as this can interact with many medications, so talk to your doc first if you are taking anything right now.

As far as SHBG, I don't see that as an issue if you are really still at about 27.  If you were low SHBG, it can clear out your estradiol (and T).

Very useful and thank you.  I'm going to comment on that thread as well.  I'm digging through that very question, my records and my bottles to answer it definitively.  I used letrozole (not a suicide inhibitor) end of April/Start of May in response to the 161 E2 value.  Then I started feeling similar symptoms again but I did not want to use letro because I'd read slightly better things after resuming the IM tesosterone so I did actually use the anastazole (suicide inhibitor) but it was in a very very small quantity total no more than 3 mg start of June.  I had forgotten it was there, I started it but then chose to not continue it.  The symptoms of the super high E2 were awful, the letro had helped them subside, but I was being very conservative because I simply did not trust that my E2 was terribly high yet.  I'm very glad that nearly all of my anastazole remains on the shelf, un-used.  Really most of the letrozole too.  I'm obviously hyper-sensitive to the stuff. 

I'm going to be optimistic and say that--because I only had a low amount of E2 to bind to anyway--the limited amount of an SI I used to manage (presumed) high E2 was enough the crush the recuperating value out of existence.   But since I had very little E2 to bind to permanently, the rest of the suicide inhibitor has hopefully flushed its unbound self out of my system without anything to actually affect to begin with.  In other words, it was not so much a question of dose and use over an extended duration as it was of bad timing.

One hopes.

I also do have SHBG on the low side (19) so I guess it is likewise clearing stuff out?? 

Yeah I have to watch grapefruit juice.  Soy is supposed to build E2 as well but that has other issues.

[PeakT]

Soy won't impact testosterone or estradiol significantly almost for sure (unless you consume a massive amount).  The reason someone told you that was that soy has a high amount of phytoestrogens.  The pros and cons of soy are actually quite involved.  It has pros, such as boosting nitric oxide, but cons, such as a possible negative impact on the male brain, so I shy away from it for reasons I outline here:

http://www.peaktestosterone.com/soy_men

Hey, anastrozole is not a suicide inhibitor:  it's just a standard AI.  Some guys are definitely sensitive to it.

That fairly low SHBG may explain some of the problem actually.  Men with low SHBG for example often have quite low total testosterone even though they are on TRT.  Their body clears it out rapidly.  And the same would apply to estradiol.  However, I have not seen any low SHBG guy with medium testosterone like yours and basement level E2. 

fyi:

http://www.peaktestosterone.com/low_shbg

[HunterPDX]

Soy won't impact testosterone or estradiol significantly almost for sure (unless you consume a massive amount).  The reason someone told you that was that soy has a high amount of phytoestrogens.  The pros and cons of soy are actually quite involved.  It has pros, such as boosting nitric oxide, but cons, such as a possible negative impact on the male brain, so I shy away from it for reasons I outline here:

http://www.peaktestosterone.com/soy_men

Hey, anastrozole is not a suicide inhibitor:  it's just a standard AI.  Some guys are definitely sensitive to it.

That fairly low SHBG may explain some of the problem actually.  Men with low SHBG for example often have quite low total testosterone even though they are on TRT.  Their body clears it out rapidly.  And the same would apply to estradiol.  However, I have not seen any low SHBG guy with medium testosterone like yours and basement level E2. 

fyi:

http://www.peaktestosterone.com/low_shbg

OH...yeah I see.  Anastazole = Armidex, not Aromasin.  That was my point of confusion.  I blame low estrogen brain fog.  So it was two Type II AIs I used, non-concurrently, and not a suicide inhibitor.  How long does it take for a Type II AI to stop its action in the body?  It's still been about 6-8 weeks since I've used any armidex with no estrogen recovery.  Also I seem to have plenty of free testosterone, that's on the high side.  I'm not sure if I'm right about this, but SHBG binds tightly with testosterone, albumin weakly, and the rest is free and available for the body to use and/or be aromatized?  Though the albumin bound testosterone can be freed up for some functions.  I think.

Does the SHBG test measure only unbound SHBG or total?  I read the article on low SHBG and some of this sounds like me, but certainly the bit about my testosterone being high-normal now doesn't quite make sense unless you look at the thought that I was over 1500 for quite a while and, eventually, it went down.  I did not do anything to reduce it other than time, so perhaps SHBG has been hard at work.  Maybe the thing to do would be get another SHBG test and see, I've only had the one. 

If this is true then, over time, my testosterone should continue to inch downward even though my TRT dose remains consistent.  That is what happened the last time on the topical TRT.   It becomes tricky, and I'll be mentioning SHBG to my doctor tomorrow.  Will keep people posted as it's a pretty strange anomaly that not many men have to deal with.  But because of that, not many people have great knowledge or firsthand experience of it.  Like so many things, I bet it's under-diagnosed. 

[PeakT]

Soy won't impact testosterone or estradiol significantly almost for sure (unless you consume a massive amount).  The reason someone told you that was that soy has a high amount of phytoestrogens.  The pros and cons of soy are actually quite involved.  It has pros, such as boosting nitric oxide, but cons, such as a possible negative impact on the male brain, so I shy away from it for reasons I outline here:

http://www.peaktestosterone.com/soy_men

Hey, anastrozole is not a suicide inhibitor:  it's just a standard AI.  Some guys are definitely sensitive to it.

That fairly low SHBG may explain some of the problem actually.  Men with low SHBG for example often have quite low total testosterone even though they are on TRT.  Their body clears it out rapidly.  And the same would apply to estradiol.  However, I have not seen any low SHBG guy with medium testosterone like yours and basement level E2. 

fyi:

http://www.peaktestosterone.com/low_shbg

OH...yeah I see.  Anastazole = Armidex, not Aromasin.  That was my point of confusion.  I blame low estrogen brain fog.  So it was two Type II AIs I used, non-concurrently, and not a suicide inhibitor.  How long does it take for a Type II AI to stop its action in the body?  It's still been about 6-8 weeks since I've used any armidex with no estrogen recovery.  Also I seem to have plenty of free testosterone, that's on the high side.  I'm not sure if I'm right about this, but SHBG binds tightly with testosterone, albumin weakly, and the rest is free and available for the body to use and/or be aromatized?  Though the albumin bound testosterone can be freed up for some functions.  I think.

Does the SHBG test measure only unbound SHBG or total?  I read the article on low SHBG and some of this sounds like me, but certainly the bit about my testosterone being high-normal now doesn't quite make sense unless you look at the thought that I was over 1500 for quite a while and, eventually, it went down.  I did not do anything to reduce it other than time, so perhaps SHBG has been hard at work.  Maybe the thing to do would be get another SHBG test and see, I've only had the one. 

If this is true then, over time, my testosterone should continue to inch downward even though my TRT dose remains consistent.  That is what happened the last time on the topical TRT.   It becomes tricky, and I'll be mentioning SHBG to my doctor tomorrow.  Will keep people posted as it's a pretty strange anomaly that not many men have to deal with.  But because of that, not many people have great knowledge or firsthand experience of it.  Like so many things, I bet it's under-diagnosed.

You bet it's underdiagnosed:  most docs could care less about estradiol.  To get it pulled you have to beg and whine.

I don't know how to explain what happened to you.  It kind of reminds me of Propecia:

Davie posted an article that it seems to leave some men in a permanent high estradiol and prolactin state and they don't know why.

From what I have read, enzymes are restored after a few weeks - say three - post-Aromasin.  With anastrozole, you should snap right back in a couple of weeks.  I will say that estradiol seems to kind of lag.  My guess is that it's an enzyme thing - they get upgraded and downgraded in ways that we don't understand.

[HunterPDX]

Soy won't impact testosterone or estradiol significantly almost for sure (unless you consume a massive amount).  The reason someone told you that was that soy has a high amount of phytoestrogens.  The pros and cons of soy are actually quite involved.  It has pros, such as boosting nitric oxide, but cons, such as a possible negative impact on the male brain, so I shy away from it for reasons I outline here:

http://www.peaktestosterone.com/soy_men

Hey, anastrozole is not a suicide inhibitor:  it's just a standard AI.  Some guys are definitely sensitive to it.

That fairly low SHBG may explain some of the problem actually.  Men with low SHBG for example often have quite low total testosterone even though they are on TRT.  Their body clears it out rapidly.  And the same would apply to estradiol.  However, I have not seen any low SHBG guy with medium testosterone like yours and basement level E2. 

fyi:

http://www.peaktestosterone.com/low_shbg

OH...yeah I see.  Anastazole = Armidex, not Aromasin.  That was my point of confusion.  I blame low estrogen brain fog.  So it was two Type II AIs I used, non-concurrently, and not a suicide inhibitor.  How long does it take for a Type II AI to stop its action in the body?  It's still been about 6-8 weeks since I've used any armidex with no estrogen recovery.  Also I seem to have plenty of free testosterone, that's on the high side.  I'm not sure if I'm right about this, but SHBG binds tightly with testosterone, albumin weakly, and the rest is free and available for the body to use and/or be aromatized?  Though the albumin bound testosterone can be freed up for some functions.  I think.

Does the SHBG test measure only unbound SHBG or total?  I read the article on low SHBG and some of this sounds like me, but certainly the bit about my testosterone being high-normal now doesn't quite make sense unless you look at the thought that I was over 1500 for quite a while and, eventually, it went down.  I did not do anything to reduce it other than time, so perhaps SHBG has been hard at work.  Maybe the thing to do would be get another SHBG test and see, I've only had the one. 

If this is true then, over time, my testosterone should continue to inch downward even though my TRT dose remains consistent.  That is what happened the last time on the topical TRT.   It becomes tricky, and I'll be mentioning SHBG to my doctor tomorrow.  Will keep people posted as it's a pretty strange anomaly that not many men have to deal with.  But because of that, not many people have great knowledge or firsthand experience of it.  Like so many things, I bet it's under-diagnosed.

You bet it's underdiagnosed:  most docs could care less about estradiol.  To get it pulled you have to beg and whine.

I don't know how to explain what happened to you.  It kind of reminds me of Propecia:

Davie posted an article that it seems to leave some men in a permanent high estradiol and prolactin state and they don't know why.

From what I have read, enzymes are restored after a few weeks - say three - post-Aromasin.  With anastrozole, you should snap right back in a couple of weeks.  I will say that estradiol seems to kind of lag.  My guess is that it's an enzyme thing - they get upgraded and downgraded in ways that we don't understand.

Yeah the fight I had to go through to get my doctor to run an estrogen test was seriously tough, and it was only because I had a prior test I had ran myself in hand that was so out of range I backed him into a corner with it.  We came up with this plan to measure that and the testicular-pituitary-thyroid axis before and after resuming IM testosterone E.  I held up my part, but despite sending the nurse back to him twice on lab day to confirm that he was indeed not just taking a metabolic panel and CBC (he does that for every visit, I think he has it on some kind of standing order) but also repeating these tests.  Eventually they said they'd run the testosterone again after much refusing the orders and sending them back for updating I just accepted it was covered on insurance at least and stopping fighting the wave of estrogen denial.

I'm currently running with the theory that's a little modified; I hit fairly low estrogen with a little armidex, which annihilated it.  My low side SHBG is not estrogen's friend, so maybe that's a factor in keeping it too low to rebuild?  It can never generate enough "oomph" to bring it back from zero.  I know this isn't a long term problem, it was 161 in April and 10 a month later.  So I have it, when I have sufficient aromatase it probably works.  Given my past history and how well I know my body my guess is that my estrogens have always been on the low to medium side.  When they went up to 161 my body freaked out for about a week.  Now I'm just having an issue booting up from zero, so to speak.  I might have some aromatase right now, just not enough to generate sufficient estradiol to become detectable before it gets dealt with by low SHBG. 

It will be a very interesting discussion tomorrow with the ND.  Initially I expect the answer to be conservative, slow and simple (lets strengthen your liver) because it's hard to go wrong with that plan.  Things will hopefully be evolved and refined over time, with close monitoring to see how I respond to changes, and collaboration to determine what things work best for me and the goals I have while maintaining overall health, vigor and safety.   The clinic I've selected has numerous disciplines in alternative and complimentary care represented, and my insurance is good. 

I'm kind of excited to see what happens and what positive changes I can make.   Because zero estradiol is putting a crimp in my Master Plan, which is to rewind the decade physically and start over at 40 again.  First one was a trial run, and I'm doing it over. 

[PeakT]

Ha ha.  I like that rewind idea - gonna use that!

Again, though, if that estradiol stays low for much longer, you need to ask for a bone scan imo...

[tamaharbor]

Please let me know what you find out.

I am 51, 6'4, 215#.  My T consistently ranges from 800-1000, but E2 is typically < 10 and I have ZERO libido.

At various times via four different doctors I have been prescribed T gels, T compounded creams, TCyp IM injections, TCyp subQ injections, clomid, cabergoline, danazol, cytomel(T3), synthroid(T4), and HCG injections in the hopes of raising estradiol, but my E2 remains very low.

The only things that ever 'work' are the peptides PT-141 and Melototan 2, but timing and dosage are very hard to determine consistently.

Any help or suggestions would be greatly appreciated.  As you have indicated, many doctors and others seem to just shrug off my/our unusual problem.  Thank you in advance.

[HunterPDX]

Please let me know what you find out.

I am 51, 6'4, 215#.  My T consistently ranges from 800-1000, but E2 is typically < 10 and I have ZERO libido.

At various times via four different doctors I have been prescribed T gels, T compounded creams, TCyp IM injections, TCyp subQ injections, clomid, cabergoline, danazol, cytomel(T3), synthroid(T4), and HCG injections in the hopes of raising estradiol, but my E2 remains very low.

The only things that ever 'work' are the peptides PT-141 and Melototan 2, but timing and dosage are very hard to determine consistently.

Any help or suggestions would be greatly appreciated.  As you have indicated, many doctors and others seem to just shrug off my/our unusual problem.  Thank you in advance.

I'm a newcomer to the low E2 party myself.  I'm just figuring out the scope of the issue within the past three months. 
I'd also be interested to know a little of how your own estradiol problems came into your awareness, if you know.  Seems like you've a lot bigger history with this than I have.

[PeakT]

Guys,

Something just hit me: 

I think HCG Monotherapy is worth a try.  This ramps up estradiol like nothing else, at least in semi-healthy males.  Typically guys, when they get to about 500-600 ng/dl, find that their estradiol is very high from what I have seen on here.  So, if the testes are working okay, this may very well do it for you:

http://www.peaktestosterone.com/hcg_monotherapy

Also, you may want to alk to a smart doc about this.  Also, you might try someone that has been in HRT for awhile:  Defy Medical, Dr. Shippen, etc. do long distrance phone consults.  (I have no affiliation.)

[PeakT]

I added your story to my potenial problems with Arimidex page:

http://www.peaktestosterone.com/Arimidex_Problems

[PeakT]

I'm curious about something:

When you are were taking the Arimidex, what dose were you taking and how often?

[swoony]

Are you taking zinc by any chance? Or high dose Vitamin D3?

[HunterPDX]

My testes have been nearly shut down a long time.  I'm taking the IM testosterone as replacement therapy and have been for years.  There has never been any "shrinkage" per se and, when testosterone levels are normal, sexual function and drive are mostly normal.  It goes through peaks and valleys, but this is just related to state of mind and not hormones imho.

The problem with all this is that I never even had an estrogen test until end of April 2015.  I don't have a baseline for comparison pre-aromatization or post-suppression with an AI.  To me, I think estrogens should be checked, if not as often at testosterone in men, then at least every other blood draw.  I don't think I'll get much argument on this point.

I was taking Armidex for only about a 5-7 days, daily, at maybe 0.25 to 0.5mg/day.  I had thought I had a resumption of my earlier high-E symptoms (my legs were getting puffy again) but I don't think that was the case.  I think that symptom was more related to borderline hypertension and low water intake.  Since addressing those two things my BP is back to its normal self and I drink about 120 oz. of water a day, which flushes things nicely, though I piss like a race horse.

The hCG is an interesting idea, though my luteinizing hormone is a trifle elevated already at 10.8.  If I am understanding correctly that is the pituitary analog of hCG so it seems OK. 

A point of clarification on SHBG.  Does the test measure free or total SHBG?  I've seen both high and low SHBG (mine is a little low just under 20) as a possible culprit, but I guess that only makes sense in presuming that a lot of it is being bound up to the estradiol?  I should really get another SHBG test, and maybe some others, to see what's what at this stage. 

Saw the new naturopathic doc.  As expected he's being conservative and starting with the liver because it is so obviously overworked with a lot of different medications for various issues.  Some are pretty tough on it.  The liver enzymes I closely watch and treat with milk thistle and dandelion and have been in normal range over the years but according to him just because your enzymes are in range doesn't mean that there isn't a backlog on how the liver is addressing detoxification and protein synthesis and other things.  For me, creating aromatase might just be a low-priority item that keeps getting knocked out of the queue every day.  We're going with castor oil externally to help it detox.  I'm not sure how I feel about that at this point other than taking a "wait and see" approach because, certainly, detoxing the liver will not result in any harm.  It's kind of the solution that anyone would come up with and you'd be perfectly safe in suggesting, so long as the detox did not jeopardize health in other ways.

I'm not taking zinc.  I take about 2000iu of Vitamin D3. 

I'm glad you referenced stories of low E2 problems on the Armidex page.  These are powerful drugs and some men seem to have a hyper sensitivity to them.