Please help me with my blood test results

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    Please help me with my blood test results


    My background: I'm an 18 year old male and have been lifting for the past 1.5-2 years. Since about a year I've been noticing decreased libido, virtually no attraction to the other sex and a feeling of indifference (towards people/friends in general. I realise that this impression is subjective and may have different explanations but after roaming the boards and hearing about the symptoms of low T, I decided to have a blood test done (2 months ago). I don't have it right here but the numbers were something like:
    Testosterone: 270 or 280 ng/dl (low end of normal range);
    Free T was also tested. I just remember it being barely above the low end (Edit: 9.3 ng/l; normal range: 8.8-27).
    All else was Ok except for creatine kinase, which is imho explained by breakdown of muscle tissue. That doc said everything's fine, but I didn't agree and argued with my mother (who's a pediatrician) until she sent me to an andrologist at the university hospital. It seemed to me as if the prof didn't listen to me at all, he would just go through his list, pointing out that my protein shake in the morning and creatine use could be to blame due to some contaminations and that no one could ever make him drink that.
    Anyway, today I got a letter with the results:
    To make it brief I quote his comment at the end (loosely translated from German):
    "The symptoms described by you... aren't caused by a lack of the peripheral androgen, as the level of the peripheral androgen is in the very high normal range (!!!).
    Note:
    Contrary to the first blood test, no free testosterone was measured.
    Total T (this time 300 ng/dl) and SHBG (9.20 nml/l, below normal range) were calculated into the "free androgen index".
    And to top it, I quote: "The elevated level of creatine kinase and a marginally low level of HDL-Cholesterol (37 mg/dl) are conspicuous. This indicates a possible exogenic use of androgenic drugs(!!!). This may also explain the marginal level of Estradiol (98.3 pg/ml) as well as the elevated GPT."
    Note: , I've never touched AS!
    "...Therapeutically, it is recommended to cease the supplementation of protein and the intake of creatinine, as well as to reduce physical strain. At the moment there is a cardiovascular risk for a coronary heart disease, advice regarding further action is necessary". I'm speechless. Need advice.
    ps: I wasn't sure where to put this thread, but the anti-aging/testosterone related issues category seems to fit best.
    Thanks for your help.

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    lol find a new doctor

    ur one year younger than me and ur T levels are even lower than mine, so i can imagine how "dead" you feel
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    Quote Originally Posted by ECTOmorph
    lol find a new doctor

    ur one year younger than me and ur T levels are even lower than mine, so i can imagine how "dead" you feel
    yeah, I noticed your thread right after posting mine. I'm glad I'm not the only one at my age who has to go through this.
    But back to topic: That doctor was really stubborn as a mule. I'm not attacking his test results (which seem suspicious though), but he was that kind of unfriendly person you don't want to meet. What really perplexes me is his opinion on supplements! I got to admit that I dont think much of him but explain that to my mother. After all he's a prof.
    I feel as if I'm stuck in a dead end. And the results of that second
    test are freaking me out! Maybe someone could interpret them, so that I'll be prepared for my next appointment.
    •   
       

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    Quote Originally Posted by lowvolume
    I quote: "The elevated level of creatine kinase and a marginally low level of HDL-Cholesterol (37 mg/dl) are conspicuous. This indicates a possible exogenic use of androgenic drugs(!!!). This may also explain the marginal level of Estradiol (98.3 pg/ml) as well as the elevated GPT."
    I'm no Dr but I believe it could be the inverse. Low levels of HDL (good cholesterol) could be contributing to your low T levels. The low T levels could be the trigger for elevated E2. The body wants to produce more test and its producing elevated E2 to trigger the body to produce T to balance the T/E2 ratio.

    BTW, what is your body composition and activity level? Lean, obese, sedentary, active, etc?

    Consider looking into your diet and its healthy fat content. It may need to have increased amounts of EFAs (healthy fats) like EVOO, fish oils, Flax Seed oils, and other healthy fats. This in turn may improve your HDL and indirectly improve your T and as a result your E2.

    JMHO
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    Quote Originally Posted by B5150
    BTW, what is your body composition and activity level? Lean, obese, sedentary, active, etc?

    Consider looking into your diet and its healthy fat content. It may need to have increased amounts of EFAs (healthy fats) like EVOO, fish oils, Flax Seed oils, and other healthy fats. This in turn may improve your HDL and indirectly improve your T and as a result your E2.

    JMHO
    I'm very lean at 1.73m and 150 pounds. I'd say that I'm rather active during the week since I'm still occupied with school; go to school by bike.
    I introduced flax oil to my diet some months ago and also brought up the role of "good fats" when talking to the doctor but he told me that I shouldn't bother about it (Still taking flax oil).

    Quote Originally Posted by B5150
    I'm no Dr but I believe it could be the inverse. Low levels of HDL (good cholesterol) could be contributing to your low T levels. The low T levels could be the trigger for elevated E2. The body wants to produce more test and its producing elevated E2 to trigger the body to produce T to balance the T/E2 ratio.
    JMHO
    Hmm I understand your reasoning but didn't he come to the conclusion that my level of free T was exceptionally high (Which completely contradicts the results of the first test)?
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    Quote Originally Posted by lowvolume
    Hmm I understand your reasoning but didn't he come to the conclusion that my level of free T was exceptionally high (Which completely contradicts the results of the first test)?
    "The symptoms described by you... aren't caused by a lack of the peripheral androgen, as the level of the peripheral androgen is in the very high normal range (!!!).
    Note:
    Contrary to the first blood test, no free testosterone was measured."

    What evidence does he have to draw this conclusion.

    BTW very lean at 150lb. How tall are you?
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    What about total cholesterol, triglycerides, ect. If you have high cholesterol, triglycerides then you might want to look towards inuslin imbalances as well as adrenal/thyroid as well. With out knowing your Estrodial you can not get total horomone picture. Adrenal fatigue is very common and should be investigated with salvia testing. Your profile is very similar to mine at the begnining and then all hell broke loose because drs tend to skip a few test here and there. Dhea -s level would be a nice test to add too. Get to an open minded dr that is willing to investigate thoroughly. My testosteone was down to 20 at one time and morons never even tested for estrogen problems..
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    Quote Originally Posted by B5150
    BTW very lean at 150lb. How tall are you?
    At 1.73M, he is just over 5' 8".
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    5'8"+ and 150lbs. Consider putting on some weight and doing some resistence training? Hormones, diet, training and mood do go hand in hand. One or more promotes the other to a good degree.

    Anyway, I'm not a Dr, but 5'8" and 150lbs seems unhealthy to me. I mean no disrespect. Eat, train be happy
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    Quote Originally Posted by B5150
    "The symptoms described by you... aren't caused by a lack of the peripheral androgen, as the level of the peripheral androgen is in the very high normal range (!!!).
    Note:
    Contrary to the first blood test, no free testosterone was measured."

    What evidence does he have to draw this conclusion.

    BTW very lean at 150lb. How tall are you?
    Total T (this time 300 ng/dl) and SHBG (9.20 nml/l, below normal range) were calculated into the "free androgen index"
    --> The FAI seems to be his evidence. Btw, isn' the FAI inferior to a "direct" measurement of free testosterone?

    Quote Originally Posted by B5150
    5'8"+ and 150lbs. Consider putting on some weight and doing some resistence training? Hormones, diet, training and mood do go hand in hand. One or more promotes the other to a good degree.

    Anyway, I'm not a Dr, but 5'8" and 150lbs seems unhealthy to me. I mean no disrespect. Eat, train be happy
    Why is it unhealthy? I always thought my body height/weight ratio was perfectly normal. I've already been lifting for 1.5 years btw.
    Edit: Just to clarify it, 68-69 kgs ~ 150 pounds, or am I wrong?
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    Like I said, I mean no disrespect at all. But 150lbs seems quite light for a 5'8" male. Just my opinion, FWIW, and not to be taken as deragatory by any means.

    My point was that to whatever degree of leaness or low(er) body weight you are at can significantly effect hormone levels. My thought in making the suggestion that you might be a bit light is that if you increae your bodyweight you may find some relief to some symptoms and or test results. I could be wrong and am not suggesting or advising either way. JMHO.
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    I would look into overtraining and adrenal fatigue. Still, your doc needs to go if he isnt even going to help you with advice etc. How often do you excercise, how intense and how stressed/stimmed up are you?

    also, look into your thyroid as well. Of course, Fsh and LH would help to know why your test is so low.

    Im 23, so not much older and am in similar circumstances. Im on androgel now but not sure if its the right bet. I just picked up some isocort for adrenal fatigue so we'll see how that goes.
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    Im confused, his total T is only 300, and everyone is saying it could thyroid or adrenals?
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    Everyone? No.
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    Well I didnt mean it literally, but the gist of the conversation is to look at other reasons such as overtraing etc, but 300 is really low.

    I am at 550ng/dl wich is the levels of a 50-60 year old. He is at 300 wich is the levels of someone if they were 100+ years of age, its off the chart. ref: Center For Clinical Age Management - Natural Hormone Replacement, Boca Raton Florida.
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    I know you didn't. I agree that he is low for his age.

    These forums are very limited in their ability to help people when there are underlying matters that only a doctor and a lab can diagnose.
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    Quote Originally Posted by Scottyo
    I would look into overtraining and adrenal fatigue. Still, your doc needs to go if he isnt even going to help you with advice etc. How often do you excercise, how intense and how stressed/stimmed up are you?

    also, look into your thyroid as well. Of course, Fsh and LH would help to know why your test is so low.

    Im 23, so not much older and am in similar circumstances. Im on androgel now but not sure if its the right bet. I just picked up some isocort for adrenal fatigue so we'll see how that goes.
    One way to figure out overtaining is to check pulse, day after workout, in the morning up on awakening.

    I have only heard about it. Welcome more details.
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    Quote Originally Posted by ItsHectic
    Im confused, his total T is only 300, and everyone is saying it could thyroid or adrenals?


    Yes, because the CNS is all interelated, and adrenal fatigue or thyroid problems can CAUSE low test.

    All we have is a test that says his testosterone is low. If we had his fsh and lh, it could point to pituitary concerns or somewhere else. But if you havent noticed, the significant number of 18-21 year old males who are showing up again and again with low test values is in itself telling. It is NOT normal for someone this age to have such low values, and if he has not used any androgens...something must be causing it. Instead of jumping the gun and saying its all low test, get this kid on TRT, how about looking at what is CAUSING the low test? Since he hasn't had a mri on the pituitary (another important thing to be done....but which often checks out A-ok), I asked about information he could provide without any more tests, any more studies etc.
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    Yes, but at the end of the day, he (his parents in this case) and his physician need to seek do the actual diagnosis and establish any and all treatment protocol.

    This virtual-cyber-self-diagnosis-and-treatment-protocol we engage in on these forums is....well, just that.

    Get a Dr that will treat you completely and thoroughly.
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    Quote Originally Posted by B5150
    Like I said, I mean no disrespect at all. But 150lbs seems quite light for a 5'8" male. Just my opinion, FWIW, and not to be taken as deragatory by any means.

    My point was that to whatever degree of leaness or low(er) body weight you are at can significantly effect hormone levels. My thought in making the suggestion that you might be a bit light is that if you increae your bodyweight you may find some relief to some symptoms and or test results. I could be wrong and am not suggesting or advising either way. JMHO.
    @B5150
    I didn't mean to offend you either, I was just a bit surprised at your opinion. Anyway, the thing is that I'm rather ectomorphic by nature and have a hard time putting on even an ounce of fat. I've read similar studies on that issue but on the other hand, if I think back, I've always been lean since my early childhood but haven't always felt the way I do now.

    http://img295.imageshack.us/img295/7030/cimg048wc2.png

    And youre right: It's pointless to debate over what may cause low test, which is apparently a very complex issue.
    I think I should have clarified it from the beginning: At the moment I'm torn between the results of my first and second test (read my first post). If the second blood picture was right (compare it to the first one), it would actually mean that I have VERY HIGH free testosterone levels, despite constant (low) Total T levels! How can that be? Maybe Dr. John could give his opinion.
    BTW, FSH, LH, Prolaction.. everything was tested and as far as I know in the normal range. The only abnormal values are those that I've posted above (testosterone, estradiol, cholesterol,...). So in the case that it REALLY is low test
    that is causing my problems, I would suspect it to be stress induced.
    @Scottyo: I train 3 times a week, it's a 2 Day low volume(1-max. 3 sets p.b.p.)/high intensity Split. A single training session takes about 45 minutes. No signs of overtraining so far. I don't train if I don't feel well for some reason.
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    it looks like you are either hypogonadal or some external factor is causing a huge drop - thyroid is a fair bet. blood sugar is easy to find out, but i dont think it's related. do you have a beard to speak of? are your testicles relatively large? are your genitals "man-sized"? (i'm not kidding). do you have body hair?

    anyway - go see a good endo. we are all speculating here.
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    Quote Originally Posted by lowvolume
    @B5150
    I didn't mean to offend you either, I was just a bit surprised at your opinion.
    Hey, opinions are like *******s and I've heard I am too. That's not just speculation
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    Quote Originally Posted by lowvolume
    @B5150
    I didn't mean to offend you either, I was just a bit surprised at your opinion. Anyway, the thing is that I'm rather ectomorphic by nature and have a hard time putting on even an ounce of fat. I've read similar studies on that issue but on the other hand, if I think back, I've always been lean since my early childhood but haven't always felt the way I do now.

    http://img295.imageshack.us/img295/7030/cimg048wc2.png

    And youre right: It's pointless to debate over what may cause low test, which is apparently a very complex issue.
    I think I should have clarified it from the beginning: At the moment I'm torn between the results of my first and second test (read my first post). If the second blood picture was right (compare it to the first one), it would actually mean that I have VERY HIGH free testosterone levels, despite constant (low) Total T levels! How can that be? Maybe Dr. John could give his opinion.
    BTW, FSH, LH, Prolaction.. everything was tested and as far as I know in the normal range. The only abnormal values are those that I've posted above (testosterone, estradiol, cholesterol,...). So in the case that it REALLY is low test
    that is causing my problems, I would suspect it to be stress induced.
    @Scottyo: I train 3 times a week, it's a 2 Day low volume(1-max. 3 sets p.b.p.)/high intensity Split. A single training session takes about 45 minutes. No signs of overtraining so far. I don't train if I don't feel well for some reason.

    Ok, things generally (from my limited view) seem to be in check regarding training, diet etc...at least nothing stands out. I would still try lowering the intensity and refrain from going to failure on any sets for a month or so. That is just one aspect. As for the bloodwork, I would demand to get all the bloodwork results, not just the abnormal ones. Tell them you want to have a copy for your own records...seems to work with me (discovering that after doctors repeatedly refused to provide me with copies or kept 'forgetting'). Get those results to see if anyone like Dr. John can get a more nuanced look.

    An MRI on the pituitary might be the next step, although I hope you have insurance as its not cheap at all.
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    With some doctors it can be really hard to get infomation off them when they think you dont need it, I have heard doctors go by a saying wich I cant remember the exact wording but translates to less known by a patient, the better treated.
    Last edited by ItsHectic; 11-21-2006 at 04:05 AM.
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    Right now by taking isocort you are self diagnosing one self with low cortisol. Symptoms of low cortisol and elevated cortisol are almost identical. Seeking a trained md who is opening minded would be your best bet. Salva cortisol test would be a good start and these can be covered by insurances if they are done through your MD through great smokies, Blue cross blue shield personal choice definietely covers these. You need to examine life stlye and events that were 6 months prior before having these symptoms. I am not saying it is all in your head, but events and over traiining could have triggered it. People who have incredible diets still are lacking in vital nutrients. I commonly hear all the time that people take there multivitamin and still have numerous low minerals and they wonder why. I tell them that most people eat a high fiber breakfast with coffee and vitamins are just flushed out of system never getting properly absorbed. These are all factors that need to be considered and are over looked. Some times the most complex problem has the simpliest solution.
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    I am not sure about what supplements your taking but If I were you I would stop them. Do you do Soy your Estradiol it higher then mine was when I first had it tested and I was 59 at the time and on TRT for many yrs. I have bead ED, could not reach an orgasm had a bed rash that kept comming back in the same place and my nipples were hard and sore all the time. Your Testosterone levels are low because all your cells are full of Estradiol the brain thinks this is Testosterone and is not telling your Testis to make more Testosterone. You need your LH and FSH tested. I had a poster about 23 yrs. in age with about the same problem after a lot of questions we got to his diet he said he does a healthy diet and drinks a lot of Soy Milk. I told him this is his problem the Soy has a Estrongen maker in it and this can fill the cell in his body and the brain thinks it's Testosterone and stops sending the LH and FSH messages to make more T. He stopped the Soy Milk and the next time I heard from him his levels were back and his libido was great.
    Phil
    Quote Originally Posted by lowvolume
    My background: I'm an 18 year old male and have been lifting for the past 1.5-2 years. Since about a year I've been noticing decreased libido, virtually no attraction to the other sex and a feeling of indifference (towards people/friends in general. I realise that this impression is subjective and may have different explanations but after roaming the boards and hearing about the symptoms of low T, I decided to have a blood test done (2 months ago). I don't have it right here but the numbers were something like:
    Testosterone: 270 or 280 ng/dl (low end of normal range);
    Free T was also tested. I just remember it being barely above the low end (Edit: 9.3 ng/l; normal range: 8.8-27).
    All else was Ok except for creatine kinase, which is imho explained by breakdown of muscle tissue. That doc said everything's fine, but I didn't agree and argued with my mother (who's a pediatrician) until she sent me to an andrologist at the university hospital. It seemed to me as if the prof didn't listen to me at all, he would just go through his list, pointing out that my protein shake in the morning and creatine use could be to blame due to some contaminations and that no one could ever make him drink that.
    Anyway, today I got a letter with the results:
    To make it brief I quote his comment at the end (loosely translated from German):
    "The symptoms described by you... aren't caused by a lack of the peripheral androgen, as the level of the peripheral androgen is in the very high normal range (!!!).
    Note:
    Contrary to the first blood test, no free testosterone was measured.
    Total T (this time 300 ng/dl) and SHBG (9.20 nml/l, below normal range) were calculated into the "free androgen index".
    And to top it, I quote: "The elevated level of creatine kinase and a marginally low level of HDL-Cholesterol (37 mg/dl) are conspicuous. This indicates a possible exogenic use of androgenic drugs(!!!). This may also explain the marginal level of Estradiol (98.3 pg/ml) as well as the elevated GPT."
    Note: , I've never touched AS!
    "...Therapeutically, it is recommended to cease the supplementation of protein and the intake of creatinine, as well as to reduce physical strain. At the moment there is a cardiovascular risk for a coronary heart disease, advice regarding further action is necessary". I'm speechless. Need advice.
    ps: I wasn't sure where to put this thread, but the anti-aging/testosterone related issues category seems to fit best.
    Thanks for your help.
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    Pgrmmer can soy lechithin do the same thing with estrogen. I have a choline deficiency and been using soy lechithan at 2 TBSP x 3 times a day. WOuld this also be considered a soy product as well since its only a derviative from soy beans. Could this also be another reason why soy effects thyroid is that it actually lowers testosterone as well thyroid needs adqeute testosterone for thyroid to be optimal.
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    Quote Originally Posted by hardasnails1973
    Pgrmmer can soy lechithin do the same thing with estrogen. I have a choline deficiency and been using soy lechithan at 2 TBSP x 3 times a day. WOuld this also be considered a soy product as well since its only a derviative from soy beans. Could this also be another reason why soy effects thyroid is that it actually lowers testosterone as well thyroid needs adqeute testosterone for thyroid to be optimal.
    Is there anything you can take besides this soy lechithan. Basically if it says less than 2% of soy then go ahead and eat it. But if you eat soy cereal, and drink soy milk, and put soy based dressing on your salad, etc, you are messing yourself up!

    I don't do any kind or soy I have enough problems with Estradiol let along put a E into my body that does nothing but take up space and not let other hormones work.
    Phiil
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    Quote Originally Posted by pmgamer18
    I am not sure about what supplements your taking but If I were you I would stop them. Do you do Soy your Estradiol it higher then mine was when I first had it tested and I was 59 at the time and on TRT for many yrs. I have bead ED, could not reach an orgasm had a bed rash that kept comming back in the same place and my nipples were hard and sore all the time. Your Testosterone levels are low because all your cells are full of Estradiol the brain thinks this is Testosterone and is not telling your Testis to make more Testosterone. You need your LH and FSH tested. I had a poster about 23 yrs. in age with about the same problem after a lot of questions we got to his diet he said he does a healthy diet and drinks a lot of Soy Milk. I told him this is his problem the Soy has a Estrongen maker in it and this can fill the cell in his body and the brain thinks it's Testosterone and stops sending the LH and FSH messages to make more T. He stopped the Soy Milk and the next time I heard from him his levels were back and his libido was great.
    Phil
    Just came back from the kitchen... The protein supplement I take for breakfast contains soy protein. Damn, and it doesn't even taste well. I'll definitely eliminate that from diet. Thanks for the hint!
    Besides that I have a whey protein shake after my workout.

    @hardasnails1973
    Right now it looks like I'll get myself a new doctor, show him the blood test results and convince him to look into my stress hormone levels. Btw, I now have the complete analysis in my hands, which also includes DHEA-S (356 g/dl, elevated).
    Just out of curiosity, what are the possible ways to treat adrenal fatigue/chronic cortisol imbalances?
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    Quote Originally Posted by pmgamer18
    Is there anything you can take besides this soy lechithan. Basically if it says less than 2% of soy then go ahead and eat it. But if you eat soy cereal, and drink soy milk, and put soy based dressing on your salad, etc, you are messing yourself up!

    I don't do any kind or soy I have enough problems with Estradiol let along put a E into my body that does nothing but take up space and not let other hormones work.
    Phiil
    Say, my last test show E2=27 (10-30) that would be acceptable
    but
    Estrone=78 (12-72)
    Total Estrogens=260 (40-115)

    so even if my E2 is ok, I may still have estrogen problem because of other (weaker) estrogens.

    How to fight high Total E and not screw up on the god level of E2 ??
    .
    Is it really proven that this line of reasoning is correct?
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    Some times just a change in TRT will help I found doing my shots every 3 days made a big change in this. I need to say that the other E's never were as big a problem as E2 was.
    How are you feeling with these levels.
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    Ideal E2 level is 20, I have heard someone say they feel best at 25, you could try Calcium D-glucarate 200mg twice a day.
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    I agree you may need to switch up TRT because since changing creme to under arm pit as indicated alot of my anxiety has gone down and I stop being so emotional like a women, Prgmmer if there is an estrogen imbalance how long till it actually corrects it self so at the receptor levels? like 8-12 weeks Thanksl..Prgmmer you may be vulnerable to hidden estrogens such as heated plastic and environment as well as hormones found in meat. I do only eat solid food, but I was eating a **** load of beans a day that are high in lecithin. some people are just more sensitive then others. My boobs stop hurting too !! I will be getting follow up work in a week.
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    Quote Originally Posted by hardasnails1973
    I agree you may need to switch up TRT because since changing creme to under arm pit as indicated alot of my anxiety has gone down and I stop being so emotional like a women, Prgmmer if there is an estrogen imbalance how long till it actually corrects it self so at the receptor levels? like 8-12 weeks Thanksl..Prgmmer you may be vulnerable to hidden estrogens such as heated plastic and environment as well as hormones found in meat. I do only eat solid food, but I was eating a **** load of beans a day that are high in lecithin. some people are just more sensitive then others. My boobs stop hurting too !! I will be getting follow up work in a week.
    If your taking something to keep E2 ansd E's down it can come down in less then 2 weeks be dam careful not to do too much of a dose and come down to fast one can go to low and miss feeling better. Also if your not doing Zinc/Copper get on the program this helps a lot.
    Solaray Zinc & Copper 100 capsules, Solaray - Solaray Multiple Minerals 50% Off
    Phil
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    Quote Originally Posted by Dr. John
    E2 that high is not acceptable for my patients. We also have to look at SHBG levels.

    Total Estrogens is not a valid assay for adult males.
    It's almost high--in every adult male.

    I would have a 24 hour urine panel done. This will give you better answers--as well as the 2, 4 and 16 metabolites.

    Setting aside the fact that E1 and E3 are much weaker estrogens than estradiol, are we to assume that Total Estrogen in the high 200's for a male isn't sufficient to cause suppresion at the hypothalamus/pituitary?


    - Jawohl
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    Quote Originally Posted by Dr. John
    I just edited my previous post to say what it was supposed to, that "Total estrogen is almost always high". That is why it is not a valid assay for adult males. There is no way 95% of the guys I have run it on are that high. The local PhD Lab Director and I discussed it, and he agrees.
    AFAIK, there are three principle forms of estrogen found in the human body, estrone, estradiol and estriol, also known as E1, E2 and E3 respectively, plus (minor) others, combined they would represent Total E.
    I just learned to not to worry about Total E, because it cannot be measured correctly in men.
    I know I have to monitor E2, estradiol.
    Is there anything else I should worry/monitor in a way of the other two (E1 & E3) estrogens? What to do if not in desired range?
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    Quote Originally Posted by Dr. John
    I just edited my previous post to say what it was supposed to, that "Total estrogen is almost always high". That is why it is not a valid assay for adult males. There is no way 95% of the guys I have run it on are that high. The local PhD Lab Director and I discussed it, and he agrees.

    This might be a stretch... but couldn't it be that 95% of ur guys have high Total E's precisely because they have hormonal imbalances to beginwith, therefore making them want to seek medical help such as yourself? Or were you refering to assays done on healthy males with no known endocrine issues?



    Jawohl
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    Quote Originally Posted by JanSz
    AFAIK, there are three principle forms of estrogen found in the human body, estrone, estradiol and estriol, also known as E1, E2 and E3 respectively, plus (minor) others, combined they would represent Total E.
    I just learned to not to worry about Total E, because it cannot be measured correctly in men.
    I know I have to monitor E2, estradiol.
    Is there anything else I should worry/monitor in a way of the other two (E1 & E3) estrogens? What to do if not in desired range?
    I take Arimidex to keep my E2 down I test Total E's and have found if my E2 is good my Total E's are down. I have tested Total E's for some time and when my E2 is high Total E's were on the high side. But I have my last test where E2 is at 20 pg/ml and my Total E's are 125 range 29 -127 pg/ml and like Dr. John said every test I did was over the top but this one. Still it was higher when e2 was higher. So we don't pay it any mind anymore. We even stopped testing it.
    Phil
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    Quote Originally Posted by Jawohl
    This might be a stretch... but couldn't it be that 95% of ur guys have high Total E's precisely because they have hormonal imbalances to beginwith, therefore making them want to seek medical help such as yourself? Or were you refering to assays done on healthy males with no known endocrine issues?



    Jawohl


    After trying to look up some more info on Total Estrogens and possible suppresion to the HP, I found a few posts from a thread in a different forum that I found interesting. The poster is a practicing physician and he sounds pretty knowledgable too. Here's a copy and paste of a few posts...


    Quote Originally Posted by SWALE
    Here is what I have seen in my clinical practice: I lower Estradiol levels with Arimidex, to mid range. But Total Estrogens go up, sometimes to 50% over the top of their collective physiological range. Since Estradiol is going down, that means Estrone and/or Estriol is going up even more. I have not gathered enough labs to figure this out yet, but am working on it.

    Analysis of the metabolic pathways would make one think this could not be true, as an AI inhibits both the conversion of Testosterone to Estradiol, AND androstenedione to Estrone. Also, the conversion of Estrone to Estradiol must be inhibited as well, because, as I have said, estradiol is going down while the rest are elevating. But obvioulsy the body is not willing to be ruled by intuitive thought from a lovely picture of the metabolic pathways.
    Quote Originally Posted by SWALE
    Arimidex also prevents the conversion of androstenedione to estrone.

    That is what is so puzzling. Why is it, if we are inhibiting the production of estrogens, and as demonstrated by lowered Estradiol levels, Total E's can remain at 50% over the top of physiological range??.

    Here's a response from a diff poster..

    Quote Originally Posted by Snipe
    My estrone went from 23 to 104 afer discontinuing Arimidex. (0.25mg. 3x/week)

    Estradiol went from 12 to 52 but is not valid since the latter value was not obtained using the extraction method. (I will retest soon.)

    My total E's went down form 180 to 100 after several weeks of I3C @400mg/day, and remained at 100 after discontinuing Arimidex.

    I intend to stay off Adex, remain on I3C, and retest in about 6 weeks.

    Quote Originally Posted by SWALE
    Let's be careful not to hang our hats on this observation I have made about Total E's rising on Arimidex. I have seen this on a few patients, not all. It is only recently I began checking Total E's. Before, that, it was cutting edge to just order E2. In those patients with good E2 but elevated Total E, I am going to begin ordering fractionated estrogens, to explore this further.

    Of note, I am seeing a trend in that these are the same guys who complain of estrogen symptoms even after adding in Arimidex (and controlling E2 to mid-range).

    All I have at this time is basically a few case studies. Puzzling? Yes

    A good question from another poster..

    Quote Originally Posted by Maxzax
    HI Swale,

    With the 50% increase in Total E's how does that affect LH production?

    I guess my main concern is would arimidex lowering E1 and E2, be enough to restore my HPTA and fix the symptoms?

    Do high Total Estrogens mean much in terms how your patients feel?

    Thanks!!!

    And finally...


    Quote Originally Posted by SWALE
    Max--That is a good question. I do not know if there is a differential in how the different varieties of estrogen inhibit the HPTA. I would hazard a guess that when Total E's goes up, even in the presence of mid-range Estradiol, that suppression is increased as well.
    I quit running follow-up LH and FSH levels, except when the patient specifically requests them. So I have no data with respect to this question.

    Does anyone have any ideas or know if E1 or E3 has any role in the negative feedback loop whatsoever? I also wonder if Dr.John meant 95% of his regular patients or a seperate study group of men with no known hormonal issues/imbalances?
    I, much like the poster Maxzax, am wondering if lowering Total Estrogens could possibly be enough to restart the HPTA axis in some men with idiopathic hypogonadotropic hypogonadism.


    Jawohl
  

  
 

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