I recently attended an endocrynologist about fatigue, obesity and gynecomastia.
I had some tests, and the results show that I've got an excess of Free Testosterone. The Estradiol is pretty high, yet not above the limit. And the SHBG is quite low.
Since I know some stuff about this matter, I argued with the doctor that what's happening here is:
The Testosterone is excessively high, hence convreting to estrogen, hence making the estrogen high, hence making me feel the way I do. Plus, the SHBG is very low, and this has got to count for something, right?
Although she says that this is not my problem.
I do not get this. Can someone with experience please assure me whether my "theory" regarding the converted estrogen issue is correct, and what medicine is usually prescribed for it?
I'd give you the actual result figures, although the units they use in my location are different. Tell me please if you MUST have the figures in order to determine what I am talking about.
You seem to have a good handle on it. The low SHBG is what is causing the high free T. Most T is bound to proteins the primary one being SHBG (sex hormone binding globulin). Since your SHBG is low, it makes your free T high. Free T being the T that is not bound to SHBG, albumin and other proteins.
This may be contributing to your conversion of T to estradiol. The gyno is likely from the estradiol. The upper limits here in the U.S. for Estradiol for men is around 53 pg/mL which is actually way to high for man. It should be between 20 and 30 pg/mL, 35 max. So its possible if you are close to the upper limit and the limit is really too high there like it is here then that may be the cause of the gyno. It would help if you post your results so I can convert to what we have here.
Anyway, this does not fully explain your fatigue though. However high estradiol can also cause loss of libido, sexual problems, water retention, anxiety, panic attacks and generally feeling of being unwell. High estradiol can also cause low T by tricking the hypothalmus into thinking you have enough T. It in turns sends less GnRH to the pituitary which in turn sends less LH to the testicles. LH is what tells the testicles to make more T. If you SHBG is low enough it could cause you to have low total T even if free T is high. You didnt mention if your total T was normal or not but low T could be a cause of fatigue of course.
The simple thing to try first that you don't need a doctor for is DIM which is an extract from cruciferous vegetables like cauliflower and brocoli. I use a brand called "Indoplex with DIM" by Phytopharmica. All brands do not seem to be equal in quality. Try one pill a day and see if you feel better. The best thing would be to get labs run again while on it for a week or so if you can. For many men 1 pill is too much and you have to take 1/2 pill a day. Its trial and error for which the labs will help.
The Rx solution could be arimidex which will reduce estrogens but it has side effects and is expensive and requires a doctor to get , at least here it does. Hope this helps.
Thanks hayfarmer for your reply. I am sorry for the late response, but I've been having some log-in problems.
Anyhow, these are the scores from my blood tests:
Free Testosterone: 128 (ratio is 14.8-94.8)
Estradiol: 227 pmol/L (ratio is up to 256)
Total Testosterone: 16 nmol/L (ratio is 8.7-33)
SHBG: 12.5 nmol/L (ratio is 11-85)
Cortisol: 648 nmol/L (ratio is 140-690)
I hope you can convert them easily, if you do not mind to of course. I am 21, just so you know.
It is important to note that I have hypothyroidism, and am taking about 500 mg of Eltroxin per week right now.
Another thing that was noticed in my tests was an elevated level of CPK, which led me to have an EMG which showed that I have some myopathic areas in my muscles. I wonder if this could somehow be connected to my hormonal imbalance. I was meant to see a Rheumatologist, although I am not sure which problem to address first, the hormones or the muscular problem?
As for Diabetes and LH. Those were actually okay. Actually, I was less concerned with this because they cause low T. and of course, I have the opposite problem that is probably caused by the low SHBG. Although now I'm wondering if the Cortisol levels could be a culprit here.
I think I will put the medication on hold for now until I find out further where exactly my problems stem from.
Hope I did not give you too much information
Thank you very much for your help!
If you don't mind telling me.......... where did you possess your knowledge of this subject? Are you a doctor or something? You obviously know a lot more than the average person.
I might add that you seem to know more about the hormones than your doctor. Find another doctor.
I self inject Tetsosterone Cyp 100 to 120mg per week in two doses, Tue & Fri.
I self inject HCG 500iu 2 or 3 time a week
The DIM will reduce the existing estradiol. At your age it should be in the lower 1/4 of the range. I take 2 per day with one TMG
Arimidex will prevent the testosterone from converting into estradiol. I take 1/2 tablet 3 time a week.
Saw Palmetto will reduce the testosterone to DHT conversion. I ahve to take 5 or 6 tablets a day.
At your age the total testosterone shoukld be in the upper 1/4 of the range.
I feel best when my Testosterone:Estradiol ratio is above 30:1
I'm not a doctor. I have learned what I know by necessity because I have secondary hypogonadism. I went for 4 years being treated by a doctor with a poor understanding of it. I tried an endo and she was no better. Finally I found a good doctor. In the meantime I did a lot of reading which is how I came to the conclusion my first doctor didn't know what he was doing.
You forgot to post units on your free T but I dont think its really too high. The lab ranges for those are often misleading. Your SHBG is quite low which as you know leads to higher free T. Going by the target level for free T my doctor uses you are actually just a bit low on free T. You don't need a high total T to achieve the free T required because your SHBG is low. What it all boils down to is your T levels are only slightly low but your estradiol is very high. You want to get it down to 75-100 pmol/L. This is where I would start if I were you. Your T may rise as the estradiol goes down also. You can try "Indoplex with DIM" by Phyopharmica if you want to try something that does not require a supplement at first. Start with one pill a day. Its best to get labs done to see if Estradiol is dropping but if your doctor won't cooperate you can try to judge it by how you feel if the quality of your morning erections. Arimidex is a prescription that many use, but I don't think my doctor approves of it. Also, limit alcohol to 2 drinks a day, try to lose any excess body fat, take 30 mg of zinc per day. All of these will help reduce armoatase enzyme that converts T to E.
Sorry, I"m not familiar with CPK. Your cortisol is at the upper end of the labs range but I doubt that is the problem although I'm not an expert on adrenal problems to be sure. The one thing that really stands out to me is the estradiol. I recommend the book "The Testosterone Syndrome" by Eugene Shippen. I hear he has another book coming out soon too.
I actually have an appointment with an Endocrinologist at a major hospital here this Monday. I am hoping a reputed hospital will have doctors of higher caliber.
There was actually something that hit me the other day that I may be reading wrongly on the blood test sheets, and wanted to verify it, if you don't mind. Since it could change the way I am looking at the results.
How does excess Free T. appear in the blood test sheets? Will it appear in the Free T. category, before it's conversion to Estrogen. Or will it appear in the Estrogen category, in which the excess T. would have already been converted to Estrogen?
As of now I've been looking at my Free T. levels alone thinking if they are high, then I must have excess T. Although, now I am wondering if the Free T. results are after it's been converted to Estrogen, and therefore will no longer reside in the Free. T category.
I hope you understnad my quesition. I do want to have everything clear before my appointment next week so I can explain my situation better to the doctor.
Btw, I did not forget to post the units for the Free T. For some reason it simply does not appear on the test sheets. Although you seemed to work it out just fine. I comprehend what you mean about the Free T. being lower, I understand it a bit differently now.
The Free T will be shown as Free T. Any T that has been converted to estradiol will be shown as estradiol. If you can, for example, take DIM or arimidex to prevent some of the aromatase activity from converting T to Estradiol you might find your free T would rise and your estradiol would drop.
In your case I dont think the problem is that your free T is not high enough though. Its that your estradiol is too high. Estradiol can bind to the same receptors in the body as T and wreak havoc with many things. It can cause gyno, sexual problems, anxiety, low T and contribute to some cancers like breast and prostate.