Just wanted to say that I just read thru all 104 comments and this Augie dude from TCT took the time to answer nearly everyones comment! Not only did he answer, but he answered with very informative, thorough, and research based information and he did it all for FREE!!!! Very impressed!!!!
@MrJd5996: Thank you for the feedback! I truly appreciate your noticing. Since publishing our first video in 2015, I have tried my best to keep up with every thread and have always sought to be a source of information. The TRT industry can, at times, be an expanse of misinformation. We seek to partner with educated patients, working on sound foundations and good judgment. Thank you for taking the time to comment! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@martinmagaard325: Thank you for your feedback! The editing chopped up the answer a bit, but if you go to 7:31 in the video, I talk about hot flashes and dry joint aches. In addition to these, you can sometimes see a decrease in libido or the presentation of erectile dysfunction, even despite having an optimized free testosterone level. So, hot flashes, diffuse and unexplained joint pain, decreased libido, and erectile dysfunction are symptoms commonly seen when estradiol levels are too low. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
I was injecting .25mL twice a week into my dealt and started to experience ocular disturbances here and there. Where I wouldn’t be able to see well. I get these blotches in my vision where parts of whatever I was looking at were just missing from my sight. I didn’t relate it to the TRT. When I increased the testosterone another .25mL every other week the ocular disturbances started to happen a couple times a week. Really freaked me out. I mentioned what I was going through to a nurse practitioner and she said it sounded like my estrogen was spiking and causing this to take place. Anybody else have this experience?
Hello my current blood work showed a total t of 579ng/dl, free t of 15.54 and estradiol 12.7 pg/ml. All test were LC/MS. Should I be concerned about my estradiol levels. I’m currently not on any hrt and never have been. I’ve been experiencing low energy, low libido, loss of sensation on my penis, extremely dry flaky skin.
@bobjohnson2977: If your free t measurement is not a calculated free testosterone level, I would put zero stock in it. Aside from that, the symptoms you are reporting matter more than any of the numbers. I would recommend looking into things further. Seek a provider who prioritizes your symptoms and doesn't just stop at the first "normal lab value." Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
My biggest concern is my anxiety and insomnia. I have a low SHBG of 12, mid range estrogen at 34.6 and total t of 789. My anxiety is through the roof and my sleep has gone to absolute crap!!! Any help or non-medical advice would be appreciated!! I crashed SHBG due to oxandrolone, not knowing the effect it had on SHBG a couple weeks ago. I'm at 200 mg cyp/ week 1x and no AI at the moment. I've taken anastrozole at .25 mg twice so far the whole time of 7 weeks and it doesn't seem to help the anxiety and sleep!
@roblincoln10: Unfortunately, the role of SHBG in androgen regulation is much more complex than once thought. Take a look at this excerpt: "In this study we have demonstrated that in the absence of SHBG large amounts of Te rapidly enter the cell where they are inactivated by conjugation to glucuronic acid and effluxed." When symptoms and lab results disagree, it is important to remember that labs only give us insight into serum levels when it's the intracellular environment that we should be most concerned with. You may need to rely on the "tincture of time" to allow things to balance and resolve. I estimate your calculated free testosterone to be ~26 ng/dL. Alone, that number looks pretty good, but chronically low SHBG levels could leave you open to rapid metabolism of free T and thereby actually exacerbate Low T symptoms. Li H, Pham T, McWhinney BC, Ungerer JP, Pretorius CJ, Richard DJ, Mortimer RH, d'Emden MC, Richard K. Sex Hormone Binding Globulin Modifies Testosterone Action and Metabolism in Prostate Cancer Cells. Int J Endocrinol. 2016;2016:6437585. doi: 10.1155/2016/6437585. Epub 2016 Nov 20. PMID: 27990161; PMCID: PMC5136390. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@TCTmed thank you a Augie!! Would that rapid metabolism of T also be applied to my e2? This has been a massive rollercoaster ride. I messed up with the anavar and wished I would've kept that out of the picture for a while. It could have been another story, one more positive.
@@TCTmed so those massive swings in the e2 could be suspect as well. I'm 4 days post injection on the 200mg and I feel exponentially better each day. Still unusual anxiety and restlessness but absolutely nothing like the first couple right after shot. Even the DHEA and progesterone is affected by this theory, so it could be multifactorial
@@roblincoln10 Yep, it's ALWAYS multifactorial. Even with our best testing, we are still left to make educated guesses about intra/extracellular dynamics and receptor modulation.
Hello Augie! I'm on TRT and my estrogen can rise if not managed. I tried anastrozole but it dulled my cognition and thinking. I now take DIM and it seems to manage the estrogen symptoms without the side effects of anastrozole. Do you recommend DIM? Your response is much appreciated!
@dennisdavis2103: Hello, Dennis! DIM as a standalone for treating estradiol elevations may not be enough in some cases, but not everyone on TRT needs "estrogen blockers" (aromatase inhibitors). Whether you need a medication to manage your symptoms/levels should be determined by studying your response to TRT, surveillance of your symptoms, and monitoring your levels. For a patient who isn't a "high converter," DIM can help metabolize estradiol efficiently. I prefer DIM with CDG, as it helps to preferentially support E2 metabolism into more desirable metabolites. Remember that there are other AIs, so anastrozole isn't your only choice. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner
@THERHINOFORZA4: Yes, there are many ways to boost testosterone production naturally. Please look at our blog (tctmed.com/exercise-and-testosterone/) for various options. A balanced diet high in protein and good fats, plentiful, regular, and restorative sleep, avoiding toxins, proper supplementation (zinc, magnesium, vitamin D), and vigorous exercise (HIIT) all contribute to production. To aid the metabolism of estradiol, you can look at adding DIM+CDG. I like the formulation from Jarrow Labs. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@THERHINOFORZA4 Controlling the hormonal influences and potential imbalances is key. However, it's not just a testosterone/estrogen thing. Other factors like prolactin and body composition can influence gynecomastia. For that, I would recommend seeing a specialist. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@moniquelogtenberg3640: Thank you for your question! I am happy to explain. The estrogen synthase aromatase, a component of the cytochrome P450 family, enzymatically catalyzes the metabolism of testosterone molecules. Through a multi-step process, aromatase essentially strips away methyl groups and alters the remaining molecule to arrive at estradiol (E2), an estrogen. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner
Hello i Just cheked my estrogen and testosterone i i finaly understand my big problem. Testosterone is in perfect in the midle but estrogen ( my estradiol) is only 18 in norm of 94 - 223. I train Hard from little kid now im 24, 75 kg, but from around 6 yeras start fitness and diet around 4000 + colories and never get any results. What to do now how to fix super low estrogen?
@Workout Instrumental: The best way to fix a low estrogen level is to not block its production. People on TRT tend to overuse aromatase inhibitors and SERMs. If your testosterone levels are optimal and you don't overuse AIs and SERMs, your E2 should be good to go! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@lynxeffect84 Without an AI, a persistently low E2 may need an "Ultra-sensitive" estradiol test to be more accurately measured. Ultimately, I suspect your free testosterone level to be deficient. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
6 weeks in on trt - and I am retaining water and gained weight. Also irritability muscle cramps & numbness- but at the same time I have hot flashes and night sweats - thats like all the symptoms
@Tobias Birmingham: It definitely sounds like it's time to check your estradiol levels. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@michaelwops: Unfortunately, you are right. That was a splicing error in the editing process. However, if you fast forward to the 7:00 mark, the discussion on the symptoms of low estrogen (hot flashes, sexual dysfunction, dry joint ache, and osteoporosis) is listed there. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner
Why is it that every time people talk about the side effects, they always just mention gyno and rage. What about head aches and joint stiffness... is that from hi or low estrodiol?? And also the segment of symptoms of low estrodiol did not mention any side effects.. so what are the symptoms of hi or low testosterone beyond the gyno and rage. Please elaborate on these symptoms beyond the same info that is already out there. Thank you. Just looking for more info.
@hectorcrissien163: Thank you for your feedback! The editing chopped up the answer a bit, but if you go to 7:31 in the video, I talk about hot flashes and dry joint aches. In addition to these, you can sometimes see a decrease in libido or the presentation of erectile dysfunction despite having an optimized free testosterone level. So, hot flashes, diffuse and unexplained joint pain, decreased libido, and erectile dysfunction are symptoms commonly seen when estradiol levels are too low. More common symptoms get mentioned more often, which is why you see a lot of attention paid to gynecomastia and "roid rage." I have not seen headaches reported with a high level of consistency in relation to estradiol issues. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
my testosterone levels are 163.3 ng/dl and my estradiol levels are 23.09 pg/mL. My doctor told me to lose weight as I'm between 30-35% body fat. My body doesn't produce Testosterone (or doesn't produce enough). My doctor told me to inject saxenda to lose weight and gave me a medication (which I checked is mainly used to treat erectile dysfunction and boost fertility). I have gynecomastia for sure. Apart from losing weight, what can I do to improve my quality of life?
@naumanashraf1684: In my experience, I have not seen significant increases in testosterone production, even with substantial weight loss. There is more to it than most providers realize. I recommend seeing someone specializing in hormonal wellness for a second opinion. TRT may be your best option. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@naumanashraf1684 Assuming your fertility is normal pre-TRT, you should be able to successfully mitigate the fertility impression seen with testosterone use with drugs like hCG or enclomiphene. You can also consider using those drugs as monotherapy to avoid fertility suppression altogether. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner
Doc, I'm on 160mg/wk and thats all (no other medications) for some months - the entire time I have low E2 symptoms. Last blood: 1100 test, 177 free, E2 was 15 (Ultrasensitive test method). It seems my body does not aromatize much. I'm quite skinny - what do you recommend in such a case? HCG? My doctor is a joker, does not know anything!
@pressf4896: Based on the number (and assuming the unit of measure), it looks like they have reported a "direct" or "analog" free testosterone assay. Before you adjust your regimen, I would recommend you look at your calculated free testosterone. Check out www.issam.ch/freetesto.htm. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
I don't know if you answer comments, but I have been looking everywhere for information and can't seem to find it. Do you know of any cases where you used TRT to treat low testosterone, but it had no effect on estrogen, even when not using aromatization blockers? My testosterone is slightly above the upper limit of normal, while my estrogen is well below the lower limit. Do you have any advice on what could be potentially causing this that I could bring up to my doctor?
@Doc Walrus, hold the pickles: There can be several things affecting your estrogen levels. You may benefit from looking at your calculated free testosterone instead of just your total. Even an above-normal total could yield a below normal free, and less free testosterone means that there will be less aromatization. An ultrasensitive estradiol test can be ordered to get an accurate read on estradiol levels. There is an outside chance that aromatase deficiency could be present. This is a rare condition but can explain low estradiol levels in the face of high testosterone levels. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@TCTmed Thank you so so much. I'll certainly ask if my free testosterone is still low, even having high levels in total. I didn't know about that distinction. He has mentioned a possible aromatase deficiency, or even a broader endocrine disorder starting with the pituitary or hypothalamus: I have abnormally high and low levels of several other hormones and neurotransmitters as well.
@@mnbgt101: You're most welcome! I hope you find some definitive answers! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@OSAMA: If low testosterone is the cause, then a balanced TRT regimen is the best way to treat. We do not use Clomid, and aromatase inhibitors are usually overdone. Your care needs to be directed by someone who has experiencing at managing therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@tylerbond5024: You are correct. Typically, optimizing your testosterone levels will help balance your estradiol levels as well. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
On was on testosterone for 3 weeks and started to get tingling on my arms and legs so I had to stop.. I went to the er and they said I don’t have anything wrong with me.. I been off testosterone for a week already and still feel the tingling on my arms and legs.. I also noticed blotting on my face being on testosterone.. please help
@Luis-gn7li: Unfortunately, I have never encountered that type of reaction with any of our patients taking testosterone. You could have a drug sensitivity or an allergy to some component of your injection, but based on my almost 12 years in this space, I would have to say that the symptoms you experienced are rare with TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
hi dr.can you help me please.i m on trt,but my estrogen is super low,porgesterone is high.im not taking aromatase inhibitors. what can be problem? and can low estrogen in man cause insomnia? thx 🙏
@burek sa sirom: Typically, low estradiol means your testosterone levels are too low. Low estrogen levels can contribute to difficulty sleeping if you are experiencing symptoms such as hot flashes. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@Zachary Scott: Ultimately, whether you bald or not is up to your genetics. DHT, a metabolite of testosterone is involved, but it doesn't make someone who has no genetic predisposition to balding, bald. However, if low testosterone levels are keeping a genetic inevitability at bay, then correcting may accelerate the loss. You can find more comprehensive answers here: tctmed.com/genetics-of-male-pattern-baldness/ Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@bm2618: Unfortunately, volatile changes in estradiol can have profoundly adverse effects on some people. This is why balance in dosing and monitoring is so critical. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Great video! For a male in his 40’s on TRT, is 68 a high level? If so, how many mg’s of Anastrozole do you recommend & how many per week? Thank you for your time.
@gust9464: Thank you for the feedback! Whether a level is too high has more to do with the severity or presence vs. absence of associated symptoms. An estradiol level of 68 is "high" per most reference ranges. Still, such a level might be acceptable if you are tolerating it well and not experiencing related irritability, fluid retention, or breast tenderness/tissue growth. I don't recommend doses publicly, but I will tell you that not everyone on TRT needs anastrozole. As with most medical interventions, I prefer the lowest dose possible to achieve optimal results. I hope that helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@qsdailydose: When I do recommend DIM I typically ask patients to get Jarrow's DIM+CDG product. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@qsdailydose8970 I do understand, but I cannot give treatment management advice without seeing someone as a patient. It's part of the standards I am held to as a provider.
So i took too much anti estrogen blockers because of the water weight high esteogen gave me.its been 8 weeks and i dont think my esteogen is producing enough it may be low what can i do to fix this? I produce very slow
@Richard Carrrsco, check out my response to Workout Instrumental. Make sure you stay away from AIs and SERMs unless they are absolutely necessary. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@siuuuuuuuuuu813: This method can work for some individuals who aren't predisposed to a high degree of aromatization, but for "high converters," the increased potency of pharmaceutical intervention may be necessary. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@Unknown-f8b8r: That may not be related to your hormone levels, but it is certainly something that you can broach with a qualified provider. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
I’m on trt now. 150 a week test cyp 25 mg enclomaphene the day before I shoot. “Twice a week” then every other week 1 tablet of an anastrazol . I can’t last at all in bed when before I could go an hour or more. A when that dosent happen I have low libido. Why can’t I last long anymore. Any idea what to change to help my issues a little bit???? I’m desperate literally desperate
@brandontomalewski8277: Your symptoms can definitely be related to estradiol abnormalities. Infuriatingly, they could be explained by a low OR a high E2. Lab and a thorough history will be needed to sort that out. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
In your opinion what should be my next step because like I said I’m desperate because this is ruining my life. Any advice would be much appreciated thank you
@@brandontomalewski8277 For patients in similar situations, my typical recommendation is immediate cessation of aromatase inhibitors (anastrozole) and a full lab assessment to be performed as soon as possible. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
I haven’t asked a question on here , but reading thru the comments the good doctor pretty much has answered everyone’s questions ( which can help us all ) thank you doctor for your help ! You’re a diamond in the rough good sir ! 😃😊
What does a typical TRT look like for your average patient? Like how much test and AI would you normally put them? Or does it vary dramatically from person to person?
@Chee Kiat Teo: It is individualized. If I were to pull 5 random charts from established patients, it would be unlikely that you would see any of the 5 on the exact same dosage. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
I’ve been taking trt I felt great at first and 3 months later I’ve lost all the benefits that come with trt like sex , mood and hard body . What should I look at
@Tim Miller: By the third month in, my patients have usually had 1 or 2 retests to assess biochemical response alongside the development of symptomatic improvement. Estradiol changes, if left unmitigated, are often the cause of a dampening of positive response to TRT. If you haven't sat down with your provider to review your change in symptoms and up to date lab results, that's the place to start. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Question my test is at 882 and estrogen at 10 with injection eod .I don’t use an ai at all .How can I raise my estrogen a bit please would love your input.Thank you!
@Victor Diaz: I would strongly recommend sitting down with a provider who understands the value of the calculated free testosterone level and how it can inform decisions on the numbers side. Don't get me wrong, symptoms and safety matter most, but things like units of measure and global evaluation matter. For TRT purposes, a male almost never needs estrogen supplementation. Now, if your body fat percentage is extremely low, you have next to zero phyto/xenoestrogens in your system, you never consume alcohol, and you aren't affected by the numerous things that can stimulate aromatization, then you might be organically low. My presumption is that your total testosterone is not telling the whole story. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@siuuuuuuuuuu813: The effects of AIs are typically limited to their term of use, and the effects will vary in relation to the half-life of the particular medication. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
I’m on TRT and whenever my Estrogen goes really high my joints start to hurt just as bad as when i have Low Estrogen. I wonder if the high Estrogen blocks my Thyroid because at that point my appetite is a lot less as well and the brain fog makes it hard to talk even. I suffered with this a lot for the first year on TRT but now that i’m dialed in i dont have high estrogen and the severe brain fog. And hungry as a horse😂
@Milo: There are a few things to unpack here. First, estrogen (estradiol - E2) levels can definitely impact fluid management. High E2 levels can lead to bloating and fluid retention. This extra fluid doesn't stay in just the vascular space. It pushes into interstitial spaces and even joint spaces. The resultant joint swelling can be painful. On the flip side, dehydration and a reduction in synovial fluid in the joint space can also cause pain. There are many other factors, of course, like intra-articular joint pressure and the osmotic pressure of the synovial fluid itself. Also, changes in E2 can have an impact on SHBG dysfunction/production. In turn, there is a relationship between SHBG levels and thyroid function. Finally, when your thyroid function is properly maintained, your metabolism is better supported. Depending on your activity level, this can certainly have an impact on your appetite. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@TCTmed sore joints when estrogen is high ? More fluid into the joints should mean more lubrication surely . That's how bodybuilders / poweifters lift such heavy weights its protects the joints. Surely it must be an androgen/ imbalanced ratio that wud make his joints sore or else just low estrogen
@@lynxeffect84 On the contrary, swollen joints can cause discomfort too. The mechanism is different, but if you sprain a joint and it swells up to twice its normal size, a portion of that swelling is due to fluid trapped inside the joint capsule. In a setting where an encapsulated joint is "over-filled," this creates stiffness and discomfort, not just lubrication. The dry joint ache associated with low E2 levels differs, but both presentations can lead to discomfort. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@augiegalindo isn't spraining or injury total differant tho. There's no injury here . He said high estro from trt. Trt isn't going to produce massive doses of high estro.
@tom jerry: Since DHT is also a metabolite of testosterone, low DHT levels start with testosterone deficiency or a deficiency of another hormone higher in the steroid hormone cascade. Low testosterone or DHT levels can contribute to a depressed mood. However, I would not go as far as to say that these imbalances are solely responsible for severe moderate to severe clinical depression. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
I was at 1700 test level on simply 200mg of sust a week taking exemestane twice a week abs e levels were good. I recently dropped to 100-125 a week and was still taking exemestane twice a week and then started taking once a week but I’m starting to lose sex drive, very depressed don’t want to do much/low energy through the day. I just had a day with some join paint and one or two days with some sweats at night.But I can’t figure out if it’s high or low because the symptoms of high and low are so similar. I had got a test a month ago and was going to test in another month and a half to 2 that’s why I didn’t want to get another blood test so soon. But I don’t want to keep crashing the estrogen if it’s too low or neglect it if it’s high and get gyno. Thoughts?
@JWhyOfficial: Aromatase inhibitors are remarkably potent. Without intentionally getting all "soap-box" on you, making guesses on levels and dosing changes is never a good approach. Your changes would suggest that you did, in fact, bottom out your estradiol, but you need expertise and lab results to direct your care. It can take quite a while to get your estradiol back on track. Best regards,
When I crash my estrogen (I'm extremely sensitive to AI's) I just pop a quarter tab of 50mg Dbol per day and within a few days its back up to normal. Normally, I feel better immediately following a dose of dbol. Dbol converts to methylestradiol which is a very powerful form of estrogen. It works for me... Without using this method, it can literally take weeks on just test and absence of AI to start feeling better again.
please can someone help 🙏🙏 i m on trt(testogel),not using aromatase inhibitors but my estrogen is low.t levels and other hormone blood work is fine. can some other medical condition cause low estrogen?can someone help cause in my country they dont know shit about hormones and hormonal problems
@vitor belfort: Typically, low estrogen levels mean that your testosterone levels are relatively low. If you have a considerably low body fat percentage, that could also be a contributing factor. Aside from that, more rarely, hemochromatosis or autoimmune diseases lower estrogen levels in males. The most likely culprit is that your testosterone levels are not adequately supported by the gels you use. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@augiegalindo thnx a lot for answering🙏 my testesterone levels are fine,above middle range. question is what kind of autoimmune disease can cause high estrogen?🙏i dont what to look for,what blood work or which doctor to ask 😢
Hi Doc, i have low Test below the low reference point and low estrogen again below the low reference point. What potentially could be the reason. I have not used or abused steroids, being active, eating meat, plenty of eggs etc. What could potentially be the reason and treatment. Of course I am planning on meeting a doctor. Thank you in advance.
@petkovalevski2502: This is a daunting question. The best minds in the field point primarily to endocrine system disruptors. Some of these are natural environmental factors, but most are manmade. Unfortunately, even when people do "everything right," Low T is becoming more prevalent. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@TheShadeOfTea: You could have normal total testosterone and still have below-normal free testosterone. This would leave less testosterone available for aromatization. Testosterone is aromatized in many different tissues, but primarily in adipose (fat) tissue. If you have a low body fat percentage, you would be prone to aromatizing less. Your diet, activity level, and chemical/environmental exposures may have an impact as well. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
my e2 levels are 49 pg/ml , and thats without using any testosterone, my test levels are at 490 ng/ml (i am 37 years old) , i think my e2 levels are high, i have puffy nipples and struggle with sleep, do any of you have any recomendations on monotherapy dosage using arimidex?
Try DIM. Arimidex is far too harsh when you are a natural and only at 49 pg/ml. Wich is a bit high for your total T but its not borderline high either.
Usually very good content, but the video never really answered the question, what are the signs and symptoms of low estrogen in men? Only thing mentioned was osteoporosis, but that is not an identifiable symptom that a person would notice. So, a guy would just have to wait for lab results to know if they were being too aggressive with the Anastrozole?
@Jim Mski: Thank you for your feedback! The editing chopped up the answer a bit, but if you go to 7:31 in the video, I also mention hot flashes and dry joint aches. In addition to these, you can sometimes see a decrease in libido and erectile dysfunction, even despite having an optimized free testosterone level. So, hot flashes, diffuse and unexplained joint pain, decreased libido, and erectile dysfunction are symptoms commonly seen when estradiol levels are too low. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Yeah all of these symptoms plus extreme anxiety is what experienced when I discovered my pill bottle was labeled wrong, I was taking my estrogen blocker daily instead of weekly! Absolute torture!!
@Loveng Briian: It is possible. Estradiol levels have a fairly profound effect on fluid balance. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
I’m on 24mg daily but still having issues idk if I need more test or less test: TT 1139 (250-1100) FT 273 (46-224) DHT 105 (12-65) TSH 2.13 (.4-4.5) E2 46 (
@qsdailydose: Unfortunately, I cannot render dosing recommendations without having an established relationship with a patient. I would caution you to look at why your HCT is so high. This can lead to some dangerous adverse events. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Hello! I have normal testosterone level, normal SHBG level, but my estrogen is around 20-25% higher than the upper limit. Do you have any tips what can be the cause of this? Everything seems balanced but my estrogen. Im also very active, im around 13-15% bodyfat, have no problem with building muscle, but my sexdrive is close to zero cause of the high estrodile level i guess. Im 30 years old and i dont take any drugs or hormones. Thank you for your time!
@Gabor B: Many things lead to increased estradiol production. While increase body fat doesn't appear to be a factor, it could be due to certain dietary components. Research is split on whether or not plant based estrogens, or phytoestrogens, affect our serum levels. Alcohol consumption also increased aromatization, or conversion of testosterone to estradiol. Some people don't metabolize estradiol well, and this is why many recommend the use of supplements like DIM (diindolylmethane). Keep in mind, there are other hormones to consider. Your prolactin level and other pituitary hormones like LH and FSH should be evaluated. Finally, "normal" total testosterone level and "normal SHBG" doesn't necessarily equate to a normal calculated free testosterone level, which in my opinion, is the most important number to know. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Do you take Tramadol for pain management? I do and researched it...it will raise your estro...so will Metformin in diabetics. Its suppresses test thus increasing estro. thus
Im on 1ML a week of TRT. My mood swings are rough. I’m also having the breast issue. I feel tired but I haven’t done anything lol. Depression is the big one. How would you treat this?
@JohnRayez-md7dq: I recommend looking at your estradiol levels to guide you. I can't give treatment recommendations, per se, but there is much more to optimizing TRT than just starting someone at 1 mL. If your provider isn't looking deeper, it may be time to find a different provider. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@JB B: Yes, they can. However, their efficacy is far below that of aromatase inhibitors in reducing estradiol levels. So, it just depends on where you feel best, and your personal biochemistry and related tendencies. See the above comment. Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@GSD07: Gynecomastia is typically induced in states of excess estrogen influence. As for the differences between low testosterone and low estrogen, it depends on the cause. Low estrogen is typically caused by (in males) a lack of testosterone or perhaps by an overuse of estrogen "blockers" by people on TRT. Isolated symptoms of low estrogen include hot flashes, bone demineralization, mood changes, and sexual dysfunction. For isolated low T, you can see fatigue, decreased libido, erectile dysfunction, poor quality of sleep, irritability, trouble concentrating, and negative changes in body composition. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@TCTmed Just curious if you also ever see hot flashes in patients with high estrogen as well? And if so, do they differ much from the low estrogen hot flashes?? I feel as if when my estrogen is high, I have really bad hot flashes... But when its low I do as well. And what about sleep issues with high estrogen vs low? How do they each affect sleep? Thanks!
@@ColdSun87 Estrogen levels abnormalities or even normal but imbalanced estrogen can cause hot flashes (flushing) AND sleep disturbance on both sides of the spectrum. The character of the flushing doesn't seem to differ significantly, based on what my patients have reported over the years. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@Kevin Brown: Physical symptoms and side effects are the most important rate-limiting factors, but a calculated free testosterone level between 9-30 ng/dL is what I consider normal. Normal is not necessarily optimal, so that range for me is more narrow. Converting your reported free T to ng/dL shows you to be at 28.5 ng/dL. So, technically, that is high-normal. However, there is a myriad of issues to consider alongside the numbers. The day of your injection interval, your blood was drawn on, your potential side effects, and your symptomatic improvement, to name a few. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@TCTmed thanks for your reply.. Those numbers were at its lowest point, the morning of my injection. Hardest part for me is not getting stuck on numbers... thanks again
@@kevinbrown1399: You're welcome! I have those conversations often, lol. It's all about symptoms, and the numbers are just our guideposts. That said, if this is a 7-day trough, I find that I often don't need numbers that high to elicit an optimal response. I would encourage you to track "when you feel what". In other words, through the dosing interval, patients tend to feel different strengths vs. side effects. I have found that higher numbers better support anabolic benefits, and that lower (yet still optimized) numbers support androgenic benefits. Both are good and desirable. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@TCTmed Noted. I lowered my numbers as of my last lab-work (taken monday). Free T 17.6 ng/dl, Total T 548 ng/dl, and still waiting on E2....I only drop things down due to mental sides from the high estrogen. Sensitive to it i guess. I don't like it. I'll return to the higher levels and try to control with an AI and lose a little fat and get off the AI. Its definitely a journey
@Loveng Briian: Hypercholesterolemia is listed as a potential adverse reaction with anastrozole. However, I can't say that I've ever seen a case where this was clearly a problem. That being said, most side effects are dose dependent, and very small doses of anastrozole are typical in TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Hello TCT, I’m a 26-old young man. previously take Tamoxifen(40mg/day) and clomid(50mg/day) to increase my LH andFSH, then to increase my testosterone level. However, after two weeks tablet taking, I started feeling tired easily being irritated, loss of muscle strength, apparently erectile dysfunction compared with before taking tablets. Then I go to do a blood test, the blood test showed that I have high level of LH, testosterone, Estradiol and prolactin (LH-23.07mIU/mL; testosterone-1035.86ng/dL; Estradiol-56.8pg/mL; Prolactin-23.9ng/mL). I assumed that the reason of the symptom after taking tablets is due to the high level of E2 and prolactin, which were aromatized from high level testosterone. Does my assumption make sense? kindly let me know! Thank you!
While it is possible that your response to clomiphene (Clomid) included an elevation of your prolactin levels, it isn't a certainty. This study (www.ncbi.nlm.nih.gov/pubmed/19359408) showed no changes in prolactin levels measured before and 10 days, 4, 8, and 12 weeks after clomiphene. So, you may have had elevations prior to using clomiphene. If so, a work up would be in order to find the source of the hyperprolactinemia. Non-cancerous pituitary tumors, prolactinomas, could be one cause. Second, tamoxifen does nothing to reduce estrogen levels, only affecting the receptor response. Yes your E2 elevation was secondary to the aromatization of testosterone, but the prolactin elevation was not. I hope this helps. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
You have a high Total T level, but Free T is what exerts its effect on the body. Clomid increases SHBG, which is a function of Total T, therefore increasing the Total T and Free T may still be low. Clomid for men with high SHBG is a fool’s errand.
@Jay Cee: This is different from patient to patient, and I have found that cookie cutter ranges don't work well. That being said, I definitely want to see a normal number here. Some patients feel better with a "low normal" estradiol, and others need it hovering at the upper limits of normal to feel optimized. Rarely do I see patients tolerating levels that are frankly elevated above normal. The point that eliminates high concern for gynecomastia, reduces the need for aromatase inhibitors to a bare minimum, and leaves estrogen levels in the normal range is the target. Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Testosterone Centers of Texas thanks doc I have another question for you, I got my total test back at 415and free at 60 would it help running some clomid and nolvadex to see if I naturally come back before going on TRT?
@@diabeticmuscle45: Be leery of any free testosterone reading that is not a calculated free T or equilibrium dialysis. (www.issam.ch/freetesto.htm) Aside from that, using clomiphene and aromatase inhibitors won't jump start natural production, you will still be dependent on the medication to maintain higher levels. Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Hello, I'm a 40-year-old male from New Zealand. Here are my blood test results requested by my doctor: Testosterone 11.3, Oestradiol 22, Prolactin 240 and LH 4.5 Do I have low testosterone levels for a male my age and is my Oestradiol level high for a male?
@m_ax_i!! akerman: Unfortunately, units of measure are not universal so I can't speak to what these results may or may not suggest, and numbers alone don't complete the picture. You really need to be evaluated by a medical professional who can review your history, exam, symptoms, and clinical presentation. That, in conjunction with your lab results will give you the best answer. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@Jutemlop: Yes, chronic hypoestrogenism can lead to bone demineralization or osteoporosis. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@gavbrown85: A few things could be at play. The phrase "good test levels" always gives me pause. If you are judging based on your total testosterone levels only, it's easy to be misled. Typically, low estrogen levels are most often seen with an overuse of aromatase inhibitors (if you are taking them), an aromatase deficiency (reasonably rare, could be related to an extremely low body fat percentage), or a relative deficiency in free testosterone. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@TCTmed I’ve not taken any inibitators I’m all natural I do hav low body fat as I fast and eat clean my normal test levels are at 18.8 but I’ve not had my free testosterone checked
@@TCTmed I tell a lie tho I did think my east was high as to my moods and off balance I was feeling so I took half a tablet easttogen blocker 2 weeks ago may be that could be the cause so I am booked back in.In 4 weeks time for my free test to be checked and my estrogen again so fingers crossed they will all be ok and estrogen back in good range
@@TCTmed hi mate yes I’m going to as I don’t think half a estrogen tablet blocker would make it drop that’s much so I’m in for full hormone bloods in 4 weeks
What's your opinion of HCG? My TRT doc has me on it, but I'm experiencing all the High E2 symptoms and I think it's because of the HCG. Thinking of getting off the HCG.
@Jay Abrams: We use hCG only in specific cases. I do not subscribe to the theory that hCG is a necessary component of TRT. Also, I avoid using hCG as monotherapy unless the patient is adamant about that being their only option. In our practice, hCG is used with the lowest effective dosing to combat testicular atrophy or for the promotion of fertility while on therapy. Unless a patient requests it (i.e. is bothered enough by it to ask for treatment), we do not routinely prescribe it for mild atrophy. Furthermore, hCG is soon to become scarce if not entirely unavailable on the compounding market. The FDA has reclassified it as a biologic and has moved to make it illegal to import the raw material used for compounding the product. There are alternatives, but as it stands, hCG is on the way out as a compounded medication. The commercially available products are far more expensive. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@B88_f: Unfortunately, you are right. That was a splicing error in the editing process. However, if you fast forward to the 7:00 mark, the discussion on the symptoms of low estrogen (hot flashes, sexual dysfunction, dry joint ache, and osteoporosis) is listed there. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner
So Im on a self prescribed trt(well kind of a cycle right now) my estradiol levels were at 80 while my test levels were at 470(this was 5.5 days post injection of 80-100mg test cyp so yes obviously it goes down after 48 hours post peak) and free test in the 150s; but also was running 150-175mg of test cyp for 5 weeks. Question is I saw that my estro was high I was doing alot of cardio; taking var, 50mg proviron everyday and eating like I was when I was cutting natty and couldnt even lose weight even lowering my carbs; I know I was burning through those cals quick because I was goin to sleep everynight extremely hungry. So what I did was took some exemestane I had on deck; started at 12.5mg eod since last Friday. I skipped the dose today because I realized I had symptoms of low estro; really bad mood swings, lethargic, hard to workout, and literally no sex drive even though Im on low dose test with proviron so I stopped taking the aromasin which I thought 12.5mg eod was a low dose; thats what most people do on moderate doses. I literally had hot flashes, really bad insomnia; so I know my estro is crashed. Weeks before I took exemestane I felt very good the entire time even though my estro was high, sex drive was high, energy, mood, etc.; but I had a hard time losing weight because of water retention. Ever since I started aromasin since last week I even upped my cals kept everything the same(cardio/workout) and lost nearly 3-4lbs automatically. Should I just stop taking the aromasin; or just dose it on pin days? which is twice a week, literally I know i crashed my estro; cause I have all the symptoms of low estrogen. I've had symptoms of high estro before on cycle running anadrol(meaning over 100) only side effects I had was very emotional, lifts went up like crazy and water retention. I realized with low estro I literally have no emotions, and just fucking pissy all the time like I have pms and it is hard to workout and havent had a boner in a week.
@Chris Dopez: Unfortunately, this is just completely different than what we do in TRT. I don't recommend any anabolics like Anavar, or nandrolone. It is always a risky endeavor to make dosing adjustments by "feel" only. I recommend medically managed TRT only. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
If you ever found out how to fix low estrogen please let me know my levels of estrogen producing naturally are too slow its beem ten weeks and i have some emotion and random sex drives bur its nit garanter
Dr. Galindo, Over the past year I've been feeling symptoms which I have never felt before, and which I've read can be associated with low testosterone or high estrogen levels; I am 53 years old. I feel that my energy levels and my mood have dropped, I am accumulating more belly fat, I am irritable, and I have noticed reduced muscle mass. I am a little worried about getting on TRT because I've heard that you may have to remain on it for life because your body stops naturally making its own. I went to a lab which doesn't require a prescription and had my blood work done to see if that the results matched my symptoms. These are the results: Total Testosterone - 468 (250-1100 ng/dl). Free Testosterone - 76.3 (35-155 pg/Ml). Estradiol (E2)- 27 (0.00-39 pg/Ml). What is your opinion on these numbers? Is there something I can take which will lower my Estradiol numbers, without having to get on testosterone (instead of doing it the other way)? Thanks for your help, Joe
@Master Armedforces: Hello, Joe! For transparency's sake I am a PA, not a doc, so Augie works just fine. I agree that your symptoms are very consistent with what we see with low testosterone. Now, while natural production is definitely suppressed when someone takes testosterone, the myth that you will never make your own testosterone again is exactly that, a myth. Keep in mind, however, that if your symptoms are due to a significant decrease in your testosterone production, then what you are fixing is a broken system. If your vision was deteriorating, it would be fantastic if you could use an exercise, device, or medical treatment to retrain your eyes to refract light accurately again. Lasik surgery, and the like, offer a corrective, though somewhat invasive approach that does correct many unwanted changes of the eye at the expense of a costly and somewhat invasive procedure. Sadly, though, our only choice with the failure to produce enough testosterone is more akin to vision correction via the use of external lenses. So, as long as you want to see better, you have to use contacts or glasses. Or, as long as you want to not feel the symptoms of Low T, you have to use TRT once natural means are exhausted. Therefore, in this measure, this is why some people may say that "you have to remain on it for life", but it is NOT because you won't ever produce your own again. Typically, if you've only been on TRT for a short time, you can expect a rebound to you pre-treatment production levels with a few months of stopping TRT. As for estradiol, some supplements like DIM (Diindolylmethane) can help your body metabolize estrogen more efficiently. Additionally, avoiding things like alcohol, phytoestrogen, xenoestrogens, and increase in body fat can help. The following is an excerpt from one of our blog articles, The Importance of Estrogen (Estradiol) in Men’s Health (tctmed.com/estrogen-in-men/). "There are many reasons why your body may be producing too much estrogen. For instance, if you suffer from obesity, your excess fat can actually start producing additional estrogen beyond what your body already produces." Finally, your numbers are incomplete. A total without a calculated free testosterone (issam.ch/freetesto.htm) leaves out the most important part. The Endocrine Society has deemed the analog (direct) free testosterone test to be clinically useless. For your calculated free testosterone you will need your total testosterone, sex hormone binding globulin (SHBG), and your albumin. I hope this helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Augie, could high E2 cause extreme fatigue and muscle soreness? I recently had labs done and the only thing that came back high was E2 at 73. Total test was 864.
@@ericadar3386 Alone, probably not, but what you aren't seeing is with those two numbers is that your SHBG is probably elevated due to the high estradiol, making your calculated free testosterone much lower than you would expect with a total of 864 ng/dL. Therefore, a lower free T matched up with an excessively high E2 can certainly wreak havoc. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@@TCTmed Augie, I see that you have about four clinics in the Ft Worth/Dallas area; I would go to one of them without hesitation if I lived nearby. I have a question about having my blood work being done without fasting. The people at the any lab test now facility here in Sarasota told me that I did not have to be fasting, but I have heard from numerous other people afterwards that I should have been. Is this true?
@@MasterArmedforces Thank you for the affirmation, sir. Yes, you should be fasting. Remember that labs are not run by clinicians, so their recommendations typically only speak to the integrity of the test. It is The Endocrine Society, insurance guidelines, and the physiology of testosterone production that detail why initial testing should be done in the morning, and in a fasting state. The goal is to look at your natural production when it is its highest. Testing before 10 AM, while fasted, is what allows for this. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@Victor Diaz: Thank you for the vote of confidence! We will be moving in that direction soon!! Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Hi Dr, I hope all is well with you. From your experience can high or low E2 cause social anxiety/awkwardness symptoms i.e difficulty maintaining eye contact, being in crowded places etcetera? I do know low testosterone levels can cause these anxiety symptoms due to the relationship between hormones and neurotransmitter production. It'll be interesting to know your views.
@Yasin Patel: Thank you for your question! I have routinely seen higher or unopposed estrogen levels ("estrogen dominance") influence patients to be more anxious and irritable. While it is often coupled with an underlying predisposition, maintaining normal estradiol levels has successfully managed these symptoms for many patients. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
This can vary from person to person, but generally, staying out of the lower third of the normal range would be desirable. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Good video 🙏🏼 Do you ever work from test results derived from the “Dutch Test” by Precision Analytical inc❓ My results show a Testosterone score of 2 & Estradiol (E2) of 0.49 with their test. I’m late 30’s This was after being subjected to Toxic Mold poisoning. Best Wishes
@J R: Thank you for the feedback! No, use only serum testing. Both saliva and DUTCH testing show promise, but the narrow sample data used to define reference ranges, when compared to serum, limit their versatility. Bias studies and redundant testing would be needed over a period of time, with a large cohort to move this to the forefront of testing. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
What would you consider a high estrogen. I'm on 240 test a week with my total testosterone at low 500s and estrogen 49. To note that my test results were at the end of the week. So not for sure what my peak numbers would be.
@Michael Trogdon: The most important factor here is side effects, and the most worrisome (and irreversible one) would be gynecomastia. For most labs, an estradiol of 49 pg/mL would be high-normal, or elevated. Measuring at the trough is fine, but monitoring symptoms like nipple sensitivity, fluid retention, breast tissue change, and irritability is very important. So, the short answer is, it depends. You're clinical presentation and labs must be assessed in concert to answer more definitively. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@@TCTmed ok I'm not experiencing any sides. I have been using stinging nettle root to see if it helps, just wondering if a prolactin level of a 33.4 would cause any red flags for your office...
@@michaeltrogdon3469 It also depends. Prolactin levels that are elevated above the normal reference range should be repeated in a fasting state. If still elevated, and especially if above 30, may warrant further investigation. Particularly, there would be concern for the presence of a non-cancerous pituitary tumor. Typically, if present, we we sometimes find a microadenoma/prolactinoma on a brain MRI. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@@TCTmed ok thanks for the responses. They said they would monitor the prolactin levels. Wish I knew about the fasting for my last blood test though...
@@michaeltrogdon3469 You're welcome, we always do this with the initial baseline testing, which should also be done in a fasting state. Make sure to fast before your repeat test. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@PK S: Thank you for the feedback! Check out me earlier videos. I played the guitar intro, lol. let me know if that's any better. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@Gary Simone: This depends on the lab, because each reference laboratory sets their own normal reference range and each manufacturer may have different approaches to running the same assay. For my practice and the 3rd partly lab we use, normal is between 17-60.
On 150 mg /week sub q daily injection Tt is 1130 ng dL e2 (eclia method « non sensitive »)40 pgml .penis looks smaller that before and I have e2.e 2 too high or too low?
@Hgg Hkgv: Without the reference range for your particular lab listed I can't be entirely sure, but it appears that you have a high normal E2 level. Your total also looks a smidge high if you are doing daily injections, but TT doesn't always correlate with your free testosterone the way one might think it would. As for penile changes, especially a reduction in size, that is not at all a reaction to TRT that I would classify as common. I hope that helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Testosterone Centers of Texas thx for your answer .lab range is 10 to 44.do you test your patients with sensitive or regular method?if you do both does eclia tend to show higher résultat than sensitive?
@@hgghkgv4843 We typically use the standard test unless there is a mismatch with symptoms and a lab result that shows the number to be below the lower limit of normal. Honestly, if a man's estradiol is so low that a high-sensitivity test is needed, then there is something wrong. The standard test does seem to read slightly higher than the sensitive. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Testosterone Centers of Texas thx for your answer .i have erectile dis function with this e2 number. As soon as I take a small amount of arimidex érection comes back but arimidex makes me feel really anxious.thats why I think that (in my case)eclia is not correct
@@hgghkgv4843 You can certainly have estrogen excess symptoms with a high-normal estradiol level, and it is entirely possible for a lab error to occur. Your pattern of symptoms seems to suggest that your estrogen level is high for you. Also, consider this: the body's long term reaction to a critically low estradiol level is to balance things out. The body seeks to maintain an even-keel environment called homeostasis. This means that it does what I can to react and achieve balance. If your body is deprived of estrogen for extended periods of time, your body can respond by "up-regulating" your estrogen receptors; increasing your sensitivity to estrogenic influence. So, because of this increased sensitivity, when you do finally have an estrogen level that becomes "low-normal" or even just approaching normal, you can experience symptoms that you would normally only see if your estrogen level were extremely high. It can be a bit of a catch-22, but still, normalizing estradiol levels, and maintaining that normalcy, is very important. On the flip side, you can also experience symptoms one would normally see with elevated estradiol levels, even if they are normal, but approaching the upper limits of normal. Now, anxiety is not a common side effect for anastrozole, but this could be related to your body's own reaction to being "high-normal". I hope that helps! Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner
@Andy Yarrington: Hey, Andy! The atrophy seen secondary to TRT is typically reversible, so if you aren't seeing the results you want, make sure to discuss that with your provider. They should be able to adjust your dosing to improve the effectiveness of the hCG therapy! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Oh my! I stumbled across this vid by chance! Trying to lower estrogen? Yowie, I add estrogen to keep mine high! Way high, like pregnancy high. Alternate this for 3 months and then 6 months none. My boobs are way past what any man would ever want! Fill a B cup! My butt is also getting bigger but that is so slow! (I'm trans)
Maybe people should learn to eat a clean diet and workout and sit less on their ass. And this whole trt bs would be out of the conversation. I more than tripled my testosterone by diet and excersize alone and I was already much higher than the average according to my doctor.
@Uberdriver9: I applaud your success! Diet and activity definitely do impact testosterone production, and if you're lucky, that's all you need to fix. However, that's not the case for millions of patients. Always remember that one person's experience can never characterize all people's genetic, environmental, biological, and personal circumstances. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Just wanted to say that I just read thru all 104 comments and this Augie dude from TCT took the time to answer nearly everyones comment!
Not only did he answer, but he answered with very informative, thorough, and research based information and he did it all for FREE!!!!
Very impressed!!!!
@MrJd5996: Thank you for the feedback! I truly appreciate your noticing. Since publishing our first video in 2015, I have tried my best to keep up with every thread and have always sought to be a source of information. The TRT industry can, at times, be an expanse of misinformation. We seek to partner with educated patients, working on sound foundations and good judgment.
Thank you for taking the time to comment!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Hey doctor, is this chat still active, I have some questions :)
@Itspep1: Yes, I do my best to respond to all comments!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I agree... didnt mention any symptoms on low eastrogen
@martinmagaard325: Thank you for your feedback! The editing chopped up the answer a bit, but if you go to 7:31 in the video, I talk about hot flashes and dry joint aches. In addition to these, you can sometimes see a decrease in libido or the presentation of erectile dysfunction, even despite having an optimized free testosterone level. So, hot flashes, diffuse and unexplained joint pain, decreased libido, and erectile dysfunction are symptoms commonly seen when estradiol levels are too low.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I was injecting .25mL twice a week into my dealt and started to experience ocular disturbances here and there. Where I wouldn’t be able to see well. I get these blotches in my vision where parts of whatever I was looking at were just missing from my sight. I didn’t relate it to the TRT. When I increased the testosterone another .25mL every other week the ocular disturbances started to happen a couple times a week. Really freaked me out. I mentioned what I was going through to a nurse practitioner and she said it sounded like my estrogen was spiking and causing this to take place. Anybody else have this experience?
I am suffering from low estradiol level 5. I have puffy nipple. What are the treatment options for low estrogen levels.
Hello my current blood work showed a total t of 579ng/dl, free t of 15.54 and estradiol 12.7 pg/ml. All test were LC/MS. Should I be concerned about my estradiol levels. I’m currently not on any hrt and never have been. I’ve been experiencing low energy, low libido, loss of sensation on my penis, extremely dry flaky skin.
@bobjohnson2977: If your free t measurement is not a calculated free testosterone level, I would put zero stock in it. Aside from that, the symptoms you are reporting matter more than any of the numbers. I would recommend looking into things further. Seek a provider who prioritizes your symptoms and doesn't just stop at the first "normal lab value."
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
My biggest concern is my anxiety and insomnia. I have a low SHBG of 12, mid range estrogen at 34.6 and total t of 789. My anxiety is through the roof and my sleep has gone to absolute crap!!! Any help or non-medical advice would be appreciated!! I crashed SHBG due to oxandrolone, not knowing the effect it had on SHBG a couple weeks ago. I'm at 200 mg cyp/ week 1x and no AI at the moment. I've taken anastrozole at .25 mg twice so far the whole time of 7 weeks and it doesn't seem to help the anxiety and sleep!
@roblincoln10: Unfortunately, the role of SHBG in androgen regulation is much more complex than once thought. Take a look at this excerpt: "In this study we have demonstrated that in the absence of SHBG large amounts of Te rapidly enter the cell where they are inactivated by conjugation to glucuronic acid and effluxed." When symptoms and lab results disagree, it is important to remember that labs only give us insight into serum levels when it's the intracellular environment that we should be most concerned with.
You may need to rely on the "tincture of time" to allow things to balance and resolve. I estimate your calculated free testosterone to be ~26 ng/dL. Alone, that number looks pretty good, but chronically low SHBG levels could leave you open to rapid metabolism of free T and thereby actually exacerbate Low T symptoms.
Li H, Pham T, McWhinney BC, Ungerer JP, Pretorius CJ, Richard DJ, Mortimer RH, d'Emden MC, Richard K. Sex Hormone Binding Globulin Modifies Testosterone Action and Metabolism in Prostate Cancer Cells. Int J Endocrinol. 2016;2016:6437585. doi: 10.1155/2016/6437585. Epub 2016 Nov 20. PMID: 27990161; PMCID: PMC5136390.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed thank you a Augie!! Would that rapid metabolism of T also be applied to my e2? This has been a massive rollercoaster ride. I messed up with the anavar and wished I would've kept that out of the picture for a while. It could have been another story, one more positive.
@@roblincoln10 It certainly could. Free estradiol doesn't get as much press as free testosterone, but the free hormone theory remains pertinent.
@@TCTmed so those massive swings in the e2 could be suspect as well. I'm 4 days post injection on the 200mg and I feel exponentially better each day. Still unusual anxiety and restlessness but absolutely nothing like the first couple right after shot. Even the DHEA and progesterone is affected by this theory, so it could be multifactorial
@@roblincoln10 Yep, it's ALWAYS multifactorial. Even with our best testing, we are still left to make educated guesses about intra/extracellular dynamics and receptor modulation.
Hello Augie! I'm on TRT and my estrogen can rise if not managed. I tried anastrozole but it dulled my cognition and thinking. I now take DIM and it seems to manage the estrogen symptoms without the side effects of anastrozole. Do you recommend DIM? Your response is much appreciated!
@dennisdavis2103: Hello, Dennis! DIM as a standalone for treating estradiol elevations may not be enough in some cases, but not everyone on TRT needs "estrogen blockers" (aromatase inhibitors). Whether you need a medication to manage your symptoms/levels should be determined by studying your response to TRT, surveillance of your symptoms, and monitoring your levels. For a patient who isn't a "high converter," DIM can help metabolize estradiol efficiently. I prefer DIM with CDG, as it helps to preferentially support E2 metabolism into more desirable metabolites. Remember that there are other AIs, so anastrozole isn't your only choice.
Best regards,
Augie Galindo, PA-C
Testosterone Centers of Texas | Managing Partner
@augiegalindo Calcium D Glucerate combo is a great suggestion👍 Also happy to know there's other E2 blocker meds out there too. Thanks Augie!
@@dennisdavis2103 You're welcome!
@dennisdavis2103 hope ypur doing well man i just want to ask what is DIM actually is?
Helpful video, thank you for answering all these questions!
@mkultra9361: You are most welcome!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Are there any non expensive ways for a teenager to decrease estrogen and increase testosterone?
@THERHINOFORZA4: Yes, there are many ways to boost testosterone production naturally. Please look at our blog (tctmed.com/exercise-and-testosterone/) for various options. A balanced diet high in protein and good fats, plentiful, regular, and restorative sleep, avoiding toxins, proper supplementation (zinc, magnesium, vitamin D), and vigorous exercise (HIIT) all contribute to production. To aid the metabolism of estradiol, you can look at adding DIM+CDG. I like the formulation from Jarrow Labs.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed i have another question is it possible to stop gyno from getting larger im 16 and its really killing my confidence
@@THERHINOFORZA4 Controlling the hormonal influences and potential imbalances is key. However, it's not just a testosterone/estrogen thing. Other factors like prolactin and body composition can influence gynecomastia. For that, I would recommend seeing a specialist.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Can you explain how testosterone converts to estrogen?
@moniquelogtenberg3640: Thank you for your question! I am happy to explain. The estrogen synthase aromatase, a component of the cytochrome P450 family, enzymatically catalyzes the metabolism of testosterone molecules. Through a multi-step process, aromatase essentially strips away methyl groups and alters the remaining molecule to arrive at estradiol (E2), an estrogen.
Best regards,
Augie Galindo, PA-C
Testosterone Centers of Texas | Managing Partner
Hello i Just cheked my estrogen and testosterone i i finaly understand my big problem. Testosterone is in perfect in the midle but estrogen ( my estradiol) is only 18 in norm of 94 - 223. I train Hard from little kid now im 24, 75 kg, but from around 6 yeras start fitness and diet around 4000 + colories and never get any results. What to do now how to fix super low estrogen?
Snap the balance between my Testosterone to E2 ratio is way I'm out. Tired , low libido and mood swings. ... What can raise it ?
@Workout Instrumental: The best way to fix a low estrogen level is to not block its production. People on TRT tend to overuse aromatase inhibitors and SERMs. If your testosterone levels are optimal and you don't overuse AIs and SERMs, your E2 should be good to go!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed what if your not using an ai and it's super low and wont rise , is an estradiol valerate tablet the next step ?
@@lynxeffect84 Without an AI, a persistently low E2 may need an "Ultra-sensitive" estradiol test to be more accurately measured. Ultimately, I suspect your free testosterone level to be deficient.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@augiegalindo my free test is high
6 weeks in on trt - and I am retaining water and gained weight. Also irritability muscle cramps & numbness- but at the same time I have hot flashes and night sweats - thats like all the symptoms
@Tobias Birmingham: It definitely sounds like it's time to check your estradiol levels.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
What a decent estradiol levels while on trt ???
You literally didn’t state a single symptom in your low estrogen symptom segment.
@michaelwops: Unfortunately, you are right. That was a splicing error in the editing process. However, if you fast forward to the 7:00 mark, the discussion on the symptoms of low estrogen (hot flashes, sexual dysfunction, dry joint ache, and osteoporosis) is listed there.
Best regards,
Augie Galindo, PA-C
Testosterone Centers of Texas | Managing Partner
Thank you!
@@michaelwops you’re welcome!
Why is it that every time people talk about the side effects, they always just mention gyno and rage. What about head aches and joint stiffness... is that from hi or low estrodiol?? And also the segment of symptoms of low estrodiol did not mention any side effects.. so what are the symptoms of hi or low testosterone beyond the gyno and rage. Please elaborate on these symptoms beyond the same info that is already out there. Thank you. Just looking for more info.
@hectorcrissien163: Thank you for your feedback! The editing chopped up the answer a bit, but if you go to 7:31 in the video, I talk about hot flashes and dry joint aches. In addition to these, you can sometimes see a decrease in libido or the presentation of erectile dysfunction despite having an optimized free testosterone level. So, hot flashes, diffuse and unexplained joint pain, decreased libido, and erectile dysfunction are symptoms commonly seen when estradiol levels are too low.
More common symptoms get mentioned more often, which is why you see a lot of attention paid to gynecomastia and "roid rage." I have not seen headaches reported with a high level of consistency in relation to estradiol issues.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
my testosterone levels are 163.3 ng/dl and my estradiol levels are 23.09 pg/mL.
My doctor told me to lose weight as I'm between 30-35% body fat. My body doesn't produce Testosterone (or doesn't produce enough). My doctor told me to inject saxenda to lose weight and gave me a medication (which I checked is mainly used to treat erectile dysfunction and boost fertility). I have gynecomastia for sure. Apart from losing weight, what can I do to improve my quality of life?
@naumanashraf1684: In my experience, I have not seen significant increases in testosterone production, even with substantial weight loss. There is more to it than most providers realize. I recommend seeing someone specializing in hormonal wellness for a second opinion. TRT may be your best option.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed will TRT affect ruin or reduce my chances of becoming a father?
@@naumanashraf1684 Assuming your fertility is normal pre-TRT, you should be able to successfully mitigate the fertility impression seen with testosterone use with drugs like hCG or enclomiphene. You can also consider using those drugs as monotherapy to avoid fertility suppression altogether.
Best regards,
Augie Galindo, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed thank you so much for responding. Appreciate it
@@naumanashraf1684 You're welcome!
Doc, I'm on 160mg/wk and thats all (no other medications) for some months - the entire time I have low E2 symptoms. Last blood: 1100 test, 177 free, E2 was 15 (Ultrasensitive test method). It seems my body does not aromatize much. I'm quite skinny - what do you recommend in such a case? HCG?
My doctor is a joker, does not know anything!
@pressf4896: Based on the number (and assuming the unit of measure), it looks like they have reported a "direct" or "analog" free testosterone assay. Before you adjust your regimen, I would recommend you look at your calculated free testosterone. Check out www.issam.ch/freetesto.htm.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I don't know if you answer comments, but I have been looking everywhere for information and can't seem to find it. Do you know of any cases where you used TRT to treat low testosterone, but it had no effect on estrogen, even when not using aromatization blockers? My testosterone is slightly above the upper limit of normal, while my estrogen is well below the lower limit. Do you have any advice on what could be potentially causing this that I could bring up to my doctor?
@Doc Walrus, hold the pickles: There can be several things affecting your estrogen levels. You may benefit from looking at your calculated free testosterone instead of just your total. Even an above-normal total could yield a below normal free, and less free testosterone means that there will be less aromatization. An ultrasensitive estradiol test can be ordered to get an accurate read on estradiol levels.
There is an outside chance that aromatase deficiency could be present. This is a rare condition but can explain low estradiol levels in the face of high testosterone levels.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed Thank you so so much. I'll certainly ask if my free testosterone is still low, even having high levels in total. I didn't know about that distinction. He has mentioned a possible aromatase deficiency, or even a broader endocrine disorder starting with the pituitary or hypothalamus: I have abnormally high and low levels of several other hormones and neurotransmitters as well.
@@mnbgt101: You're most welcome! I hope you find some definitive answers!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Did you solve your low estrogen?
So i used estrogen blockers ( clomid , Nolvadex ) for 11 weeks!! How can i treat my low libido?
@OSAMA: If low testosterone is the cause, then a balanced TRT regimen is the best way to treat. We do not use Clomid, and aromatase inhibitors are usually overdone. Your care needs to be directed by someone who has experiencing at managing therapy.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed i used them because of POST CYCLE THERAPY , I was on steroids
I have low estrogen 5 pg per ml if i where to take testosterone it would raise that to a healthier level or am I wrong with that?
@tylerbond5024: You are correct. Typically, optimizing your testosterone levels will help balance your estradiol levels as well.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
On was on testosterone for 3 weeks and started to get tingling on my arms and legs so I had to stop.. I went to the er and they said I don’t have anything wrong with me.. I been off testosterone for a week already and still feel the tingling on my arms and legs.. I also noticed blotting on my face being on testosterone.. please help
@Luis-gn7li: Unfortunately, I have never encountered that type of reaction with any of our patients taking testosterone. You could have a drug sensitivity or an allergy to some component of your injection, but based on my almost 12 years in this space, I would have to say that the symptoms you experienced are rare with TRT.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
hi dr.can you help me please.i m on trt,but my estrogen is super low,porgesterone is high.im not taking aromatase inhibitors. what can be problem? and can low estrogen in man cause insomnia? thx 🙏
@burek sa sirom: Typically, low estradiol means your testosterone levels are too low. Low estrogen levels can contribute to difficulty sleeping if you are experiencing symptoms such as hot flashes.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed yeah,i know that testosterone levels should be low.but they arent,they are even closer to upper range.wtf?🤷🤷
@@bureksasirom5651 Look into your calculated free testosterone level. Total serum levels can be very misleading.
www.issam.ch/freetesto.htm
Can you please elaborate on whether or not TRT contributes to hair-loss, receding hair line, balding etc. please and thank you for the vids
@Zachary Scott: Ultimately, whether you bald or not is up to your genetics. DHT, a metabolite of testosterone is involved, but it doesn't make someone who has no genetic predisposition to balding, bald. However, if low testosterone levels are keeping a genetic inevitability at bay, then correcting may accelerate the loss. You can find more comprehensive answers here: tctmed.com/genetics-of-male-pattern-baldness/
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
That makes sense ! Thank you so much for your response
@@zacharyscott1264 Of course!
Hi Dr! Do you accept insurance? Thanks
@Dennis Davis: Yes, sir! We do for our in-clinic patients.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Rapid elevations in e2 made me psychotic
@bm2618: Unfortunately, volatile changes in estradiol can have profoundly adverse effects on some people. This is why balance in dosing and monitoring is so critical.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Great video! For a male in his 40’s on TRT, is 68 a high level? If so, how many mg’s of Anastrozole do you recommend & how many per week? Thank you for your time.
@gust9464: Thank you for the feedback! Whether a level is too high has more to do with the severity or presence vs. absence of associated symptoms. An estradiol level of 68 is "high" per most reference ranges. Still, such a level might be acceptable if you are tolerating it well and not experiencing related irritability, fluid retention, or breast tenderness/tissue growth. I don't recommend doses publicly, but I will tell you that not everyone on TRT needs anastrozole. As with most medical interventions, I prefer the lowest dose possible to achieve optimal results. I hope that helps!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
What are your thoughts on calcium d glucerate and dim
@qsdailydose: When I do recommend DIM I typically ask patients to get Jarrow's DIM+CDG product.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Testosterone Centers of Texas idk of its helping me or hurting me I’m having erectile issues idk if I need more free t or less
@@qsdailydose8970 DIM and CDG don't have a direct effect on free T. You likely need a full lab evaluation and history with an experienced provider.
Testosterone Centers of Texas doc my point is idk if I should increase my dose or decrease my dose
@@qsdailydose8970 I do understand, but I cannot give treatment management advice without seeing someone as a patient. It's part of the standards I am held to as a provider.
So i took too much anti estrogen blockers because of the water weight high esteogen gave me.its been 8 weeks and i dont think my esteogen is producing enough it may be low what can i do to fix this? I produce very slow
@Richard Carrrsco, check out my response to Workout Instrumental. Make sure you stay away from AIs and SERMs unless they are absolutely necessary.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
hi tct is anti estergenic diet help to keep e2 in normal range? foods like red grape mushrooms or broccli
@siuuuuuuuuuu813: This method can work for some individuals who aren't predisposed to a high degree of aromatization, but for "high converters," the increased potency of pharmaceutical intervention may be necessary.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed god bless you❤️❤️❤️
I've had boobs and a bubble butt since I was 11 I'm 29 now and bi been bi since 17yrs old I do have mood swings and I don't take meds for this
@Unknown-f8b8r: That may not be related to your hormone levels, but it is certainly something that you can broach with a qualified provider.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I’m on trt now. 150 a week test cyp 25 mg enclomaphene the day before I shoot. “Twice a week” then every other week 1 tablet of an anastrazol . I can’t last at all in bed when before I could go an hour or more. A when that dosent happen I have low libido. Why can’t I last long anymore. Any idea what to change to help my issues a little bit???? I’m desperate literally desperate
@brandontomalewski8277: Your symptoms can definitely be related to estradiol abnormalities. Infuriatingly, they could be explained by a low OR a high E2. Lab and a thorough history will be needed to sort that out.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed thank you so much
In your opinion what should be my next step because like I said I’m desperate because this is ruining my life. Any advice would be much appreciated thank you
@@brandontomalewski8277 For patients in similar situations, my typical recommendation is immediate cessation of aromatase inhibitors (anastrozole) and a full lab assessment to be performed as soon as possible.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I haven’t asked a question on here , but reading thru the comments the good doctor pretty much has answered everyone’s questions ( which can help us all ) thank you doctor for your help ! You’re a diamond in the rough good sir ! 😃😊
What does a typical TRT look like for your average patient? Like how much test and AI would you normally put them? Or does it vary dramatically from person to person?
@Chee Kiat Teo: It is individualized. If I were to pull 5 random charts from established patients, it would be unlikely that you would see any of the 5 on the exact same dosage.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I’ve been taking trt I felt great at first and 3 months later I’ve lost all the benefits that come with trt like sex , mood and hard body . What should I look at
@Tim Miller: By the third month in, my patients have usually had 1 or 2 retests to assess biochemical response alongside the development of symptomatic improvement. Estradiol changes, if left unmitigated, are often the cause of a dampening of positive response to TRT. If you haven't sat down with your provider to review your change in symptoms and up to date lab results, that's the place to start.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Question my test is at 882 and estrogen at 10 with injection eod .I don’t use an ai at all .How can I raise my estrogen a bit please would love your input.Thank you!
@Victor Diaz: I would strongly recommend sitting down with a provider who understands the value of the calculated free testosterone level and how it can inform decisions on the numbers side. Don't get me wrong, symptoms and safety matter most, but things like units of measure and global evaluation matter. For TRT purposes, a male almost never needs estrogen supplementation. Now, if your body fat percentage is extremely low, you have next to zero phyto/xenoestrogens in your system, you never consume alcohol, and you aren't affected by the numerous things that can stimulate aromatization, then you might be organically low. My presumption is that your total testosterone is not telling the whole story.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed thank you so much
@@cuba1266 You're welcome!
hi hope you have good day sir
does body make a normal E2 after you cutting AIs or effects are permenant?
does it back to natrual and safe excretion?
sorry to commemt agwin i dont know any oerson or doctor to speak about it
@siuuuuuuuuuu813: The effects of AIs are typically limited to their term of use, and the effects will vary in relation to the half-life of the particular medication.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed thanks a lot1😍😍
I’m on TRT and whenever my Estrogen goes really high my joints start to hurt just as bad as when i have Low Estrogen. I wonder if the high Estrogen blocks my Thyroid because at that point my appetite is a lot less as well and the brain fog makes it hard to talk even. I suffered with this a lot for the first year on TRT but now that i’m dialed in i dont have high estrogen and the severe brain fog. And hungry as a horse😂
@Milo: There are a few things to unpack here. First, estrogen (estradiol - E2) levels can definitely impact fluid management. High E2 levels can lead to bloating and fluid retention. This extra fluid doesn't stay in just the vascular space. It pushes into interstitial spaces and even joint spaces. The resultant joint swelling can be painful. On the flip side, dehydration and a reduction in synovial fluid in the joint space can also cause pain. There are many other factors, of course, like intra-articular joint pressure and the osmotic pressure of the synovial fluid itself.
Also, changes in E2 can have an impact on SHBG dysfunction/production. In turn, there is a relationship between SHBG levels and thyroid function. Finally, when your thyroid function is properly maintained, your metabolism is better supported. Depending on your activity level, this can certainly have an impact on your appetite.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
What is your current protocol
@@TCTmed sore joints when estrogen is high ? More fluid into the joints should mean more lubrication surely . That's how bodybuilders / poweifters lift such heavy weights its protects the joints. Surely it must be an androgen/ imbalanced ratio that wud make his joints sore or else just low estrogen
@@lynxeffect84 On the contrary, swollen joints can cause discomfort too. The mechanism is different, but if you sprain a joint and it swells up to twice its normal size, a portion of that swelling is due to fluid trapped inside the joint capsule. In a setting where an encapsulated joint is "over-filled," this creates stiffness and discomfort, not just lubrication. The dry joint ache associated with low E2 levels differs, but both presentations can lead to discomfort.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@augiegalindo isn't spraining or injury total differant tho. There's no injury here . He said high estro from trt. Trt isn't going to produce massive doses of high estro.
How about dht my estrogen is low is that contribute depression
@tom jerry: Since DHT is also a metabolite of testosterone, low DHT levels start with testosterone deficiency or a deficiency of another hormone higher in the steroid hormone cascade. Low testosterone or DHT levels can contribute to a depressed mood. However, I would not go as far as to say that these imbalances are solely responsible for severe moderate to severe clinical depression.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I was at 1700 test level on simply 200mg of sust a week taking exemestane twice a week abs e levels were good. I recently dropped to 100-125 a week and was still taking exemestane twice a week and then started taking once a week but I’m starting to lose sex drive, very depressed don’t want to do much/low energy through the day. I just had a day with some join paint and one or two days with some sweats at night.But I can’t figure out if it’s high or low because the symptoms of high and low are so similar. I had got a test a month ago and was going to test in another month and a half to 2 that’s why I didn’t want to get another blood test so soon. But I don’t want to keep crashing the estrogen if it’s too low or neglect it if it’s high and get gyno. Thoughts?
@JWhyOfficial: Aromatase inhibitors are remarkably potent. Without intentionally getting all "soap-box" on you, making guesses on levels and dosing changes is never a good approach. Your changes would suggest that you did, in fact, bottom out your estradiol, but you need expertise and lab results to direct your care. It can take quite a while to get your estradiol back on track.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
When I crash my estrogen (I'm extremely sensitive to AI's) I just pop a quarter tab of 50mg Dbol per day and within a few days its back up to normal. Normally, I feel better immediately following a dose of dbol. Dbol converts to methylestradiol which is a very powerful form of estrogen. It works for me... Without using this method, it can literally take weeks on just test and absence of AI to start feeling better again.
please can someone help 🙏🙏 i m on trt(testogel),not using aromatase inhibitors but my estrogen is low.t levels and other hormone blood work is fine. can some other medical condition cause low estrogen?can someone help cause in my country they dont know shit about hormones and hormonal problems
@vitor belfort: Typically, low estrogen levels mean that your testosterone levels are relatively low. If you have a considerably low body fat percentage, that could also be a contributing factor. Aside from that, more rarely, hemochromatosis or autoimmune diseases lower estrogen levels in males. The most likely culprit is that your testosterone levels are not adequately supported by the gels you use.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@augiegalindo thnx a lot for answering🙏 my testesterone levels are fine,above middle range.
question is what kind of autoimmune disease can cause high estrogen?🙏i dont what to look for,what blood work or which doctor to ask 😢
sorry,low estrogen not high...
Hi Doc, i have low Test below the low reference point and low estrogen again below the low reference point. What potentially could be the reason. I have not used or abused steroids, being active, eating meat, plenty of eggs etc. What could potentially be the reason and treatment. Of course I am planning on meeting a doctor.
Thank you in advance.
@petkovalevski2502: This is a daunting question. The best minds in the field point primarily to endocrine system disruptors. Some of these are natural environmental factors, but most are manmade. Unfortunately, even when people do "everything right," Low T is becoming more prevalent.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
My testosterone, FSH and LH are all normal but my oestradiol is low. 21 M. Why is that?
@TheShadeOfTea: You could have normal total testosterone and still have below-normal free testosterone. This would leave less testosterone available for aromatization. Testosterone is aromatized in many different tissues, but primarily in adipose (fat) tissue. If you have a low body fat percentage, you would be prone to aromatizing less.
Your diet, activity level, and chemical/environmental exposures may have an impact as well.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed I agree , what would the treatment be like if my normal testosterone is fine but free test is low ?
@@theshadeofjett Treatment is managed the same way. We focus primarily on calculated free testosterone level optimization.
my e2 levels are 49 pg/ml , and thats without using any testosterone, my test levels are at 490 ng/ml (i am 37 years old) , i think my e2 levels are high, i have puffy nipples and struggle with sleep, do any of you have any recomendations on monotherapy dosage using arimidex?
Try DIM. Arimidex is far too harsh when you are a natural and only at 49 pg/ml. Wich is a bit high for your total T but its not borderline high either.
Usually very good content, but the video never really answered the question, what are the signs and symptoms of low estrogen in men? Only thing mentioned was osteoporosis, but that is not an identifiable symptom that a person would notice. So, a guy would just have to wait for lab results to know if they were being too aggressive with the Anastrozole?
@Jim Mski: Thank you for your feedback! The editing chopped up the answer a bit, but if you go to 7:31 in the video, I also mention hot flashes and dry joint aches. In addition to these, you can sometimes see a decrease in libido and erectile dysfunction, even despite having an optimized free testosterone level. So, hot flashes, diffuse and unexplained joint pain, decreased libido, and erectile dysfunction are symptoms commonly seen when estradiol levels are too low.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Yeah all of these symptoms plus extreme anxiety is what experienced when I discovered my pill bottle was labeled wrong, I was taking my estrogen blocker daily instead of weekly! Absolute torture!!
Do you get dry skin with low e 2 ?
@Loveng Briian: It is possible. Estradiol levels have a fairly profound effect on fluid balance.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
@@TCTmed thank you very much for answering my questions
@@lovengbriian6363 You're most welcome!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
I’m on 24mg daily but still having issues idk if I need more test or less test:
TT 1139 (250-1100)
FT 273 (46-224)
DHT 105 (12-65)
TSH 2.13 (.4-4.5)
E2 46 (
@qsdailydose: Unfortunately, I cannot render dosing recommendations without having an established relationship with a patient. I would caution you to look at why your HCT is so high. This can lead to some dangerous adverse events.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Hello! I have normal testosterone level, normal SHBG level, but my estrogen is around 20-25% higher than the upper limit. Do you have any tips what can be the cause of this? Everything seems balanced but my estrogen. Im also very active, im around 13-15% bodyfat, have no problem with building muscle, but my sexdrive is close to zero cause of the high estrodile level i guess. Im 30 years old and i dont take any drugs or hormones. Thank you for your time!
@Gabor B: Many things lead to increased estradiol production. While increase body fat doesn't appear to be a factor, it could be due to certain dietary components. Research is split on whether or not plant based estrogens, or phytoestrogens, affect our serum levels. Alcohol consumption also increased aromatization, or conversion of testosterone to estradiol. Some people don't metabolize estradiol well, and this is why many recommend the use of supplements like DIM (diindolylmethane). Keep in mind, there are other hormones to consider. Your prolactin level and other pituitary hormones like LH and FSH should be evaluated. Finally, "normal" total testosterone level and "normal SHBG" doesn't necessarily equate to a normal calculated free testosterone level, which in my opinion, is the most important number to know.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Do you take Tramadol for pain management? I do and researched it...it will raise your estro...so will Metformin in diabetics. Its suppresses test thus increasing estro. thus
Im on 1ML a week of TRT. My mood swings are rough. I’m also having the breast issue. I feel tired but I haven’t done anything lol. Depression is the big one. How would you treat this?
@JohnRayez-md7dq: I recommend looking at your estradiol levels to guide you. I can't give treatment recommendations, per se, but there is much more to optimizing TRT than just starting someone at 1 mL. If your provider isn't looking deeper, it may be time to find a different provider.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I heard supplements like needle root and dim can help balance estrogen and tetesterone in men
@JB B: Yes, they can. However, their efficacy is far below that of aromatase inhibitors in reducing estradiol levels. So, it just depends on where you feel best, and your personal biochemistry and related tendencies. See the above comment.
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
What would be the main differences in symptoms between low test and low estrogen if there is no sign of gynocomastia etc?
@GSD07: Gynecomastia is typically induced in states of excess estrogen influence. As for the differences between low testosterone and low estrogen, it depends on the cause. Low estrogen is typically caused by (in males) a lack of testosterone or perhaps by an overuse of estrogen "blockers" by people on TRT. Isolated symptoms of low estrogen include hot flashes, bone demineralization, mood changes, and sexual dysfunction. For isolated low T, you can see fatigue, decreased libido, erectile dysfunction, poor quality of sleep, irritability, trouble concentrating, and negative changes in body composition.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Testosterone Centers of Texas TY appreciated
@@TCTmed Just curious if you also ever see hot flashes in patients with high estrogen as well? And if so, do they differ much from the low estrogen hot flashes?? I feel as if when my estrogen is high, I have really bad hot flashes... But when its low I do as well.
And what about sleep issues with high estrogen vs low? How do they each affect sleep? Thanks!
@@ColdSun87 Estrogen levels abnormalities or even normal but imbalanced estrogen can cause hot flashes (flushing) AND sleep disturbance on both sides of the spectrum. The character of the flushing doesn't seem to differ significantly, based on what my patients have reported over the years.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
What is considered too high? I'm at 122 pg/ml (e2), free T is 285 pg/ml, and total is 1025 ng/dl... thx
@Kevin Brown: Physical symptoms and side effects are the most important rate-limiting factors, but a calculated free testosterone level between 9-30 ng/dL is what I consider normal. Normal is not necessarily optimal, so that range for me is more narrow. Converting your reported free T to ng/dL shows you to be at 28.5 ng/dL. So, technically, that is high-normal. However, there is a myriad of issues to consider alongside the numbers. The day of your injection interval, your blood was drawn on, your potential side effects, and your symptomatic improvement, to name a few.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed thanks for your reply.. Those numbers were at its lowest point, the morning of my injection. Hardest part for me is not getting stuck on numbers... thanks again
@@kevinbrown1399: You're welcome! I have those conversations often, lol. It's all about symptoms, and the numbers are just our guideposts. That said, if this is a 7-day trough, I find that I often don't need numbers that high to elicit an optimal response. I would encourage you to track "when you feel what". In other words, through the dosing interval, patients tend to feel different strengths vs. side effects. I have found that higher numbers better support anabolic benefits, and that lower (yet still optimized) numbers support androgenic benefits. Both are good and desirable.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed Noted. I lowered my numbers as of my last lab-work (taken monday). Free T 17.6 ng/dl, Total T 548 ng/dl, and still waiting on E2....I only drop things down due to mental sides from the high estrogen. Sensitive to it i guess. I don't like it. I'll return to the higher levels and try to control with an AI and lose a little fat and get off the AI. Its definitely a journey
@@kevinbrown1399 That it is!
Be better without the noisy "music".
Agree
Does arimadix cause high cholesterol?
@Loveng Briian: Hypercholesterolemia is listed as a potential adverse reaction with anastrozole. However, I can't say that I've ever seen a case where this was clearly a problem. That being said, most side effects are dose dependent, and very small doses of anastrozole are typical in TRT.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Hello TCT, I’m a 26-old young man. previously take Tamoxifen(40mg/day) and clomid(50mg/day) to increase my LH andFSH, then to increase my testosterone level. However, after two weeks tablet taking, I started feeling tired easily being irritated, loss of muscle strength, apparently erectile dysfunction compared with before taking tablets. Then I go to do a blood test, the blood test showed that I have high level of LH, testosterone, Estradiol and prolactin (LH-23.07mIU/mL; testosterone-1035.86ng/dL; Estradiol-56.8pg/mL; Prolactin-23.9ng/mL). I assumed that the reason of the symptom after taking tablets is due to the high level of E2 and prolactin, which were aromatized from high level testosterone. Does my assumption make sense? kindly let me know! Thank you!
While it is possible that your response to clomiphene (Clomid) included an elevation of your prolactin levels, it isn't a certainty. This study (www.ncbi.nlm.nih.gov/pubmed/19359408) showed no changes in prolactin levels measured before and 10 days, 4, 8, and 12 weeks after clomiphene. So, you may have had elevations prior to using clomiphene. If so, a work up would be in order to find the source of the hyperprolactinemia. Non-cancerous pituitary tumors, prolactinomas, could be one cause. Second, tamoxifen does nothing to reduce estrogen levels, only affecting the receptor response. Yes your E2 elevation was secondary to the aromatization of testosterone, but the prolactin elevation was not. I hope this helps.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
You have a high Total T level, but Free T is what exerts its effect on the body. Clomid increases SHBG, which is a function of Total T, therefore increasing the Total T and Free T may still be low. Clomid for men with high SHBG is a fool’s errand.
Where do men feel the best around 20-30? I just got my test back at 17
@Jay Cee: This is different from patient to patient, and I have found that cookie cutter ranges don't work well. That being said, I definitely want to see a normal number here. Some patients feel better with a "low normal" estradiol, and others need it hovering at the upper limits of normal to feel optimized. Rarely do I see patients tolerating levels that are frankly elevated above normal. The point that eliminates high concern for gynecomastia, reduces the need for aromatase inhibitors to a bare minimum, and leaves estrogen levels in the normal range is the target.
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Testosterone Centers of Texas thanks doc I have another question for you, I got my total test back at 415and free at 60 would it help running some clomid and nolvadex to see if I naturally come back before going on TRT?
@@diabeticmuscle45: Be leery of any free testosterone reading that is not a calculated free T or equilibrium dialysis. (www.issam.ch/freetesto.htm) Aside from that, using clomiphene and aromatase inhibitors won't jump start natural production, you will still be dependent on the medication to maintain higher levels.
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Sir.. I have estrogen rebound problem..how I get rid of high estrogen dominant permanently in men.
Hello, I'm a 40-year-old male from New Zealand. Here are my blood test results requested by my doctor: Testosterone 11.3, Oestradiol 22, Prolactin 240 and LH 4.5 Do I have low testosterone levels for a male my age and is my Oestradiol level high for a male?
@m_ax_i!! akerman: Unfortunately, units of measure are not universal so I can't speak to what these results may or may not suggest, and numbers alone don't complete the picture. You really need to be evaluated by a medical professional who can review your history, exam, symptoms, and clinical presentation. That, in conjunction with your lab results will give you the best answer.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Can low estrogen cause bone loss?
@Jutemlop: Yes, chronic hypoestrogenism can lead to bone demineralization or osteoporosis.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Good video! Thanks
Nice painting... looks like one of my father-in-laws works
I’ve got good test levels but low estrogen wot can I do to get it higher
@gavbrown85: A few things could be at play. The phrase "good test levels" always gives me pause. If you are judging based on your total testosterone levels only, it's easy to be misled. Typically, low estrogen levels are most often seen with an overuse of aromatase inhibitors (if you are taking them), an aromatase deficiency (reasonably rare, could be related to an extremely low body fat percentage), or a relative deficiency in free testosterone.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed I’ve not taken any inibitators I’m all natural I do hav low body fat as I fast and eat clean my normal test levels are at 18.8 but I’ve not had my free testosterone checked
@@TCTmed I tell a lie tho I did think my east was high as to my moods and off balance I was feeling so I took half a tablet easttogen blocker 2 weeks ago may be that could be the cause so I am booked back in.In 4 weeks time for my free test to be checked and my estrogen again so fingers crossed they will all be ok and estrogen back in good range
@@gavb85 I recommend taking a look at your calculated free testosterone level.
@@TCTmed hi mate yes I’m going to as I don’t think half a estrogen tablet blocker would make it drop that’s much so I’m in for full hormone bloods in 4 weeks
What's your opinion of HCG? My TRT doc has me on it, but I'm experiencing all the High E2 symptoms and I think it's because of the HCG. Thinking of getting off the HCG.
@Jay Abrams: We use hCG only in specific cases. I do not subscribe to the theory that hCG is a necessary component of TRT. Also, I avoid using hCG as monotherapy unless the patient is adamant about that being their only option. In our practice, hCG is used with the lowest effective dosing to combat testicular atrophy or for the promotion of fertility while on therapy. Unless a patient requests it (i.e. is bothered enough by it to ask for treatment), we do not routinely prescribe it for mild atrophy.
Furthermore, hCG is soon to become scarce if not entirely unavailable on the compounding market. The FDA has reclassified it as a biologic and has moved to make it illegal to import the raw material used for compounding the product. There are alternatives, but as it stands, hCG is on the way out as a compounded medication. The commercially available products are far more expensive.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
You don’t explain any low e2 symptoms….!? Great!
@B88_f: Unfortunately, you are right. That was a splicing error in the editing process. However, if you fast forward to the 7:00 mark, the discussion on the symptoms of low estrogen (hot flashes, sexual dysfunction, dry joint ache, and osteoporosis) is listed there.
Best regards,
Augie Galindo, PA-C
Testosterone Centers of Texas | Managing Partner
Never heard worded like that with roid rage, right on the money though. High androgens and estrogen is definitely the culprit.
@Brian O'Donnell: Thank you for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
So Im on a self prescribed trt(well kind of a cycle right now) my estradiol levels were at 80 while my test levels were at 470(this was 5.5 days post injection of 80-100mg test cyp so yes obviously it goes down after 48 hours post peak) and free test in the 150s; but also was running 150-175mg of test cyp for 5 weeks. Question is I saw that my estro was high I was doing alot of cardio; taking var, 50mg proviron everyday and eating like I was when I was cutting natty and couldnt even lose weight even lowering my carbs; I know I was burning through those cals quick because I was goin to sleep everynight extremely hungry.
So what I did was took some exemestane I had on deck; started at 12.5mg eod since last Friday. I skipped the dose today because I realized I had symptoms of low estro; really bad mood swings, lethargic, hard to workout, and literally no sex drive even though Im on low dose test with proviron so I stopped taking the aromasin which I thought 12.5mg eod was a low dose; thats what most people do on moderate doses. I literally had hot flashes, really bad insomnia; so I know my estro is crashed. Weeks before I took exemestane I felt very good the entire time even though my estro was high, sex drive was high, energy, mood, etc.; but I had a hard time losing weight because of water retention.
Ever since I started aromasin since last week I even upped my cals kept everything the same(cardio/workout) and lost nearly 3-4lbs automatically. Should I just stop taking the aromasin; or just dose it on pin days? which is twice a week, literally I know i crashed my estro; cause I have all the symptoms of low estrogen. I've had symptoms of high estro before on cycle running anadrol(meaning over 100) only side effects I had was very emotional, lifts went up like crazy and water retention. I realized with low estro I literally have no emotions, and just fucking pissy all the time like I have pms and it is hard to workout and havent had a boner in a week.
@Chris Dopez: Unfortunately, this is just completely different than what we do in TRT. I don't recommend any anabolics like Anavar, or nandrolone. It is always a risky endeavor to make dosing adjustments by "feel" only. I recommend medically managed TRT only.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
If you ever found out how to fix low estrogen please let me know my levels of estrogen producing naturally are too slow its beem ten weeks and i have some emotion and random sex drives bur its nit garanter
@@richardcarrasco4292 estradiol valerate tablet
@@lynxeffect84 would I have to find someone to get this from? Im fine now but I'd like to have some in case this ever happens again
@@richardcarrasco4292 prescribed from endo or trt clinic
Dr. Galindo,
Over the past year I've been feeling symptoms which I have never felt before, and which I've read can be associated with low testosterone or high estrogen levels; I am 53 years old.
I feel that my energy levels and my mood have dropped, I am accumulating more belly fat, I am irritable, and I have noticed reduced muscle mass.
I am a little worried about getting on TRT because I've heard that you may have to remain on it for life because your body stops naturally making its own.
I went to a lab which doesn't require a prescription and had my blood work done to see if that the results matched my symptoms. These are the results: Total Testosterone - 468 (250-1100 ng/dl). Free Testosterone - 76.3 (35-155 pg/Ml).
Estradiol (E2)- 27 (0.00-39 pg/Ml).
What is your opinion on these numbers?
Is there something I can take which will lower my Estradiol numbers, without having to get on testosterone (instead of doing it the other way)?
Thanks for your help,
Joe
@Master Armedforces: Hello, Joe! For transparency's sake I am a PA, not a doc, so Augie works just fine. I agree that your symptoms are very consistent with what we see with low testosterone. Now, while natural production is definitely suppressed when someone takes testosterone, the myth that you will never make your own testosterone again is exactly that, a myth. Keep in mind, however, that if your symptoms are due to a significant decrease in your testosterone production, then what you are fixing is a broken system. If your vision was deteriorating, it would be fantastic if you could use an exercise, device, or medical treatment to retrain your eyes to refract light accurately again. Lasik surgery, and the like, offer a corrective, though somewhat invasive approach that does correct many unwanted changes of the eye at the expense of a costly and somewhat invasive procedure. Sadly, though, our only choice with the failure to produce enough testosterone is more akin to vision correction via the use of external lenses. So, as long as you want to see better, you have to use contacts or glasses. Or, as long as you want to not feel the symptoms of Low T, you have to use TRT once natural means are exhausted. Therefore, in this measure, this is why some people may say that "you have to remain on it for life", but it is NOT because you won't ever produce your own again. Typically, if you've only been on TRT for a short time, you can expect a rebound to you pre-treatment production levels with a few months of stopping TRT.
As for estradiol, some supplements like DIM (Diindolylmethane) can help your body metabolize estrogen more efficiently. Additionally, avoiding things like alcohol, phytoestrogen, xenoestrogens, and increase in body fat can help. The following is an excerpt from one of our blog articles, The Importance of Estrogen (Estradiol) in Men’s Health
(tctmed.com/estrogen-in-men/). "There are many reasons why your body may be producing too much estrogen. For instance, if you suffer from obesity, your excess fat can actually start producing additional estrogen beyond what your body already produces."
Finally, your numbers are incomplete. A total without a calculated free testosterone (issam.ch/freetesto.htm) leaves out the most important part. The Endocrine Society has deemed the analog (direct) free testosterone test to be clinically useless. For your calculated free testosterone you will need your total testosterone, sex hormone binding globulin (SHBG), and your albumin. I hope this helps!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Augie, could high E2 cause extreme fatigue and muscle soreness? I recently had labs done and the only thing that came back high was E2 at 73. Total test was 864.
@@ericadar3386 Alone, probably not, but what you aren't seeing is with those two numbers is that your SHBG is probably elevated due to the high estradiol, making your calculated free testosterone much lower than you would expect with a total of 864 ng/dL. Therefore, a lower free T matched up with an excessively high E2 can certainly wreak havoc.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
@@TCTmed Augie, I see that you have about four clinics in the Ft Worth/Dallas area; I would go to one of them without hesitation if I lived nearby. I have a question about having my blood work being done without fasting. The people at the any lab test now facility here in Sarasota told me that I did not have to be fasting, but I have heard from numerous other people afterwards that I should have been. Is this true?
@@MasterArmedforces Thank you for the affirmation, sir.
Yes, you should be fasting. Remember that labs are not run by clinicians, so their recommendations typically only speak to the integrity of the test. It is The Endocrine Society, insurance guidelines, and the physiology of testosterone production that detail why initial testing should be done in the morning, and in a fasting state. The goal is to look at your natural production when it is its highest. Testing before 10 AM, while fasted, is what allows for this.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Low Volume vs. Audible Videos on UA-cam.
I just called your office to see if I can come over from Viking but you can’t serve out side of Texas.Thanks for your response anyway
@Victor Diaz: Thank you for the vote of confidence! We will be moving in that direction soon!!
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Hi Dr,
I hope all is well with you.
From your experience can high or low E2 cause social anxiety/awkwardness symptoms i.e difficulty maintaining eye contact, being in crowded places etcetera?
I do know low testosterone levels can cause these anxiety symptoms due to the relationship between hormones and neurotransmitter production.
It'll be interesting to know your views.
@Yasin Patel: Thank you for your question! I have routinely seen higher or unopposed estrogen levels ("estrogen dominance") influence patients to be more anxious and irritable. While it is often coupled with an underlying predisposition, maintaining normal estradiol levels has successfully managed these symptoms for many patients.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed Many thanks Dr, that answers my question.
What is the best free t level for optimal Erectile function
This can vary from person to person, but generally, staying out of the lower third of the normal range would be desirable.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Good video 🙏🏼
Do you ever work from test results derived from the “Dutch Test” by Precision Analytical inc❓
My results show a Testosterone score of 2
&
Estradiol (E2) of 0.49
with their test. I’m late 30’s
This was after being subjected to Toxic Mold poisoning.
Best Wishes
@J R: Thank you for the feedback! No, use only serum testing. Both saliva and DUTCH testing show promise, but the narrow sample data used to define reference ranges, when compared to serum, limit their versatility. Bias studies and redundant testing would be needed over a period of time, with a large cohort to move this to the forefront of testing.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
What would you consider a high estrogen. I'm on 240 test a week with my total testosterone at low 500s and estrogen 49. To note that my test results were at the end of the week. So not for sure what my peak numbers would be.
@Michael Trogdon: The most important factor here is side effects, and the most worrisome (and irreversible one) would be gynecomastia. For most labs, an estradiol of 49 pg/mL would be high-normal, or elevated. Measuring at the trough is fine, but monitoring symptoms like nipple sensitivity, fluid retention, breast tissue change, and irritability is very important. So, the short answer is, it depends. You're clinical presentation and labs must be assessed in concert to answer more definitively.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
@@TCTmed ok I'm not experiencing any sides. I have been using stinging nettle root to see if it helps, just wondering if a prolactin level of a 33.4 would cause any red flags for your office...
@@michaeltrogdon3469 It also depends. Prolactin levels that are elevated above the normal reference range should be repeated in a fasting state. If still elevated, and especially if above 30, may warrant further investigation. Particularly, there would be concern for the presence of a non-cancerous pituitary tumor. Typically, if present, we we sometimes find a microadenoma/prolactinoma on a brain MRI.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
@@TCTmed ok thanks for the responses. They said they would monitor the prolactin levels. Wish I knew about the fasting for my last blood test though...
@@michaeltrogdon3469 You're welcome, we always do this with the initial baseline testing, which should also be done in a fasting state. Make sure to fast before your repeat test.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Music is unbearable
@PK S: Thank you for the feedback! Check out me earlier videos. I played the guitar intro, lol. let me know if that's any better.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
What is a normal level
@Gary Simone: This depends on the lab, because each reference laboratory sets their own normal reference range and each manufacturer may have different approaches to running the same assay. For my practice and the 3rd partly lab we use, normal is between 17-60.
@@TCTmed I understand my lab is 16 30. Thus I am at 56 so I am way over per lab
@@garysimone4977 That's definitely concerning.
On 150 mg /week sub q daily injection Tt is 1130 ng dL e2 (eclia method « non sensitive »)40 pgml .penis looks smaller that before and I have e2.e 2 too high or too low?
@Hgg Hkgv: Without the reference range for your particular lab listed I can't be entirely sure, but it appears that you have a high normal E2 level. Your total also looks a smidge high if you are doing daily injections, but TT doesn't always correlate with your free testosterone the way one might think it would. As for penile changes, especially a reduction in size, that is not at all a reaction to TRT that I would classify as common. I hope that helps!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Testosterone Centers of Texas thx for your answer .lab range is 10 to 44.do you test your patients with sensitive or regular method?if you do both does eclia tend to show higher résultat than sensitive?
@@hgghkgv4843 We typically use the standard test unless there is a mismatch with symptoms and a lab result that shows the number to be below the lower limit of normal. Honestly, if a man's estradiol is so low that a high-sensitivity test is needed, then there is something wrong. The standard test does seem to read slightly higher than the sensitive.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Testosterone Centers of Texas thx for your answer .i have erectile dis function with this e2 number. As soon as I take a small amount of arimidex érection comes back but arimidex makes me feel really anxious.thats why I think that (in my case)eclia is not correct
@@hgghkgv4843 You can certainly have estrogen excess symptoms with a high-normal estradiol level, and it is entirely possible for a lab error to occur. Your pattern of symptoms seems to suggest that your estrogen level is high for you. Also, consider this: the body's long term reaction to a critically low estradiol level is to balance things out. The body seeks to maintain an even-keel environment called homeostasis. This means that it does what I can to react and achieve balance. If your body is deprived of estrogen for extended periods of time, your body can respond by "up-regulating" your estrogen receptors; increasing your sensitivity to estrogenic influence. So, because of this increased sensitivity, when you do finally have an estrogen level that becomes "low-normal" or even just approaching normal, you can experience symptoms that you would normally only see if your estrogen level were extremely high. It can be a bit of a catch-22, but still, normalizing estradiol levels, and maintaining that normalcy, is very important. On the flip side, you can also experience symptoms one would normally see with elevated estradiol levels, even if they are normal, but approaching the upper limits of normal.
Now, anxiety is not a common side effect for anastrozole, but this could be related to your body's own reaction to being "high-normal". I hope that helps!
Best regards,
Augie Galindo, PA-C
Testosterone Centers of Texas | Managing Partner
i wish i would have stayed on the hgc,,my nuts are ruined from trt,,lol,,thats one of the bad things about trt,,shrunken nuts,beware of it ,lol
@Andy Yarrington: Hey, Andy! The atrophy seen secondary to TRT is typically reversible, so if you aren't seeing the results you want, make sure to discuss that with your provider. They should be able to adjust your dosing to improve the effectiveness of the hCG therapy!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Oh my! I stumbled across this vid by chance! Trying to lower estrogen? Yowie, I add estrogen to keep mine high! Way high, like pregnancy high. Alternate this for 3 months and then 6 months none. My boobs are way past what any man would ever want! Fill a B cup! My butt is also getting bigger but that is so slow! (I'm trans)
SPEAK UP! WE CAN'T HEAR YOU
Maybe people should learn to eat a clean diet and workout and sit less on their ass. And this whole trt bs would be out of the conversation. I more than tripled my testosterone by diet and excersize alone and I was already much higher than the average according to my doctor.
@Uberdriver9: I applaud your success! Diet and activity definitely do impact testosterone production, and if you're lucky, that's all you need to fix. However, that's not the case for millions of patients. Always remember that one person's experience can never characterize all people's genetic, environmental, biological, and personal circumstances.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I have fax labs over..