19M, 6' , ~165 lb, narrow ectomorphic frame, gluteo-femoral fat distribution since age 9 or 10 (speculation ) , possible subtle glandular gynecomastia (chest tenderness, no obvious droop), no AAS/TRT history, currently 1.5 yrs into a sustained cut and lifestyle change, on maintenance right now. Provider flagged my estrogens as 12x normal and said he doesn't know what to do — endo appointment in 3 weeks. Key labs: Total T 435 ng/dL (range 264–916), Free T 23.6 pg/mL (direct), SHBG 41 nmol/L (16.5–55.9), E2 16.4 pg/mL (Roche immunoassay, range 7.6–42.6), Estrogens Total 649 pg/mL (range 56–213, ~12x ULN), LH 2.6 (1.7–8.6), FSH 3.72 (0.95–11.95), Prolactin 5.29 (low), Insulin 2.2 (below range), HbA1c 4.6 (below range), Cortisol AM 14, TSH 1.69 / fT4 0.96, Vit D 38, Ferritin 170, eosinophils 12.7% / 0.8 abs (elevated). The elevation is speculatively, essentially all estrone (E1) since E2 is normal. Has anyone seen a similar pattern? Aromatase excess syndrome? What additional things would you push for before the endo visit ? I'd appreciate any thoughts and clarifying questions?
u/Acrobatic_Tea9109
19M, 6 ft, ~165 lb, narrow ectomorphic frame, (~17-21% BF, not measured).
gluteo-femoral (hip/thigh/glute) and estrogenic fat distribution in general, since
puberty , maybe slightly before too, never developed typical masculine body composition or fat distribution, did have a masculine fat distribution when i was really young (5-7).
Have an endocrinologist appointment in 3 weeks but want to learn
as much as possible before then.
Symptoms / phenotype:
- Gynoid (feminine) fat distribution since puberty
- Subtle chest tenderness, no obvious droop — possible subclinical
glandular gynecomastia
- Soft features, weak masculinization despite normal puberty timing
- Tall (6') so growth plates probably closed normally
- Currently 1.5- 2y ears into a lifestyle 180 + cut, lost significant fat (70+ lbs, gained significant lean muscle tissue , net lbm gain change not measured)
- No medications. Stopped DIM 1 week before labs (took ~3-4 days).
Key lab results (fasted AM, not on TRT, no AAS history):
| Marker | Result | Range | Notes |
|---|---|---|---|
| Total Testosterone | 435 ng/dL | 264–916 | Low for age |
| Free T (direct) | 23.6 pg/mL | n/a | Direct assay |
| SHBG | 41 nmol/L | 16.5–55.9 | High-normal |
| Estradiol (E2) | 16.4 pg/mL | 7.6–42.6 | Low-normal (Roche ECLIA, not LC-MS) |
| Estrogens, Total | 649 pg/mL | 56–213 | ~12x ULN |
| LH | 2.6 mIU/mL | 1.7–8.6 | Low-normal |
| FSH | 3.72 mIU/mL | 0.95–11.95 | Low-normal |
| Prolactin | 5.29 ng/mL | 3.46–19.4 | Low |
| Insulin (fasting) | 2.2 µIU/mL | 2.6–24.9 | Below range |
| HbA1c | 4.6% | 4.8–5.6 | Below range |
| Cortisol AM | 14.0 µg/dL | 6.2–19.4 | Normal |
| TSH | 1.69 mIU/mL | 0.35–4.94 | Slightly above optimal |
| Free T4 | 0.96 ng/dL | 0.70–1.48 | Below midpoint |
| Vitamin D | 38 ng/mL | 30–96 | Suboptimal |
| Ferritin | 170 ng/mL | 21–264 | Good |
| Eosinophils | 12.7% / 0.8 abs | <6% / <0.5 | Moderately elevated |
| Lipids | TC 131, HDL 51, LDL 65, TG 45 | — | All optimal |
The headline: total estrogens are ~12x the upper limit (649 vs
<50 expected for males my age according to my provider) but estradiol
alone is only 16.4. That means the elevation is almost entirely
estrone (E1) and/or estrogen metabolites — not E2.
I will see an endo in 3 weeks, but before that I would like to know and receive any help possible. Feel free to ask any clarifying questions, I want to change the distribution pattern, I do realise that I will have to lose fat in order to do so no matter what the situation is, but I'm giving my body a break, the multi - month deficit has put significant amounts of stress.
Questions -
(most generated with AI support)
Has anyone seen a similar pattern — dramatically elevated total
estrogens with normal/low E2? What was the underlying cause?
Is this consistent with aromatase excess syndrome / CYP19A1 variant,
or does the lack of overt gynecomastia + tall stature argue against
the classical form?
What additional tests should I push for before/at the endo visit?
I'm planning: scrotal ultrasound, beta-hCG, AFP, DHEA-S,
androstenedione, DHT, sensitive LC-MS/MS estradiol + estrone,
karyotype.
For those who've had similar workups — what was your treatment
pathway? Enclomiphene + AI? TRT? Something else?
Anyone with experience seeing chest tenderness without obvious
gyno resolve once estrogens normalized?
Does the elevated eosinophil count (12.7%) + atopic profile fit
into anyone else's hormonal picture? Wondering if inflammation
is driving aromatase up.
Any red flags I should be pushing harder on for the endo to take
seriously?
Goals: masculinize, normalize fat distribution, restore proper
T:E ratio. Open to whatever protocol is needed.
Thanks for any input. Will update with endo findings.