Should I Keep Taking Novaldex

Pharma TRT
1

Hi there

I’m 33 and have been taking prescribed Novaldex for a couple of months now after a Low T diagnose back in March. This is my first post : http://tnation.T-Nation.com/hub/RamboTaco#myForums/thread/6238020/

Some feedback and recommendations would be appreciated as I feel no to little improvement on Novaldex. ( I tried Clomid then switch to Nolva ). My current protocol is Novaldex 20mg/daily + Aromasin 12.2mg twice a week. Will continuing taking Nolva and Aromasin improve my numbers? Are injections my next step?

So far I have taken 3 blood test since starting Nolva .

Baseline:

APRIL

Total Testosterone : 6.3 ( 6.1-27.1) nmol/L

Free T : 196 ( 110-660) pmol/L

Bio-available T : 4.4 ( 2.8-15.5) nmol/L

SHBG: 11 ( 13-84) nmol/L

Estradiol : 78 (40-160) pmol/L

FSH: 2.1 ( 1.0-19.0) IU/L

LH: 2 ( 1.0-9.0) IU/L

DHEAS : 7.7 (2,9-12.6) uml/L

Free T3: 5.4 (3.3-6.0) pmol/L

T4: 11.9 ( 9.0-19.1) pmol/L

Prolactin: 8 (3-13.) ug/L

Progesterone: 4 (0.5-6.6) nmol/L

May

Total Testosterone : 16.5 ( 6.1-27.1) nmol/L

Free T : 489 ( 110-660) pmol/L

SHBG: 15 ( 13-84) nmol/L

Estradiol : 124 (40-160) pmol/L

Bio-available T : 11.5 ( 2.8-15.5) nmol/L

FSH: 3.4 ( 1.0-19.0) IU/L

LH: 4 ( 1.0-9.0) IU/L

Hematocrit: 0.471 ( 0.410 - 0.510 L/L )

June

Total Testosterone : 15.9 ( 6.1-27.1) nmol/L

Free T : 473 ( 110-660) pmol/L

SHBG: 15 ( 13-84) nmol/L

Estradiol : 109 (40-160) pmol/L

Bio-available T : 11 ( 2.8-15.5) nmol/L

FSH: 2.7 ( 1.0-19.0) IU/L

LH: 2.9 ( 1.0-9.0) IU/L

Hematocrit: 0.477 ( 0.410 - 0.510 L/L )

August

Total Testosterone : 18.4 ( 6.1-27.1) nmol/L

Free T : 500 ( 110-660) pmol/L

SHBG: 20 ( 13-84) nmol/L

Estradiol : 107 (40-160) pmol/L

Bio-available T : 11.7 ( 2.8-15.5) nmol/L

FSH: 3.6 ( 1.0-19.0) IU/L

LH: 5.9 ( 1.0-9.0) IU/L

Hematocrit: 0.428 ( 0.410 - 0.510 L/L )

Ever since I started Serm my stomach has been bloated. Diet is the same so im not sure whats going on…

2

I would start looking elsewhere. You should feel pretty normal with those T values. They are pretty solid.

3

E2 is a bit above target of 22pg/ml 80pmol/L
But that does not explain bloat.

Stop SERM and does bloat resolve? fast/slow?

Alternative is injecting hCG.

Your August Nolvadex numbers are best so far. FSH is best indicator as LH is pulsatile and labs can catch highs or lows.

Similarity, TT can be a better indicator than FT as FT is pulsatile. FT is strong on Clomid and Nolvadex as SHBG is low. That can be a good thing unless SHBG is low from a separate pathology.

Your pituitary response to SERMs seems low.

Hematocrit dropped and this does not seem right. Any issues with heart burn, digestion or food sensitives/allergies?
Bloat related?

Concern is GI blood loss [GI bleed]. Occult blood test would be useful, simple poop smear test.

  • half life is 24 hours, try taking EOD and E2 may be better.
  • note how this feels in 5-7 days, if you feel worse, revert or do E2 labs
  • how you feel is the point, lowering SHBG is not the goal in your case
4

[quote]KSman wrote:
E2 is a bit above target of 22pg/ml 80pmol/L
But that does not explain bloat.

Stop SERM and does bloat resolve? fast/slow?

Alternative is injecting hCG.

Your August Nolvadex numbers are best so far. FSH is best indicator as LH is pulsatile and labs can catch highs or lows.

Similarity, TT can be a better indicator than FT as FT is pulsatile. FT is strong on Clomid and Nolvadex as SHBG is low. That can be a good thing unless SHBG is low from a separate pathology.

Your pituitary response to SERMs seems low.

Hematocrit dropped and this does not seem right. Any issues with heart burn, digestion or food sensitives/allergies?
Bloat related?

Concern is GI blood loss [GI bleed]. Occult blood test would be useful, simple poop smear test.

  • half life is 24 hours, try taking EOD and E2 may be better.
  • note how this feels in 5-7 days, if you feel worse, revert or do E2 labs
  • how you feel is the point, lowering SHBG is not the goal in your case
    [/quote]

Hey Ksman could you give me some feedback on my new bloods ? I trust your insight very much… These are fresh from this month.

Current regiment: Torimifen 20mg daily + Aromasin 12.2 twice a week + DIM

October:

Total Testosterone : 20.2 ( 6.1-27.1) nmol/L

Free T : 495 ( 110-660) pmol/L

Bio-available T : 11.6 ( 2.8-15.5) nmol/L

SHBG: 27 ( 13-84) nmol/L

Estradiol : 87 (40-160) pmol/L

FSH: 2.7 ( 1.0-19.0) IU/L

LH: 3 ( 1.0-9.0) IU/L

DHEAS : 6.6 (2,9-12.6) uml/L

Free T3: 6.1 (3.3-6.0) pmol/L High

T4: 11.9 ( 9.0-19.1) pmol/L

Prolactin: 6 (3-13.) ug/L

HDL: 1.5 (1-10) mmol/L

LDL: 2.5 ( 0.00-3.5) mmol/L

As you can see my numbers are " normal" now but honestly man I dont feel like this has drastically change my life. I dont expect a magic bullet but at least a push in the right direction.

Libido has improved a bit and muscle mass is getting good traction tho…

Also I am leaner all over my body except stomach. In fact I have gain a belly/fat despit losing fat in other places. Diet is good.

Do Serms sometime mask the real good benefits ?

Why is T3 high? normal?

Could injection make a difference?

My doc wont do HCG stand alone.

Whats next if HCG alone not available?

Any feedback is appreciated 1000 times.

5

E2 values are not very meaningful on a SERM because SERMs block the effects of the E2 you have in many tissues, so taking that E2-blocking effect into account your E2 may effectively be too low in, e.g., brain, the most important organ for affecting how you feel.

In case this is what is happening, you could experiment with dropping the aromasin for a couple of weeks and see if you feel better. If not, you can just restart it.

6

DHEA is low for 33YO

Thyroid: Check body temperatures as per the thyroid basics sticky.
If low temperatures, elevated fT3 suggests rT3 blocking fT3.

You may have low cholesterol undermining steroid hormone production.

FSH/LH still low, I would ask to try more SERM and see if those will increase. If not, top end of HPTA seems broken. Then you could MRI to look for a non-prolactin secreting adinoma.

What fixed the bloat?

7

[quote]KSman wrote:
DHEA is low for 33YO

Thyroid: Check body temperatures as per the thyroid basics sticky.
If low temperatures, elevated fT3 suggests rT3 blocking fT3.

You may have low cholesterol undermining steroid hormone production.

FSH/LH still low, I would ask to try more SERM and see if those will increase. If not, top end of HPTA seems broken. Then you could MRI to look for a non-prolactin secreting adinoma.

What fixed the bloat?

[/quote]

Bloat is the same. I tried reducing Serm but no result so far.

My doctor ruled out any tumors.

Are cyp injections a possible treatment at this point ?

8

"My doctor ruled out any tumors. "
How?
Lower prolactin rules out prolactin secreting adinomas.

9

[quote]KSman wrote:
"My doctor ruled out any tumors. "
How?
Lower prolactin rules out prolactin secreting adinomas. [/quote]

After my first blood test he ruled the tumor out because of the results. I dont know what he was looking at.

At times he gives not so good recommendations. For example he is reluctant to prescribe HCG and would not mind starting me at 160 mg test cyp. Aggressive much?

Anyhow at this point Ksman I am less incline to take a Serm or HCG for another year to see If I feel better.

Could Test Cypionate make a difference ?

There might be a reason Serms do not always provide the benefits.

" This is an interesting question since it has been observed by many SERM users that the subjective physical response one gets from a SERM often does not correlate with the measured substantial increase in circulating testosterone. In other words, you don***8217;t feel the same when your blood testosterone is doubled by taking a SERM as compared to when it is doubled by a testosterone injection or testosterone gel. Why is that?

There are some theories. Number one, SERMs may act as estrogen antagonists in the brain and it is well known that many of the effects of testosterone upon libido and mood are due to its local conversion to DHT as well as estrogen (estradiol) in the CNS. Therefore blocking the effects of estrogen upon key levels of the brain may blunt the psychological response one would expect from testosterone.

SERMs also are known to act as estrogen agonists (active estrogens) in the liver. This can have a couple of relevant effects. First of all, estrogens strongly promote the production of sex hormone binding globulin (SHBG). This protein circulates in your blood and irreversibly binds to sex hormones such as testosterone, rendering them inactive. So with a SERM you may have high total testosterone levels but actual bioactive testosterone may not be so high.

Another consequence of SERM estrogen agonist action in the liver is suppression of IGF-1 production. IGF-1 is a systemic hormone responsible for whole body anabolism and it is produced in the liver under the positive influence of growth hormone, as well as other hormones such as insulin, thyroid hormone, and androgens. Estrogens on the other hand suppress IGF-1 production in the liver. In a recent study* it was directly demonstrated that administration of either tamoxifen or raloxifene to males increased LH and testosterone levels (as expected).

However they also significantly reduced circulating IGF-1 production. Given the fact that it is well demonstrated that exogenous administration of testosterone increases IGF-1 levels in the blood you begin to see that this may be a big part of the SERM testosterone mystery. Systemic IGF-1 levels may not do much for contractile muscle tissue growth but they can lead to overall body composition changes and increases in bodyweight. The difference between the suppressed IGF-1 state (compared to control) of the SERM user to the heightened IGF-1 state (compared to control) of the exogenous testosterone user may indeed be quite profound."

10

TRT would make a difference. Could make your balls small and sterile without [SERM | hCG].

SERMs and IGF-1 in males, please link to source.
As for what guys feel with a SERM, the discussion needs to be qualified by the drug as in Clomid vs Nolvadex.

11

[quote]KSman wrote:
TRT would make a difference. Could make your balls small and sterile without [SERM | hCG].

SERMs and IGF-1 in males, please link to source.
As for what guys feel with a SERM, the discussion needs to be qualified by the drug as in Clomid vs Nolvadex.[/quote]

Source:

http://press.endocrine.org/doi/full/10.1210/jc.2011-3347

http://patrickarnoldblog.com/serms-as-an-alternative-to-testosterone-replacement-therapy/

12

[quote]RamboTaco wrote:

[quote]KSman wrote:
TRT would make a difference. Could make your balls small and sterile without [SERM | hCG].

SERMs and IGF-1 in males, please link to source.
As for what guys feel with a SERM, the discussion needs to be qualified by the drug as in Clomid vs Nolvadex.[/quote]

Source:

http://press.endocrine.org/doi/full/10.1210/jc.2011-3347
Results:

In women, but not in men, tamoxifen significantly attenuated the GH response to arginine. The GH response was not significantly blunted by raloxifene in both sexes. Both SERMs significantly reduced mean IGF-I levels to a similar degree in men and women. In men, both SERMs significantly increased LH and testosterone levels.
Conclusions:

In summary, GH secretion was blunted by tamoxifen in women in the face of reduced IGF-I feedback inhibition but not in men in whom the gonadal axis was stimulated. We conclude that potential blunting of GH secretion in men by SERMs was counteracted by concomitant central stimulation of GH secretion by testosterone. In therapeutic doses, tamoxifen may induce detrimental metabolic effects in women, but not men.

http://patrickarnoldblog.com/serms-as-an-alternative-to-testosterone-replacement-therapy/[/quote]

That is quite interesting. Noting testosterone tends to counteract that, with high-normal TT and FT in TRT, perhaps the effects are not so much of a concern.

“In both women and men, mean IGF-I levels did not change significantly during treatment with 10 mg of tamoxifen. In both women and men, the mean IGF-I level significantly fell during treatment with 20 mg tamoxifen (P < 0.01; Fig. 3 and Table 1); however, the effect between women and men was not significantly different. In women, mean IGF-I levels fell significantly with a 120-mg dose of raloxifene (P < 0.05; Fig. 3 and Table 1). In men, IGF-I levels did not fall significantly with this dose, although a trend was evident. The reduction in IGF-I levels was significantly greater with tamoxifen than raloxifene treatments in both men and women (P < 0.05). The effect of both SERMs on circulating IGF-I levels was not significantly different between men and women.”

So 10mg/day Nolvadex/tamoxifen for men/women does not appear to be a problem.

IGF-1 is really what we need to be concerned with.

SERM’s increase E2 and T levels. The increased E2 levels could increase SHBG. The paper did not show SHBG effects for 10mg Nolvadex.

Clear advantage for Torimifen.

So the BB guys doing insane amounts of Clomid and/or Nolvadex are messing with IGF-1 and increasing SHBG at the time that they are trying to restart their HPTA’s.