'Some' Lab Results, Any Advice?

Pharma / TRT Testosterone Replacement
21

lab is Quest Diagnostics

I plan to stick with the .25mg anastrozole EOD and hopefully the Tamoxifen takes care of the nipples.

in regards to the nipples-
1) if the Tamoxifen works, will the “gyno” come right back after I stop taking the tamoxifen?
2). if the tamoxifen doesn’t work, what do I do?

thanks

22

Tamoxifen will block estrogens in breast area, so should work. But the key is managing E2 levels. Hopefully E1 and E2 are not out of balance with E2.

There can be transient effects on the nipples from TRT just from an increase in E2 even if E2 is not high. It can be about the transient, not the absolute levels. So those effects can often resolve on their own to some extent in many cases.

When you taper off of a SERM, you need to have E2 under control with an AI. Perhaps a bit more AI at the time if transition, then back to normal after a week.

SERM’s increase E2 levels, so you need SERM+AI. And when you stop the SERM the breast area will perceive an increase in estrogens when the blindfold comes off. You need to slowly taper off of the SERM to avoid that transient.

You can’t do E2 labs and anastrozole dose tuning while on SERM !

Too much SERM can cause high T–>E2 inside the testes and anastrozole cannot control that. Start with 20mg Tamoxifen for two days then down to 10mg and see where that goes.

IMPORTANT: Stop hCG while on SERM as LH+hCG is just as bad as too much LH from higher SERM dose or too much hCG. Result can be high E2 and LH receptor desensitization.

Higher FT/Bio-T opposes estrogens, but more FT/bio-T also means more T–>E2. But if E2 levels are optimal [near 22pg/ml], higher T levels will oppose the effects of that level of estrogens.

23

thanks KSman.

had follow up appt today to go over labs, unfortunately the labs were incomplete! only had LH, FSH, and SHBG.

I don’t have the sheet in front of me, but the LH and FSH were essentially zero (one was 0.2 and other was 0.7 don’t remember which was which) which, although doesn’t tell us much, it rules out that tumor you mentioned above.

the SHBG was 26, range 10-50, don’t recall units. itself, I don’t think that tells us anything. when T and E results are back, I will post.

told doc of nipple issue, he wrote script for .5mg Arimidex/week, said may adjust up to 1mg/week. my thought is to see what the numbers come back at, and if appropriate convince him to put Arimidex at 1mg/wk and continue with that.

Until I see the numbers, I will keep with following protocol:
100mg Test Cyp/wk (dosed 50mg x2)
.25 Anastrozole EOD
10mg Tamoxifen Citrate E/D until nipples subside, then make adjustments to reintroduce HCG

24

picked up a iodine supplement today as body temps are consistently low as thyroid thread explains.

supplement is 800mcg/.03ml/drop

800x62.5= 50,000mcg = 50mg

.03ml x 62.5 = 1.875ml = 50mg

hopefully temps begin to improve within a few days and I can at least halve that dose, as 1.875ml of this stuff seems kind of crazy, tastes amazing too

25

some more lab numbers, I got these numbers over the phone without units of measure, I hope we can infer the units from the numbers and ranges…

Estradiol, Ultrasensitive (Quest diagnostics): 44, range 10-40

total testosterone: 855 (not sure range)
free testosterone: 153, range 35.0-155.0

last week doc said based on my high estrogen symptoms, the T dose (100mg/wk) may be too high and extra T may be aromatizing. He suspected that I may be over 1000 total T. I asked what # Total T he would like to see and he said 900, so I’m happy to see a number that is pretty close to that, in which case I don’t suspect he would want to lower the T dose. I inject 50mg Sunday morning and Wednesday evening, labs were done on Tuesday morning, so based on what I’ve read, this should be close to my peak. Next time I do labs I will do perhaps Wednesday afternoon to see what a trough looks like.

Now, questions. I know that me going back and forth from .25mg and .5mg Anastrozole EOD, an accurate dose of now much Anastrozole I need cannot be determined-

QUESTION>>>> is it possible to make an educated guess? I have RC anastrozole, and Rx arimidex which I have not taken yet as doc said .5mg/wk and from reading on here I don’t agree with that. Labs just in today so I haven’t had an opportunity to discuss this with him. I did mention to the nurse that called with labs that I’d prefer 1mg/wk and she said she would ask but she thinks he will stick with .5mg.

I have been using Tamoxifen Citrate since 11/5 on the following schedule:

11/5: 20mg
11/6: 20mg (.25mg anastrozole)
11/7: 10mg
11/8: 10mg (.25mg anastrozole)
11/9: 10mg
11/10: 10mg (.25mg anastrozole)
11/11: 10mg

I felt that the nipples showed improvement over the first two days at the 20mg tamoxifen dose, but I haven’t seen any improvement since then- though they have not gotten worse.

QUESTION>>> Is it worth trying 20mg again for a few days, or do I just need to ride the 10mg dose out for a while longer? In addition to fixing my nipples, I’m very concerned about the length of time I have been off of the HCG and want to resume that ASAP as we are attempting to make a baby.

Thank you.

26

Tamoxifen may be better than hCG, induced FSH promotes sperm production. So don’t worry about hCG. You can test LH/FSH while on a SERM and see what the pituitary is doing and what the testes are seeing.

Try anastrozole 1mg/week. If it gets you into the lower 20’s, you should feel vastly improved in 7-10 days. That will tell you a lot without lab work.

I think that your T dose and T levels are OK.

If you want steadier T levels, inject EOD, [take 1/4 mg anastrozole at that time]

Doc might have run into an anastrozole over-responder and got spooked, not grasping the fact that there are to distinct populations of males.

27

Thanks again KSman!

28

  1. quick question- I just read in someone else’s thread you said AI could be dosed at the same time as twice weekly T shots, or EOD. for 1mg/wk of anastrozole, .5mg x2 is just a tad easier than ~.285mg/EOD, but I will stick to whichever is “better”.

  2. Also, I was really hoping this Tamoxifen would make some quick changes to the gyno I seem to be getting, but it is not. Is 20mg/day for a week or two worth trying? If the tamoxifen does not work, I’m a little worried that I may have to try Letro, and to say I’m unclear how that would affect the TRT process overall, would be an understatement.

thanks again

29
  1. When injecting twice a week, there will be some rise and fall of T levels, and anastrozole needs to balance T levels to keep E2 steady. When you take T and AI at same time twice a week, serum levels will be moving in the same direction which is a good feature as well as making things easier. If one is balanced with 1mg anastrozole per week, then 1/2 mg is easy to dose. But if that dosing does not workout after lab work, one would have to resort to an anastrozole solution to allow for flexible dosing. Injecting twice a week and juggling AI EOD creates a odd cycle that repeats every two weeks: T=testosterone, A=anastrozole

The following may not line up properly because of proportional font effects.

MTWTFSSMTWTFSS
T___T____T___T___
A_A_A_A_A_A_A_A

VS
MTWTFSSMTWTFSS
T___T____T___T___
A___A___A___A___

But if doing hCG EOD, you will want to do T_AI_hCG EOD to keep things sane. So its really whatever you want to do and your preferences may change over time after new newness of injecting becomes a bore.

  1. Assuming that tamoxifen is good, the “selective [tissue]” may not apply to you. In any case, you can control E2 levels with anastrozole IF there is not a high level of T–>E2 inside the testes [which anastrozole cannot manage], which can be cause by an SERM dose that is creating high levels of LH which create that outcome. We often see unmanageable E2 levels when SERM or hCG dose is too high and that varies by individual, so definition of “too high” is whatever is too high for you. That been said, the effects are similar for most guys but not all. A few freely convert DHEA–>E2, sort of rare and they must reduce supplement dosing. If E2 does not come down with AI, you need to reduce SERM/hCG dose. Note sure how fast one would improve and resolve issues if SERM and/or AI is effective. So its not easy to know what is going on in some cases without lab work. You would also want to check LH/FSH when on a SERM to see whats going on in situations like this.
30

great reply, thank you KSman

what do you think of the following schedule whenever I get back on my prescribed protocol?

Sun
50mg T
.34mg Anastrozole
330iu HCG

Mon

Tues

Wed
50mg T
.34mg Anastrozole
330iu HCG

Thurs

Fri
.34mg Anastrozole
330iu HCG

I do prefer the 50mg T Sunday AM and Wednesday PM.

my logic is to have a schedule that isn’t constantly revolving with the Anastrozole and HCG, and stacking 2 of the 3 on Test shot days means the Anastrozole could then be doing it’s job of controlling the E2 reaction for both the Test and HCG. or is this not how it works? or is 330iu HCG too high at once?

31

that would work. I would just do 33mg of T on those 3 days so everything is evened out

32

So inject T 3x or 2x and less injecting.

No need for that much hCG, 250 would do and cost less [875mg]

If 1mg anastrozole tablets, 1/2mg can be done, not 1/3rd [unless a liquid product]

33

I think I will:

-stick with the 2x week T
-do 250iu of HCG 3x on the schedule above
-do .34ml of anastrozole 3x a week on the above schedule

I have liquid Anastrozole from a research company, and I have arimidex pills, which are quite small and I think cutting it in half is probably the best I could do. with the doctors current recommendations of .5 arimidex a week, with my E2 at 44 I’ve basically just been ignoring the .5 arimidex and using the liquid Anastrozole.

Good news! the nipples are easing up! the sensitivity is way down. the swelling is down, although it seemed to be even better yesterday, but I will keep with the Nolva (tamoxifen) and hopefully start to taper off soon.

34

KSman,

I’ve been running the tamoxifen at 10mg/day for a bit now, nipples seem fine. I feel like it is time to taper off the tamoxifen so I can get back to the HCG as balls seem to have shrunk a bit and are hanging up high.

today I did 9mg. should I just keep going, -1mg/day until I hit zero? I know you mentioned maybe increasing AI for a week at this time too, please advise me how to taper off the Tamoxifen, what dose Anastrozole to use (RC), and when to re-introduce HCG.

thanks

35

[quote]dez6485 wrote:
I’m very concerned about the length of time I have been off of the HCG and want to resume that ASAP as we are attempting to make a baby. [/quote]

You should get a semen analysis done since with FSH near zero it’s likely you’ll be infertile.

36

[quote]C27 H40 O3 wrote:

[quote]dez6485 wrote:
I’m very concerned about the length of time I have been off of the HCG and want to resume that ASAP as we are attempting to make a baby. [/quote]

You should get a semen analysis done since with FSH near zero it’s likely you’ll be infertile.[/quote]

have you read everything I’ve posted? what you just said makes no sense to me, based on what I’ve read here. my understanding is that FSH and LH are EXPECTED to be near 0 when on TRT, and that is largely why we use HCG.

37

Because the analogue of hCH, LH, cannot alone promote spermatogenesis. The only place I’ve seen hCG reported as being useful for spermatogenesis is in forums like this one. As useful as this site is I don’t consider it reliable information. From what I’ve read in this thread, you’ll be FSH deficient.

38

If you had not been using testosterone but were using hCG alone, your gonadotropins would not be inhibited to near zero levels. This is where hCG works to increase spermatogenesis. However, taking testosterone exogenously will impair FSH release and all that will happen in the testes is leydig stimulation and some dysfunctional spermatogenesis.

39

CONCLUSION: Once spermatogenesis is induced in patients with secondary hypogonadism by GnRH or hCG/hMG treatment, it can be maintained in most of the patients qualitatively by hCG alone, in the absence of FSH, for extended periods. However, the decreasing sperm counts indicate that FSH is essential for maintenance of quantitatively normal spermatogenesis.

This is only true for males that have had FSH stimulated by GnRH or replaced by HMG(LH and FSH collected from post-menopausal women). Once the FSH declined so did sperm count and quality to the point of infertility though not zero except in 10%. So if you stopped hCG for a period of time it likely won’t reboot the system and even if it did the likelihood of conception is greatly reduced. This study doesn’t include conception rates or viability of sperm which is all highly reliant on FSH being present.

40

ok I’ve been on TRT a total of something like 6 weeks. the past 3 weeks stopped HCG in order to use tamoxifen to clear up some gyno issues.

so you’re telling me in 6 weeks total of TRT, or 3 weeks of not using HCG, I’ve made myself irreversibly sterile?