Brook nailed it. Adex should do the job, but you do not want to lower E2 to the point that makes you unwell. But the gyno needs a silver bullet. Using a effective AI dose plus a SERM will be the double barreled shotgun that you need short term that will allow for lower but still healthy levels of estrogen.
Often letro will create very low E2 levels that can mess with your mental state and libido. You can try letro, but be watchful and pull back on the dose if you feel messed up. One's Letro dose-response does not seem to be predictable.
I have no idea if SERMs can interfere with prolactin receptors. No reason to expect that that would happen. If prolactin is that high, libido would be tanked. But if the actions of prolactin on breast tissue cannot happen without estrogen receptor activation [thanks Brook], then a SERM should be helpful even if prolactin levels are otherwise troublesome.
I rant, as an outsider, that all cycles that can aromatize should utilize adex all through the cycle, PCT and past that, in appropriate amounts. This typically results in some objections. Elevated estrogen levels should never be accepted, for several reasons.
Past accepted practice can simply be wrong for some and non-optimal for all. We do see lots of adverse outcomes here and in the TRT context that seem to defeat the arguments that high androgen levels will competitively block estrogen at ER's or out compete the influence of [E] activated ER's. We know what the optimal E2 levels seems to be [serum E2=22pg/ml] in a TRT context.
The concept of an optimal level of E2 in the context of gear should not be swept from consideration. When one struggles in the gym and spends huge amounts of money, pain, dedication to diet, supplements and gear, E levels should be controlled.
For those who are professional BB's, -what do you want to do that is sub-optimal? When guys indicate that their criteria for having to take an AI is bloat or gyno and everything else is fine, I see a problem in understanding and a big problem for some.
On the flip side I get some young guys with complete long lasting?permanent HPTA damage from stupid cycles... not that than has anything to do with -knowledgeable- readers here; the point is that I am perhaps more in tune or aware than others here will be, to some of the adverse things that happen to one degree or another. I hope that I have not over argued my point.