T Nation

Fatigue/Depression/Low Libido and Pseudo Gyno - 25Y/O

Hi, I’m a 25 year old male and I’ve been having issues with fatigue, libido and general depression/anxiety for the last few months. My background is fully natural up to November 2017 when I quit competing in drug tested powerlifting, so I thought I’d try a low dose aromasin/exemestane by itself for physique improvements (I was using 3.125mg ED for one month and then bumped it to 6.25mg ED for another month). I realized my stupidity in using an AI on its own without prior use of hormones/steroids so I stopped (and I was also getting side effects such as poor sleep and fatigue, basically everything associated with crashed estrogen). I did look good visually but that was only due to the transient water shedding.

I felt really good prior to taking aromasin like an idiot. My blood work before taking anything (exemestane is the only hormonal thing I have ever taken and it was for two months at the above dose) was:

Total Testosterone: 28.9 nmol/L [ref 8-29]

Estradiol: 99 pmol/L [ref 0-160]

TSH: 1.4 mIU/L [ref 0.2-4]

Free T3: 4.1 pmol/L [ref 3.5-6.5]

My blood work from last week (3 months after full cessation of aromasin/anything hormonal):

Total Testosterone: 32.8 nmol/L [ref 8-29]

Free Testosterone: 573 pmol/L [ref 175-700]

Estradiol: 80 pmol/L [0-160]

Prolactin: 8 ug/L ref [0-15]

SHBG: 54 nmol/L [ref 10-55]

FSH: 4 IU/L [ref 1-18]

LH: 8 IU/L [ref 1-9]

Albumin: 42 g/L [ref 33-48]

IGF-1: 203 ug/L [ref 105-316]

eGFR: 65 mL/min/1.7 [ref >=60]

TSH: 0.12 mIU/L [ref 0.2-4]

Free T3: 4.7 pmol/L [ ref 3.5-6.5]

Free T4: 16.6 pmol/L [ref 10.0-25.0]

Creatinine: 131 umol/L [ref 50-120]

1. I’ve bolded what I think might be an issue. All other basic blood work came back fine. I am suspecting that my bout of aromasin will take longer for my HPG/HPA/HPT axes to recover (not to mention time for my poor aromatase enzyme to regenerate itself), but it looks like I have low total E2 for my age and possibly low free E2? Since my total E2 is low-moderate and my SHBG is high, in theory my free E2 would be really low right according to this statement:
“High SHBG Men (not on HRT): High SHBG will naturally push down free estradiol levels. So a man with low medium estradiol could end up with overly low free estradiol levels due to so much of his estradiol pool being bound up.”

2. Do you see any other possible issues? I also think that my prolactin could benefit from being lowered a tad so I would like to give cabergoline a try. I have legit Dostinex on its way, I’m thinking of trying it at 0.125mg twice a week to start and see how it goes. I’ve used mucuna pruriens (from Inhibit P, contains 180mg l-dopa) and based on that I feel like I’d benefit from a dopamine agonist at very low - low doses for off-label depression treatment. I also realize that my I’m borderline hyperthyroid based on my TSH but my free T4/T3 are in range so my endo wasn’t concerned but he did reduce my dosage of thyroid meds to 100mcg levothyroxine + 10mcg lioothyronine.

3. Also, I seem to have perpetual pseudo gyno in that I have fatty tissue/a visually large amount of fat in my chest despite having my E2 and prolactin in check. Would a SERM help at all or cause more damage than worth?

4. ​One last thing, I wasn’t able to get my DHT or DHEA-S measured for some reason. Do you think taking a T boosting supplement like cordyceps and shilajit would be beneficial in bringing my e2 back up?

Thank you for your generous time!

Keep in mind that Aromasin is a suicidal AI, meaning that it doesn’t just inhibit aromatization, it also prevents a rebound effect after the drug is ceased. For that reason it is possible that your e2 recovery could take longer. But I’m just spitballing here.