T Nation

Gyno - SERM Restart, Other TRT Struggles

Started low dose TRT and after 6 to 8 weeks I noticed what apperaed to be some GYNO forming. NO history of it ever. I stopped the TRT immediately and my doc got me letrozole - taking 2.5mg per day. I also went in for labs before I started it, assuming I would have high E2 based on the typical symptoms, which I experience, and the new gyno. But my E2 came back pretty solid - at 19pg/mL. Labs are below, all done with Quest. I do not have much pre TRT as neither my doc nor I knew what to test…

Pre TRT:
TT: 380

Post TRT (6-8 weeks, 40mg T-cyp Mon and Fri IM):
TT: 542 (250-1100)
FT: 84.8 (35-155)
DHT: 34 (16-79)
FSH: <.7 (1.6-8) one final time to ensure shut down
LH: <.2 (1.5-9.3)
Prolactin ; 6.4 (2-18)
Estradiol: 19 (<39)
PSA: .5 (<4)

Age: 33
Body: 5’11", about 205, approx 10% BF, 33" waist. I hold fat around my midsection, but I have never been seriously overweight.
workout: as much as I can. weights and cardio, more cardio these days as I travel a good bit.
No medical history, never used any AAS or much of anything at all.
I will give more info if it is necessary - not sure it is for this.

On the letrozole 2.5mg ED and off TRT for about 10 days. I have not noticed much of a difference in the gyno, but I feel like crap, of course. Taking some Phentermine to help with energy and keep working out.

I want to go back on TRT and my doc will go to 50mg Mon and Fri and keep my on an AI - I would switch to 1.0mg anastrozole per week in divided doses. He is doing some more research on hCG but will clear it if I push - I have a great doc!

But I am freaked out about the gyno! So where do I go from here?

I am in the middle of finding a balance in my E2 levels myself, so I am by no means an expert. That being said, why would you go off the TRT? And now that you know E2 is where is ought to be, by taking more AI without adding in testosterone or HCG you are just going to pound your E2 levels into the ground, which will take a while to recover from.

Are you sure you know what gyno is?

I have always been in great shape and never carried fat on my pecs. I was working out when I started TRT and my workouts got better after starting. Then, I started to notice a little bit of “extra” around my nipple and surrounding area. And when I lean over all of the sudden I see that it forms a point and pulls away from my chest. Never did that before! I am certainly not a gyno expert, and most people may not notice - but it caught my attention.

I did jump off the TRT quickly - fear of gyno. But that is also why I had labs done right away, and before I started the AI. I did not expect such low E2 scores. I expected, based on reading others experiences and symptoms to have high E2 levels. I planned on just taking an AI for 4-6 weeks and then rechecking labs. But again, E2 is already low. Hence, my predicament…

Want to continue TRT
Good E2 scores
But the gyno has me freaked out!

Face palm, you and your Doc should slap each other.
Read this, print and give to your DOC.

That thread is one of the places I read about the letrozole, hence why I am on 2.5mg ED. Planned to take it about 3 weeks and then, considering results, taper down and switch to anastrozole. Planned to restart TRT at that point. This is in-line with that thread.

But my E2 is already pretty low - this is what surprised me. Has anyone else had issues with gyno at lower E2 levels?

There is a difference in gyno (lump formation under or around your nipple area) and pseudogyno which is
the tendency of fat accumulation on the sides of your chest and under the nipple area. It sounds like you
have the later. Pseudo is usually caused by low t and gaining weight. Not real sure what is happening to you, have you gained any weight since beginning TRT ? How accurate is the 10% BF ?

I have not had my body fat actually measured in about 10 years. But I used to measure it frequently, on myself and on others. Did it with calipers, water tank and even the egg. Water tank was always the most accurate, but also most difficult to get as its difficult to hold your breath underwater with no breath in you! Anyway, I am estimating about 10% based on what I was then. I could be higher (as I squeeze my belly).

But whatever it is, I am still pretty lean. My abs still show pretty well and even my upper obliques. I did have some weight gain creep up on me two or three years ago - all right around my midsection - but only about 10lbs. I dropped it when my 34 dress slacks felt tight. Never got “fat.” Never noticed extra fat on my pecs. And I definitely hold fat around my torso, not on legs, butt or chest.

Did not gain any weight when I started TRT. I have been trying to drop weight just to be “lighter” so I have lost a few pounds. Want to run/train with my kids more but it kills my knees until I get under 200. But the TRT almost makes it hard to drop weight - it definitely fires up my muscles - they want to Grow!

I am unsure if I feel any lumps or not. Maybe smaller ones on each side. Definitely extra fat around, below and outside nipple. It seemed to come from nowhere…

I very much doubt you’re experiencing gyno with an E2 of 19. Adipose and glandular breast tissue are not the same…at least my wife’s breasts (real breast tissue) doesn’t feel like mine do (pseudogyno).

My wife has been “enhanced” after having four kids and I forget what real breast tissue feels like…

I have been on letrozole for almost three weeks and have seen a slight improvement. But it probably is a case of pseudogyno instead of the real thing.

A few questions for anyone reading:

  • I have read about prolactin causing puffy nipples. My scores were pretty low {Quest 6.4 (2-18)}, but i do seem to have some puff going on. What was the recommendation to treat this? I know it is different than gyno…

  • Whatever it is - psuedogyno, gyno, puffy nipples - it came on after starting TRT. Has anyone expereinced this at a low T dose and with low E2 scores?

  • I noticed this past weekend that after one beer, my heart seemed to be pounding! Anyone noticed an increased heart rate while taking letrozole and having even small amounts of alcohol?

You should be using a SERM, recommend nolvadex, do not recommend clomid because it makes some guys feel like crap.

Take the SERM, get back on T and add anastrozole. Do not front load anastrozole, you do not know if you are an over responder.

Letro without T will tank your E2 levels and that can make one feel light total crap and put the whole body out of balance.

Your breast tissue may be more sensitive to estrogens than other guys. Do you have a sister with big breasts? That is a serious question.

I have read many different suggestions for the dosage on nolvadex.

  • What dosage do you suggest?
  • Would you taper off the 2.5mg letrozole ED or just make a clean break and go back to the T and anastrzole?
  • Get labs again before I stop the letrozole?

I ask about the labs because although I am a little tired, I think I actually feel better mentally. I am curious if my T levels are higher as I am having more nocturnal erections and MW, as well as feel a little better mentally. Weird, huh? I originally thought this would happen because I thought I had high E2 levels, but they really weren’t, and I still think the AI by itself has drastically increased my T levels…

Funny question on first read, but I get it. I have five sisters and they and my mom are all of average or smaller “endowment.” No history of breast cancer either. Four brothers, but one passed away as a child. One is 49 and muscular - in good shape. Another brother is fat, but he’s not working out and drinks way too much. Younger brother is thin and in good shape.

I didn’t notice your routine for your TRT. When I switched my injections from IM every 2 weeks, too SQ EOD my gyno (hard sore lumps under nipples) went away.

First does was 100mg IM. Doctor wanted me to take it every two weeks. I knew this was not preferred, but agreed just to get it started. He then agreed to twice a week injections and upped the dose slightly the next week.

(All T-cyp)
Week 1:

  • Friday 100mg IM
    Week 2:
  • none
    Week 3 on:
  • Mon 40mg IM
  • Fri 40mg IM

Based on my labs he agreed to go up to 50mg twice a week, or 100mg weekly as often as I decided to inject. Twice a week is preferred for me as I travel weekly.

I am not currently taking the T because I have made to many decisions without enought information so far, but I have been considering doing sub-Q shots instead of IM when I start again. (I want to get one more set of labs in another week) I am looking for an upper limit for T shots given sub-Q. The IM shots do not bother me, but slower release is better and my main reason for TRT is my mood - it sucks! And if I switch to Mon-Weds-Fri, sub-Q would be easier.

My doctor is calling me in nolva - is 20mg daily acceptable?

As I have already F-cked this up, I am thinking I want to keep on the letro at 2.5mg daily and add the nolva 20mg daily for two weeks (six weeks letro with last two weeks adding nolva). Then I am going to get new labs. At this point I feel like it is a science experiment on myself and I am curious to see my labs with just taking these so I can give feedback to others. However, I also need to get rid of the girly looking nips that came from nowehere!

Once done with this, what is the best way to taper off the letro and nolva? Seems staying on the nolva would be smart as I taper off the Letro. I can drop the letro to 1.25mg Ed for a week and then to 1.25 EOD for a week, but should I stay on the Nolva during this time frame and after and then taper it too?

From there, how long would I need to wait to get my body back to its normal (whatever that means) state? I would like to get new labs establishing a baseline - since I never had these. Should I take anything else to help my body recover from this f-cked up trip to assist it getting back to its baseline?

2.5mg of letro for about six weeks and tapered off. Added nolva at 20md ED.

I wanted to get labs before I tapered off the letro but was unable to do so because my doctor was recovering from a surgery. I had what I think was an incredible increase in T from the Letro: nocturnal erections (could barely sleep!), morning wood, and some increased muscle density. I used this to motivate myself in the gym and starting making some time to push some heavy weights around again. Really wish I would have gotten the labs as i will swear my TT/FT must have been higher than they have been in a long time!

Anyway, dropped the letro and been running the nolva for almost four weeks at 20mg ED. I recently split it into 10mg morning and night. Gyno is gone - no more point at my nipples and very little fat in the area - much like before!

My nipples are still a little puffier at time than they were before, but overall things look much better!

Also - I want to turn the nolva into a SERM restart if possible. I have read about trying this in many spots, but cannot find a solid, complete protocol for it. I do not have any HCG but I have the nolva and arimidex, although I am not currently taking the a-dex.

Anyone give me a clear protocol for the SERM restart attempt?

NEW LABS - THIS IS INCREDIBLE!!!:

FSH: 18.8 [1.6-8.0 mIU/mL]
LH: 7.5 [1.5-9.3 mIU/mL]
E2: 27 [< 39 pg/mL]
TT: 1045 [250-1100 ng/dL]
FT: 216.3 [35-155 pg/mL]

Again, this is after the 2.5mg letrozole ED for six weeks, plus a taper. For the last week of letro, I started the 20mg nolva. For two weeks I took it in the morning. Then for two weeks I took 10mg AM and PM. These labs are from day 27 of the nolva!

I did not expect results like this. After day 30 of the nolva, I doubled the dose to 40mg (20mg AM and 20mg PM). I have been on this dose for about three days now (just got labs today). I also added .25mg arimidex EOD. I planned to follow this for 10 days, then cut back to 20mg nolva (10mg AM and PM) for 6 days, then down to 10mg (5mg AM and PM) until I run out.

Please advise if this is a good protocol to follow for the SERM restart and if not - what the heck should I be doing?

I dont want to F this up and lose these results!

Hoping to get some feedback - look at my labs above from a SERM resart. They are incredible! So how to I ween off this and keep these numbers?

Down to my last week of nolva. Taking 5mg AM and PM every day and .25mg Adex Tues/Fri. I think T levels are still good. Planning to get more labs in a week or so.

Any last suggestions to maintain my FSH and LH production?