T Nation

Need Help and Advice!

Here’s what I’ve got going on…short version to spare everyone the long drawn out details.

The wife and I were trying to have kids, she checked out fine and testing on me found my Testosterone low and a zero sperm count. So, I went to a Urologist and the doc put me on HCG shots. 1500 IU / EOD (A LOT HUH?) Over the past 6 months my Test came up to good levels and I’ve now got sperm!

About 6 weeks ago I started getting very sore nips and lumps. Sadly gyno had set in. The doc put me on 1mg Arimidex every day…and that DID NOT HELP ANYTHING AT ALL. He told me to give it time and I did for a month on the Arimidex with no results.

Fear of the Gyno setting in permanently made me take further action as I couldn’t wait on the doc to schedule a blood test and then wait weeks for him to get back to me with the results and “maybe” a different script for meds. I started Letro 2.5 ED and Tamox/Nolva 40 ED.

Not sure if it was one or both, but that worked wonders! Gyno is pretty much all gone and my nips don’t hurt anymore. So, here’s my problem. Now that I’ve bombed my system with anti-E medicine…

Arimidex for the past 6 weeks
Letro past 11 days
Tamox past 11 days

How do I get my Estrogen levels back up to where they should be? Obviously the HCG shots that I’ve been on and have to continue taking caused too much T in my system and it converted / raised my E levels. I’ve bombed that down to nearly nothing I can tell due to low sex drive and weak boners.

Should I lay off of the Arimidex for a while? How long? Then, start taking it again to stop the conversion? Or, will dropping the Letro and Tamox/Nolva be enough to let my E come back up a little bit?

I hope this all makes sense and you guys can follow what I’m getting at here. Basically, just the HCG leads to too much conversion to E and the gyno. I then took drastic measures with 3 anti Estrogen to kill it all off. So, I guess it boils down to the question…should I lay off of the Arimidex for a week and then start taking it again? Or, should I take a lower dose of Arimidex so that I get some conversion to E, but still keeping excessively high levels of E from occuring?

I want to get back to feeling normal and have that awesome sex drive back to where it was, but without the GYNO of course! Dropping my E this low has definitely affected my well being. I’m tired as hell all the time and can’t get more than 5 hours of sleep at a time, lightheaded, dizzy, workouts suck the last few days.

Fire away with comments / suggestions / help! I’d appreciate it!
Thanks!

Taking both letro and adex at the same time is dumb when they both do the same thing.

Letro is harsh in its effects and dose response varies wildly. For that reason it is best avoided.

You cannot stay on SERMs. Do not stop the SERM suddenly, taper off.

1mg adex EOD is a large amount of adex, that should be more than enough.

Suggest that you reduce hCG dose now that your testes are physically recovered. Too much can actually down regulate your LH receptors - a bad thing. Try 500iu SC EOD. Get the adex levels down first. You do not want to be on the adex + letro when you reduce your hCG and E production. Your large dose of hCG is not sustainable.

There is aromatase in the testes and normal T levels inside the testes are 80 times higher than serum levels. That is a lot of testosterone pressure on the aromatase reaction process. With your current hCG dose that is 6 times what is normally used for TRT, your intratesticular testosterone levels are probably way beyond normal.

What were your LH labs? List level, units and range.

Most on TRT use 250iu hCG EOD to counteract the loss of LH from HPTA shutdown.

If your T levels are not satisfactory with 500iu EOD, then start injecting.

What are your free and total T levels now?

Do you have E2 lab results?

When you did adex alone, did you get E2 labs? When on adex alone, what happened to your libido and mood?

Did you have prolactin levels tested? Elevated prolactin can shut down your HPTA. Prolatin + estrogen = gyno.

You did not state your age or physical condition. If younger, your pituitary should be scoped to check for a growth that reduces LH and/or increases prolactin. Did you have any accidents, whiplash or blows to the head in the time frame leading up to these problems? Have you had any disturbances to your vision? You are having symptoms treated, but the root cause is not known.

Some drugs/meds can affect the liver, increase E, which lowers T. These can be Rx, OTC, alcohol, stimulants. Liver problems can do the same. Tea tree oil or lavender are also estrogenic and there are a few examples where these have create gyno.

[quote]KSman wrote:
Taking both letro and adex at the same time is dumb when they both do the same thing.
--------> I always thought Arimidex stops the conversion process from T to E and Letro actually kills off the E that’s there. This is why I was on Adex so long and it was not helping my Gyno at all, in fact it was getting worse. Adex did nothing to reduce my blood levels of E that were already elevated.

Letro is harsh in its effects and dose response varies wildly. For that reason it is best avoided.
------------> Fact is, it worked wonders and has almost erased the gyno in just 11 days.

You cannot stay on SERMs. Do not stop the SERM suddenly, taper off.-----Will do for sure! I’m in the taper off phase now.

1mg adex EOD is a large amount of adex, that should be more than enough.------See above…yes, enough once E levels are dropped but not enough to do anything about the E that was already in my system.

Suggest that you reduce hCG dose now that your testes are physically recovered. Too much can actually down regulate your LH receptors - a bad thing. Try 500iu SC EOD. Get the adex levels down first. You do not want to be on the adex + letro when you reduce your hCG and E production. Your large dose of hCG is not sustainable.----I asked 2 docs about the dosage I’m on of the HCG (1500 units every other day) and they both tell me that’s a common fallacy and they don’t know where it comes from. Both said they’ve seen multiple medical studies showing long term 1500 EOD is fine and causes no problems. Also, said they have NEVER seen any studies showing down regulation. Wish I could find this info showing that somewhere on the net! (Besides simple statements made by everyone on BB and TRT forums.) Let me know if you can point me towards one so I can show the docs!

There is aromatase in the testes and normal T levels inside the testes are 80 times higher than serum levels. That is a lot of testosterone pressure on the aromatase reaction process. With your current hCG dose that is 6 times what is normally used for TRT, your intratesticular testosterone levels are probably way beyond normal.

What were your LH labs? List level, units and range.
------LH tests DATE / LEVEL
March .3
April .3
May 3.4 (maybe a different test method of reporting?)
July .3
December <.20

Most on TRT use 250iu hCG EOD to counteract the loss of LH from HPTA shutdown.

If your T levels are not satisfactory with 500iu EOD, then start injecting.

What are your free and total T levels now?
----------->Just now talked the doc into doing the Free Test and supposed to get the results tomorrow. Tests so far for total T are:
March 1.62
April .83
May 1.65
July 7.61
December 4.54
I think he put me on the HCG about June, thus the increase in July December readings.

Do you have E2 lab results?
----------------->Yes, and again, waiting on more results tomorrow…but thus far tests were:
April 18.69
December 68.47 <—that’s when he put me on the A-dex, took it all January, 1 mg per day and gyno kept growing!

When you did adex alone, did you get E2 labs? When on adex alone, what happened to your libido and mood?------> Those test results I get tomorrow will show the Adex only results of E. Didn’t start the other until after that blood test.

Did you have prolactin levels tested? Elevated prolactin can shut down your HPTA. Prolatin + estrogen = gyno.
------->Yes, and currently on .25MG Dostinex 2 x per week. (.5mg per week total.
march 22.33
april 8.01
July 4.55
December 1.95
As you can see, started the Dostinex after the March test and it’s been dropping since. No Prolactin problem at all connected to this bout with Gyno as you can tell by above results.

You did not state your age or physical condition. If younger, your pituitary should be scoped to check for a growth that reduces LH and/or increases prolactin. Did you have any accidents, whiplash or blows to the head in the time frame leading up to these problems? Have you had any disturbances to your vision? You are having symptoms treated, but the root cause is not known.
------------------> 38 years old, 5-8, 185, muscular, lift 5 days per week and about 3 hours total cardio per week, have been lifting since 16. Right off the bat, he suspected pituitary probs, did an MRI and came back all normal, no tumors. No major head injuries / whiplash since playing highschool sports, nothing significant then either.

Some drugs/meds can affect the liver, increase E, which lowers T. These can be Rx, OTC, alcohol, stimulants. Liver problems can do the same. Tea tree oil or lavender are also estrogenic and there are a few examples where these have create gyno.---------Don’t really take too much OTC stuff. I eat very clean and lean but I do have very strong coffee in the mornings and once in a while pop an ephedrine to help bust out a good workout.

[/quote]

See above comments below yours, trying to anwer all of your questions. Hope this helps you get a better understanding of what’s going on. Thanks for the comments, greatly appreciated. Any additional comments with the new info above? Also, here’s a chart I made up…note the E has been cut in 1/2 of what real values are since it was screwing up the graph, so double the E values line.

Are you using Rx Arimidex?

I have never seen any report of someone who is non adex responsive. You could drop the adex and try to find a letro dose that allows for E2 moderation instead of elimination.

Your prolactin response to cabergoline is very impressive. The fact that it is progressive would indicate that something else is changing over time.

What was the relative timing of cabergoline, hCG and gyno?

Yes, scripted from the doc and bought from local well known pharmacy chain. Brand name stuff too, not a generic. So I can only assume it’s good and it’s nowhere near the expiration date so I assume it’s fresh.

He put me on the Cabergoline after the first blood test, so that’s why it shows such a drop on the very next test.

Have been on that HCG for 6 MONTHS prior to the Gyno flare up 6 weeks ago. What could have changed in my system to make gyno flare up after 6 months of HCG.

p.s. How do I post up a picture? I’ve got a nice graph that shows all my levels and the changes that have been taking place…I just can’t figure out how to post it here.