T Nation

SERM or AI on TRT?


I’m permanently on TRT because of hypopituitarism. I’ve been trying to get rid of these puffy nipples for quite some time now.
I usually take 200mg cyp 1x p/wk, but my test has skyrocketed. Recent blood-work showed the day before my next injection I was at 1262.
I also got my estrogen results, which were very high. 340 with a range of 40-115.
Because of this I have reduced my dose to 160mg cyp 1x p/wk
I’ve been taking Androst-3, 5-dien-7,17-dione 40mg 2 to 3 times a day with little to no results.
My doctor didn’t prescribe me anything, even after I asked him, because he wants me to see an endocrinologist. I usually see one, but long story short is he was holding the referral ransom.
An AI is easy to get, but i’m not too sure about the SERM.
Appreciate any help.


Typically men start out at 100mh weekly with 2-3 injection per week unless SHBG is skyhigh then once weekly will do. I say drop down to 50mg twice weekly until you see an endo who will likely not know what he’s doing anyways. Most doctors get TRT wrong.

I’m betting it’s the female E2 test, as I said most doctor get TRT wrong and often use the female E2 testing which isn’t sensitive enough for males. Using the wrong test overstates your actual E2 score. Tell your current doctor if you get gyno you’ll sue since your doctor prescribe it without know what the **** he’s doing.


Looks like he is testing total estrogens.

The concern is FT–>E2 and we test E2 and OP does not have that lab work and his doctor seems unworkable.


We need labs in list format, properly identified with lab ranges.

You need to modulate aromatization with anastrozole.

SERMs typically increase E2 while reducing visibility of estrogens in Selected tissues. SERMs do not reduce estrogen levels. SERMs useful short term to deal with gyno, but lower estrogens via AI is the solution.

High E2 causes liver to produce more SHBG that leads to more SHBG+T that inflates TT, reduces FT and overstates your T-status.

E2 can be increased by impaired liver clearance.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re Thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number Aand ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


I uploaded a copy of the results. I prefer to pin weekly, just my preference. I definitely wouldn’t cut it down to 100mg a week though, that’s half of what I was doing and 60mg less than what I’m doing now.


Unfortunately my doc didn’t test for T3/T4 and only tested TSH after I told him not to because I have no pituitary gland which means no TSH. You answered the question though, I should look for an AI product. I found Estro Stike 2.0. Maybe you or someone else has heard of a better brand?


Do not do that, search for ‘liquid anastrozole’.

So zero TSH and you are alive?


Yea, long story short I had a brain tumor wrapped around my pituitary gland and the surgeon removed both. On full hormone RT. I’ll always be taking test.


I will second what KSMan said about anastrozole. Don’t use an AI that’s non-pharmaceutical. Most of the OTC versions of AIs are a waste of your money and in all likelihood will make it significantly harder to dial in your numbers.


hGH as well. What IGF-1 levels do you get?

Body temps are the bottom line and if good, no need to check fT3.

Just remember that fT3 is the only active hormone.