T Nation

Sore Nipples on TRT


#1

Wt 150lbs ht 5’6 bf 18% been on trt for about 5 Wks. So I inject .4 two times per week. It says 200mg on bottle, so I would assume I am doing .8 of that amount. I started on .5 Adex 2* per week. Then doc bumped it up to .5 3*per week. Still had nipple sensitivity. Now he had me stop running adex for one week and run 10mg of novedex for 7 days to “rest” my receptors. Anyone else had sore nipples? Other symptoms are after the first week back to feeling out of energy. Talked to the doc about doing 2mg of adex per week. He said that was too much. Just wondering if anyone else has had this, what caused it, and what can be done to fix it. Lastly I am not dropping any body fat or weight after 5wks and diet has been primary low carb high protein. Would have expected more if this was working the way I anticipated.


#2

Have you had any follow up blood work done since you started TRT? 160mg a week is kind of a high starting dose. You could be aromatizing a lot. I’ve been on for about 5 months and have not seen any reduction in body fat. If anything I’ve gained some because I’m hungry more often than I was before. It’ll be interesting to see where that dose puts you. Good luck!


#3

No no follow up bloodwork yet. I will be very interested to see where my estrogen levels come back at. I just wondered if some people get sore puffy nipples no matter what when they are on trt.


#4

For you guys out there, could increased prolactin be the problem here? I too feel kinda puffy nipples even though my e2=22.

About your diet. Are you burning more calories than you consume? Have you gained muscle? You mention low carb and high protein…but what about fats? You need healthy fats. The diet that has gotten me the leanest to this day has been a keto diet. Basically high fat and high protein with about 20-30g carbs per day. But this is getting off topic for T replacement forum.


#5

Your doc is an absolute idiot. You need to learn this stuff in self-defense.

Stay on adex, Nolvadex will be increasing E2, not decreasing. Stop Nolvadex after 10 days and do as per:

Inject 50mg twice a week, subq not IM, #29 1/2" 0.5ml insulin syringe, pinch up skin over upper leg and inject into end of fold with needle parallel to muscle layers.

0.5mg anastrozole at time of injections. Will take 7=10 days to balance out.

Nipples react to E2 and/or prolactin. E2 comes from FT–>E2

Post your pre-TRT lab work with ranges.

Labs on TRT:
TT
FT
E2
CBC
AST/ALT
hematocrit
PSA if > 40
prolactin if <35
fasting glucose
fasting cholesterol
TSH

age
height
weight
waist size

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.


#6

Lab work
LabCorp Patient

REPORT DATE
MAR102017
Vitamin B12
Hemoglobin A1c
5.3NORMAL
Reference Range: 4.8-5.6 %
Vitamin B12
Vitamin B12
496NORMAL
Reference Range: 211-946 pg/mL
DHEA-Sulfate
DHEA-Sulfate
288.0NORMAL
Reference Range: 102.6-416.3 ug/dL
Cortisol
Cortisol
7.8NORMAL
Cortisol AM 6.2 - 19.4 Cortisol PM 2.3 - 11.9
Luteinizing Hormone(LH), S
LH
5.5NORMAL
Reference Range: 1.7-8.6 mIU/mL
FSH, Serum
FSH
3.7NORMAL
Reference Range: 1.5-12.4 mIU/mL
Insulin
Insulin
8.3NORMAL
Reference Range: 2.6-24.9 uIU/mL
Estradiol
Estradiol
16.2NORMAL
Reference Range: 7.6-42.6 pg/mL
Roche ECLIA methodology
Ferritin, Serum
Ferritin, Serum
264NORMAL
Reference Range: 30-400 ng/mL
C-Reactive Protein, Quant
WBC
6.1NORMAL
Reference Range: 3.4-10.8 x10E3/uL
RBC
4.95NORMAL
Reference Range: 4.14-5.80 x10E6/uL
Hemoglobin
15.4NORMAL
Reference Range: 12.6-17.7 g/dL
Hematocrit
45.2NORMAL
Reference Range: 37.5-51.0 %
MCV
91NORMAL
Reference Range: 79-97 fL
MCH
31.1NORMAL
Reference Range: 26.6-33.0 pg
MCHC
34.1NORMAL
Reference Range: 31.5-35.7 g/dL
Neutrophils
71NORMAL
Immature Granulocytes
0NORMAL
Lymphs
20NORMAL

Monocytes
8NORMAL

Eos
1NORMAL

baso
0NORMAL

Platelets
309NORMAL
Reference Range: 150-379 x10E3/uL

Neutrophils (Absolute)
4.3NORMAL
Reference Range: 1.4-7.0 x10E3/uL

Immature Grans (Abs)
0.0NORMAL
Reference Range: 0.0-0.1 x10E3/uL
Lymphs (Absolute)
1.2NORMAL
Reference Range: 0.7-3.1 x10E3/uL

Monocytes(Absolute)
0.5NORMAL
Reference Range: 0.1-0.9 x10E3/uL

Eos (Absolute)
0.1NORMAL
Reference Range: 0.0-0.4 x10E3/uL

Baso (Absolute)
0.0NORMAL
Reference Range: 0.0-0.2 x10E3/uL

RDW
13.2NORMAL
Reference Range: 12.3-15.4 %

C-Reactive Protein, Quant
C-Reactive Protein, Quant
0.4NORMAL
Reference Range: 0.0-4.9 mg/L
Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum
0.5NORMAL
Reference Range: 0.0-4.0 ng/mL
Roche ECLIA methodology. . According to the American Urological Association, Serum PSA should decrease and remain at undetectable levels after radical prostatectomy. The AUA defines biochemical recurrence as an initial PSA value 0.2 ng/mL or greater followed by a subsequent confirmatory PSA value 0.2 ng/mL or greater. Values obtained with different assay methods or kits cannot be used interchangeably. Results cannot be interpreted as absolute evidence of the presence or absence of malignant disease.
IGF-1
Insulin-Like Growth Factor I
188NORMAL
Reference Range: 75-216 ng/mL

Triiodothyronine,Free,Serum
Triiodothyronine,Free,Serum
3.1NORMAL
Reference Range: 2.0-4.4 pg/mL
Vitamin D, 25-Hydroxy
Vitamin D, 25-Hydroxy
32.8NORMAL
Reference Range: 30.0-100.0 ng/mL
Vitamin D deficiency has been defined by the Institute of Medicine and an Endocrine Society practice guideline as a level of serum 25-OH vitamin D less than 20 ng/mL (1,2). The Endocrine Society went on to further define vitamin D insufficiency as a level between 21 and 29 ng/mL (2). 1. IOM (Institute of Medicine). 2010. Dietary reference intakes for calcium and D. Washington DC: The National Academies Press. 2. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. JCEM. 2011 Jul; 96(7):1911-30.

Sex Horm Binding Glob, Serum
Sex Horm Binding Glob, Serum
30.4NORMAL
Reference Range: 16.5-55.9 nmol/L

Lipid Panel With LDL/HDL Ratio
Comment:
up to 40 years old.
Adult male reference interval is based on a population of lean males
Testosterone, Serum
248LOW
Reference Range: 348-1197 ng/dL
Free Testosterone(Direct)
9.3NORMAL
Reference Range: 6.8-21.5 pg/mL
TSH reflex to T4F
Cholesterol, Total
284HIGH
Reference Range: 100-199 mg/dL

Triglycerides
179HIGH
Reference Range: 0-149 mg/dL

HDL Cholesterol
48NORMAL
Reference Range: >39 mg/dL
Comment:
fasting LDL cholesterol is above 189 mg/dL or non-HDL cholesterol is above 219 mg/dL. A family history of high cholesterol and heart disease in 1st degree relatives should be collected. J Clin Lipidol 2011;5:133-140
Possible Familial Hypercholesterolemia. FH should be suspected when
LDL/HDL Ratio
4.2HIGH
Reference Range: 0.0-3.6 ratio units
VLDL Cholesterol Cal
36NORMAL
Reference Range: 5-40 mg/dL

LDL Cholesterol Calc
200HIGH
Reference Range: 0-99 mg/dL

TSH reflex to T4F
TSH
1.800NORMAL
Reference Range: 0.450-4.500 uIU/mL

Homocyst(e)ine, Plasma
Calcium, Serum
9.6NORMAL
Reference Range: 8.7-10.2 mg/dL

Glucose, Serum
99NORMAL
Reference Range: 65-99 mg/dL

BUN
14NORMAL
Reference Range: 6-24 mg/dL

Protein, Total, Serum
6.9NORMAL
Reference Range: 6.0-8.5 g/dL

Albumin, Serum
5.0NORMAL
Reference Range: 3.5-5.5 g/dL
Bilirubin, Total
0.4NORMAL
Reference Range: 0.0-1.2 mg/dL

Alkaline Phosphatase, S
90NORMAL
Reference Range: 39-117 IU/L

AST (SGOT)
25NORMAL
Reference Range: 0-40 IU/L

Potassium, Serum
4.3NORMAL
Reference Range: 3.5-5.2 mmol/L

Sodium, Serum
139NORMAL
Reference Range: 134-144 mmol/L

Chloride, Serum
96NORMAL
Reference Range: 96-106 mmol/L
Creatinine, Serum
1.05NORMAL
Reference Range: 0.76-1.27 mg/dL

ALT (SGPT)
27NORMAL
Reference Range: 0-44 IU/L
Carbon Dioxide, Total
25NORMAL
Reference Range: 18-29 mmol/L

BUN/Creatinine Ratio
13NORMAL
Reference Range: 9-20

Globulin, Total
1.9NORMAL
Reference Range: 1.5-4.5 g/dL

A/G Ratio
2.6HIGH
Reference Range: 1.1-2.5
Effective March 13, 2017 the reference interval for A/G Ratio will be changing to: Age Male Female 0 - 7 days 1.1 - 2.3 1.1 - 2.3 8 - 30 days 1.2 - 2.8 1.2 - 2.8 1 - 6 months 1.3 - 3.6 1.3 - 3.6 7 months - 5 years 1.5 - 2.6 1.5 - 2.6 > 5 years 1.2 - 2.2 1.2 - 2.2
eGFR If NonAfricn Am
88NORMAL
Reference Range: >59 mL/min/1.73

eGFR If Africn Am
101NORMAL
Reference Range: >59 mL/min/1.73
Homocyst(e)ine, Plasma
Homocyst(e)ine, Plasma
5.7NORMAL
Reference Range: 0.0-15.0 umol/L
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Patient Portal 2.00.01.1

age is 43
Ht is 5’6
Wt 150
Waist size 31
Lift 4 to 5 5 days per wk
Eat iodized salt


#7

Cortisol was not AM cortisol that would be done at 8AM or 1 hour after waking up. So cannot make any judgement about the lab value.

TSH=1.8 is normal, but still shows a problem that your requested oral body temperatures would address. FT3=3.1 is slightly below mid-range and would be expected to deliver good body temperatures. If body temps are low, we suspect that rT3 may be elevated and blocking some fT3 action at T3 receptors.

Vit-D25 is below optimal. Suggest 5000iu tiny oil filled gel caps.

E2 was low, low average FT led to low fT–>E2

Your body is storing iron well and RBC, HTC are as expected VS your T levels. No suggestion of any GI blood lost that we sometimes detect/suspect in some lab results.

What AI dosing now and have nipples settled down?


#8

On .5 adex Monday Wed Friday, and they are better but if feels like I need one more pill.


#9

May take time. It takes a week on a steady dose for a given anastrozole dose time to just get serum levels of the drug steady, then E2 needs to drop and gene expression and tissue changes in your nipples needs time too. I am not trying to minimize the issue. Act with knowledge, give changes a week to eval.

Please to not ignore thyroid and body temperature issues.


#10

Nipples are still sore as shit. Also I am on 100mg per week of test cyp 2x per week. I believe I said 100mg total before. I think I will try .5 adex 4 times this week to see if I can get this nipple issue resolved. Next step is blood work.


#11

So you’re on 200mg test cyp per week. That’s pretty high man. It makes sense that you would need around 2mg anastrozole per week at that test cyp dosage. You can also lower your test cyp to 150mg per week and stay with your current 1.5mg anastrozole per week. In my situation I am taking 112mg test cyp per week and I need 1.33mg anastrozole per week to stay around E2=22


#12

Whatever you do. Whenever you change any part of your protocol, wait atleast 2 or 3 weeks before blood work. Take your injections and anastrozole together so blood work will show true values. You need to get blood drawn half way between injections


#13

Sounds good man. Thanks for the advise.


#14

If AI dose is good, you should feel good in 5-7 days.


#15

I thought I read on here that the “normal” dosage is 1mg of Adex per 100ml of test cyp. Is that accurate?


#16

Most of the time. But some, not rare, are anastrozole over-responders who will crash E2 on that and then feel like crap. They need to stop for 5-6 days then resume at 1/4th the expected dose. One guy had to get to 1/8th. We don’t all have the same genetics, mostly in genes that code for enzymes.


#17

So my dose of test was lowered to 160mg per week and hcg is 60iu’s per week. Is 1.75mg of anastrozole about the correct dose? On hcg dosage what ever .6 is on the insulin syringe is what I do. I get
That is is about 100mg of anastrozole per 1ML of Test, but does it need to be increased when hcg is added to the protocol?