T Nation

What's the Community's Thought on the TRT Hormone Optimization Guys?

I’ve been watching their videos on E2 and how you “don’t need” AI. I feel off on my current protocol, considering going off AI entirely to see if i can feel better. One thing they don’t address i’ve noticed, is guys who are gyno sensitive. I have hypogonadism (original test levels were 300), and had gyno in HS, and again when my first clinic fucked up my protocol. I had it surgically removed, and i don’t think tissue can regrow based on the surgeons technique, BUT that’s a big risk to take. I’d rather not have to get tits again. My symptoms right now are brain fog, erection issues, low energy, nagging tennis elbow - i think that’s related. Part of that stems from the fact the provider changed the strength of the AI without telling me. They were trying to save money and switched me from .125 anastrazole to .25 since they were the same price, but since i had no idea i was doubling my AI for the past 2 months - Before that, the protocol was working great. This lead me down the trt without AI rabbit hole, and i’m wondering if it would work for me. I’m wondering if the no AI thing is a possibility for me, or if i’m on too high a dose to go without.

My current protocol: – Since i’m gyno sensitive, the provider let me lower my T, and supplement with deka.

  • Change T Cyp 200 mg/ml – 0.171 every other day
  • Increase Nandrolone 200mg/ml 0.2ml IM/SQ every otherday
  • Change HCG 225 iu SQ every other day – (I plan on scaling this back to 150 IU - trying to find my minimum effective dose to prevent painful testicle shrinkage)
  • Change Anastrozole 0.25mg every other day (2 pills with injections) - scale back to one if you notice low estrogen
  • Continue DHEA 25 mg by mouth every night

Recent lab results: - i can post full labs if that’d help, but here are the important ones i believe.
1432 total test
30.3 free test
prolactin 12.1
estradiol sensitive - 24.7
SHBG - 20.7

The general feeling on here is don’t take an AI if you don’t need it. Start without, preferably with only testosterone, and see what happens. If you need to add something, make only one change at a time. As in, don’t change your dose and change your frequency or do both of those and add an AI at the same time, etc.
Most guys do not need an AI. A lot more guys use one than need one. And gyno is not necessarily a thing that comes with TRT just becasue you raise your E2. Danny, on that channel, had gyno in highschool but has no issues now, as an example. Most importantly, listen to your body, be very patient, and do what works for you. Some guys have issues with HCG. Most guys have issues with Deca long term, some have issues right away. AI’s can cause lots of sides. Raloxifene or Nolvadex would be a better choice for gyno issues anyway.

I was on a bad protocol for the first year. They had me taking 140mg of test cyp weekly, 500iu (i forget, maybe that was twice/week) of HCG with no ai. It caused moderate gyno. I begged for AI and they finally gave it to me but it was too late. I later found a better clinic, and i was on AI from that point on.

I never tried a good protocol without AI. I just don’t know how to tell if i’ll get gyno again if i try it out. They say to make small changes, but i’m not sure what my path to a no AI attempt would be. First. Half the deka. Then half the hcg, then drop the AI? This would take 12 weeks if i waited 4 weeks to make each change. I would do daily injections if it meant no AI. I’m a pin cushion at this point anyways with 9-10 injections/week. I’m fucking with Mt2/pt-141 to get a tan/deal with erection issues. (can’t take viagra because of my retina eye disease)

I should probably talk to my doc about this, huh? I was status quo before and feeling pretty good until they fucked with my AI

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Are you sure? This doesn’t make sense. We’re talking about a prescription drug, and just because you can get it at a 2 for 1 price doesn’t mean you should double your dose. Maybe the pharmacy sent the wrong prescription? I find it hard to believe the doctor would double the dose without discussing it with you.
Anyway, what’s done is done. I hope you double check prescription labels going forward.

Most take more without the need for an AI. However, you have a previous history and while following surgery it should not come back, it’s still possible. For me, it’s a shared decision making process with the patient fully understanding the pros and cons of all choices. Sounds as though you do.

Unless i didn’t catch it, the strength change wasn’t discussed. The doc wrote it out the protocol the same as the previous protocols .250 anastrazol after injection - I was already doing that using 2 .125 pills. I think it was an administrative mistake where they thought he was changing the pill strength. I’m not trying to throw stones, just get to the root of the issue. I think i felt good before the AI was fucked with.

Since posting, i called the provider to setup an interim consult - no labs. I just want to talk it out. Ask about the long term issues with taking deka. See if he thinks i could get away with taking no AI if i had the right protocol. Until the consult, i think i’ll just scale back my AI and take the last known dose where i felt ok.

I’ll update y’all if we make any changes

I’d say your elbow are sore based on your E2 to T ratio. Its low. I would at the very least cut way back on your AI. Maybe you are one of the few that actually is genetically prone to gyno and need a bit, though Danny Bossa had gyno removed and keeps his T and E2 high now and doesn’t have a problem.

Is there a typical minimum effective dose people take? I was going to try .125 of anastrazole at time of injection, and maybe .125 the next day. Without that, i feel a little nipple sensitivity day 2. But i haven’t had any new gyno, so maybe i shouldn’t take pill on the days i don’t inject.

.171mL EOD = 120mg/week, right? You likely won’t need an AI at that dose, and your TT:e2 could come down a bit. Ask them for Tamoxifen if gyno is a concern.

I had the surgery too and a little grew back on one side (that’s also the side he didn’t take as much tissue out). But it’s not noticeable, I’m just hyper-aware of it.

Most folks dont know what gyno really looks or feels like. Some think its an itchy nipple. Trying to block gyno with Anastrozole is like using a sledgehammer for fine, detailed work.

I think that is true, mastalgia is not gynecomastia.

Do you mean it does not work, or there are other things which are better? I know a lot of guys who have successfully treated gynecomastia with AIs.

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Anastrozole works, and you can master it. But there are other options that can target E at the source.

I know what gyno feels like. I had it, and had surgery to remove it. I’m trying not to get it again.

This is Danny Bossa from the TRT and Hormone Optimization YouTube channel. I happen to be extremely gyno sensitive and even made a video about it and what I did to fix my gyno.

Let me know your thoughts:

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Never use anastrazole for gyno. If you want to use anything, a SERM such as Nolvadex would be way more appropriate given it blocks activity at the breast receptor site instead of blocking aromatase everywhere (such as the brain!). This can be used temporarily in some cases to prevent excessive swelling but the root cause needs to be addressed to ensure it doesn’t come back. The key here is to keep hormonal activity stable.

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Thanks. Didn’t realize you were on this forum. I setup a consult for Friday with my provider to ask if he thinks i could go AI free if i switched to daily injections. Just watched your video - thanks! you’re up to 300mg/week of test with no AI and no gyno symptoms? That’s incredible.My doc lowered my T and put me on deka/test together thinking there would be less aromitization. I’m sure i was dialed in at some point, but got greedy and wanted more lean muscle mass so ive prompted tweaks to my protocol at nearly every 6 month check-in trying to get above 30 free T, But i need to drop the AI. my erections have suffered big time because of it. I’m only 38, way too young for actual ED. This is self induced.

Right now i’m taking EOD:

  • T Cyp 200 mg/ml – 0.171 every other day
  • Nandrolone 200mg/ml 0.2ml IM/SQ every otherday
  • HCG 225 iu SQ every other day
    .25mg of anastrazole at time of injection

Oh boy…

Some things to keep in mind:

  1. Frequency of injection: some guys will do better with twice weekly, some with EOD, and some with daily. You’ll need to experiment over a period of time to see where you feel best. If there is a big difference, stick with that. If no big difference, twice weekly is more than sufficient.

  2. 200mg of nandrolone for ‘therapeutic doses’ is quite high. I personally would not exceed 100mg a week for this purpose. You also do not need to dose this EOD because the half life is quite long. Most guys inject once a week or, at the most, twice a week. EOD is unnecessary here.

  3. Why are you taking HCG? If you’re trying to retain fertility, fine. If not, ditch the HCG as it just complicates a protocol most of the time. I always prefer to have someone dialed in on T FIRST and THEN try to incorporate HCG if they’d like to see if they feel a benefit or not. Doing all this all at once is just going to make things take that much longer to get figured out. Test one thing at a time.

  4. You’re taking almost 1mg a week of anastrazole. That’s INSANE. Please slap your doctor for me. Not to mention you’re taking testosterone and nandrolone which means your E2 is already going to get quite low and then you’re adding this much AI? On second thought, slap him twice.

If I was in your shoes: 200mg a week of T EOD shots, 100mg nandrolone once a week. That’s it. HCG if only to retain fertility.

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Thanks for responding. I’ll bring up lowering deka - i saw in one of your videos they like to do a 2:1 ratio of test to deka. my testicles ached and sucked up inside my body when i was on T alone. not sure if that phase passes, but i didn’t stick around to find out. HCG was offered as an option from the start and i went for it. I have 3 kids and i’m snipped, so its not for fertility

Nandrolone. Good at adding muscle mass… bad for erections.

Probably.

Not necessarily. Many men suffer ED at this age but you are making this more complicated than it needs to be. I think you need to go back to square one with a solo testosterone regimen. Start tweaking from there unless you remember a protocol that had you well. Nandrolone is only going to make all matters worse as its a wild card for side effects (ie neurological problems and ED most commonly). Also, long term Nandrolone is bad idea, please read a few recent threads on this. If you want to use it for muscle building and joint relief so be it just beware of the risks you are taking.

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@blshaw I was always under the impression that nandrolone caused the infamous ‘deca dick’ for everyone until I tried it for myself and, by some miracle, 100mg a week actually improved libido and erection strength. I found others who experienced the same. This appears to be one of those things you have to try for yourself and see like anything else. Anything under 100mg a week is typically fine though some men wind up with E2 getting too low and a deficiency of this is not good. Definitely avoid nandrolone if you’re still using an AI for some crazy reason. I would not use anything more than 100mg long term. 50mg is usually plenty for therapeutic doses and I get benefits from that myself. Higher doses can eventually have a detrimental impact on neurotransmitters and that is something you definitely do not want to mess with (I’ve seen this occur with some guys and it’s NOT good).

@waylon1981 then by all means take it. Some guys only get mild atrophy that they barely notice (like me) and others get something more severe which causes pain (like you) so a touch of HCG will definitely help to maintain size to prevent atrophy. This is a case where it becomes necessary so stick with it, by all means.

Just in case you guys never saw this one… quite interesting: