47 y/o Male Multi-sport athlete new to TRT/HRT

[alpinist]

I’m a 47 y/o male recently diagnosed with low T.

5’7”, 158 lbs. 12% BF

I’ve been an ‘adventure/endurance athlete’ my entire life. All of my activities/sports are powered by me so power-to-weight ratio is important. The last couple years my training has consisted of mountain biking (3 to 6 hrs week), trail running, hiking with a 40 lb. pack on (2 to 4 hrs week), weight training (mainly to keep muscle groups balanced/toned. 2 hrs week), and rock climbing (training in a climbing gym. 4 hrs. week). I know how to train and can still make my bike go and climb at a level higher than a casual weekend warrior.

I was a ski racer in my late teens. Transitioned to bicycle racing and triathlons. Surfed a bunch. MMA for a couple years. Rock, ice, and mountain climbed all over the place last 10 years.

I’m an MBA and have been an entrepreneur forever. I’m very risk tolerant in everything I do.

I’m mostly vegetarian and have eaten very clean/smart my entire life. I eat adequate protein. Elevated cholesterol is hereditary. Vit D was a bit low so have begun a supplement.

No smoking, virtually no alcohol or caffeine.

My fitness is excellent and other than totally fading in the evenings my energy has seemed OK. Libido reasonable (I think) for my age. My sleep is not great but I do manage to get 7 to 8 hrs. a night.

Recently I went to a Naturopathic doctor to check for mild food intolerances (I have virtually none). Blood panels came back Low T. Dr. prescribed 200 mg T Cyp every 7 to 10 days. I had my first injection 7 days ago and the 2nd yesterday (6 days apart because of scheduling). I’m possibly projecting but it seems I’m sleeping a bit better and have a slightly better mood.

I’m completely new to TRT/HRT and am hopeful I can get some feedback. (I’ve been reading here for a couple weeks) Dosages, other dr*gs to consider, blood panels, concerns, books, articles, etc? I understand I’m on this track for the rest of my life and I’m cool with that. I just want to get up to speed fast as possible.

Thanks and Peace

[steroid.com 1]

Welcome to the community alpinist!

Wow man, what a life you live!

Now if you said you were as good looking as Brad Pitt and had the hottest chicks on the planet constantly chasing you down I'd have you banned from the forum...jk LOL!

Good for you though and I for one am really impressed with your dedication.

With the exceptions of Vit D and Test levels you look great!

Get your Vit levels up by taking the best quality of D3 you can find. Get it in 5000iu caps and take twice a day with a meal and good multi.

Your low Test levels are probably just age related and with some influence do to the amount of exercise you do...may need a few breaks.

Ok, now why 200mg every 7 to 10 days? This is the higher end of what is normally prescribed by a Physician in the know AND pushing the envelope of half life. Dosage amounts like 60 to 100mg are what the leading TRT practitonares are starting men out on.

Also, are you injecting yourself (you should be)?

If so split your dosage into two 100mg twice a week like Monday AM and Thursday PM.

Did your physician talk to you about what happens to your HPTA when you start on exogenous testosterone .

Did he talk to you about the need to hCG (if you didn't read the sticky on this...read it)?

Your E2 looks good at 30 but there's an excellent chance it will rise in time so did the Doc talk to you about the use of an aromatase inhibitor?

Also, read the noted sticky here and read about back filling your pathways with Pregnenolone and DHEA.

[kelkel]

Agree with GD. Only thing is it would have been nice to at least try some alternative therapy and see if it could have helped prior to TRT. And yes, 200 is a high end dosage. Make sure you get complete follow up BW. It's in the stickies. Great first post Alpinist! You've landed in a great place here. Welcome!

[keep fightin]

think I will go hang glide off my roof or something! great informative post alpinist..please listen to our knowledgable members and digest those stickies, you've shown great diligence to your health but you need more info to fully benifit from this new chapter, great to have you on board, best forum by far!

[alpinist]

Cool. Thanks for your time, info, and warm welcome. This is definitely all that's cool about humanity and the internet!

My doc has very limited experience with HRT. However, he is young, bright, admits when he doesn't know, is willing to learn, and I like him. Therefore, I'm gonna, with all your and this boards help, get him up to speed so my sack doesn't shrivel to labia-like status!

I'm reading my ass off on the stickies and taking notes. I kinda feel I jumped a bit fast but will hopefully get the chute out before going splat...

I wasn't aware 200 ew was a high dosage so I'm definitely going to query him. Also, about hCG and Pregnenolone. E2 is Estradiol, I presume? If so, yes he did mention the conversion of T to little t (tits).

I have not given the T injections myself but intend to. I just haven't figured out how to draw the plunger back whilst the thing is shoved in my bum. (upper/hip)

What are some of the alternative therapies kelkel refers to and is it too late/hard for me to even consider them?

Thanks again!

[steroid.com 1]

Dr. John Crisler is considered by many as one of the leading practitioners in TRT for men. The links below were written for men to take to their Physicians as a guide to proper Testosterone Repla***ent and ongoing management.

Print both of these out and take them to your Physician as they are probably the two most downloaded documents on the Internet of this subject matter.

Read and study them yourself. If it goes over your head...fine...now Google what you don't know and learn!

Both of these will be of great assistance to your young and open minded Doc...and if he gets it...he'll have a nice new line of business for his practice!

http://www.allthingsmale.com/word_docs/TRT.doc
http://www.allthingsmale.com/word_docs/HCGupdate.doc

[ecdysone]

Like GD said your 200 is going to be way to high (most likely) and will force you into HCG and AI's (probably). Your estradiol will require some work.

Me, I would still be concerned with your chol/trigly: endurance athletics drop dead all the time... what have you considered?

Have you done any nuclear stress tests or the like?

[alpinist]

Thanks for the links GD. Definitely interesting reading!

So it certainly appears I should pull the T cyp back to 100 wk or 50 2x week. Besides that should I be seriously be thinking about hCG or an AI right away? Or a supplement like DIM? Or should I just wait and see what my next BW shows? On the note of BW, when should I check again? I kinda feel like I should check it weekly for awhile or should I wait a month? (The expense to check weekly is not a concern)

ecdysone, thanks for the concern on the Chol. I've had my carotid arteries scanned for plaque buildup and they are perfectly clean. Also, there is no heart disease in my family. I've had an EKG stress test and I pretty much 'crushed it'. Not totally relevant but I've also ton a bunch of VO2 max testing and it certainly appears everything is working as intended. Also, my LDL/HDL ratio is, for now, below average risk and my CRP for future cardiovascular event is low. I totally understand that none of that guarantees I don't have a heart attack next time I'm doing intervals but given all the above info vs. more Rx stuff I'm taking my chances au naturale.

Last, where are you guys self pinning the T? I'm trying to figure out how to one-handed get it into my hip/ass and being able to pull the plunger back with the same hand.

Thanks

[kelkel]

Regarding pinning check out spot injections .com and/or just google the site you want to inject and you'll get decent videos. It's easier than you think to aspirate as the plunger barely has to move back for you to see what you need. Some people stick to one spot, others (myself included) rotate around. I go between delts and glutes so 4 entry points. Occasionaly sub-Q but not often. Delts are amazingly easy. I'd recommend at least a 25ga 1" pin (even 27) with extra 18ga tips for loading only. The smaller gauge forces you to push the compound in slower which is beneficial.

Alternative therapies I was referring to was Clomid, Nolvadex (both serms) and HCG . All in effort to stimulate natural production. Works for some, doesn't for others. At this point you'd basically have to come off and do a pct in effort to re-start your own hpta.

[zaggahamma]

welcome

good info so far

just have to add that a lot of members do well with injecting only once a week

[bullshark99]

Enjoyed your post alp, normally once gd, kel or a few other comment, I dont bother. In this instance, the 200 your doing is clearly high for a starting dose, however, I too am on 200mg weekly and have never had a blood test out of range with anything other than E2. You will definetly have to talk A.I. with your Dr, unless you are like a couple exceptions, you will get elevated pretty quick and experience the undesireable side of high E2 not to mention defeating the whole purpose of t supplementation.
Surprised how aggressive your Doc is but again, you are not the "lone ranger" here doing 200 per week as many others do. As you already know, you are totally "shut down" so you body is operating purely on Exg tes. I have considered dropping to 150 myself , but until the BW dictates, probably not. May want to consider 2 shots per week, especially if you dial it down a bit.
HcG is also a must (IMO), I do not realize the benefits that others claim (well being, energy ect) but cosmetically this will take care of the testicle atrophy, it truely works.
Sounds as if you understand the lipid deal so I'll leave that alone, the Vit D is sooooooooo common amongst men, but 5000iu's per day should solve that.
Be well, and welcome!

[APIs]

Enjoyed your post alp, normally once gd, kel or a few other comment, I dont bother. In this instance, the 200 your doing is clearly high for a starting dose, however, I too am on 200mg weekly and have never had a blood test out of range with anything other than E2. You will definetly have to talk A.I. with your Dr, unless you are like a couple exceptions, you will get elevated pretty quick and experience the undesireable side of high E2 not to mention defeating the whole purpose of t supplementation.
Surprised how aggressive your Doc is but again, you are not the "lone ranger" here doing 200 per week as many others do. As you already know, you are totally "shut down" so you body is operating purely on Exg tes. I have considered dropping to 150 myself , but until the BW dictates, probably not. May want to consider 2 shots per week, especially if you dial it down a bit.
HcG is also a must (IMO), I do not realize the benefits that others claim (well being, energy ect) but cosmetically this will take care of the testicle atrophy, it truely works.
Sounds as if you understand the lipid deal so I'll leave that alone, the Vit D is sooooooooo common amongst men, but 5000iu's per day should solve that.
Be well, and welcome!

x2 on this. However, people automatically like to bash 200 mgs/week around here it seems. Discussions with your Doctor, BW results & how you feel should be the deciding factors in the amount of Test Cyp administered per week. I started treatment at 50 mgs, twice per week also. My "sweet spot" in terms of both strength & energy was found to be @ 200 mgs/week divided into 100 mg doses every 4 days. With your level of training, you may find this to be true for you as well. As for injection sites, I do well alternating Delts alone. Sounds like you found a good Doc, so I'm sure you'll work this out.

[alpinist]

Thanks to all. I guess I'm surprised how new TRT is and how little consensus actually exists on protocols. Even tho it's all incredibly complex with many interdependent variants, it seems there's a big opportunity for some primary research. For now tho I'm happy to post my results/progress to add more anecdotal evidence. This place seems to have a good crew of caring folks and I'm stoked to have found it. I'll try to support it best I can.

Anyhow, kelkel, thanks for the youtube suggestion on pinning. Of course youtube has it!

jpkman, bullshark, and apis, thanks as well for the 'alternative' viewpoints and tips.

Last, I've been feeding my doc the info you guys are posting here. He is genuinely interested. Also, he asked if you had any opinion or experience with the Wiley protocol. Apparently it's cream based 2x day that has some type of 'rhythmic dosing' throughout the month.

Also, he mentioned natural AI's such as Chrysin and Myosin. Also, I have a friend on DIM.

Thanks again!

[steroid.com 1]

Wiley Protocol = Rhythmic Dosing.

The idea here is to "try" at best to mimic the bodies own natural androgenic rhythm.

The protocol looks more like "hocus pocus" to me and I've never read where any of the leading Testosterone Repla***ent Physicians ever prescribed this type of protocol.

From the Wiley site:

Based on 8 day Sun cycles of magnetic fields.
Consists of Rhythmic dosing of Testosterone and DHEA color-coded syringes in burgundy and pale blue
The Men’s rhythm is based on 4 day Sun cycles, not Moon rhythms like the WP for Women.
The Men’s Protocol is based on Magnetism, not Light. (That's funny shit right there!)
The DHEA is only applied in the morning when men’s androgens normally peak. DHEA provokes an androgen receptor quicker and lowers estrogen reception.
Dose elevations occur every 4 days, not every 3 like with women, to allow DHEA to create more receptors for testosterone.

It's controversial at best and I don't recall any member here ever on this type of protocol.

Natural AI's are hit and miss as they are OTC and are unregulated so you don't know what you are getting.

If natural AI were as effective as say Anastrozol we'd all be on them...tells you something right there.

[kelkel]

None of the above works without a copper bracelet!

[zaggahamma]

ur gettin there kel

[alpinist]

Thanks for the feedback and for the lengthy post, gdevine.

I'm quite spiritual and believe there is energy that moves in and out of living things. However, that energy is def not related to magnets!

I'm in to see the doc this morning for my next shot, discuss this thread and AI's.

I guess my specific question to you guys is how often should I be getting my BW done at this early stage? Weekly? Also, if I'm injecting weekly how many days after should I hit the lab?

Thanks

[kelkel]

Thanks JPK!

Get the doc to allow you to inject at home asap. If he allows it, consider a 25 ga 1" syringe and have him write you for 18 ga tips for loading purposes also. You'll barely feel the 25. About 6 weeks is fine for BW. Get your BW on day 6 or day 7 just before your pin. That way you know your trough level. Settle in a bit with your protocol then you can get one earlier to see more of a peak level. Monitor how your feeling toward the end of your week prior to your injections also. As you've read on this site some of us prefer 1/2 the dose every 3.5 days for more stable levels.

[alpinist]

Thanks for the tips, Kelkel, on pinning with a 25 ga 1". I'm definitely gonna give it a try. When using those slin pins it's not IM is it? If not, can you just pin anywhere? And since it appears to be subq do you bother pulling the plunger back to check for blood?

Update: Last week was my 3rd 200 weekly T cyp. In 2 days I'll have my 4th. Libido tho not a 'problem' has certainly has been picking up. I've been working like mad and not training near enough so no comment on recovery or strength. However, what I have noticed is weight gain. And for me it's a significant amount. I've bounced between 157 and 159 for years. Within 2 weeks I saw 162 and 163 on the scale. I use the same accurate scale so no sampling error. It's obviously water weight I've added and I'm not psyched on it. It's extra damn weight I've got to carry or drag up hills/crags/mountains.

Is this instant water gain a sign my 200 weekly is negatively affecting my e2 or other numbers?

Also, many of you expressed concerns about the 200 weekly while a few offered their experience on 200 was good. I'm thinking of dropping to 100 weekly. Does this make any sense? Is there a good way to go about this or just do my next pin at 100?

Last, should I get some BW done now? Frankly, I kind of want to get it weekly to possibly prevent getting too far off the track by waiting 3 more weeks. The expense is of zero concern.

Much thanks!

[kelkel]

25 ga 1" if for any IM injections. Slin pins are SQ only and can be used anywhere you can pinch some fat. Always aspirate . Normally guys seem to wait around 6 weeks for BW to allow everything to stabalize but if you feel the need, go for it maybe at 4 weeks. See where your at before you just change protocols! Then you can adjust as needed with something to base it on. Weekly BW is a waste of money IMO.

Yes, I imagine your E2 is rising at that dosage with the commensurate water weight. Hence, another reason to start lower and titrate up! Make sure you get it checked via a sensitive assay and begin to keep all your own copies of BW also.

[steroid.com 1]

Thanks for the tips, Kelkel, on pinning with a 25 ga 1". I'm definitely gonna give it a try. When using those slin pins it's not IM is it? If not, can you just pin anywhere? And since it appears to be subq do you bother pulling the plunger back to check for blood?

Update: Last week was my 3rd 200 weekly T cyp. In 2 days I'll have my 4th. Libido tho not a 'problem' has certainly has been picking up. I've been working like mad and not training near enough so no comment on recovery or strength. However, what I have noticed is weight gain. And for me it's a significant amount. I've bounced between 157 and 159 for years. Within 2 weeks I saw 162 and 163 on the scale. I use the same accurate scale so no sampling error. It's obviously water weight I've added and I'm not psyched on it. It's extra damn weight I've got to carry or drag up hills/crags/mountains.

Is this instant water gain a sign my 200 weekly is negatively affecting my e2 or other numbers?

Also, many of you expressed concerns about the 200 weekly while a few offered their experience on 200 was good. I'm thinking of dropping to 100 weekly. Does this make any sense? Is there a good way to go about this or just do my next pin at 100?
Last, should I get some BW done now? Frankly, I kind of want to get it weekly to possibly prevent getting too far off the track by waiting 3 more weeks. The expense is of zero concern.

Much thanks!

To put starting dosages into perspective some of the best TRT Docs are starting men out on 60mg to 80mg per week and seeing excellent results.

We've had discussion here lately that maybe we don't need as much of everything in a TRT as originally thought...seeing lower dosages of AI as well now.

100mg weekly may be the ticket but only BW will tell you the truth.

BTW, water retention = elevated E2 in many cases...keep an eye additional sides.

[DanMan250]

Thanks for the tips, Kelkel, on pinning with a 25 ga 1". I'm definitely gonna give it a try. When using those slin pins it's not IM is it? If not, can you just pin anywhere? And since it appears to be subq do you bother pulling the plunger back to check for blood?

Update: Last week was my 3rd 200 weekly T cyp. In 2 days I'll have my 4th. Libido tho not a 'problem' has certainly has been picking up. I've been working like mad and not training near enough so no comment on recovery or strength. However, what I have noticed is weight gain. And for me it's a significant amount. I've bounced between 157 and 159 for years. Within 2 weeks I saw 162 and 163 on the scale. I use the same accurate scale so no sampling error. It's obviously water weight I've added and I'm not psyched on it. It's extra damn weight I've got to carry or drag up hills/crags/mountains.

Is this instant water gain a sign my 200 weekly is negatively affecting my e2 or other numbers?

Also, many of you expressed concerns about the 200 weekly while a few offered their experience on 200 was good. I'm thinking of dropping to 100 weekly. Does this make any sense? Is there a good way to go about this or just do my next pin at 100?

Last, should I get some BW done now? Frankly, I kind of want to get it weekly to possibly prevent getting too far off the track by waiting 3 more weeks. The expense is of zero concern.

Much thanks!

I know a lot of very good endurance athletes, some of them on TRT and some who just cycle testosterone . NONE of them use more than 100-125mg per week because they found that they gained too much weight which negatively affected their performance.
Adding HCG would be a good idea, but you may need to drop your test dose to as low as 80-100mg week.

[alpinist]

Thanks again, guys.

My mail-order T is supposed to arrive today and will be the beginning of my self pinning. I'm gonna get my BW done next week and not wait till week 6. If I can only get one panel done after this injection should I check for the peak or trough of T levels?

Even if my BW come back in range, upon advice of this board, I will likely pull back to 100 a week and move up if necessary.

[alpinist]

Oh, and the panel my doc wants consists of:

Lipid panel
Liver panel
CBC
Total T
Free T
Estradiol (sensitive assay)
FSH
LH
PSA

Anything else I should be checking?

Thanks

[kelkel]

I would get BW done right before injection. But remember, if you switch to an every 3.5 day protocol there really won't be "low" days.

[alpinist]

I'd be willing to do the every 3.5 day protocol but it would be difficult. I routinely make trips into the backcountry/mountains for a few days. I still haven't figured out what I'm going to do when I'm out for 3 weeks. Gels/creams, I guess.

Kelkel, first self injection with the 25 ga 1" absolutely no problem. Thanks for the tip.

I'm getting my bw done next wed (5 days after my 4 dose). I remain very concerned my e2 levels or something else is amiss. I'm sleeping better than without the T but it appears my libido and disposition are back to 'normal'. Water/weight gain is still there.

[kelkel]

Why can't you take it with you? Valid prescription, right? Don't mix gel/injections. Just make sure you get the sensitive E2 assay and if high we can help you with your protocol.

Where'd you pin for your first time btw?

[alpinist]

Yup, I've got a valid Rx. I suppose most excursions I could theoretically give myself an injection. The entire kit for pinning does't weigh much but vial, syringe, alcohol wipe, 2 needles, is at best very inconvenient. However, freezing cold or scorching hot temps will be a challenge too. Sweat, dirt, harness, layers of clothes, and an impatient partner are also considerations. Not all of those are in play at once but there are definitely going to be times where a bunch of those combine to make it impossible or at least impractical. I certainly figured mixing gels and injections would not be ideal but a makeshift work-around 1 to 2x year. Maybe implants will become a better longterm solution? I dunno but I'm not messing with anything till I get my hormones more stable and I understand more of this stuff.

I pinned in my upper glute toward my hip a bit. Not sure what it's called.

[kelkel]

Well it doesn't sound like fun trying to haul the gear around with all your doing. Maybe pellets would be a consideration sometime in the future based on your endeavors. If Nebido ever jumps the pond that will be the way to go.

Next learn to do delts....

[alpinist]

Delts will be next on the pin list.

Never heard of Nebido till you just mentioned it. Very informative and interesting website they have. Do you guys have any feedback on it? Is it available in Mexico, Canada or black market? (not asking for sources just whether it's around).

[alpinist]

Not to clog this place with minutiae but one of my nipples is a bit swollen and tender. (I'm using this thread to track my changes and gratefully accept advice and feedback as you guys have been doing)

Going in for bw in 2 days, a day prior to my next injection. If E2 comes back elevated or other issues I'm seriously thinking of pulling the dosage way back and sorta starting over if possible. From current 200 wk to maybe 60 to 80 week. Probably an AI at least in the short term too. Damn. Not doing a damn thing until I see the BW, review with my doc, and post here. Thanks

[kelkel]

Odds are your E is high. Only BW will tell. At that point you'll probably need an AI at a low dose (.25 x 2 per week to start) as part of your protocol along with titrating down from 200 to a lower number. It just takes time to find out how your body responds to each additional med and then adjust accordingly. Hopefully your doc helps you with all of this. Nolvadex (a SERM) would be of immediate assistance to your nip issue and probably resolve it post haste. Nolva won't effect E levels but will block it at chest receptors. Also see if your doc will write you a couple extra scripts for E2 testing to have on hand. Mine does. If you use Labcorp I can give you their proper codes.

http://jcem.endojournals.org/content/96/1/15.full

[alpinist]

Thanks kelkel. My doc is quite bright and forward thinking so getting m*e*d*s or prescriptions should be no problem.

Also, to add to the minutiae of this thread please add the size of my testes. Yup, confirmed my nuts are shrinking. Is it possible for them to shrink by 30% in just one month? I guess adding HcG is now also on the agenda.

This shit is complicated...

[kelkel]

Or your now obsessed with your nuts! They can definitely shrink. Mine took longer than that and never really did come back all the way, although the onset of TRT is tumor related for me. Complicated yes. Worth the trip, absolutely.

[alpinist]

I did not just now become obsessed with my nuts and their brainless sidekick. The three of them have been the center of my universe as long as I can remember!

[alpinist]

Blood drawn on the 6th day just before my 4th weekly injection. I'll post the spreadsheet with everything next week but for now:

Total T: 816 (was 175 & 267) range 270 to 1730
Free T: 19.7 (was 3.2) range 7.2 - 23.0
Estradiol: 43.8 (was 30.2) range 0 - 56
FSH: <0.1 (was 5.9) range 1.0 - 8.0
LH: < 0.1 (was 4.6) range 0.8 - 7.6

My disposition remains poor, nipples more sensitive and swollen everyday, weight gain has to be mostly water, and my nuts are shrinking. I'm having all the sides and experiencing zero benefit.

Help!

Even before the results came back I pulled this week's shot back to 140 from 200 T Cyp. I have Arimidex in my arsenal but haven't started it yet. My doc say to sit tight for a few more weeks to see if my e2 stabilizes. Thoughts? What about HcG ? My FSH & LH are zero and my balls are shrinking. Should I start on it now?

I feel pretty out of control on this project and am willing to bring in a hired gun to help my doc and I get squared away. Besides Crisler who are the top and renowned Drs?

Much Thanks!

[kelkel]

Crisler would be the go-to guy and will consult with your doc for a fee. Your LH/FSH are zero because your shut-down. Not sure about your range for total T? Is that right?

Your E is high as expected and the only way it will go down IMO is to reduce dosage or add the AI. If you add one in I would not go over .25 x 2 per week to start and re-test in a month with the new protocol. LEF recommends E between 20-30. Exactly why we preach 1 protocol change at a time so you know what does what. If your doc won't go for that have him at least write you Nolvadex (SERM) which will block your chest receptors from the E issues and get rid of the sensitivity/swelling until he decides if your E "settles." It really works great and won't effect the rise and fall of your E level.

And yes, HCG for your boys.

ps: I'm still under the impression that mine are the center of the universe...

[alpinist]

I double checked the labs and the Total T range is correct. Age 20 - 49 is 270 - 1730 ng/dl

Thanks again, brutha. I wanna pull the T Cyp way back to like 75 week and start over. In the meantime I really thing the AI is what I need to feel better sooner. It'll take me a month or so longer to get things straightened out than adjusting only one variable at a time.

Is there realistic chance my e2 will decline as I adjust to the T or is going to keep climbing or stabilize at this level? Any downside to taking the AI for just a few weeks?

[kelkel]

As several of us stated in the beginning of this thread, 200 is a high starting point. To many and to quick with changes won't give you a good snapshot with BW. Pick what your pulling back to and stick with it. If my nips were that way I'd immediately jump on nolva to calm it down and then add in low dose (emphasis on low) AI and retest in 4 weeks. You can run both the AI and Nolva at the same time but it's not normally done unless your nips are hyper-sensitive. It won't take you long to get rid of the sensitivity with nolva. No downside to the AI but just run the bare minimum as you don't know how you will respond to it and you don't want to crash your E. Been there as have many here and it sucks.

Yes, your E2 will rise and fall contingent on your T level. Your normal. No clue on where it will land until repetitive BW is done. I ran BW for E2 three months in a row to find my norm, which ended up at 15-16 so no AI for me fortunately, although I'd prefer to have my E higher.

[DanMan250]

alpinist, are you on the west coast? I know a doc there who is better than Crisler. His name is Dr Mark Gordon.