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06-30-2014, 11:38 AM #1~ HRT Specialist ~
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The E2 Miracle - Voodoo
You begin TRT, and you are prescribed no Aromatase Inhibitor or anti-estrogen of any type. As your TRT progresses you find your estradiol levels crash, often into low single digit levels. Your dose of testosterone may be as high as 200mg per week, maybe even higher but your E2 continues to crash. As time goes by you become extremely irritated with your doctor - after all, you feel like garbage and can only conclude your physician has no idea what they're doing. At this stage you may discontinue your treatment, at least with the physician in question. Alternatively, you may begin manipulating your blood test, waiting a little longer than normal for your next injection hoping this will produce lower levels of testosterone resulting in a larger prescription dose. If all other aspects of your health are in good standing the physician may agree to increase your testosterone and/or HCG dose, but a lot of physicians aren't comfortable with testosterone doses much higher than 200mg/wk. Sometimes such doses are legitimately needed, but they are not doses we can call commonly needed by any means. Yet E2 continues to fall...
What's the cause of this E2 miracle? Is there something physically wrong with the patient? Before he began TRT his estradiol levels were good, a bit on the low side but nowhere near where they are now. At the present stage his testosterone levels have increased significantly - how is it possible that E2 keeps going down? What is the cause of this evil voodoo?
The cause is simple and in part due to an irrational fear held by the patient - Gynecomastia . We've all read on numerous threads here and other places where it's said you must use an AI if you're on TRT. Therefore, many take this to heart and take it upon themselves to get an AI whether they need it or not - after all, some guy online with a bunch of post other nameless individuals refer to as "Bro" said you need one so it has to be true. You then lie to your doctor, you're not taking an AI and how could you be, you weren't prescribed one. Your doctor isn't a member of steroid .com so he knows nothing about research sites or ordering from online pharmacies, or so you think - you'd be surprised how many doctors are more than aware, yet everyone continues to play dumb. But you are so petrified of gynecomastia that you will continue to destroy your hormones with this unneeded AI. I know, when your E2 levels were once at 32 pg/ml your nipples were killing you and that's a sign of gyno, right? Actually, no it's not - nipple pain itself does not mean gynecomastia and that's a common misconception people need to do away with. Yes, nipple sensitivity can be an indicator, but not overnight and not the end all. If your E2 levels are still in a healthy range, and yes over 30 pg/ml can and is often still healthy, nipple sensitivity is often a result from the higher testosterone levels. In fact, nipple sensitivity has been linked with increased libido, which makes sense - testosterone levels go up, libido goes up, nipples become more sensitive and there you go.
The long and short - countless men use AI's that don't need to or far more AI's than they should. I see and speak to these men every day and often wonder "do they think I'm an idiot?" You can't outright call someone a liar, not in this situation, but the truly sad part is many men are ruining their TRT due to an irrational fear. It's not voodoo, it's simply a poor understanding. Always remember, nipple sensitivity is NOT gyno.
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06-30-2014, 05:17 PM #2
Amen low t.
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06-30-2014, 05:26 PM #3
Always love your posts!
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06-30-2014, 07:09 PM #4Associate Member
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I went full retard when I 1st started before I stopped dicking around and got a good doc, I took 100mg a week and a AI. after 2 days I could not get a hardon with any amount of V or C and I could not squat or walk down steps, I pulled my E2 and it was 3. At that point I said **** this called Crisler and never looked back.
Best thing you guys can do is go see a good doc, I know I say this over and over and over again but if I did not I would of wasted the last 3 year of my life playing doc and going all over the charts trying to figure this out. After all was said and done I never needed an AI.
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06-30-2014, 07:20 PM #5
My e2 was still low on 100mg a week. I'm on 150mg a week and still don't feel great, blood work due in a month. I gave a feeling the e2 is still low. Better, I must admit (I use joint pain as an indicator) but still not great.
And I truly don't use an ai, prescribed or otherwise
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06-30-2014, 10:01 PM #6
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07-01-2014, 10:04 AM #7Member
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I was 47 with no ai then .05 mg twice a week crashed my e2 to under 3. Stopped all ai and 6 weeks later 33. I'm sure i'm probably back around 47 now but I'm unsure what to do. Is there other alternatives like the old 6-oxo that Patrick Arnold created?
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07-01-2014, 10:29 AM #8
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07-01-2014, 10:31 AM #9Member
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07-01-2014, 11:43 AM #10
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07-01-2014, 12:37 PM #11
OH how I would love for this to work for me! They didn't and I still wonder why. Should I try it again? I just don't know if I should even bother. Other opinions?
Low T, I just want to make sure I understand your post correctly. Are you saying that this voodoo crashed E2 is brought on by self medicating and one cause is a patient not telling or lying to his practionter?
I'm glad many men don't need an AI. Can you tell us about what percentage this is? Sadly, I don't seem to fall into this category.
A little story: I'm on about 105mg T Cyp/week (15mg/day) 100iu hCG /day. Each week, I try to put off my Aromasin dose as long as I can. Day 5 came and symptoms gradually started - loss of evening and morning erections, decrease in libido. Took 12.5mg that afternoon, Thursday (7 days from my last dose). More fatigued than usual on Friday (though I slept well). In the gym on Saturday I was dragging my ass, BIG time. Took 6.25mg right there in the gym (Friday), (I happened to be carrying my pill bottle in my bag.) The next day I felt like Superman. A day later my staff started to stiffen and OH those sensitive nipples! LOVE it! (I won't elaborate.)
My imagination? I highly doubt it. The placebo effect? Horse shit. I felt BETTER. My conclusion: I need an AI - and more often than E7D. I'm starting 12.5mg E5D. Do you think I'm missing something?Last edited by 2Sox; 07-01-2014 at 03:51 PM. Reason: typo
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07-01-2014, 03:37 PM #12~ HRT Specialist ~
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07-01-2014, 04:23 PM #13~ HRT Specialist ~
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Yes, I'm saying the crashed E2 is due to the patient doing whatever he wants and not telling his doctor. You'd be surprised (or maybe you wouldn't be) how many guys self-medicate an AI but actually have no idea what the purpose of an AI is for. Once their E2 levels crash and they feel like crap, they blame the doctor. Some guys you can talk to about it and explain things, but many simply won't listen. I blame this on the internet. The net has been the single worst and best thing for TRT. It's the worst because it tends to promote a lot of bad ideas and misunderstandings, but it's the best because it also promotes the opposite of that...don't get me wrong, overall it's a good thing.
In my opinion, when you don't allow things to settle and even out, it's hard to know what's going on inside you. For example, if you take an AI based on how you feel that's not necessarily a good thing. I'm referring to taking one on this day, not on these days because you feel good and then one day taking one because you don't feel as good. First and foremost, even on perfect TRT, all the numbers are perfect, you're going to have days you feel better than others, that's just life. That is true with or without TRT. Secondly, you're never allowing your body to normalize, to get used to anything. I'd rather see someone stick to a schedule, a set schedule every week and after a time adjust things if needed based on that. Going all over the place with medications is never a good idea, again back to the normalization concept.
Another important note regarding E2 and something you eluded to, libido. Very low E2 can crush your libido, that's a given. It's also assumed that high E2 can as well, but how high? Check out this thread with Nelson Vergel discussing Testosterone , Estradiol and Libido. Should provide somethings to think about:
High Estradiol Boosts Libido in Men on Testosterone Therapy
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07-01-2014, 05:49 PM #14
This is very wise counsel. I'd like to ask a few questions about what you say here and give some anecdotes to illustrate.
I started on patches and then Androgel . Felt absolutely fantastic within days. In a few weeks, I felt like I was in my youth. A few months go by and I'm feeling pretty poorly. My education through reading and on this forum coincided with what was going on. I decided to do shots. Went to Ageless Mens Health in NYC. Started me on 100mg T Cyp once a week and .5mg adex twice weekly. Felt like crap every time I took that ai along with my shot. Didn't know enough at the time to realize that it was the ai that was lowering my E2 and that's why I felt like crap. Did this for a month then stopped.
Continued my TRT education.
Went back to gels and decided to use the Adex along with it. It was a new day for me! Libido and energy came back immediately. I felt great. Self medicating? Yes. Told my doctor about this? No But insisted on the estradiol sensitive each time I visited the office and my E2 was always in range.
Thank you Internet for making this possible!
My question: Should I have let things go for a few months to have things "even out" as you suggest? In other words, should I have just let myself feel like shit for a few months just to see how things work out? No thanks. I did my homework. Lots of it. I educated myself. It's not scientific method by a long shot but my thinking goes: Well, I took an ai and I felt better right away. When I stopped the ai, I felt like shit again. It must be the ai - not coincidence. I think I'll continue treating with an ai.
I'm exceedingly aware that the body is static and changes day to day. I ALWAYS have this in my mind when I consider my treatment options. Nevertheless, I have come to these conclusions.
My present doctor who is an internist and TRT "specialist" does not write for ai's right off. He keeps an eye on prolactin, progesterone, and of course estradiol. I was shocked recently that he actually wrote me a script for Aromasin when I asked. A year ago he had dismissed estradiol and ai's. "If your nipples don't hurt, don't worry about it." Wanna take a guess why his office changed? The INTERNET. And all the guys asking him the same questions I was asking.
Low T, I don't know how many guys who come to your office that are lazy and sadly lacking in education on the subject of TRT. But I bet there are plenty. And I'd also bet THESE are the guys who blame you for their condition when they crash their estrogen. And before I read Vergel's article a FYI about me and E2. When my E2 goes above the high 30's or into the 40s, I don't feel much like a functioning man with a healthy libido and an acceptable energy level. That's not the way I want to live my life.Last edited by 2Sox; 07-01-2014 at 05:54 PM.
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07-01-2014, 06:47 PM #15
I get nipple sensitivity as my e2 is dropping, usually notice it when resuming taking an ai.
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07-01-2014, 07:31 PM #16
when I started TRT I was prescribed a pro cycle stack plus 1mg AI ED. yes Each Day! after 30 days I felt like shit, then went to a doc that didn't know much about TRT, she said to drop all except testosterone , one month later my E2 came back at 102! way too high, and still felt like shit and started having PVCs, or at least started noticing them. then after much research I finally found a good doctor, now I am on 100 each week split, hCG and NO AI! yes my e2 is very low.
I totally agree with LT, with the exception to new patients, at the beginning of TRT e2 usually go up until the body gets used to the new hormones. so monitor regularly and treat as needed.
Lets not forget how many members posted here complaining about their e2 being high! then again, TRT does were up there. also no one really know if they were telling the full truth! the bottom line is find a good TRT doc and follow his instructions, and don't be shy to ask questions if things don't make sense to you.
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07-01-2014, 08:28 PM #17
Bass, Are you suggesting that in the beginning of TRT, E2 levels rise and then they stabilize at a "normal" level (if dose is reasonable)? This can't be a hard and fast rule, can it?. I'd like to know the incidence of this happening. To extrapolate, this means if I let myself feel like shit for a few months I'd feel fine after awhile. To extrapolate further, if a person begins on an AI prematurely, he becomes dependent on it forever. You get an AI addict. I'd love to have this cleared up by someone.
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07-01-2014, 09:03 PM #18
I am on self prescribed aromasin . On 120mgs a week I got severe nipple sensativity and formation of gyno so got BW. Test was at 550 and e2 at 51. Doc said it wasn't that high and said either lower dose or deal with it. Luckily my father is a GP and I convinced him to prescribe aromasin. Since I've upped my Mg's and got e2 under control. For me it wasn't hard at sll to dial in. At a point where I'm feeling great. With online sites offering cheap BW there's no excuse not to be perfectly dialed in. I have a shitty Dr, but he gives me the script I need. I take it upon myself to do the rest,and to be honest it's not very hard. Especially with the vets on this board who give up a lot of Their time to help others
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07-01-2014, 10:43 PM #19
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07-02-2014, 07:00 AM #20Associate Member
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NO good doctor is going to start someone on test and a AI at the same time. I did bloodwork monthly for 9 months and your E2 rides around for me its 18-38, so what if when it was 38 I took a AI then I hit that 18 point and had ED? Then I would post here that my doc sucks and the AI killed me lol.
best thing again I think anyone can do is give it a few months before anything, maybe pull your E2 before you even start test, cut body fat is prob the best thing you can do, ya it sucks but in the long run that will help everything.
Copper and zinc work well for me and to be honest I have no idea if my E2 is 18 or 40 but I sure as hell knew when it was 3
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07-02-2014, 07:50 AM #21
The highest my E2 got was 60. I was much heavier then but was also dosing higher HCG . I've cut some weight and been training very hard and it's been more under control. My only issue has beed ED. So I cut my HCG down a bit and it's further under control. Now I started missing the morning woods, so I skipped it and am feeling great. Not looking at numbers now but rather how I feel. Benefits of being dialed in I guess.
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07-02-2014, 11:21 AM #22
actually Yes, that's what I was sating. I found out form personal experience and others who posted here. in the beginning of TRT and based on BW our e2 went through the roof no matter what T does we were on! and we needed AI on a regular bases, but as time goes we found that we needed lees and less AI while maintaining same T dose. and of course what you say is true also "depending on T dose" some people convert more than others, this is why BW and leaning how to read signs of high/low e2 symptoms is essential.
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07-02-2014, 11:33 AM #23
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07-02-2014, 11:59 AM #24
So there seems to be some difference of opinion between you and Kel. Just for clarification, I'll pose my questions again for the purpose of seeing if we can really get to something about this:
Does this mean that if a guy who begins TRT allows himself to feel like shit for a few months to let things "even out", he'd feel fine after awhile. To extrapolate further, if a person begins on an AI prematurely, does he become dependent on it forever? Does he become an AI addict? It would be great to get the real story on this.
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07-02-2014, 12:36 PM #25
Just to add my .5c here. I don't think there is a "real story" with this. I'm old, rather lean, on only 7.5mg of testim/day and have never purchased an rx ai. I've been between 47 and 24 on e2 sensitive assay. Dim/zinc is all I've ever taken. I felt great at 47 and great at 24. My doc prescribes more test than I use. At my age, 600-800 is more than sufficient. Not speaking to anyone in particular, but some guys want really high t levels. With that comes other issues. But, I couldn't agree more with LT-there are a lot of guys self-medicating all types of ancilliaries here on this board. Of course, their Dr. has no idea what they are doing. Just find another Dr.
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07-02-2014, 12:45 PM #26Junior Member
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This is a good question. My E2 has gone up in the 80's on injections, and it currently sits in the 40's on 2 pumps of agel 1.62. I bumped it up to 3 pumps and just took a blood test today. I don't feel any different at 80, or 40, or even in the 20's (before I started TRT). I'll see where I sit once the results come in.
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07-02-2014, 01:36 PM #27~ HRT Specialist ~
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Lot’s of comments, rather than addressing each post individually here are my opinions overall.
1. There is nothing wrong with AI’s. I wanted to clarify that first in case my initial responses implied that. I do believe too many tend to rely on them too much or have a false sense of security because of them.
2. 2sox, in reference to most patients being lazy or lacking in education on the matter – it’s really no different than any other topic that’s medically related. Most people do not want to dig deep into the issue and in my opinion that’s OK. If you have any condition or ailment, whatever that might be, you go to the doctor expecting him to know how to fix it or help you. Granted, TRT can be a bit different, not because it’s complicated but because many physicians don’t know how to treat this very simple condition. I do think it’s a good idea for the patient to learn at least a little but I by no means expect it. I know nothing about cars short of changing a flat tire and when I take my car to the mechanic I don’t expect or have any desire to learn – just fix my car.
3. 2sox again, in reference to your E2 levels being over 30 and the way you feel – it may have more to do with your ratio of testosterone to estradiol rather than the estradiol level itself.
4. Nipple sensitivity is not a direct indicator of gyno or E2 being too high. Yes, it can be but growth in the chest is more of an indicator. Nipple sensitivity can be an indicator of increased libido and often is. Further, I have yet to see a man develop gyno with his E2 in the 30-40 range.
5. If a man stays on TRT for a long period of time (remember, most don’t. Most men try it for 6-8 months once or run through several 6-8 month periods and stop and start.) But men who stay on for years, more often than not those that needed an AI early on need less and less and in many cases, none at all. This is very common. I do not have a good scientific answer to this, but it does seem men tend to aromatize less years later than they did in the beginning. We can make the argument that this is because many men are in better shape after being on TRT for an extended period of time, therefore carry less body fat and possibly more muscle tissue. But I am not convinced that this is the reason. I have seen very overweight men who when on TRT aromatize very little and very lean men who aromatize heavily, and on that basis body fat cannot be the primary reason. Do some men always need an AI no matter how long they are on TRT? Yes.
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07-02-2014, 02:33 PM #28
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07-02-2014, 02:57 PM #29Junior Member
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So does high e2 need to be treated with an AI if there are no symptoms?
If my labs come back 40 or higher, should I sit here or be proactive and start the AI?
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07-02-2014, 03:10 PM #30
obsoletely not! under any circumstances you should not let TRT make you feel like shit. remember everyone responds differently, I think we've established that one size does not fit all when it comes to TRT. this is why I say in the beginning of TRT monitor closely with BW and symptoms so you know what action you need to take. for me it took about a year for things to settle, it took that long because the doctors I was seeing didn't know anything about TRT.
I believe (my opinion) it takes about 6 months on average for someone to fine tune the protocol, mostly its due to your body trying to adjust to the new hormones.
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07-02-2014, 03:14 PM #31
Kel I agree with you it is dose dependent. based on personal experience I could not do without AI even on 100mgs test EW, I needed at least 0.5mg AI EW to level things out, but now even on 120mgs a week my e2 is still in the 20s. few other members experienced the same thing, I believe GDevine, Flats and few others. of course this is not backed by any science, just personal experience and opinion.
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07-02-2014, 03:17 PM #32~ HRT Specialist ~
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07-02-2014, 06:36 PM #33
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07-02-2014, 08:20 PM #34
maybe our good friend "zaggahamma" can tell us since they were in contact at one point. I hope he's ok.
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07-03-2014, 10:19 AM #35
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07-07-2014, 11:42 AM #36Member
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I only use the AI when I get bloated. My numbers are always creeping up. The problem I got is every time I get E to high my genitals are always great. But I feel,awful I take exestamane and I feel better but my genitals take a hit in performance and looks. This stuff is very aggravating.
I found a cool doc but the only problem is he prescribes anastrolze at 1mg. I tell him that's too much and he doesn't think so
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07-12-2014, 12:35 PM #37
This thread is fantastic and just what I needed.
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07-12-2014, 02:01 PM #38
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07-12-2014, 07:18 PM #39
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07-13-2014, 01:02 PM #40Member
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