Found the source of my problem, now what?

[FloridaBrah]

Age:31
Height: 5'10
weight: 205
BF%: Id say 16-19%
Current meds: 100mg test-c weekly (haven't injected yet), Cabergoline .5mg a week split into 2 dose
Medical conditions: Pituitary microadenoma (2mm) with hyperprolactinemia and hypogonadism

Test Date: 1-7-16
Testosterone , Serum 366 Range 348-1197 ng/dL
Estradiol <5.0 Low Range 7.6-42.6 pg/mL
hematocrit 45.0 Range 37.5-51.0%
FSH 4.2 Range 1.5-12.4 mIU/mL
LH 5.0 Range 1.7-8.6 mIU/mL
WBC 6.4 Range 3.4-10.8 x10E6/uL


March or April?
Testosterone 323 (348-1197 ng/dL)
Free Test (direct) 9.8 (8.7-25.1 pg/mL)
Cholesterol, total 222 (100-199 mg/dL)
LDL/HDL Ratio 2.4 (0.0-3.6 ratio units)
LDL 147 (0-99 mg/dL)
Triglycerides 70 (0-149 mg/dL)
HDL 61 (>39 mg/dL)
TSH 1.130 (0.450-4.500 uIU/mL)
DHEA-Sulfate 349.9 (138.5-475.2 ug/dL)
Hemoglobin A1c 5.2 (4.8-5.6%)
Estradiol <5.0 (7.6-42.6 pg/mL)L
WBC 6.6 (3.4-10.8x10E3/uL)
RBC 4.98 (4.14-5.80x10E6/uL)
Hemoglobin 15.6 (12.6-17.7 g/dL)
Hematocrit 45.0 (37.5-51.0%)


Most recent: April
TSH 1.280 (0.450-4.500uIU/mL)
T4,Free(Direct) 1.24 (0.82-1.77ng/dL)
Triiodothyronine,Free,serum 2.7 (2.0-4.4pg/mL)
Cortisol AM 11.1 (6.2-19.4 ug/dL)
Prolactin 42.8 (4.0-15.2ng/mL)


6-2-2016 the Endo tested prolactin and it was 27ng/mL



After ordering blood work through an internet lab and finding I had low test, I went to a primary care Dr who then tested me again and it was low. The Dr wrote me a Rx for test-c.

I got my Rx for test-c, but decided that there had to be a reason my test was low. So I did some research and found that high prolactin can cause low test and again went through a internet lab and found my prolactin high.

I then made a appt with an Endo after I found the prolactin high. The endo did bloods and an MRI and found a 2mm adenoma. The Endo put me on the caber and set me up for a follow-up appointment with blood work in Sept.

The Endo didn't seem concerned about my test levels and told me that fixing the prolactin levels should fix my test levels.

My question is, should I wait until my appointment in Sept to see if the prolactin being lowered from the caber allowed my test to rebound? Or should I try to kick start it by running nolva or clomid? I'm kinda lost at what to do at this point. Thanks for any help

[Mp859]

Age:31 Height: 5'10 weight: 205 BF%: Id say 16-19% Current meds: 100mg test-c weekly (haven't injected yet), Cabergoline .5mg a week split into 2 dose Medical conditions: Pituitary microadenoma (2mm) with hyperprolactinemia and hypogonadism Test Date: 1-7-16 Testosterone, Serum 366 Range 348-1197 ng/dL Estradiol <5.0 Low Range 7.6-42.6 pg/mL hematocrit 45.0 Range 37.5-51.0% FSH 4.2 Range 1.5-12.4 mIU/mL LH 5.0 Range 1.7-8.6 mIU/mL WBC 6.4 Range 3.4-10.8 x10E6/uL March or April? Testosterone 323 (348-1197 ng/dL) Free Test (direct) 9.8 (8.7-25.1 pg/mL) Cholesterol, total 222 (100-199 mg/dL) LDL/HDL Ratio 2.4 (0.0-3.6 ratio units) LDL 147 (0-99 mg/dL) Triglycerides 70 (0-149 mg/dL) HDL 61 (>39 mg/dL) TSH 1.130 (0.450-4.500 uIU/mL) DHEA-Sulfate 349.9 (138.5-475.2 ug/dL) Hemoglobin A1c 5.2 (4.8-5.6%) Estradiol <5.0 (7.6-42.6 pg/mL)L WBC 6.6 (3.4-10.8x10E3/uL) RBC 4.98 (4.14-5.80x10E6/uL) Hemoglobin 15.6 (12.6-17.7 g/dL) Hematocrit 45.0 (37.5-51.0%) Most recent: April TSH 1.280 (0.450-4.500uIU/mL) T4,Free(Direct) 1.24 (0.82-1.77ng/dL) Triiodothyronine,Free,serum 2.7 (2.0-4.4pg/mL) Cortisol AM 11.1 (6.2-19.4 ug/dL) Prolactin 42.8 (4.0-15.2ng/mL) 6-2-2016 the Endo tested prolactin and it was 27ng/mL After ordering blood work through an internet lab and finding I had low test, I went to a primary care Dr who then tested me again and it was low. The Dr wrote me a Rx for test-c. I got my Rx for test-c, but decided that there had to be a reason my test was low. So I did some research and found that high prolactin can cause low test and again went through a internet lab and found my prolactin high. I then made a appt with an Endo after I found the prolactin high. The endo did bloods and an MRI and found a 2mm adenoma. The Endo put me on the caber and set me up for a follow-up appointment with blood work in Sept. The Endo didn't seem concerned about my test levels and told me that fixing the prolactin levels should fix my test levels. My question is, should I wait until my appointment in Sept to see if the prolactin being lowered from the caber allowed my test to rebound? Or should I try to kick start it by running nolva or clomid? I'm kinda lost at what to do at this point. Thanks for any help

Just follow the endo's orders. If you aren't happy find another. Best to have the least amount of variables while trying to get yourself right.

[IncreaseMyT]

Your levels are not as high as most when they have a Prolactinoma, usually levels will be outrageously high. So they are diagnosing this by the MRI correct?

Not sure I see where this huge testosterone bounce is gonna come from, if your PRL was much higher I would bet the odds would be much higher that the Endo's plan would work.

Thats a long road, good luck man hope you get it figured out.

[IncreaseMyT]

PS I would be more worried about the low E2, I bet thats is the primary cause of symptoms, its not healthy either.

[IncreaseMyT]

As you can see in this case study here:

A 32-year-old man was seen at an emergency room for evaluation of severe headaches for six weeks. Previously reported to be in good health, he had noted fatigue for approximately six months, attributed to stress, as well as a decrease in libido. He denied any visual problems. An MRI scan was performed, and showed a large pituitary tumor with marked extension outside of the sella both superiorly and inferiorly (see Figure 1 top). A serum prolactin level was drawn and was markedly elevated at 3,100 ng/ml (normal less than 15 ng/ml). Basal thyroid tests were normal. A testosterone level was decreased at 113 ng/dl (normal greater than 290 ng/dl). A growth hormone releasing hormone/arginine test was notable for undetectable growth hormone levels. A fasting serum cortisol was normal at 20 mcg/dl. Physical examination was remarkable for normal predicted height, mild gynecomastia, and deficient virilization with testicular atrophy.

Bulletin Vol 9, Issue 1, Fall/Winter 2003 - MGH Neuroendocrine and Pituitary Tumor Clinical Center - Massachusetts General Hospital - Harvard Medical School (HMS)

This also as we mentioned earlier :

Cabergoline is usually the first choice because of its increased efficacy and better tolerability compared with other dopamine agonists

[FloridaBrah]

Your levels are not as high as most when they have a Prolactinoma, usually levels will be outrageously high. So they are diagnosing this by the MRI correct?

Not sure I see where this huge testosterone bounce is gonna come from, if your PRL was much higher I would bet the odds would be much higher that the Endo's plan would work.

Thats a long road, good luck man hope you get it figured out.

Yea it was diagnosed with MRI.. Could my e2 be low because test is low? Also what would cause that to be low? If my test levels don't bounce back from fixing the prolactin could I do a restart on my own (like PCT) or is it likely it wont recover and I'll need to go on TRT regardless?

[IncreaseMyT]

Well please keep in mind you should follow the advice of your doctor, our posts are for educational purposes and are not intended to be taken as medical diagnosis or advice.

Yes that is probably why your E2 is low. You could try a restart but not sure thats gonna work for you. Its possible the microprolactinoma you have is partially suppressing HPTA function. But its small and they do not recommend surgery for it. All they do is put you on caber and titrate PRL numbers. Follow up MRI's are only done if PRL gets out of range:

If stable, subsequent scans can be scheduled less frequently unless symptoms or a significant rise in prolactin prompt an earlier scan

Bulletin Vol 9, Issue 1, Fall/Winter 2003 - MGH Neuroendocrine and Pituitary Tumor Clinical Center - Massachusetts General Hospital - Harvard Medical School (HMS)

So we personally don't see anything wrong with trying TRT or a restart, as long as PRL numbers are monitored and you get an MRI twice a year the first year, then one year after that then you should be good. Honestly PRL numbers are pretty accurate at diagnosis prolactinomas, symptoms too.

So when people say they have this big worry about this for men on TRT, not only is it extremely rare, usually you still need TRT and symptoms pretty much always come with outrageously high PRL numbers as mentioned earlier.

My point is that its not something that is easy to miss.

You could even try the Ipam peptides solo. For you maybe the combo without GHRP2.

This could possibly stimulate the pituitary and alleviate the slight suppression. May be worth a shot.

Like I said whatever you decide, do it under the supervision of a licensed physician.

Let us know if you need our help.

[hammerheart]

2mm microadenoma? Wow that's hard to diagnose even with a MRI.

If I were you, I wouldn't go for TRT. I'd definitely try to restart first. PRL is inhibitory to the HPTA, but even if caber gets rid of the (moderate) hyperprolactinemia you have, the axis might not be able to resume its normal function, so a restart is needed.

However, I'm not sure if clomiphene will be of help, as your E2 is already low, but personally I think it's worth trying.

[FloridaBrah]

Thanks for the replies... If I were to do a HTPA restart is there a recommended protocol? I've read of people using clomid and/or Nolva for s restart. Do you treat it like a PCT? And would a AI be necessary since my e2 levels are low?

[hammerheart]

Nope you won't need an AI. Go for a SERM (Clomid), and see if your test is back in September.

[IncreaseMyT]

Thanks for the replies... If I were to do a HTPA restart is there a recommended protocol? I've read of people using clomid and/or Nolva for s restart. Do you treat it like a PCT? And would a AI be necessary since my e2 levels are low?

During HCG yes you may need anastrozole. Lab work unfortunately does not tell us always the meds needed and the dosage. It just shows a deficiency. Lab work while your on TRT or during a restart or via hcg stimulation test will be the only way to determine if you have things titrated correctly based on symptomatology and exactly what you need.

My point is when you take exogenous hormones, or hormones that mimic hormones in your body, you start at 0.

Hope this helps.

[FloridaBrah]

For an HTPA restart would I run clomid solo or with Nolva at the same time?

[charger69]

For an HTPA restart would I run clomid solo or with Nolva at the same time?

I would run both together. They work synergistically.

[IncreaseMyT]

We have clients that have done it both ways. We think Clomid is more important of the two but nothing wrong with both at all.

The important part is the HCG stimulation, Clomid almost always works. HCG can take a while.

In truth I am seriously starting to wonder if SERM's are partially suppressive, have seen guys do just as good or better with just HCG or HCG and peptides and nothing else.

Hope this helps.

[FloridaBrah]

About my low e2.. What would cause that? And what could I do for it? I think I still have low e2 as my joints were sore while lifting weights the last few weeks. I'm hoping when I go to endo in sept that he checks all my hormones again and not just prolactin. When he reviewed my bloodwork at my last appointment, he didn't even mention the low e2 levels. hope the endo is not a naner. I don't wanna go through setting up an appointment again and having to wait another 3 months to get in.

[IncreaseMyT]

When your T is low, especially free T, your body cuts E2 production to try and conserve T.

HCG would help.

[FloridaBrah]

Alright, went to my endo appointment and found out the caber has been working and has lowered my prolactin to 3.8ng/ml.... BUT he didn't check ANYTHING else and said my t-levels (in the 300s) were just fine and hes not worried about it.

Now I have some clomid on the way and am going to try a restart on my own. I plan on taking 25mg clomid either EOD or E3D (haven't decided yet). I know I need to get blood work done before I start. What all do I need to get checked in bloods for a restart? would checking FT, TT, LH and E2 be fine, or is there more I need to watch. Also should I check bloods during the restart , like a month into it? and how long should the restart last, at what point should I taper off the clomid?

With my starting e2 levels being so low do I even need to bother buying an AI?

[Mr.BB]

Alright, went to my endo appointment and found out the caber has been working and has lowered my prolactin to 3.8ng/ml.... BUT he didn't check ANYTHING else and said my t-levels (in the 300s) were just fine and hes not worried about it.

Now I have some clomid on the way and am going to try a restart on my own. I plan on taking 25mg clomid either EOD or E3D (haven't decided yet). I know I need to get blood work done before I start. What all do I need to get checked in bloods for a restart? would checking FT, TT, LH and E2 be fine, or is there more I need to watch. Also should I check bloods during the restart , like a month into it? and how long should the restart last, at what point should I taper off the clomid?

With my starting e2 levels being so low do I even need to bother buying an AI?

So, your Endo tell "that is just fine" and you didnt answer him back? This what I dont understand.

Are you shy? Afraid of doctors? They dont bite...

[FloridaBrah]

So, your Endo tell "that is just fine" and you didnt answer him back? This what I dont understand.

Are you shy? Afraid of doctors? They dont bite...

I told him that is low for my age and he said that it will recover with time with my prolactin being lower by the caber.

The endo is a idiot when it comes to testosterone . I spoke to several pharmacists in my area and they didnt know of any Endos in my area who deal in TRT. The Pharmacist recommended a urologist in my area. So if this restart doesn't work. Ill make an appointment with the Urologist for the low test and continue going to the Endo for my pituitary adenoma.

[hammerheart]

I told him that is low for my age and he said that it will recover with time with my prolactin being lower by the caber.

The endo is a idiot when it comes to testosterone. I spoke to several pharmacists in my area and they didnt know of any Endos in my area who deal in TRT. The Pharmacist recommended a urologist in my area. So if this restart doesn't work. Ill make an appointment with the Urologist for the low test and continue going to the Endo for my pituitary adenoma.

Good idea, urologists/andrologists are usually more "sympathetic" about low t.

[FloridaBrah]

Since I last posted I found a new endo who ran labs on me again and my test came back low (no surprise).. Anyway he wrote me a script for test-c at 100mg a week. I started last Monday at 50mg and 3.5 days later another 50mg. I plan on keeping with the every 3.5 days of 50mg for now.

anyway, after my second injection on the same day, I had symptoms of high blood pressure. My face and ears felt warm and flushed. I don't have a blood pressure monitor, so I couldn't test it. for the past few years my BP has come back on the high end at my Dr's appointments, but not enough to be put on meds.

I'm not scheduled for post start TRT blood work until the end of June (6 weeks after start). I have read that the face flushing could be from high e2. I do have an AI on hand (not prescribed). Should I go ahead and get my own blood work done to see where my e2 is at or wait another 5 weeks for the follow-up blood work and if its high have an AI prescribed by Dr?


Also forgot to note that the first week of test-c, I have felt no different other than possibly a little tired. and prior to starting TRT my e2 levels always came by in the low range.
BTW I also did a HPTA restart attempt in Dec-Jan.

[kelkel]

Your sudden odd symptoms could easily be psychosomatic.
What do you mean by "second injection on the same day?"
E2 testing now probably a waste of money. Your body is still adjusting and searching for homeostatis. Ride it out until your doc appt.
Most guys don't feel much right away. It takes time as noted above before you realize the full beneficial effects of optimized T levels.
Patience and good luck!

[FloridaBrah]

Your sudden odd symptoms could easily be psychosomatic.
What do you mean by "second injection on the same day?"
E2 testing now probably a waste of money. Your body is still adjusting and searching for homeostatis. Ride it out until your doc appt.
Most guys don't feel much right away. It takes time as noted above before you realize the full beneficial effects of optimized T levels.
Patience and good luck!

"second injection same day." I meant the day of my second injection I felt the flush etc later in the day. sorry about my wording

[Mr.BB]

Face and ears flushed are not from BP but from the influx of hormones, your body is adapting.

But do buy a BP monitor and check it out, its cheap, just dont buy wrist BP monitor.

[bullshark99]

Agreed^^^^^ also E2 wouldn't jump that fast on 100 mags of T.

[FloridaBrah]

Current situation:
I've been doing 50mg test c 2x a week (Monday PM injection Friday AM injection)Got my 6 week labs today (Thursday) and got my total test and free t levels back today. I have not received results for my SBHG, e2 or DHT yet.
With that being said here are the results thus far:
Total test 457ng/dl (range 129-767)
Free test 11ng/dl (range 3.3-14.1)
% free test 2.4(1.5-4.2)

Also got free t3 tested and it came back as:
3.2pg/ml (range 2.2-4.0)

I was hoping that 100mg test c a week would get me to much higher than 457 the day before my next injection. Should I bump up my dosage to 150mg a week split up in two doses? Or do more frequent injections possibly every 3 days rather than 3.5? I'm thinking it's going to take a higher dosage to get my test numbers up. What do you all think?

Also note that my endo is typical clueless.. so I'll probably have to imply what I'd like to do.

[kelkel]

TT is lower but your FT is near the top, and that's the main number to watch as it's what works for you. I'd make only a small, incremental titration to maybe 60mgs x 2. Don't worry about the 3.5 day thing. Just pick two days and inject on them. Time of day is really not worth worrying about.

Main question is how do you feel?

[FloridaBrah]

As far as how I'm feeling? I've been feeling tired a lot and not much energy. My sex drive has increased a little. I was concerned about free test being 11 even though it shows in the top end of the range of my lab, because I have seen other lab ranges of labs that others have posted and the 11 would be low on those lab ranges. Anyway, I got my other labs back today and they are as follow:

Estradiol 40pg/mL (male range: 11-53)
SHBG 24nmol/L (range: 10-85)

Triclyceride 128mg/dL (35-200)
Cholesterol 217mg/dL (0-200)
HDL 42mg/dL (40-60)
LDL Calculated 149
RBC 5.43 (4.60-5.90)
Hemoglobin 17.3g/dL (14.0-18.0)
Hematocrit% 50.7 (42.0-52.0)


With my estradiol being 40 the day before my next injection, should I start .25 armidex the days of my injections (2x a week)?

I'm thinking about bumping up test C to 120/week and adding AI at .25 2x week. I have AI on hand and I believe that the estradiol being in the 40's (it was under 5 pre TRT) is causing me to be tired with no energy. I have felt a flush in my face from it and itchy nipples. I also believe I am holding water and look moon faced/bloated.

[Youthful55guy]

2mm microadenoma? Wow that's hard to diagnose even with a MRI.

However, I'm not sure if clomiphene will be of help, as your E2 is already low, but personally I think it's worth trying.

I disagree with the latter part of the comment! Clomiphene is an selective estrogen receptor blocker. It's very selective to blocking the negative feedback loop to the HPTA for LH/FSH secretion. With no E2 (per your tests) to provide negative feedback what's the point of taking clomiphene?

[Youthful55guy]

For an HTPA restart would I run clomid solo or with Nolva at the same time?

Again, what's the point? There's no E2 to block.

I strongly suggest you listen to your endocrinologist. You have a tumor on your pituitary, that is going to mess up your endocrine system. You need advice from someone who is experienced in handling this specific medical condition.

[FloridaBrah]

Again, what's the point? There's no E2 to block.

I strongly suggest you listen to your endocrinologist. You have a tumor on your pituitary, that is going to mess up your endocrine system. You need advice from someone who is experienced in handling this specific medical condition.

I tried the restart to no avail. Im currently on TRT test c 2x a week. Above I posted my first lab results six weeks after starting TRT. With the latest results I think I need an AI and to possibly up my test c dose (see my above post). I'm just looking for advice after the lab results

[Youthful55guy]

As far as how I'm feeling? I've been feeling tired a lot and not much energy. My sex drive has increased a little. I was concerned about free test being 11 even though it shows in the top end of the range of my lab, because I have seen other lab ranges of labs that others have posted and the 11 would be low on those lab ranges. Anyway, I got my other labs back today and they are as follow:

Estradiol 40pg/mL (male range: 11-53)
SHBG 24nmol/L (range: 10-85)

Triclyceride 128mg/dL (35-200)
Cholesterol 217mg/dL (0-200)
HDL 42mg/dL (40-60)
LDL Calculated 149
RBC 5.43 (4.60-5.90)
Hemoglobin 17.3g/dL (14.0-18.0)
Hematocrit% 50.7 (42.0-52.0)


With my estradiol being 40 the day before my next injection, should I start .25 armidex the days of my injections (2x a week)?

I'm thinking about bumping up test C to 120/week and adding AI at .25 2x week. I have AI on hand and I believe that the estradiol being in the 40's (it was under 5 pre TRT) is causing me to be tired with no energy. I have felt a flush in my face from it and itchy nipples. I also believe I am holding water and look moon faced/bloated.

I finally made it all the way through the replies. Probably should have done that first.

Bottom line is that you need patience. Take this slow and easy and I would be hesitant about adding in non-medically prescribed stuff until you more stable with your current protocol. Remember it can take up to 6 weeks for your body to read a new hormonal equilibrium after making protocol changes.

Your E2 is within range (assuming that is the right panel for men), so why much with it at this point?

Your Free T is excellent per a previous post, so why muck with the T dose? Total T is pretty much a worthless number. Free T is what counts. If you bump up your T and push the Free T out of range, you may be chasing after side effects that are going to be more difficult to handle (high E2, high DHT, polycythemia, etc.).

You claim flushness and itchy nipples. Flushness can simply be the hormones coming to balance. Give it time. Regarding the itchy nipples, are they really itchy or are you simply experiencing normal nipple reactivity to stimuli? With you E2 in range, I hardly think you are in danger of gynecomastia unless your progesterone is high. You might want to have that checked.

[FloridaBrah]

I'm just not sure about the lab range. It seems that my doctors office's lab ranges are different than all the others I've seen.

For instance, my labs range for Free T is (range 3.3-14.1), other tests I've seen the lab ranges for free t was (8-25). Also the estradiol range for my lab is (11-53) for men and on other labs I've seen it with (7-42). I think my lab is being conservative with its ranges. I'm just afraid I'm low to medium low on the free t, if I go off other lab ranges I've had at other labs and seen posted on the forums. I've also seen that estradiol should be between 20-30 for men to feel best and mine is 40 the day before my next injection. I'll wait to see what my endo says at my appointment, but I have a feeling he will think all is fine, because everything is "within range."

[Youthful55guy]

I'm just not sure about the lab range. It seems that my doctors office's lab ranges are different than all the others I've seen.

For instance, my labs range for Free T is (range 3.3-14.1), other tests I've seen the lab ranges for free t was (8-25). Also the estradiol range for my lab is (11-53) for men and on other labs I've seen it with (7-42). I think my lab is being conservative with its ranges. I'm just afraid I'm low to medium low on the free t, if I go off other lab ranges I've had at other labs and seen posted on the forums. I've also seen that estradiol should be between 20-30 for men to feel best and mine is 40 the day before my next injection. I'll wait to see what my endo says at my appointment, but I have a feeling he will think all is fine, because everything is "within range."

You cannot compare ranges between ranges. I see this mistake so often in these forums. Lab ranges are specific to the laboratory running the test. They are derived during validation procedures by sampling a specific number of patients and then determining what ranges fall with the 95% confidence interval. They are often grouped by age ranges and sex too if the ranges are determined to be linked to those characteristics, as T and E2 definitely are.

Therefore, the labs MUST be interpreted within the range specific to the laboratory running the test. More than likely, if that same blood sample were to be analyzed by another lab you would get a different number, but there is a high likelihood that the number would be within the same range percentile as the first test.

I do want to elaborate a bit more on your fear of nipple sensitivity because it's something I see way to often here. Guys need E2 too. If you overshoot the mark with estrogen inhibitors or complicate it with estrogen receptor blockers, you run the risk of low E2 symptoms which can be very similar to high E2 and low T symptoms. In particular ED. It's one of those ironies of biology that guys need certain amounts of a "female" hormone to achieve and sustain erections.

Nipple erections are also normal (and even pleasurable) for guys. Given that you had low E2 for some time, you probably don't understand or remember what it's like to have nipple reactivity and it can easily be confused with the onset of gynecomastia . However, given that your E2 is within range, it's likely not the case. If however, you begin to see puffiness or development of breast tissue under the nipple, then it may be time to take some action.

I previously mentioned that you might want to consider monitoring your progesterone (P4) levels. You are at higher risk of gynecomastia if you have a combination of 3 hormones out of whack: 1) High E2, High Progesterone, and 3) high prolactin. This is what happens to women during the 3rd trimester of pregnancy when there is rapid breast development. Given your history with high prolactin, you will want to monitor both E2 and P4. it's also worth mentioning that the root of this male crazy obsession with E2 while on TRT is in bodybuilder abuse of steroids , not in TRT. Bodybuilders often stack anabolic hormones on top of each other using Testosterone as the base hormone of most cycles because the other steroids inhibit natural T production. Testosterone as you know has the ability to aromatize to E2. What many bodybuilders don't realize is that some of the hormones they stack on top of T have progesterone-like activity, two of the more common being Trenbolone and Nandrolone . So, if E2 is high and you add in progesterone activity there is increased possibility of gynecomastia. Add in high prolactin, and you are at serious risk.

[FloridaBrah]

Ok thanks for the feedback. I don't think I'll change anything on my protocol on my own, but I'm going to ask the Dr about adding 500iu a week of hcg .. if I add hcg will I need to change anything else or just keep doing weekly 100mg test c and no AI?
Also do you all know of any articles on hcg I could give to my endo?

[Youthful55guy]

Ok thanks for the feedback. I don't think I'll change anything on my protocol on my own, but I'm going to ask the Dr about adding 500iu a week of hcg .. if I add hcg will I need to change anything else or just keep doing weekly 100mg test c and no AI?
Also do you all know of any articles on hcg I could give to my endo?

There is almost nothing published in the medical literature on the use of HCG with men on TRT, just the one article I already posted an that is focused on fertility preservation. For what it's worth, my opinion is that 500 IU per week in at least 2 split doses is a fine starting dose and probably a good maintenance dose. I reiterate, don't fall victim to the E2 hysteria perpetuated by bodybuilders using ridiculously high doses of T and/or stacking it in ways they don't fully understand. LABS must drive your decisions! If your doc won't order the right ones, foot the bill yourself and get them done. https://www.discountedlabs.com/ is an excellent and reasonably priced lab available in most states.

[FloridaBrah]

Mr Dr currently has me on 125mg test-c per week that I have been splitting up into e3d. My last bloodwork my E2 was 40pg/ml and I thought that was high. At the time my Dr said to take zinc to see if that would lower it and come back in 3 months for labs to see where my E2 was.

Well in the time since, I took it upon myself (dumb I know) to manage my E2 by getting pharma grade armidex. I had been doing .5 armidex at the time of my test injections (e3d). I figured that I would do that until my next blood work and go off it so that my e2 would be high and my Dr would write me an Rx for an AI.

with that being said a week prior to my blood work I came off the armidex. I guess I either crashed my e2 or the armidex was still in my system. The latest bloods my e2 was 9pg/ml and the Dr said it was good and to come back for labs again in 6 months (June 2018).

I have been having what I thought were symptoms of high e2 with being irritable and hot flushing in my face. But now that I saw the latest e2 results, Im thinking I may have been having low e2 symptoms.

I have lowered my dose of armidex to .25 per injections (e3d) and am considering lowering it to .125 per injection.

SHould I come off the armidex completely until I get e2 raised or continue to take a low dose such as .125 per injection (e3d)? BTW before TRT when my testosterone was in the 300s my e2 consistently came back as to low to read.

Here is my current labs: 1-3-2018

Estradiol: 9.4pg/mL Reference Range: 7.6-42.6 pg/mL (Roche ECLIA methodology) Guessing it would be lower with sensitive e2
Testosterone, Serum: 863ng/dl Reference Range: 264-916 ng/dL
Free Testosterone(Direct): 22.2ng/dl Reference Range: 8.7-25.1 pg/mL
Hematocrit: 53.7% (HIGH) Reference Range: 37.5-51.0 %
RBC 5.67 Reference Range: 4.14-5.80 x10E6/uL
WBC: 6.4 Reference Range: 3.4-10.8 x10E3/uL
Hemoglobin: 17.5 Reference Range: 13.0-17.7 g/dL
Prolactin: 5.5 Reference Range: 4.0-15.2 ng/mL
Cholesterol, Total: 230 (HIGH) Reference Range: 100-199 mg/dL
Triglycerides: 104 Reference Range: 0-149 mg/dL
HDL Cholesterol: 45 Reference Range: >39 mg/dL
LDL Cholesterol Calc: 164 (HIGH) Reference Range: 0-99 mg/dL
Calcium, Serum: 10.5 (HIGH) Reference Range: 8.7-10.2 mg/dL
Glucose, Serum: 96 Reference Range: 65-99 mg/dL
BUN: 21 (HIGH) Reference Range: 6-20 mg/dL
Protein, Total, Serum:7.2 Reference Range: 6.0-8.5 g/dL
Albumin, Serum: 5.0 Reference Range: 3.5-5.5 g/dL
Bilirubin, Total: 0.6 Reference Range: 0.0-1.2 mg/dL
Alkaline Phosphatase, S:62 Reference Range: 39-117 IU/L
AST (SGOT): 16 Reference Range: 0-40 IU/L
Potassium, Serum: 5.6(HIGH) Reference Range: 3.5-5.2 mmol/L
Sodium, Serum: 141 Reference Range: 134-144 mmol/L
Chloride, Serum: 98 Reference Range: 96-106 mmol/L
Creatinine, Serum: 1.52(HIGH) Reference Range: 0.76-1.27 mg/dL
ALT (SGPT): 21 Reference Range: 0-44 IU/L
Carbon Dioxide, Total:24 Reference Range: 18-29 mmol/L
BUN/Creatinine Ratio:14 Reference Range: 9-20
Globulin, Total:2.2 Reference Range: 1.5-4.5 g/dL
A/G Ratio: 2.3(HIGH) Reference Range: 1.2-2.2
eGFR If NonAfricn Am: 60 Reference Range: >59 mL/min/1.73


Also got lab work done sepratly with my Endo who is treating my pituitary adenoma. The endo is checking my thyroid and pituitary. Looking at these results is kinda alarming due to my IGF-1 being high and my GH being LOW. What does this mean any incite on it? Here are those results:

Thyroxine (T4) Free, Direct, S: 6.6 Reference Range: 4.5-12.0 ug/dL
Thyroxine (T4) Free, Direct, S: 1.19 Reference Range: 0.82-1.77 ng/dL
TSH: 1.680 Reference Range: 0.450-4.500 uIU/mL
Growth Hormone , Serum: <0.1 Reference Range: 0.0-10.0
Luteinizing Hormone(LH), S: 0.1 Reference Range: 1.7-8.6 mIU/mL
FSH, Serum: 0.3 Reference Range: 1.5-12.4 mIU/mL
Prolactin: 5.1 Reference Range: 4.0-15.2 ng/mL
IGF-1: 306 (HIGH) Reference Range: 88-246 ng/mL
Cortisol - AM: 13.4 Reference Range: 6.2-19.4 ug/dL

[hammerheart]

There is nothing alarming about IGF-1 is not high but quite of a good levels to have, nothing concerning there. Prolactin and thyroid are unremarkable.

You might consider dropping off AI altogether imo and see you do, and adjust from there. Eventually you could drop 50mg 2x weekly and stay golden without AI.

Hematocrit is going way to high and you should discuss donating with your doc.

[kelkel]

Drop the AI. Retest it in 4 weeks. E2 is always better a little higher than lower.

[Youthful55guy]

Mr Dr currently has me on 125mg test-c per week that I have been splitting up into e3d. My last bloodwork my E2 was 40pg/ml and I thought that was high. At the time my Dr said to take zinc to see if that would lower it and come back in 3 months for labs to see where my E2 was.

Well in the time since, I took it upon myself (dumb I know) to manage my E2 by getting pharma grade armidex. I had been doing .5 armidex at the time of my test injections (e3d). I figured that I would do that until my next blood work and go off it so that my e2 would be high and my Dr would write me an Rx for an AI.

with that being said a week prior to my blood work I came off the armidex. I guess I either crashed my e2 or the armidex was still in my system. The latest bloods my e2 was 9pg/ml and the Dr said it was good and to come back for labs again in 6 months (June 2018).

I have been having what I thought were symptoms of high e2 with being irritable and hot flushing in my face. But now that I saw the latest e2 results, Im thinking I may have been having low e2 symptoms.

I have lowered my dose of armidex to .25 per injections (e3d) and am considering lowering it to .125 per injection.

SHould I come off the armidex completely until I get e2 raised or continue to take a low dose such as .125 per injection (e3d)? BTW before TRT when my testosterone was in the 300s my e2 consistently came back as to low to read.

Estradiol: 9.4pg/mL Reference Range: 7.6-42.6 pg/mL (Roche ECLIA methodology) Guessing it would be lower with sensitive e2
Testosterone, Serum: 863ng/dl Reference Range: 264-916 ng/dL
Free Testosterone(Direct): 22.2ng/dl Reference Range: 8.7-25.1 pg/mL
Hematocrit: 53.7% (HIGH) Reference Range: 37.5-51.0 %
Hemoglobin: 17.5 Reference Range: 13.0-17.7 g/dL
Prolactin: 5.5 Reference Range: 4.0-15.2 ng/mL

Also got lab work done sepratly with my Endo who is treating my pituitary adenoma. The endo is checking my thyroid and pituitary. Looking at these results is kinda alarming due to my IGF-1 being high and my GH being LOW. What does this mean any incite on it? Here are those results:

Prolactin: 5.1 Reference Range: 4.0-15.2 ng/mL
IGF-1: 306 (HIGH) Reference Range: 88-246 ng/mL

My gut reaction is yes, you should not be taking anastrozole or any other E2 inhibitor or blocker if your E2 is in range. As you learned through this experience, they are very difficult drugs to dose in men. I've seen this same scenario over and over in the forums where guys get paranoid about normal nipple reactivity and then crash their E2 with anastrozole and end up with sides worse than the original low T. Most commonly, a bad case of ED and low energy, low cognitive ability. We need E2 too.

So, now that your doc thinks your E2 is low, there's no way he's going to prescribe any E2 management unless you come clean as to why it was so low. If he's experienced, he'll probably suspect anyway once your E2 shoots up to the normal range again. One week is not enough time for the amount of anastrozole you were taking to completely leave your system and for E2 to begin to build up again. I seem to recall that the half-life was somewhere around 4 days, so it will take a month or so for it to completely leave your system.

If you insist on taking anastrozole, you need to do this intelligently and titer it yourself using your own out-of-pocket labs with the correct test. here's a good source: https://www.discountedlabs.com/estra...itive-lc-ms-ms. I would stop trying to cut the pills (which are dosed for women), it's just too difficult to do accurately. I like the "Vodka" method. I use a small eye dropper dispenser bottle where I dissolve a 1 mg pill into 1.5 mL of vodka. It dissolves quickly. Then I administer 4 to 5 drops per day. I've done some weight change experiments with the drops using a sensitive pan balance, and 4 drops per day is about 0.062 mg per day. That equates to about 0.43 mg per week. At 5 drops per day, it's closer to 0.5 mg per week. I find this extremely effective at shaving off about 20 pg/mL from my borderline high 50-60 pg/mL E2 (with no anastrozole).

Not the highlighted hemoglobin/hematocrit values in your recent labs. You need to get that under control soon. Donate blood if you are eligible (get a phlebotomy script if you are not) and do not attempt to increase your T any higher. If you cannot keep hemoglobin within range with regular blood donations, you are going to have to cut back on the T. Remember too that it takes about 3 months for changes in T to filter down to changes in hemoglobin, slow it's a slow process. Blood donations do this pretty much instantly.