Question Regarding Estrogen Blocker

[AnthonyD7295]

Sorry i am not very knowledgable about this but looking at starting low t therapy. 45 years old. Testosterone level is 239. Doc wants to put me on Cypionate with no HCG or estrogen blocker. Says we can evaluate that as blood work comes back in 4 months. As a teenager i had terrible bout of gynecomastia . Not from steroids just puberty. Was very lean so it presented as severely puffy nipples to which i had surgery on to reduce. from the threads that i have read it seams as though guys go on HCG if they have testicular discomfort from shrinking and estrogen blocker from gynecomastia issues. My fear is that i am predisposed to gynecomastia from my past. If i wait and have visual symptoms,the estrogen blocker will stop further progression but will not reverse any visual results already caused. Is this accurate or am i totally off based?

Thanks so much for anyone taking the time to read and offer educated feedback.

Best,
Tony

[Chicagotarsier]

The doctor if legit is going to start you at a dose equaling 25mg per week. Many people fall in range estrogen at this level.

The high end they are allowed to prescribe (here anyway) is 50mg per week. You will most likely need an AI at that level.

This is real TRT from a real doctor. Medical reference material states 25-50mg per week for low test treatment.

You have to understand that it takes months to get dialed in. What works for you doesn't work for the guy next to you. You are lucky they start you out on injections. Many will give you testosterone pills for start.

[macmathews]

The doctor if legit is going to start you at a dose equaling 25mg per week. Many people fall in range estrogen at this level.

The high end they are allowed to prescribe (here anyway) is 50mg per week. You will most likely need an AI at that level.

This is real TRT from a real doctor. Medical reference material states 25-50mg per week for low test treatment.

You have to understand that it takes months to get dialed in. What works for you doesn't work for the guy next to you. You are lucky they start you out on injections. Many will give you testosterone pills for start.

25-50 mg of what ?
Test ?
If so 25mg is not an appropriate dose of testosterone weekly for ANYBODY.
100mg would be a normal starting dosage even 75mg is unheard of.

[kelkel]

The doctor if legit is going to start you at a dose equaling 25mg per week. Many people fall in range estrogen at this level.

The high end they are allowed to prescribe (here anyway) is 50mg per week. You will most likely need an AI at that level.

This is real TRT from a real doctor. Medical reference material states 25-50mg per week for low test treatment.

You have to understand that it takes months to get dialed in. What works for you doesn't work for the guy next to you. You are lucky they start you out on injections. Many will give you testosterone pills for start.

Where's this at Chicago? Asia?

[kelkel]

Sorry i am not very knowledgable about this but looking at starting low t therapy. 45 years old. Testosterone level is 239. Doc wants to put me on Cypionate with no HCG or estrogen blocker. Says we can evaluate that as blood work comes back in 4 months. As a teenager i had terrible bout of gynecomastia . Not from steroids just puberty. Was very lean so it presented as severely puffy nipples to which i had surgery on to reduce. from the threads that i have read it seams as though guys go on HCG if they have testicular discomfort from shrinking and estrogen blocker from gynecomastia issues. My fear is that i am predisposed to gynecomastia from my past. If i wait and have visual symptoms,the estrogen blocker will stop further progression but will not reverse any visual results already caused. Is this accurate or am i totally off based?

Thanks so much for anyone taking the time to read and offer educated feedback.

Best,
Tony

Starting out on just cyp is ok. I'd prefer HCG along side it but it can be implemented later. Starting with cyp solo will let you see exactly where it lands you hormonally. When you add hcg later it can / will alter levels and require dose titration. HCG is recommended though to maintain testicular function. Did your doc happen to discuss with you where your problem lies? Pituitary related, testical related or simply andropause ?

If your doctor starts you at a lower dose of testosterone, which he should do, then an AI should not be implemented immediately. It should be based on subsequent blood work at the 6 week mark. You will be fine until then. You may experience some nipple sensitivity but sensitivity is not indicative of gyno. Since you've had gyno surgery in the past the majority, if not all of your receptors in the nipple area have been removed which alleviates you of this worry even more.

Exactly what type of protocol is he talking about starting you on?

Take some time and read the sticky threads at the top of this forum as well Anthony. Welcome to the forum!

[AnthonyD7295]

Thanks so much for your reply. Very helpful. he did not mention doses. Maybe he doesn't want to share too much as this is his business and wants to make sure i am going to move forward. This is his exact email:Happy to hear you're planning on going ahead with this. As you know, your health is my primary goal. For that reason I continue to recommend starting with T alone and follow your estrogen levels and symptoms. This is what's recommended by the leading physicians in the academic aspects of this field. As we had discussed the levels of T we will be shooting for will be within normal limits and estrogen complications although possible are rare. We will reassess your Estrogen level at and symptoms at 4 months. I have no problem initiating therapy if indicated, but preventative treatment of this aspect is not my recommendation. Let me know if you still want to go ahead.

Seems legit. I am just hypersensitive to the gynecomastia . He mentioned lack of receptors as you did but of course i was skeptical as he also wants my business.

Thanks again and your insight and knowledge is greatly appreciated

[kelkel]

As stated, it's just fine starting out on only testosterone . But it's not fine waiting 4 months to assess blood work. I'm hoping it's a typo and he means 4 weeks. You need to find out exactly what type protocol he wants to initiate. It's important to know as who he may consider "leading physicians" may be quite old school and protocols and current methodologies have changed dramatically this past decade.

When it comes to protocols, the bare minimum is once per week injections. But this is really not the most effective anymore. When you look at the below graph showing the half life of testosterone post injection you'll see why. I post this all the time to give guys a visual:



Looking at the chart you can see where once per week injections or longer puts you on a hormonal roller coaster, which no one wants. Current methods by the top docs in the industry recommend twice weekly injections at smaller doses. This will maintain steadier state T levels with less testosterone turning over into estrogen, think less T injected at one time = less estrogen. It also helps mitigate RBC issues (thickening blood) which cause many men on TRT to have to donate frequently. At a minimum once every 5 day injections. You also need to be able to self-inject. Another benefit to smaller injections is that you can use insulin syringes and inject anywhere you can pinch a little fat (normally stomach.) They are as effective as normal intra-muscular injections and if your doc discounts this let him know they are backed by studies:

https://www.ncbi.nlm.nih.gov/pubmed/28379417

But with all that said, if you have to beg to be treated how you want then it's time to find another doctor! Post up how you do on this thread please.

[Youthful55guy]

Sorry i am not very knowledgable about this but looking at starting low t therapy. 45 years old. Testosterone level is 239. Doc wants to put me on Cypionate with no HCG or estrogen blocker. Says we can evaluate that as blood work comes back in 4 months. As a teenager i had terrible bout of gynecomastia . Not from steroids just puberty. Was very lean so it presented as severely puffy nipples to which i had surgery on to reduce. from the threads that i have read it seams as though guys go on HCG if they have testicular discomfort from shrinking and estrogen blocker from gynecomastia issues. My fear is that i am predisposed to gynecomastia from my past. If i wait and have visual symptoms,the estrogen blocker will stop further progression but will not reverse any visual results already caused. Is this accurate or am i totally off based?

Thanks so much for anyone taking the time to read and offer educated feedback.

Best,
Tony

You're making this harder than it needs to be, which is understandable since there's so much misinformation out there on TRT.

1) Since you had gyno surgery in the past, more than likely much of the mammary gland has been removed and with it gone, there is a lower likelihood of a second bout of gyno.

2) Gyno is not just about E2. Make sure you have you prolactin and progesterone levels monitored. It's the combination of the 3 hormones (E2, P4, and prolactin) that are the cause of gyno. I suspect you might have high prolactin levels. Get them checked.

3) IF prolactin and P4 come back normal, simply start your TRT at a dose of about 100 mg T-cyp or T-eth per week in at least 2 divided doses (e.g. 50 mg per dose). I prefer the E3D method of about 40-45 mg every 3 days.

4) Monitor your E2 after about 4-6 weeks of TRT, and if and only if, E2 comes in high, then consider using an E2 inhibitor like anastrozole or potentially and E2 blocker. Don't over do it and carefully monitor the E2 levels until you get the dose right.

5) As one of the previous posters mentioned, nipple reactivity is not a good indicator of the onset of gyno. It is perfectly normal (and in my opinion desirable) for men to have nipple erections when stimulated. In fact, I know of several guys that use it as an indicator that they've gone too far with their E2 inhibitors. Guys need a certain (normal) level of E2 for erections to occur. If you crush your E2, it is usually followed by a bad case of ED, which needless to say is not desirable. My experience is that if nipple reactivity is normal, there's minimal to no ED. When my nipples are flat and lifeless, ED usually ensues.

Hope this helps!