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pman42
11-08-2013, 10:15 PM
hello guys. After a recent 5 month run on raloxifene (with the last 2 months on letro as well) gyno has shrunk but still not gone. I believe it flared up when I was taking Trazodone relatively long-term for sleep, as that drug increases prolactin. near the end of the 5 months it seemed like raloxifene was losing its magic, that the tissue wasn't shrinking anymore. I have read that it can lose its efficacy for breast cancer as the cells become immune to it, so maybe that can happen for gyno as well. Since being off the ralox, I am kind of vacillating on whether it is getting worse.

My questions are these: in the absence of a stimuli, i.e. high estrogen, high prolactin, or aromatizing steroid (none of which are present in my system at the present) would gyno continue to grow? 3 bloodwork panels have revealed estrogen under 100 pmol/L, which translates into 27.25 pg/mL. those bloods were before letro or raloxifene, so my baseline estrogen is not elevated. and, how do I go about further reducing it? Since I believe it was prolactin-caused, would not prolactin reduction make sense? Weekend is big on prami, but I've heard bromocriptine as well can reduce prolactin. I have been taking 5g of mucuna powder, which according to 1 study reduces prolactin. but i don't want to muck up my results for an upcoming blood test. I am going to work with an endo on my hormones, as my test levels have consistently come back low.

I don't want to do any more suppressive compounds, right now or possibly ever again, so I am thinking of asking the endo for toremifene, seeing if it affects my hormones positively, then jumping on AndroHard or proviron. PCT would be toremifene. my understanding is that once gyno is 'ingrained' it can be hard to get rid of, but AH definitely helped it before.

anyway, any help you can provide would be appreciated.

burlyman30
11-08-2013, 10:32 PM
Being that your testosterone is consistently testing low, your test:estro balance may be an issue for reoccurrence. I am now on a maintenance program of ralox/anastrozole because of my issues with aromatization on even low dosed TRT. I am not a fan of running a SERM without at least a low dose of an AI. The body may not recognize the estro in the system, yet it can continue to rise and may affect other things negatively without some amount of an estro lowering compound.

As far as your situation, AH may help shift that androgen/estrogen balance enough to improve the gyno. Toremifene is a good pct... good luck getting your doc to prescribe it, as most are familiar with only clomid or nolva. But wish you luck in that conversation... try to get an AI too.

weekend
11-08-2013, 10:53 PM
I know if I was only taking masteron, prami and ralox my gyno plus be gone by the end of a full cycle. But it's shrinking slower on those plus test and tren.

You shouldn't use bromo though, use caber if afraid of prami sides.

A lot of things can make gyno worse. Essential oils of lavender and tea tree, dairy, alcohol, weed, fried food...

pman42
11-09-2013, 09:05 PM
What I don't understand is why the gyno didn't respond to 2.5mg letro ED, and even seemed to get worse. once i dropped the letro and just took the raloxifene, it improved again. possibly because it's prolactin gyno, i don't know.

weekend
11-09-2013, 09:34 PM
It's because it was prolactin and the letro also may have been bunk. Besides, your estrogen is always in range!

Jelisej
11-09-2013, 09:42 PM
Burly hit nail on its head: "Being that your testosterone is consistently testing low, your test:estro balance may be an issue for reocurrence."

No offence bro' but it seems that you're heading towards TRT, or better said HRT.

If hormones are out of balance there is lot of aromatisation, for example if cortisol is either too low or too high, there will be lot of aromatisation, same can happen with thyroid etc... But it is estrogen that causes gyno, not prolactin.

I've got a feeling that SERMS are not really increasing your testosterone levels, very likely you had low testosterone even before AAS usage, and in young men libido is not so affected by low test. especially if other hormones are tuned and there is reasonable amount of free test.

Stop messing', get off all supplements to get "clean" bloodwork otherwise you're end up chasing your own tail like so many guys do.
Once on TRT gyno will be gone.

Gynaecomastia | Doctor | Patient.co.uk (http://www.patient.co.uk/doctor/Gynaecomastia.htm#)

Jelisej
11-09-2013, 09:55 PM
It's because it was prolactin and the letro also may have been bunk. Besides, your estrogen is always in range!

But we dont know his SHBG (or even progesterone levels). Estrogen same as testosterone can be bound to SHBG or free, so one can have good reading but still have low or high free E2 (and symptoms of low or high E2)
Even with cortisol is similar if one has high transcortin (corticosteroid-binding globulin) levels even with good cortisol levels can symptoms of low levels....
Same goes for most of other hormones....

In reality when we get bloodworks for lets say freeT3 we know how much of it is in blood, but we dont know what is it really dong is it being carried into cells etc.... Thats why its always important to do extensive bloods- then we can at least guess...

weekend
11-09-2013, 11:34 PM
I guess I was just basing this on my case in which nothing really worked except more androgens or prolactin control drugs.

Jelisej
11-10-2013, 08:53 AM
I guess I was just basing this on my case in which nothing really worked except more androgens or prolactin control drugs.

More androgens would certainly work, prolactin is a bitch and gives lot of symptoms and reducing it does make lot of uneasiness/pain go away (but it will not get ridd of "lumps")- so what you have done is quite right and it would work for him as well, but it would not sort out with underlying issue (low testosterone), and I feel its better to deal with underlying cause than trying to find scapegoat (prolactin).
So, IMO extensive bloodwork is the right thing to do and then we'll see what needs to be addressed.

pman42
11-10-2013, 12:13 PM
Jeli, I think that SHBG was measured on previous bloodwork. it is definitely being tested on my upcoming draw. I will check on the previous ones and report back.

I really don't want to do TRT. It seems like, long-term, it would just compound the problem of low testosterone. plus the intricacies of proper HRT with other hormones are multi-faceted, and I trust the body to work out the levels among different hormones more than the best endo. in addition i don't want to be reliant on patches, gels, or injections, and I don't want the expense. I want to work with the endo to try some version of an HPTA reboot, a la Scally. He uses HCG in combo with clomid and tamoxifen. The HPTA is somewhat plastic, so even if I couldn't boost my levels permanently, I could boost them temporarily. better this than suppressing them further with testosterone.

anyway I really appreciate your input Jelisej. Do you have any opinion on the Scally protocol with HCG and clomid/tamox? or long term treatment with e.g. toremifene? when I get home tonight I'm going to buy the Kindle version of Scally's book and read it through.

thanks again

pman42
11-10-2013, 12:31 PM
also, I am trying my damndest to ensure that this blood draw represents my real baseline. i'm training but not overtraining, sleeping well but not oversleeping, eating well but not drastically altering any 1 macronutrient, and reducing caffeine to near zero. at the time of draw it will be almost 2 months after ralox, and over 2 months since I took .625mg of letro. so hopefully it will give an accurate picture.

this endo seems willing to work with me, the only drawback is a 1.5hr travel time to another city but I have friends and business there anyway, so good excuse to go there once in a while.

Jelisej
11-10-2013, 02:10 PM
Pman, once I watched this episode of Dr House where he finally found treatment that works well for him mentally and he became very pleasant to work with, nice to other people etc... but eventually he realised that his sudden compassion and caring attitude has negative effect on his work- and thats how it is in reality.
Wishful thinking and sympathy does not solve problems, and it does interfere.....so I hope you and others will forgive me if I'm sometimes too cold hearted or critical or blatant....
Anyway, back to the point- SERM restart protocol does not work for a lot of people for number of reasons- If their testosterone was always low (congenital) usually it does not work, when people get to around 40 the success rate is much much lower... So in your case what have you recently done is more-less some kind of SERM restart and it does not seems to be working, so trying another one like clomid restart is a good idea but chance that is going to be successful is low.
What do I think about M. Scally and his protocols? I think there are better endocrinologist out there, and better and more proven methods as well.
Some of endo's that I found interesting'knowledgable
Dr Sergey Dzugan
Dr Thierry Hertoghe
Dr Romeo Mariano
Dr Jeffrey Dach
I understand your "I really don't want to do TRT. It seems like, long-term"- and this is truth, but mind you there are different types of TRT/HRT including HCG mono or permanently using SERMS etc.... And they are all long term, sometimes person changes its own protocol, but bottom line is- it is for a life.
Lot of people boost their hormones (one way or another) and then they drop, then they boost it again only to be back to the square one- I personaly dont see point in all that, its actually very inconvenient and usually more expensive than just using routine that works.

Personally, I'm fan of "hormonal optimisation" which is basically tunning up whole endocrine system, its bit complicated but it makes people happy, healthy and even when it comes to physique it works fine.

When it comes to hormones, especially testosterone- "denial" is a big problem. It is actually hard to accept that there is a problem, and it takes time. It really does, but eventually all people that went to TRT and done things right way say that they never look back- they enjoy their life- and that is whole point.

pman42
11-10-2013, 08:21 PM
Just to be clear, I haven't yet checked bloods after 5 months on raloxifene, so I don't know if that affected them at all. ralox is supposed to have minimal effect on test anyway.

I wouldn't object to the idea of long-term SERM or HCG therapy, I just don't want to do long term TRT since it is expensive and causes further suppression. are there any books by the other endos you mentioned that you would recommend?

and i don't find you to be too harsh, i post on here to get opinions and the like.

burlyman30
11-10-2013, 08:50 PM
HCG and or SERM therapy may or may not work to provide the results you want... if it does, then great. If not, then the choice is to feel bad or to go on TRT. I waited for years before I finally went that route, so I understand you wanting to go another route.

weekend
11-11-2013, 02:11 AM
the thing is, serms have some level of toxicity, and HCG monotherapy can cause excessive aromatisation, while also suppressing your pituitary gland heavily.

ultimately, if you have already tried getting lean and healthy and the levels still don't go up... give up and go on TRT asap. you will most likely still be able to have kids, and it will probably be easy with the short term use of hCG and hMG when trying to get her pregnant...

Jelisej
11-11-2013, 05:20 PM
Just to be clear, I haven't yet checked bloods after 5 months on raloxifene, so I don't know if that affected them at all. ralox is supposed to have minimal effect on test anyway.

1 I wouldn't object to the idea of long-term SERM or HCG therapy, 2.I just don't want to do long term TRT since it is expensive and causes further suppression. are there any books by the other endos you mentioned that you would recommend?

and i don't find you to be too harsh, i post on here to get opinions and the like.

1. When it comes to test boosting properties or restart protocols SERMS (mainly clomid) come handy but thing is with SERMS you almost never get the "feel" that you get when you tune yourself up and bring test. levels up- they dont raise free test a lot and they bring SHBG up as well, then you add aromasin for couple of other reasons as well as for reducing SHBG a bit and bringing free test up, but this is not a big deal so people then add some test boosters which are usually pricey and then they add DAA to raise free test bit more and because DAA raise prolactin they add some dopamine agonist.... etc... etc... so in the end it becomes complicated and very expensive as well
Neverthless it is good to try SERM restart which will also give you an idea, tough in your case I suspect that restart protocol will not work

HCG mono works fine for some folks, but if one is primary it will not work. Apart of primary hypogonadal folks HCG is standard protocol as it has a lot of benefits- along raising test levels (people using both HCG and test shots get around 10% of their tt levels from HCG) it also stimulates adrenals and thyroid plus it raises lot of other hormones which has lot of benefits including improved libido- as Weekend pointed out HCG does aromatise

2. TRTis actually not so expensive really, and is definitely cheaper than using 101 supplement from which most of dont do much
As for supression- once your levels are 300 ng/dl, is nothing there to get supressed and if you use HCG you can always get of TRT and you still will have most of it back- tough you must understand that having low level of hormones has negative effect on your whole body


Again, I understand your reluctance, I agree that TRT/HRT is last resort but sometimes it cant be avoided and at the end of the day all of us at some point will be on some kind of medications for life, TRT is an option- dwelling in the dark is not

burlyman30
11-11-2013, 05:30 PM
Very well written post, J.

pman42
11-11-2013, 07:12 PM
I have been reading Michael Colgan's book on the subject (old, I know) and I think I would like the idea of gels or patches more, to mimic the natural rhythm. anyway I think I will try the SERM restart anyway, since I have nothing to lose, then talk to the endo again if it doesn't work.

do any of the endos you mentioned have books?

thanks again for the help guys.

Jelisej
11-11-2013, 08:00 PM
I have been reading Michael Colgan's book on the subject (old, I know) and I think I would like the idea of gels or patches more, to mimic the natural rhythm. anyway I think I will try the SERM restart anyway, since I have nothing to lose, then talk to the endo again if it doesn't work.
do any of the endos you mentioned have books?
thanks again for the help guys.

Definitely try SERM restart, thats first thing to do, and if it does not work than just go for "classic TRT"

Errrrr... I'm breaking the party again- but altough gels/patches have some interesting properites, they are not really practical and its very difficult to get stable numbers and some people have very poor absorption worst case being hypothyroid sufferers as their absorption is often almost non-existent, on top of that there is lot of testosterone-DHT conversion there, and sometimes people end up with DHT 5-6 X of the ref range, which sounds great but its not really in long term. Shots are your best bet, most simply 3X a week (before or after HCG shots) and thats it. Its done in no time, and is actually more convenient than gels/patches.

Books? I've scrolled trough some in library- I remeber Thierry Hertoghe's book was selling at some silly price like 400$ and it was all theory,
I've scrolled trough S. Dzugans book, it was very interesting- he is big on pregnenolone, I think he exaggerate a bit- I remeber he describes patient using 1300 mg of pregnenolone...

I dont think Romeo Mariano has written any books but he has lot of posts and articles in his site "definitive mind", I dont think he is active on there but there are plenty of interesting articles and posts- mind you he is neurosurgeon and he combines that with classical endocrinology, so in a way he is pioneer and definitely interesting to read


I did not mentioned Michael Lam earlier, but he has some interesting stuff- from him I've learned how to control E2 by adrenal gland function, brilliant stuff- he has website but has some books as well
Adrenal Fatigue and Hormone Therapy - DrLam (http://www.drlam.com/articles/adrenal_fatigue_and_hormone.asp?page=1)

Jeffrey Dach seems clever, he has his website and has published some books, did not read any books- he is a lot in bioidentical hormones and "natural way" medication.
Clomid For Men With Low Testosterone by Jeffrey Dach MD (http://www.swolesource.com/forum/mens-health-ancillary-medication/779-clomid-men-low-testosterone-jeffrey-dach-md.html)

pman42
11-12-2013, 12:11 AM
this has been a very informative discussion, and thank you all very much for participating.

Jeli, when you stated early on that TRT would take care of gyno, I assume this is by correcting the androgen:estrogen ratio. actually when reading in Morgentaler's "Testosterone for Life" about the testosterone patches (esp. the scrotal ones) I thought that the "side effect" you mentioned-- DHT 5x the normal range-- sounded great!! increased DHT would be awesome right about now, and as my prostate and hair health are rocksolid, bring it on!

I will discuss these issues with the endo. right now I feel that eliminating gyno is priority number 1. even though not visible it bothers me very much. after the gyno is taken care of then I can think about more complicated issues of the whole hormonal system. Or perhaps it is better to address them concurrently. there's a lot to think about here wrt what direction it takes me in.

weekend
11-12-2013, 12:19 AM
in my opinion your gyno won't budge unless your androgens are higher. for someone like me with high test when off gear, i made substantial progress using ralox, aromasin and prami concurrently, but the improvement was like double with masteron added, so i assume you really NEED androgens to fix the problem.

thus, TRT is the best option. imo.

i also realized gyno is way less bothersome on cycle, androgens seem to make me give less fucks about what people think or see on me. sure it looks way better but now i barely even think of it. during PCT when my test was probably as low as yours (:/) that shit made me want to cry...

burlyman30
11-12-2013, 12:22 AM
If I can interject something about the "TRT correcting gyno" subject. It's not entirely fact that exogenous testosterone changes the test:estro ratio... it may or may not. It is possible that aromatization occurs to the point where the ratio is still off, but the levels of both hormones are higher. I THINK what J meant to say that the TRT/HRT PROTOCOL would eliminate the gyno, meaning that testosterone plus ancillary drugs like an AI to keep the numbers of both hormones optimized would create an environment where gyno would no longer be an issue.

On a side note, I think Sperwer here on the forum uses a daily gel. A friend of mine does as well and it has helped him. Daily application was not a great fit for me, but injections work for me. There are advantages and disadvantages of either protocol.

weekend
11-12-2013, 12:23 AM
by the way, my dad tried going off TRT because he mistakenly thought the "testosterone would jump start his system"... this is how little his endo communicates.

got tested after 2 months off test and his test was a bit higher than it was before using. he went from 283 to 410 ng/dl.

after using for 2 years. he's back on it now and says he won't go off again!

so jel is right, when your test is that low, you've got nothing to lose.

- - - Updated - - -


If I can interject something about the "TRT correcting gyno" subject. It's not entirely the fact that exogenous testosterone changes the test:estro ratio... it may or may not. It is possible that automatization occurs to the point where the ratio is still off, but the levels of both hormones are higher. I THINK what J meant to say that the TRT/HRT PROTOCOL would eliminate the gyno, meaning that testosterone plus ancillary drugs like an AI to keep the numbers of both hormones optimized would create an environment where gyno would no longer be an issue.


i think this is what he meant as well. there just aren't enough androgens in his system for gyno to just disappear.

JM1000
11-12-2013, 08:49 AM
Had no clue gyno was related with androgens!

DJM
11-12-2013, 12:55 PM
by the way, my dad tried going off TRT because he mistakenly thought the "testosterone would jump start his system"... this is how little his endo communicates.

got tested after 2 months off test and his test was a bit higher than it was before using. he went from 283 to 410 ng/dl.

after using for 2 years. he's back on it now and says he won't go off again!

so jel is right, when your test is that low, you've got nothing to lose.

- - - Updated - - -




i think this is what he meant as well. there just aren't enough androgens in his system for gyno to just disappear.

id agree with this too
end of the day its a delicate balance to optimize hormones

Jelisej
11-12-2013, 06:54 PM
basically, when it comes to E2, I would say that estradiol should be around 25 pg/ml +/- 10, some folks feel better on lower and some on higher end, but basically E2 should be kept there, so obviously adding testosterone would change ratio, and that would eventually sort out gyno
As for gel/patches, they are waste of time really, no serious endo will prescribe you gel/patches- as it is simply not easy to maintain stable levels which is vital for success, assuming that adrenals/thyroid are set, once you find right test. dosage- (and right dosage is the one that keeps free test. at the top), next you make sure progesterone is at the top as well or even bit higher (as prog will protect your prostate plus other benefits) and then you top up your DHT levels if not sufficient, and IMO best way to do that is to use Andractim DHT gel, and DHT should be kept above range as well, somewhere on 50 % above us where most feel ok, and get most benefits, to have DHT more than that does not give additional benefits really just sides.

Fix list in right order:
Adrenal
Thyroid
Sex hormones; test. E2
Growth Hormone

pman42
11-14-2013, 10:46 AM
Jeli, I actually read up on Andactrim when investigating all of this. It looks interesting but is not listed in the pharmacopeia of Canada. so I would have to apply for a Health Canada drug exemption then pay most likely full price for it, since I doubt it would be covered under health benefits. I'd be paying at least a couple hundred according to some transsexual blogs I read (I swear I was only reading them for info on Andactrim!).

I've seen some studies where the patch resulted in steady blood increases into the normal range, so it definitely is do-able. But there may be a lot more factors than a simple injection, like skin thickness, sweat, etc. On the other hand, I am looking at taking a lengthy vacation coming up, and if we're talking 3x weekly injections then that means hauling tons of needles and a sharps container, explaining to customs, yada yada. I can see the pluses and minuses of both approaches.

the endos I've read aren't totally dismissive of patch, they comment that in some men it doesn't raise blood levels high enough. But if you drop a penny into a thimble of water it raises the level, that's kinda what I feel my test. levels are like.

Jelisej
11-14-2013, 05:41 PM
I should not be saying this- but you can get Andractim from Europe. Funny thing is as backward as they are European endos still do prescribe dht to patients while American are against it, anyway I know that lot of them are ordering andractim from Europe, they have no problems whatsoever.

Again, with patches its simply harder way, and even majority of those who start with patches end up with shots- point is to reach balance among hormones, and if you cant get stable or high enough test levels it is very hard work to get it done, and those who are for whatever reason stuck with patches usually have to use a lot more than than they are ment to be used.

"But if you drop a penny into a thimble of water it raises the level, that's kinda what I feel my test. levels are like. " Thing is once you add exogenous testosterone your own production will stop, so you need to add lot more than you think. And if you are adding than add enough, once I heard expression that I liked a lot:
"Better to live hundred years as a millioner than a week as a poor bloke".


I always felt sorry for that astronaut who went all the way to the moon but never actually walked on it.... So close but so far....