Beginning TRT and itchy nipples

[ZoomyR6]

Hey guys,

I just started my second week of 100mg/wk. My right nipple has been getting itchy starting the day after my injection and last a couple of days, no soreness or tenderness. I also put on about 6lbs which has to be water as I haven't changed my diet and my clothes are fitting the same.
My e2 when tested prior to trt were 26 and 29 done on the regular test and not the sensitive test. I have read the regular test greatly over estimates the number but have been reading threads from people where it actually underestimated their number and the sensitive test actually came back higher. I was going to go for blood work about 5 weeks from the start of trt but was wondering if I should go earlier due to these symptoms. I want to catch it early if my e2 is the problem. Is it best to test for e2 in trough like when following up test levels or in peak?
Any other input greatly appreciated.

 

[CoastWatcher]

Hey guys,

I just started my second week of 100mg/wk. My right nipple has been getting itchy starting the day after my injection and last a couple of days, no soreness or tenderness. I also put on about 6lbs which has to be water as I haven't changed my diet and my clothes are fitting the same.
My e2 when tested prior to trt were 26 and 29 done on the regular test and not the sensitive test. I have read the regular test greatly over estimates the number but have been reading threads from people where it actually underestimated their number and the sensitive test actually came back higher. I was going to go for blood work about 5 weeks from the start of trt but was wondering if I should go earlier due to these symptoms. I want to catch it early if my e2 is the problem. Is it best to test for e2 in trough like when following up test levels or in peak?
Any other input greatly appreciated.

Sensitive nipples at the start of TRT are common and typically don't mean anything. In fact, three years into treatment, my nipples will still occasionally itch. There is no need to rush to the lab at the start of your second week of TRT...nothing is balanced and your serum levels are in flux. Five weeks is an appropriate time for blood work. Estradiol is NOT an enemy of man. Be patient.

All testing, unless otherwise instructed by your doctor, is done at trough. E follows T - you will be capturing your estradiol level at a meaningful point if you follow this process. Try and relax - you're in a marathon, not a sprint. Patience will be rewarded.

 

[ZoomyR6]

Sensitive nipples at the start of TRT are common and typically don't mean anything. In fact, three years into treatment, my nipples will still occasionally itch. There is no need to rush to the lab at the start of your second week of TRT...nothing is balanced and your serum levels are in flux. Five weeks is an appropriate time for blood work. Estradiol is NOT an enemy of man. Be patient.

All testing, unless otherwise instructed by your doctor, is done at trough. E follows T - you will be capturing your estradiol level at a meaningful point if you follow this process. Try and relax - you're in a marathon, not a sprint. Patience will be rewarded.

Well this is a relief to hear, thank you for the response.
So when they say you want your T level between 500-900, they mean when tested in trough?

If you don't mind, can you elaborate when you say estradiol is not the enemy of man? I'm in the middle of reading Nelson's book and completed another a few days ago. Unless I'm misinterpreting it, it seems low or elevated estradiol can pose an array or problems.

 

[Vince Carter]

Men need, require, Estrogen for all manner of things from Libido, to bone health and many other things. Low E is bad, elevated E is very much up for discussion to what elevated really means, as in a number on a test. We typically advocated that Estrogen be left to find it's own level in the individual and only when accompanied by negative symptoms, should it be treated. Things like night sweats/hot in bed, hot flashes, PMS type mood swings and aggression seem to be the more common elevated E symptoms.

 

[ZoomyR6]

My other concern was that since my e2 was already in the upper end of healthy before trt, and the addition of trt will only naturally raise e2, my e2 is above normal. That was my logic of thinking anyway...

 

[ZoomyR6]

Men need, require, Estrogen for all manner of things from Libido, to bone health and many other things. Low E is bad, elevated E is very much up for discussion to what elevated really means, as in a number on a test. We typically advocated that Estrogen be left to find it's own level in the individual and only when accompanied by negative symptoms, should it be treated. Things like night sweats/hot in bed, hot flashes, PMS type mood swings and aggression seem to be the more common elevated E symptoms.

Ah, thank you for that explanation.

 

[CoastWatcher]

My other concern was that since my e2 was already in the upper end of healthy before trt, and the addition of trt will only naturally raise e2, my e2 is above normal. That was my logic of thinking anyway...

What was your pre-TRT estradiol? Was it measured via the sensitive, LC, MS/MS, lab test? Your estradiol may well climb, but that doesn't mean it will exceed the "normal" level. There is no magic spot that e2 must be confined to; it varies from man to man. To chase a number is a poor practice.

 

[ZoomyR6]

What was your pre-TRT estradiol? Was it measured via the sensitive, LC, MS/MS, lab test? Your estradiol may well climb, but that doesn't mean it will exceed the "normal" level. There is no magic spot that e2 must be confined to; it varies from man to man. To chase a number is a poor practice.

The first test was 26 and the last tests was 29, early afternoon and early evening respectively. I read not to go above 30 although I have also read that people feel best in mid 30's. All this reading is confusing!
Is the best overall protocol from blood still first thing in the morning? I believe Nelson said in his book that it shouldn't matter what time, so long as the symptoms are there.

 

[CoastWatcher]

The first test was 26 and the last tests was 29, early afternoon and early evening respectively. I read not to go above 30 although I have also read that people feel best in mid 30's. All this reading is confusing!
Is the best overall protocol from blood still first thing in the morning? I believe Nelson said in his book that it shouldn't matter what time, so long as the symptoms are there.

Things have come some ways in regard to e2 since Nelson wrote his book. He now believes, you'll find the posts here on EM, that estradiol should be allowed to rise more liberally than he argued in the past. How high? Well, that varies from individual to individual. I am fine up to 40. Gene Devine, a TRT veteran, likes to see climb above 40.

Symptoms, put in context via the appropriate testing, help determine what your response should be. A good doctor realizes that and doesn't fear estradiol or push the alarm button too quickly. By the way, those are excellent e2 values you posted before initiating therapy. It will be interesting for you to see where things are at first follow-up.

Now that that you are on TRT, you have all blood drawn the day of your injection, just prior to the administration of that shot.

 

[ZoomyR6]

Things have come some ways in regard to e2 since Nelaon wrote his book. He now believes, you'll find the posts here on EM, that estradiol should be allowed to rise more liberally than he argued in the past. How high? Well, that varies from individual to individual. I am fine up to 40. Gene Devine, a TRT veteran, likes to see climb above 40.

Symptoms, put in context via the appropriate testing, help determine what your response should be. A good doctor realizes that and doesn't fear estradiol or push the alarm button too quickly. By the way, those are excellent e2 values you posted before initiating therapy. It will be interesting for you to see where things are at first follow-up.

Now that that you are on TRT, you have all blood drawn the day of your injection, just prior to the administration of that shot.

I forgot to mention I am pretty sure it was tested with the regular assay and not the sensitive.
So we don't know when the issues with high e2 (ie; gyno) come into play, huh? Varies number to number and person to person?

I'm glad to hear those numbers were good. I can't imagine any other cause for my low T other than testicular failure at this point. Free T and SHBG were both normal (lower range of normal) and my e2 was good.

 

[CoastWatcher]

I forgot to mention I am pretty sure it was tested with the regular assay and not the sensitive.
So we don't know when the issues with high e2 (ie; gyno) come into play, huh? Varies number to number and person to person?

I'm glad to hear those numbers were good. I can't imagine any other cause for my low T other than testicular failure at this point. Free T and SHBG were both normal (lower range of normal) and my e2 was good.

What was your LH and FSH when they were tested prior to TRT? That will certainly let you know if the issue is testicular (which is to say, Primary Hypogonadism) or pituitary in nature (Secondary). The vast majority of us are secondary and never can point to the one, single thing that caused hypogonadism. What were the LH and FSH numbers, with reference ranges?

As for gyno, so many guys fear it, but it is very rare on the list of side effects. Certainly, one watches for it, but the inordinate anxiety that is attached to it contributes to the over-prescribing of Anastrozole.

 

[ZoomyR6]

What was your LH and FSH when they were tested prior to TRT? That will certainly let you know if the issue is testicular (which is to say, Primary Hypogonadism) or pituitary in nature (Secondary). The vast majority of us are secondary and never can point to the one, single thing that caused hypogonadism. What were thE LH and FSH numbers, with reference ranges?

As for gyno, so many guys fear it, but it is very rare on the list of side effects. Certainly, one watches for it, but the inordinate anxiety that is attached to it contributes to the over-prescribing of Anastrozole.

The first test:
FSH-8.3 (1.6-8.0) OUT OF RANGE
LH-3.9 (1.5-9.3)

Surprisingly, they were never tested again. I say testicular failure, not only because of that FSH number, but because I had a hernia as a new born and my left testicle never descended on its own and need surgery. Then in my early teens, I had another procedure on the left side scrotum because there was a varicose vein stopping some blood flow to the left testicle and stunted its growth slightly. Doc said then that I may have an issue with fertility when I get older, explaining that FSH number...

 

[CoastWatcher]

The first test:
FSH-8.3 (1.6-8.0) OUT OF RANGE
LH-3.9 (1.5-9.3)

Surprisingly, they were never tested again. I say testicular failure, not only because of that FSH number, but because I had a hernia as a new born and my left testicle never descended on its own and need surgery. Then in my early teens, I had another procedure on the left side scrotum because there was a varicose vein stopping some blood flow to the left testicle and stunted its growth slightly. Doc said then that I may have an issue with fertility when I get older, explaining that FSH number...

Once you start a TRT protocol LH and FSH are suppressed and of no significance. That's the nature of exogenous testosterone.

 

[themud]

Z,

My nipples were sensitive for a while too. My first E test was 25 non sensitive, then 50 the next time, but my TT was 1349 and my dr. said my E was too low for that high of TT and wanted my TT down and my E to stay there! Last TT was 998 and sensitive E was 34. I do injections daily and very low at that, 10 mg.

I was stressed about the nipples and they were always erect, which made it worse. I use to tape my nipples on long runs, and I couldn't even run a mile when I started T because my nipples just jiggling would hurt. I ran 7 miles the other day with 2 shirts and a sweater didn't even notice my nipples. On T since March.

 

[ZoomyR6]

Z,

My nipples were sensitive for a while too. My first E test was 25 non sensitive, then 50 the next time, but my TT was 1349 and my dr. said my E was too low for that high of TT and wanted my TT down and my E to stay there! Last TT was 998 and sensitive E was 34. I do injections daily and very low at that, 10 mg.

I was stressed about the nipples and they were always erect, which made it worse. I use to tape my nipples on long runs, and I couldn't even run a mile when I started T because my nipples just jiggling would hurt. I ran 7 miles the other day with 2 shirts and a sweater didn't even notice my nipples. On T since March.

Yes, I forgot about my erect nips also! They come and go thankfully and are not constant.
Your experience makes me feel better so thanks for sharing. Did the Doc say when the sensitivity will finally subside?