Supplemental progesterone makes my trt-induced water retention immediately melt away.
For those unaware, Ray Peat has done an enormous amount of work on the interaction between estrogen and progesterone, and his model explains exactly why a disturbed balance in-favour of estrogen would result in the swelling of cells (retaining water), but also why an aromatase inhibitor would not fix it.
For anyone interested, here are some of his articles on the topic:
Aging, estrogen, and progesterone.
Estrogen, progesterone, and cancer: Conflicts of interest in regulation and product promotion.
Tissue-bound estrogen in aging.
TL;DR:
Estrogen's role in endogenous physiology is to directly downregulate the metabolic rate of a cell by interphereing with efficient oxidative metabolism during times of stress, tissue damage and energetic deficiency, to facilitate the rapid growth, repair and division of a tissue. Whilst said functions play an important role under specific circumstances (i.e, tissue injury), unopposed estrogen keeps the metabolic rate of the cell chronically suppressed, with water retention being one of the manifestations, as the ability of the cell to extrude it's water (regulated largely by the flux of sodium, potassium, calcium, chloride and magnesium) is an energetically-demanding process.
Progesterone is the bodies primary anti-estrogenic substance, having the opposite effect on the metabolic rate by promoting the efficient oxidative metabolism required to keep it elevated.
Testosterone replacement therapy appears to reduce progesterone production beyond just the loss of gonadal production, as many men find themselves with undetectable serum levels after years of therapy — even with the use of HCG. The decrease in progesterone production combined with the significant increase in systemic estrogen from the abundance of it's precursor testosterone can lead to a progesterone : estrogen ratio skewed heavily towards the latter.
AIs don't help because 1.) they do nothing to address the suppression of progesterone production, so even a significant reduction in estrogen would still leave the p:e ratio itself suboptimal, and 2.) as mentioned at the top of the post, aromatase expression, and subsequently the rate of estrogen production, is increased in response to cellular stress and energetic deficiency — neither of which are addressed by an ai. In many cases, the underlying state which leads to one being prone to aromatization is more problematic than the estrogen itself, which is why elevated levels of baseline estrogen in men not on trt are associated with a cohort of undesirable diseases, but reducing estrogen artificially with an aromatase inhibitor in men on trt has few benefits, and may actually cause harm (won't get into the ai vs no ai debate here).
This is a vast, vast simplification of the content discussed in Ray Peat's articles, so please read the articles directly if you're interested in this topic.
Something to note: Ray Peat has a rather poor reputation, but that is primary off the back of other's interpretation of his work - i.e, the people on the independently-run ray peat forum who do very strange things based upon their misinterpretation of his writings - rather than what the man actually writes. Read his information directly from the source and you'll find there is a lot of incredible knowledge to be gained.
Theoretically, the combination of thyroid (the optimal dose being that required to restore body temperature to optimal) and low-dose progesterone (pregnenolone may be able to fill the role) should be able to eliminate all trt-induced water-retention, but the empahsis there is on
theoretically.
Just to be clear: I am not saying all of the above is factually correct, nor am I supporting the use of thyroid or progesterone. All I can say is that my own experience with HRT and overall health has always fallen in line with all of Ray Peat's articles, and many (but not all) of his views are supported by medical literature..
