Help me understand my side effects

[drewbaby88]

First post, been reading a while. I have been on TRT for 2 years. 38 yrs old
TT was 179 when I was initially tested and FT was 5-6.

On to my issues. I am constantly battling nipple issues. I’m currently taking 100mg Test Cypionate 2 x a week, Sunday’s and Wednesday’s. I was prescribed Arimidex a year or so ago and told to take 1 mg 2x per week. It helped some but I believe it crashed my E2. felt awful. Stopped taking it. Lumps came back. started the above protocol again. Same results. Lumps went away but felt like crap.

Flash forward to today... I have some nipple lumps on both nipples. They feel more like a "smushed something" more than a " solid lump". Not directly under the nipple but around it.

Finally ordered a lab test through discountedlabs. Results are below:

 

[Vince]

What's your for protocol and were you Labs taken on injection day before you injected?

 

[drewbaby88]

Yeah. Sorry. Just came back to edit that.

100mg Sunday’s and Wednesday’s

Labs taken before 10am day after injection

 

[KenLowT]

That's some really high Total T and Free T levels. It makes sense with labs done right after the test. Are you taking two 50mg shots a week or two 100mg shots a week?

 

[drewbaby88]

That's some really high Total T and Free T levels. It makes sense with labs done right after the test. Are you taking two 50mg shots a week or two 100mg shots a week?

I’m taking 2 100mg shots per week

 

[KenLowT]

Well the other men on this forum are more knowledgeable then me, but 200mg per week as a starting dose seems high. I felt miserable when I was at 150mg because my estrogen was through the roof, but my Total before TRT was about 386. I'm wondering what your estrogen would be on a trough day. Right now I'm dealing with symptoms of low estrogen because I took my dosage too close together.

Low estrogen symptoms for me: low sex drive, lethargy, apathy, fatigue, and dull pain in my joints.

High estrogen symptoms: low sex drive, ED, moodiness, fatigue, water retention, and anxiety.

What is your sex drive like? How is your energy level? Any joint pain? Are lumpy nipples your only side effect so far?

 

[Systemlord]

I’m taking 2 100mg shots per week

That huge Test dosage is increasing the need for a large dose AI, you may be able to decrease your dosage and either significantly reduce or not require the AI at all. AI's do nothing positive for you, only negative.

I recommend 50-60-mg twice weekly, no AI and redo labs in 6 weeks.

 

[drewbaby88]

What is your sex drive like? How is your energy level? Any joint pain? Are lumpy nipples your only side effect so far?

Sex drive - meh

Energy level - seems normal to good. Been better before though

Joint pain - none. Workout 4 days a week

Side effects currently: nipple lumps, no ED but EQ is no good. Feel fine, could use a bit more energy but no lethargy.

 

[drewbaby88]

That huge Test dosage is increasing the need for a large dose AI, you may be able to decrease your dosage and either significantly reduce or not require the AI at all. AI's do nothing positive for you, only negative.

I recommend 50-60-mg twice weekly, no AI and redo labs in 6 weeks.

I know there’s been a couple of times I’ve been traveling for work, forgot to load 2nd shot for the week and felt pretty good, if not better. I just attributed it to getting good rest or not being home with my strong-willed, hardheaded child. Ha

 

[drewbaby88]

With my estradiol being low, why do I have nipple lumps and swelling?

I decided 4 weeks ago to take no AI And go get the labs done last week.
Going on 4 weeks now and nipple pain getting worse every day.

While taking Arimidex 1mg, twice a week(day after injection)I was moody and had low EQ, low energy

Now, a month of no AI, a little more energy, less angry but nipple pain.

Should I lower my dosages of test and continue no AI for a month to see what happens?

 

[KenLowT]

With my estradiol being low, why do I have nipple lumps and swelling?

I decided 4 weeks ago to take no AI And go get the labs done last week.
Going on 4 weeks now and nipple pain getting worse every day.

While taking Arimidex 1mg, twice a week(day after injection)I was moody and had low EQ, low energy

Now, a month of no AI, a little more energy, less angry but nipple pain.

Should I lower my dosages of test and continue no AI for a month to see what happens?

I learned from the guys on here that starting low and incrementally going up based on symptoms is the way to go. Going from high dosage to lower dosing will be very hard on you though. I went from 175mg per week to 100mg per week and it led me down a bad road. My mood dipped, I was depressed, and my energy went down as well. I didn't feel any different one week after lowering my dosage, but Weeks 2-4 were difficult. I finally came out of it in Week 5 and felt much better and more stable. You should really be working with a hormone specialist before making changes like I did. My endocrinologist was good, but did not have the expertise to know how to manage my T levels and E2.

I gave up trying to be managed by doctors who were still prescribing 200mg every 2 weeks and not even prescribing an AI when my symptoms were bad. Like I have said before, I learned more on here than I ever did from a doctor.

Also, have you checked your prolactin levels. I thought I heard a lecture with Nelson Vergel that elevated prolactin levels can cause this increase in breast tissue.

 

[MarkM]

Your whole protocol is a mess to be honest with you. 200 mg a week is too much and your labs and symptoms both show it. The testosterone is too high driving up your E2 which you then suppress with a whopping 2 mg dose of anastrozole. This drives your E2 down to 10 the day after injection and you feel terrible. Breast lumps come and go becasue you have no consistency in your protocol. As long as you keep taking 200 mg a week of test and keep going on and off again with the 2 mg of anastrozole you are going to stay just where you are.

@Systemlord recommended, you should probably be on 50 to 60 mg twice a week and stop the AI altogether. Stay on that protocol for a minimum of 6 weeks, preferably 8 weeks, and get new labs. I'll bet you feel much better.

 

[drewbaby88]

Your whole protocol is a mess to be honest with you. 200 mg a week is too much and your labs and symptoms both show it. The testosterone is too high driving up your E2 which you then suppress with a whopping 2 mg dose of anastrozole. This drives your E2 down to 10 the day after injection and you feel terrible. Breast lumps come and go becasue you have no consistency in your protocol. As long as you keep taking 200 mg a week of test and keep going on and off again with the 2 mg of anastrozole you are going to stay just where you are.

@Systemlord recommended, you should probably be on 50 to 60 mg twice a week and stop the AI altogether. Stay on that protocol for a minimum of 6 weeks, preferably 8 weeks, and get new labs. I'll bet you feel much better.

I agree with it being a mess. This was all done with docs permission or advice. The AI dosage at 2 mg was his advice because I was having nipple issues on the 1mg a week he already prescribed.

 

[MarkM]

I understand that Drew. Many of us have been led down a crappy path by our doctor. It's what we do going forward that matters. Find a doctor that will give you good care, the care you deserve. This one obviously lacks a proper understanding of TRT.

We can also be a good resource for you.

 

[drewbaby88]

I understand that Drew. Many of us have been led down a crappy path by our doctor. It's what we do going forward that matters. Find a doctor that will give you good care, the care you deserve. This one obviously lacks a proper understanding of TRT.

We can also be a good resource for you.

I appreciate it too. I’ve learned more on this board than I have ever learned from my doc.

I’m gonna try the 60mg 2x per week, no Arimidex for 6-8 weeks and get new labs.

I’ve gotta do something now for the breast lumps issue. Took 1mg of Anastrozole this morning and it reduced pain and swelling within hours.

 

[HealthMan]

I can relate to you as i am also very sensitive to estradiol when it comes to gyno. My estradiol needs to be in the low 20s otherwise i get gyno. Your TT and FT are high and you SHBG is on the normal-lower side. If I were you I would check your free estradiol and try to control that variable instead of estradiol.
You have room to lower your dosage as your TT and FT are high so that way you can use less anastrozole.
If you have a lump that is already there for a while anastrozole will probably not work unless you use it to crash your estradiol and keep it crashed for a while. Tamoxifen usually works really well to get rid of lumps specially if not too old.
Be careful with the advices about lowering your testosterone dosage and stopping anastrozole. Given you are prone to gyno this might worsen your existence gyno (that happen to me). I would only do that if I was taking tamoxifen and then test estradiol and free estradiol and see where it sits. Just remember that tamoxifen will almost for sure raise your SHBG thus compromising your blood work results (meaning the results will change after your stop tamoxifen).
Gyno can be very frustrating and recurring gyno even more. I have battle this on and off for a few years. And all I can say is anastrozole is usually your friend not your enemy. I know how long gyno can take to go away taking tamoxifen and i felt terrible while taking it. And if i lowered my anastrozole a bit too much... bang... gyno again and another cycle of tamoxifen was necessary. Terrible.
Also worth checking your prolactin levels. High levels can cause gyno.

I am not a doctor and I am only sharing my personal experience. Consult with your doctor before making any changes to your protocol

 

[HealthMan]

I appreciate it too. I’ve learned more on this board than I have ever learned from my doc.

I’m gonna try the 60mg 2x per week, no Arimidex for 6-8 weeks and get new labs.

I’ve gotta do something now for the breast lumps issue. Took 1mg of Anastrozole this morning and it reduced pain and swelling within hours.

I think this is a big mistake. You can and probably will really aggravate your gyno.
Talk to your doctor and consider adding tamoxifen and reducing you anastrozole but not completely eliminating it. Testing estradiol (free estradiol as well) often you can fine tune your dosage.
You will thank me for that in the future. Trust me you don’t wanna deal with potentially having to get the gyno surgically removed or deal with tamoxifen for a long time just because you were not careful with your estradiol levels. This is coming from someone that has been through all this a few times

 

[MarkM]

I appreciate it too. I’ve learned more on this board than I have ever learned from my doc.

I’m gonna try the 60mg 2x per week, no Arimidex for 6-8 weeks and get new labs.

I’ve gotta do something now for the breast lumps issue. Took 1mg of Anastrozole this morning and it reduced pain and swelling within hours.

Probably good you took the anastrozole that you did. You may need something other than that depending on how progressed the gyno is.

 

[KenLowT]

I appreciate it too. I’ve learned more on this board than I have ever learned from my doc.

I’m gonna try the 60mg 2x per week, no Arimidex for 6-8 weeks and get new labs.

I’ve gotta do something now for the breast lumps issue. Took 1mg of Anastrozole this morning and it reduced pain and swelling within hours.

I agree. Be very careful with handling your own protocol changes though. Like I told you before, it was very hard to drop down so drastic. It was an emotional roller coaster. I kept giving my doctor chances and just finally gave up and went with Defy. Most docs do not know how to deal with TRT properly. I switched my protocol on my own here based on suggestions from other members. Even though the advice was sound, it was really miserable for a while there. The clouds are starting to clear for me, but I feel better now that I have the right people advising my protocols.

 

[drewbaby88]

Ok. Help me summarize.

We all agree testosterone dosage protocol is too high. I plan to drop that to 60mg 2x a week

Anastrozole dosage was too high due to that. I plan to take .5mg 2x a week until current sides subside with hopes of AI elimination entirely.

What other blood tests will help me right now? Prolactin? Estradiol?

Should I give it 6-8 weeks with the new protocol THEN get blood labs?