TRT and Tamoxifen for life?

[Jamestrt]

New member here! I started to TRT a little under two months ago and after one month on TRT, my estrogen and estradiol levels shot up high. Dr. prescribed me tamoxifen. At 10 mg daily. Is tamoxifen something I'll have to take every day for as long as I'm on TRT?

 

[CoastWatcher]

Welcome to Excelmale. I am puzzled. Your doctor prescribed Tamoxifen rather than Anastrozole? You have no need of a SERM, Tamoxifen; you require something to control testosterone's conversion to estradiol. So, you were given a drug that is inappropriate. As to whether you even need to control E2. it is hard to say without knowing your testosterone level and your estradiol level. As importantly, it is necessary to measure estradiol via the "sensitive" test (the "standard" test is of no vale to men. If you post your lab work, with reference ranges, I am sure you'll receive input.

 

[Vince]

there's lots of good information on estrogen at this site, here's a good place to start https://www.excelmale.com/forum/showthread.php?2309-Role-of-Estradiol-in-Men-and-Its-Management

 

[Nelson Vergel]

Tamoxifen reduces IGF-1. I would use anastrozole instead.

http://www.ncbi.nlm.nih.gov/pubmed/11299809

 

[Jamestrt]

Welcome to Excelmale. I am puzzled. Your doctor prescribed Tamoxifen rather than Anastrozole? You have no need of a SERM, Tamoxifen; you require something to control testosterone's conversion to estradiol. So, you were given a drug that is inappropriate. As to whether you even need to control E2. it is hard to say without knowing your testosterone level and your estradiol level. As importantly, it is necessary to measure estradiol via the "sensitive" test (the "standard" test is of no vale to men. If you post your lab work, with reference ranges, I am sure you'll receive input.

Thanks for the warm welcome! I believe the biggest reason for why I was prescribed tamoxifen is because two weeks after beginning treatment, I went back for a check up and told my doctor I felt tingling sensations in my nipples several times. My estradiol levels was at approximately 51–52 and my test levels were at about 700 after my 1st month on TRT. She was worried I might develop gynocemastia and she prescribed me tamoxifen. Besides the tingling sensation, I feel great overall, until I got on tamoxifen. I have been on tamoxifen for about one month now (just yesterday I finished a bottle of 10mg daily for 30 days) and just got prescribed my 2nd bottle. I have been feeling a lot more tired the whole time I've been on tamoxifen.

I will soon post my first and second blood work results for you, Vince, and Nelson to see.

 

[CoastWatcher]

Thanks for the warm welcome! I believe the biggest reason for why I was prescribed tamoxifen is because two weeks after beginning treatment, I went back for a check up and told my doctor I felt tingling sensations in my nipples several times. My estradiol levels was at approximately 51–52 and my test levels were at about 700 after my 1st month on TRT. She was worried I might develop gynocemastia and she prescribed me tamoxifen. Besides the tingling sensation, I feel great overall, until I got on tamoxifen. I have been on tamoxifen for about one month now (just yesterday I finished a bottle of 10mg daily for 30 days) and just got prescribed my 2nd bottle. I have been feeling a lot more tired the whole time I've been on tamoxifen.

I will soon post my first and second blood work results for you, Vince, and Nelson to see.

Was your estradiol measured via the "sensitive" test? If not, the values you posted are worthless. As explained by Discountedlabs.com: The standard test uses immunoassay technology that cannot differentiate C-Reactive Protein (involved in inflammation) from estradiol, so it reads the combination of the two as estradiol. Tingling in the nipple area when starting TRT indicates that androgen activity is present in the blood - it is not a sign of gynecomastia. Finally, Tamoxifen is the wrong drug to take to control estradiol - Anastrozole is the drug of choice. It's no wonder you don't feel so great: you are taking the wrong drug to control estradiol levels that may not even require management.

 

[Jamestrt]

Was your estradiol measured via the "sensitive" test? If not, the values you posted are worthless. As explained by Discountedlabs.com: The standard test uses immunoassay technology that cannot differentiate C-Reactive Protein (involved in inflammation) from estradiol, so it reads the combination of the two as estradiol. Tingling in the nipple area when starting TRT indicates that androgen activity is present in the blood - it is not a sign of gynecomastia. Finally, Tamoxifen is the wrong drug to take to control estradiol - Anastrozole is the drug of choice. It's no wonder you don't feel so great: you are taking the wrong drug to control estradiol levels that may not even require management.

Frankly I'm unsure if my E2 was measured via "sensitive" test. I highly doubt it, I'll have to speak to my doctor about that. But here is my most recent Test/E2 results about 1 month into TRT, before beginning tamoxifen.
Lab Results - July 17


% Free Testosterone Index (ng/dL) @ 59
Range = 35.00-92.60


Total Testosterone (ng/dL) @ 734
Range = 249.00-836.00


SHBG (nmol/L) @ 43
Range = 17.30-65.80


E2 (pg/mL) @ 43.9
Range = 7.6-42.6

I should be getting new lab results very soon because I took another blood test with my doctor last Friday (2 months into TRT, 1 month into TRT+tamoxifen) and will post that up as soon as I get it (although it probably won't matter). Now I'm curious as to why my doctor prescribed me tamoxifen instead of anastrozole.

 

[Jamestrt]

Also here's my full comprehensive result from that test in addition to the free/total T, SHBG, and E2 if any of this is relevant at all:


WBC @ 5.20 10^3/uL
Range = 3.50-10.30


RBC @ 5.40 10^6/uL
Range = 3.83-5.83


HGB @ 17.0 g/dL
Range = 12.6-16.0
Above high normal


HCT @ 49.2 %
Range = 37.5-51.0


MCH @ 31.5 pg
Range = 24.0-35.0


MCV @ 91.1 fL
Range = 79.0-100.0


MCHC @ 34.6 g/dL
Range = 30.0-36.0


RDW @ 13.1 %
Range = 11.0-15.0


PLT @ 242 K/uL
Range = 150-393


MPV @ 10.9 fL
Range = 9.0-13.0


NEU # @ 2.42 10^3/uL
Range = 1.90-8.00


NEUT % @ 46.5 %
Range = 40.0-77.0


LYMPH @ 2.09 10^3/uL
Range = 0.90-5.20


LYMPH % @ 40.2 %
Range = 16.0-44.0


MONO # @ 0.57 10^3/uL
Range = 0.16-1.00


MONO % @ 11.0 %
Range = 4.0-9.0
Above high normal


EOS # @ 0.07 K/uL
Range = 0.00-0.80


EOS % @ 1.30 %
Range = 0.00-7.00


BASO # @ 0.04 10^3/uL
Range = 0.00-0.10


BASO % @ 0.80 %
Range = 0.00-1.50


NA @ 141 mEq/L
Range = 134-144


K @ 4.40 mEq/L
Range = 3.50-5.20


CL @ 105 mEq/L
Range = 99-109


CO2 @ 31 mEq/L
Range = 20-31


GLU @ 106 mg/dL
Range = 60-99
Above high normal


CA @ 9.9 mg/dL
Range = 8.6-10.4


TPRO @ 6.9 g/dL
Range = 5.7-8.2


ALB @ 4.5 g/dL
Range = 3.2-4.8


GLOB(CALC) @ 2.4 g/dL
Range = 2.0-3.5


A/G @ 1.9 RATIO
Range = 1.1-2.5


ALP @ 55 IU/L
Range = 45-311


BUN @ 17 mg/dL
Range = 8-20


CREAT @ 1.2 mg/dL
Range = 0.7-1.3


BUN/Crea @ 14 RATIO
Range = 3-40


eGFR-African American @ 94 mL/min/1.73m2
Range = >60


eGFR-non-African-American @ 78 mL/min/1.73m2
Range = >60


AST @ 29 IU/L
Range = 0-34


ALT @ 27 IU/L
Range = 10-49


TBILI @ 1.0 mg/dL
Range = 0.0-1.2

 

[Jamestrt]

Was your estradiol measured via the "sensitive" test? If not, the values you posted are worthless. As explained by Discountedlabs.com: The standard test uses immunoassay technology that cannot differentiate C-Reactive Protein (involved in inflammation) from estradiol, so it reads the combination of the two as estradiol. Tingling in the nipple area when starting TRT indicates that androgen activity is present in the blood - it is not a sign of gynecomastia. Finally, Tamoxifen is the wrong drug to take to control estradiol - Anastrozole is the drug of choice. It's no wonder you don't feel so great: you are taking the wrong drug to control estradiol levels that may not even require management.

Not sure if it was a "sensitive" test. However, I stopped taking tamoxifen 3 days ago and visited my doctor today. Got some blood drawn, and surprisingly she brought up today that I should never have taken tamoxifen to begin with, I suggested anastrozole and she will be having me on anastrozole beginning next week. Quick question which relates to my original topic question. Will I take anastrozole for as long as I'm on TRT (rest of my life)?

 

[ERO]

Not necessarily. Many of us have switched to more frequent injections and eliminated the need for an AI. Smaller, more frequent doses mean less conversion to E2.

 

[CoastWatcher]

In regard to your hematocrit and hemoglobin, did your doctor note that these are values that should be closely watched? If they climb out of reference range a blood donation/therapeutic phlebotomy will have to be scheduled to avoid potentially serious issues.

 

[Jamestrt]

In regard to your hematocrit and hemoglobin, did your doctor note that these are values that should be closely watched? If they climb out of reference range a blood donation/therapeutic phlebotomy will have to be scheduled to avoid potentially serious issues.

Yes my doctor pointed that out yesterday. I let her know I'm OK with occasionally donating blood. I think my first blood test after starting TRT showed result of around 53% hematocrit and then my most recent blood test resulted closer to 49% hematocrit. I should donate blood.

 

[CoastWatcher]

Yes my doctor pointed that out yesterday. I let her know I'm OK with occasionally donating blood. I think my first blood test after starting TRT showed result of around 53% hematocrit and then my most recent blood test resulted closer to 49% hematocrit. I should donate blood.

That would be a good idea. Sooner, rather than later.

 

[CoastWatcher]

Another question. Was a psa run to note a baseline? Your doctor will want to monitor the total psa as well as the rate it rises over time.

 

[Jamestrt]

Yes I decided to donate every 3 months or so just to be on the safe side.

Another question. Was a psa run to note a baseline? Your doctor will want to monitor the total psa as well as the rate it rises over time.

I believe so. My June 2015 bloodwork shows a PSA result was 1.7 with a standard range of < 4.0. But what is PSA?

 

[CoastWatcher]

Yes I decided to donate every 3 months or so just to be on the safe side.



I believe so. My June 2015 bloodwork shows a PSA result was 1.7 with a standard range of < 4.0. But what is PSA?

Prostate-Specific Antigen

 

[Jamestrt]

Prostate-Specific Antigen

Oh yeah I should definitely keep that one in check! By the way, thanks for all your inputs, CoastWatcher.