possible high free T sides? not sure what to do

[Mprtz]

I've been on TRT for about 15 months, mostly on a dose of 200mg/week. This puts me in the high physiological range, likely sometimes over.

What I think has been happening is that my SHBG has been dropping over this time period, and my free T has gone way up. Total T was 1100+ on the last blood test, but free T was 70+, about 3.5 times top of range.

I feel fine, and I think my E2 is under control, but I'm starting to suspect that low SHBG and high free T can cause E2 sides even when E2 is low (possibly because there is more free estrogen than the E2 reading suggests).

My nipples don't quite seem right to me. I can't be sure it's not in my head, but though there is no puffiness and no lumps, they seem too firm and slightly tender to the touch. It's subtle enough that I'm not sure that I'm not talking myself into it, but I thought the other day that a tiny bit of clear liquid came out.

So, I decided to drop my T dose a little, up my adex a little ( even if that drops my E2 into the teens ), and I thought I'd take some nolvadex that I have around (for emergency PCT) to combat the suspected beginning gyno and perhaps raise SHBG.

Now I read that there are some dire warnings against taking adex and nolva at the same time, but details are sketchy and I'm not sure it's a good idea to continue it anymore.

well founded opinions and advice welcome...

 

[Megatron28]

It is easy to check out drug interactions online.
GENERALLY AVOID: Coadministration with tamoxifen may decrease the plasma concentrations of anastrozole. The mechanism of interaction has not been described. In one clinical trial, coadministration of tamoxifen (20 mg/day) and anastrozole (1 mg/day) in breast cancer patients resulted in decreased anastrozole plasma concentration by 27% compared to administration of anastrozole alone. In addition, at a median follow-up of 33 months, the combination did not demonstrate any efficacy benefit over tamoxifen therapy alone in all patients as well as in the hormone receptor-positive subpopulation, and this treatment arm was discontinued from the trial. The pharmacokinetics of tamoxifen and its pharmacologically active N-desmethyl metabolite were not affected.

MANAGEMENT: Concomitant use of tamoxifen and anastrozole should be avoided.



And you said you feel fine, so I am not sure why you are worried about all these possibilities and making such drastic changes to your TRT protocol.

 

[MBB]

I thought the other day that a tiny bit of clear liquid came out.

What's your prolactin like? I thought discharge from the nipples was elevated prolactin?

 

[Mprtz]

What's your prolactin like? I thought discharge from the nipples was elevated prolactin?

Never been tested. I've never taken a 19-nor either. I'm thinking of doing a fairly comprehensive panel that includes it.

 

[Mprtz]

It is easy to check out drug interactions online.
GENERALLY AVOID: Coadministration with tamoxifen may decrease the plasma concentrations of anastrozole. The mechanism of interaction has not been described. In one clinical trial, coadministration of tamoxifen (20 mg/day) and anastrozole (1 mg/day) in breast cancer patients resulted in decreased anastrozole plasma concentration by 27% compared to administration of anastrozole alone. In addition, at a median follow-up of 33 months, the combination did not demonstrate any efficacy benefit over tamoxifen therapy alone in all patients as well as in the hormone receptor-positive subpopulation, and this treatment arm was discontinued from the trial. The pharmacokinetics of tamoxifen and its pharmacologically active N-desmethyl metabolite were not affected.

MANAGEMENT: Concomitant use of tamoxifen and anastrozole should be avoided.



And you said you feel fine, so I am not sure why you are worried about all these possibilities and making such drastic changes to your TRT protocol.

I did some searches, rxlist describes the interaction as "Serious", Webmd characterizes the interaction as "Severe". A lot worse sounding than what you found, though far less detail was provided. What site is yours from?

Maybe I am freaking out prematurely, but I have a feeling that the SHBG / free T thing is sufficiently out of balance as to be somehow unsustainable.

 

[Megatron28]

I did some searches, rxlist describes the interaction as "Serious", Webmd characterizes the interaction as "Severe". A lot worse sounding than what you found, though far less detail was provided. What site is yours from?

Maybe I am freaking out prematurely, but I have a feeling that the SHBG / free T thing is sufficiently out of balance as to be somehow unsustainable.

Drug Interactions

Just type in your medications and click on the Professional button when the interactions come up.

You won't die from mixing the two meds. It just lessens the effectiveness of Arimidex.

 

[MBB]

Never been tested. I've never taken a 19-nor either. I'm thinking of doing a fairly comprehensive panel that includes it.

I've had low SHBG and high free T the entire time I've been on TRT and although I've had some nipple issue (due to a liver issue) I've never had fluid discharge.

I'm surprised your prolactin was never tested before being put on TRT - it's usually tested to see if you have a pituitary tumour (when finding the cause of the hypogonadism). Definitely worth a check though.

 

[theheat]

Man I wish I was in your position (I have high SHBG and very low free T, which I can't do a thing about.), but at least you're getting a lot of bang for your buck from the T. I would drop the T to 100mg a week and cut out any AI or SERM for a couple of weeks and do more BW/see how you feel..

 

[Megatron28]

Man I wish I was in your position (I have high SHBG and very low free T, which I can't do a thing about.), but at least you're getting a lot of bang for your buck from the T. I would drop the T to 100mg a week and cut out any AI or SERM for a couple of weeks and do more BW/see how you feel..

Have you checked your thyroid out?

 

[Mprtz]

I've had low SHBG and high free T the entire time I've been on TRT and although I've had some nipple issue (due to a liver issue) I've never had fluid discharge.

I'm surprised your prolactin was never tested before being put on TRT - it's usually tested to see if you have a pituitary tumour (when finding the cause of the hypogonadism). Definitely worth a check though.

I think my SHBG and free T ratio started out normal (based on original free T ratio), but it (SHBG) has gone down over the time I've been on TRT. I'm 50, so the reasonable assumption was late-onset hypogonadism, especially since it was a somewhat gradual process.

How high (%) is your free T and how long has it been that way, if you don't mind my asking. Mine is over 6%, equivalent to a TT of around 4000 at normal percentage. Maybe this is fine, but I have a feeling its going to have some negative effect.

EDIT: not really sure about the fluid discharge, will be watching closely.

 

[Alpin]

You inject E7D's ?
Any reason you want super high T at your age?

 

[Mprtz]

You inject E7D's ?
Any reason you want super high T at your age?

I inject E3.5D.

Yes, I want to look and feel as awesome as possible for as long as possible.

 

[MBB]

I think my SHBG and free T ratio started out normal (based on original free T ratio), but it (SHBG) has gone down over the time I've been on TRT. I'm 50, so the reasonable assumption was late-onset hypogonadism, especially since it was a somewhat gradual process.

How high (%) is your free T and how long has it been that way, if you don't mind my asking. Mine is over 6%, equivalent to a TT of around 4000 at normal percentage. Maybe this is fine, but I have a feeling its going to have some negative effect.

EDIT: not really sure about the fluid discharge, will be watching closely.

I don't think mine's as high as yours and it uses a complete different range, but it's 150.9 pmol/L (25 - 120). As for how long, I think since I started last December.

But having said that, at 25 I can afford to have my levels a little higher.

 

[Mprtz]

I don't think mine's as high as yours and it uses a complete different range, but it's 150.9 pmol/L (25 - 120). As for how long, I think since I started last December.

But having said that, at 25 I can afford to have my levels a little higher.

You are 25% over, I'm 250% over - that may make all the difference.

Trust me, being 50 doesn't feel as different from being 25 as you might think. It goes by in the blink of an eye compared to the first 25 years.

 

[halfwit]

Get a prolactin panel imo. I'm consistently 150-300% over on free test panels as SHBG will decrease with the use of exogenous androgens on top of the use of an AI. I do not have any issues whatsoever with my nipples either.

If I recall correctly, some antibiotics and a handful of anti-inflammatory drugs can cause those signs/symptoms as well. Hope you get it squared away bud, nobody likes questioning what's wrong with their bodies.

My .02c

 

[theheat]

Have you checked your thyroid out?

I don't think any of my BW was abnormal as far as thyroid hormones, but my Dr did a cortisol saliva test and claims that my low free T is the result of stress and excess cortisol, and that my #s will never improve until I get stress under control...

 

[Megatron28]

I don't think any of my BW was abnormal as far as thyroid hormones, but my Dr did a cortisol saliva test and claims that my low free T is the result of stress and excess cortisol, and that my #s will never improve until I get stress under control...

Don't you look at your blood work results? Post them up and let's see them -- in your own thread of course.

 

[Mprtz]

Get a prolactin panel imo. I'm consistently 150-300% over on free test panels as SHBG will decrease with the use of exogenous androgens on top of the use of an AI. I do not have any issues whatsoever with my nipples either.

If I recall correctly, some antibiotics and a handful of anti-inflammatory drugs can cause those signs/symptoms as well. Hope you get it squared away bud, nobody likes questioning what's wrong with their bodies.

My .02c

Very comforting to read that you are over by that amount without apparent ill effects.
I will definitely be including prolactin in my next panel (may check shbg and progesterone too).

 

[Megatron28]

Last time I had my Free T checked it was at 51ng/dl (5-21) or 4.7% (1.5-4.2%) while my TT was 1104 ng/dl (348-1197). I feel fine!

 

[Alpin]

I wonder what the conversion is on that Free T in pmol/l Mega...