Been Taking Exemestane To Raise Testosterone. Here's My Bloodwork. Any Thoughts?

franko

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Feb 25, 2015
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Tried some new experiments and got some new blood work. See my log for previous bloodwork.

For about 5 weeks now I've been taking 25mg of exemestane (Aromasin) every day. I have also taken tamoxifen (Nolvadex) sporadically — which I realize kind of complicates the variables here, but oh well.

Code:
2015-07-02

Testosterone 537      348-1197 ng/dL
Estradiol 25.4        7.6-42.6 pg/mL
LH 17.6               1.7–8.6 mIU/mL
FSH 8.3               1.5–12.4 mIU/mL
Prolactin 16.7        4-15.2 ng/mL     HIGH
ALT (SGPT) 52         0-44 IU/L        HIGH

The exemestane seems to be working. It has raised my testosterone — my previous level was 329 — and that's what I guessed going into the bloodwork because I could feel the physiological change. Increased confidence, increased general happiness, increased motivation, decreased social anxiety and worry. Little things made me happy for the first time in a long time. I don't want to jinx it or to oversell it — it's not like I'm super happy and everything is awesome — but I really do feel markedly better.

My prolactin is lower than before, but still higher than normal. I have not been taking any dopamine agonists to try lower it because I don't like the idea of dopamine agonists.

My slight gynecomastia is still present but at least does not seem to be getting worse. I was hoping the changes in my bodies hormonal cocktail would reverse it — but perhaps it has not been a dramatic enough change, or been a long enough time. But, it has become less important to me compared to the psychological improvements I have felt.

My LH was really high — which is interesting. I'm not exactly sure what to make of that. Perhaps it was all that estrogen that was previously signaling the negative feedback loop on my gonadotropins?

Also, the dosage of Aromasin I am taking is pretty high. Its higher than what seems to be the common dosage that AAS users take when they want to prevent high estrogen side effects. And they talk about the adverse effects of low estrogen — like dry joints — and I have not felt anything like that. I guess my body has just been making a lot of estrogen. Perhaps I should try an AI that's even stronger?

Also I've heard people talking about how prolactin is a better measure of tissue estrogen than plasma estrogen is, and that when plasma estrogen goes higher it may actually be because the body is eliminating it.

My test results seem to corroborate that. Because my plasma estrogen is actually higher than before, but so is my testosterone. And my prolactin is lower and the negative symptoms of low testosterone have diminished.

Considering the big picture:

Low testosterone sucks real bad. Raising my testosterone to this level has resulted in the biggest improvement in well-being and quality of life compared to anything I've experienced before.

But I'm not sure what is the most "healthy" and sustainable route to keeping my testosterone up. What's better/worse: continued AI use, or testosterone replacement therapy?

If I go on TRT though, I'd imagine it might make my estrogen problems worse — so I'd probably need to be on AI's anyway. I don't know.

Any thoughts or advice?
 

Mike1234

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For the prolaction you could try wellbutrin maybe, not sure how effective it would be compared to a dopamine agonist, but theoretically should help.


"Perhaps I should try an AI that's even stronger?"

Why not just up the arimidex dose slightly? Get bloods done again after a few weeks. Estradiol can get to around 20 and then you've maybe reached the limit for where AI will take you, but like the other guy said it depends on your libido/erections


Age?
Did you get free T levels checked ?
What is your BF% estimate? If you were able to lose some of the weight you might not need the AI with TRT.
I'm not sure what the long term effects/risks are of taking an AI but if they were minimal, isn't your test around what you would get on a normal TRT dose?

Glad to see things have turned around for you.

BY THE WAY, I recommend you look into Proviron :D
 

NathanK

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I'd take a wild guess and say your testosterone is higher because somewhere along the line hypothalamic estrogen is being blocked thereby increasing LH. That may be the Nolvadex though I'm not very familiar with exemestane to be sure.

Your E2 looks solid. I'd guess you weren't making much before due to not having enough T to to even aromatize. Not that you don't likely have high tissue estrogen. Often that increase in serum estrogen will give you a lot of the benefits you describe here.
 
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franko

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lexis said:
Hows your libido and morning erections?

Hmm... not great. Not having morning erections that I'm aware of. Libido is not really noticeable.

Mike1234 said:
For the prolaction you could try wellbutrin maybe, not sure how effective it would be compared to a dopamine agonist, but theoretically should help.

I just don't like the idea of upping dopamine — even though I know it's the primary method for lowering prolactin — because I think my problem is something akin to dopamine resistance. And I'm concerned that it would make my dopamine even lower in the future. But maybe I'll try it.

Mike1234 said:
Why not just up the arimidex dose slightly? Get bloods done again after a few weeks. Estradiol can get to around 20 and then you've maybe reached the limit for where AI will take you, but like the other guy said it depends on your libido/erections

It's aromasin actually, I've been reading that doses above 25mg/day are not that much more effective but yeah I might try upping the dose from 25mg/day to 50mg/day.

I actually want to know what it would take to get some of these negative low-estrogen side effects that others seem to have on smaller doses.

Mike1234 said:
Age?
Did you get free T levels checked ?
What is your BF% estimate?

27 years old. 5'11" 200lbs
guessing around 20-25% body fat

I didn't have my free T checked this time, but I did in January, this is my set of results from then. At this time I was on 1 grain thyroid/day and I had previously got an examination for gynecomastia that involved a lot of palpating of the nipples — which I believe is the explanation for prolactin being about 1.5x-2x what it has been in other tests.

2014-01-08
Estradiol 28.8 | 7.6-42.6 pg/mL
Testosterone 328 | 348-1197 ng/dL
Free T 12.7 | 9.3-26.5 pg/mL
Prolactin 35 | 4-15.2 ng/mL
Cortisol 25 | 6.2-19.4 ug/dL
Vitamin D 30 | 10-80 ng/mL


Mike1234 said:
I'm not sure what the long term effects/risks are of taking an AI but if they were minimal, isn't your test around what you would get on a normal TRT dose?

Yeah, it's pretty close. Between 600-700 ng/dL would probably be the goal level.

Mike1234 said:
BY THE WAY, I recommend you look into Proviron

I actually tried Andractim (2.5% DHT gel) for about 4 weeks and I did notice similar benefits — actually my libido was noticeably higher. Unfortunately I didn't do a blood test. But the gel was expensive — about $100 for a month's supply. So I didn't consider keeping that going — but I will look into proviron which seems like it might be more economical.
 
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franko

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lexis said:
Hows your libido and morning erections?

Hmm... not great. Not having morning erections that I'm aware of. Libido is not really noticeable.

Mike1234 said:
For the prolaction you could try wellbutrin maybe, not sure how effective it would be compared to a dopamine agonist, but theoretically should help.

I just don't like the idea of upping dopamine — even though I know it's the primary method for lowering prolactin — because I think my problem is something akin to dopamine resistance. And I'm concerned that it would make my dopamine even lower in the future. But maybe I'll try it.

Mike1234 said:
Why not just up the arimidex dose slightly? Get bloods done again after a few weeks. Estradiol can get to around 20 and then you've maybe reached the limit for where AI will take you, but like the other guy said it depends on your libido/erections

It's aromasin actually, I've been reading that doses above 25mg/day are not that much more effective but yeah I might try upping the dose from 25mg/day to 50mg/day. Here's a study that shows the difference between 25mg/day and 50mg/day in young males was pretty small.

[highlight=#ffffff]"Exemestane suppressed plasma estradiol comparably with either dose [25 mg, 38% (P <or= 0.002); 50 mg, 32% (P <or= 0.008)], with a reciprocal increase in testosterone concentrations (60% and 56%; P <or= 0.003 for both)."[/highlight]

I actually want to know what it would take to get some of these negative low-estrogen side effects that others seem to have on smaller doses.

Mike1234 said:
Age?
Did you get free T levels checked ?
What is your BF% estimate?

27 years old. 5'11" 200lbs
guessing around 20-25% body fat

I didn't have my free T checked this time, but I did in January, this is my set of results from then. At this time I was on 1 grain thyroid/day and I had previously got an examination for gynecomastia that involved a lot of palpating of the nipples — which I believe is the explanation for prolactin being about 1.5x-2x what it has been in other tests.

2014-01-08
Estradiol 28.8 | 7.6-42.6 pg/mL
Testosterone 328 | 348-1197 ng/dL
Free T 12.7 | 9.3-26.5 pg/mL
Prolactin 35 | 4-15.2 ng/mL
Cortisol 25 | 6.2-19.4 ug/dL
Vitamin D 30 | 10-80 ng/mL


Mike1234 said:
I'm not sure what the long term effects/risks are of taking an AI but if they were minimal, isn't your test around what you would get on a normal TRT dose?

Yeah, it's pretty close. Between 600-700 ng/dL would probably be the goal level.

Mike1234 said:
BY THE WAY, I recommend you look into Proviron

I actually tried Andractim (2.5% DHT gel) for about 4 weeks and I did notice similar benefits — actually my libido was noticeably higher. Unfortunately I didn't do a blood test. But the gel was expensive — about $100 for a month's supply. So I didn't consider keeping that going — but I will look into proviron which seems like it might be more economical.[/quote]
 

Mike1234

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franko said:
Hmm... not great. Not having morning erections that I'm aware of. Libido is not really noticeable.


I actually tried Andractim (2.5% DHT gel) for about 4 weeks and I did notice similar benefits — actually my libido was noticeably higher. Unfortunately I didn't do a blood test. But the gel was expensive — about $100 for a month's supply. So I didn't consider keeping that going — but I will look into proviron which seems like it might be more economical.


There's some stuff I've gleaned through google about using proviron without Testosterone and having good results as far as shutdown is concerned but there are some conflicting opinions.


Here's a post I copied from another site citing some big studies: (proviron = mesterolone)

Varma TR, Patel RH.

Department of Obstetrics & Gynaecology, St. George's Hospital Medical School London, U.K.

Two hundred fifty subfertile men with idiopathic oligospermia (count less than 20 million/ml) were treated with mesterolone (100-150 mg/day) for 12 months. Seminal analysis were assayed 3 times and serum follicle stimulating hormone (FSH) luteinizing hormone (LH) and plasma testosterone were assayed once before treatment and repeated at 3, 6, 9 and 12 months after the initiation of treatment. One hundred ten patients (44%) had normal serum FSH, LH and plasma testosterone, 85 patients (34%) had low serum FSH, LH and low plasma testosterone. One hundred seventy-five patients (70%) had moderate oligospermia (count 5 to less than 20 million/ml) and 75 patients (30%) had severe oligospermia (count less than 5 million/ml). Seventy-five moderately oligospermic patients showed significant improvement in the sperm density, total sperm count and motility following mesterolone therapy whereas only 12% showed improvement in the severe oligospermic group. Mesterolone had no depressing effect on low or normal serum FSH and LH levels but had depressing effect on 25% if the levels were elevated. There was no significant adverse effect on testosterone levels or on liver function. One hundred fifteen (46%) pregnancies resulted following the treatment, 9 of 115 (7.8%) aborted and 2 (1.7%) had ectopic pregnancy. Mesterolone was found to be more useful in patients with a sperm count ranging between 5 and 20 million/ml. Those with severe oligospermia (count less than 5 million) do not seem to benefit from this therapy.

PMID: 2892728 [PubMed - indexed for MEDLINE]

One more...
Effect of non aromatizable androgens on LHRH and TRH responses in primary testicular failure.

Spitz IM, Margalioth EJ, Yeger Y, Livshin Y, Zylber-Haran E, Shilo S.

We have assessed the gonadotropin, TSH and PRL responses to the non aromatizable androgens, mesterolone and fluoxymestrone, in 27 patients with primary testicular failure. All patients were given a bolus of LHRH (100 micrograms) and TRH (200 micrograms) at zero time. Nine subjects received a further bolus of TRH at 30 mins. The latter were then given mesterolone 150 mg daily for 6 weeks. The remaining subjects received fluoxymesterone 5 mg daily for 4 weeks and 10 mg daily for 2 weeks. On the last day of the androgen administration, the subjects were re-challenged with LHRH and TRH according to the identical protocol. When compared to controls, the patients had normal circulating levels of testosterone, estradiol, PRL and thyroid hormones. However, basal LH, FSH and TSH levels, as well as gonadotropin responses to LHRH and TSH and PRL responses to TRH, were increased.



Mesterolone administration produced no changes in steroids, thyroid hormones, gonadotropins nor PRL.




There was, however, a reduction in the integrated and incremental TSH secretion after TRH.


I used proviron for a month at ~75 mg around 2 years back when I was still in college. I became extremely attracted to most girls I wouldn't have considered much before. The libido increase was fun overall but almost a burden at times honestly ( I won't go into details much but there was soreness ). Aside from libido, there was all the other symptoms of lowered E and increased androgen, as expected based on what proviron is. I felt incredibly good and am going to be trying again after I move into my new apartment in a month at 50mg and see how it goes. Will get bloods done often to monitor closely.
 

Spondive

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I want to try proviron but I need to find a source that is safe that I can trust
 

Mike1234

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I ordered some Proviron this afternoon and hope it doesn't take longer than 3 weeks to arrive because I'll be 2000 miles away by then lol. It should be legit Bayer Proviron but we will see if/when it arrives. You can pm me for the source but I'd recommend waiting until I get it before ordering anything.
 

Mike1234

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franko, I've been looking around for solutions to your elevated prolactin levels and haven't run into a simple solution. Assuming your diet is good and you're getting all the necessary vitamins, your best bet is probably TRT or DHT with an ai as necessary and probably a slightly lower dose.
 

mlc2010

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I tried proviron and for some reason my testicles were always tight on them, maybe a sign of lowered E?
 

Mike1234

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Franko did you ever figure out something for your prolactin? My proviron should be coming Tuesday or Wednesday, been traveling so not sure if I will get a blood test before I start because I am so eager to try again. I'd say all my steroids and thyroid are in healthy/ideal ranges but I'm just assuming based on how I feel. Anyway I'll let you guys know how it goes by end of this week.



mlc2010 said:
I tried proviron and for some reason my testicles were always tight on them, maybe a sign of lowered E?

Tight testes when it's not due to cold temperature is usually a sign of decreased teste output isn't it ? What dose were you using?
 

Mike1234

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Got my proviron and I'm 100% sure it is legit mestelerone. Came in little boxes about the size of a mini toothpaste with 20 tablets in a pack by Bayer (Greece). I am having so much fun with this stuff, libido is through the roof. The gf likes it too ;) Started 25mg /day on monday then 50mg the last two days.

I didn't have low libido or any other low test symptoms before so not sure how it will be for people looking for trt effects, but I'd say it's worth a try if it fits your budget.
 
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franko

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Mike1234 said:
franko, I've been looking around for solutions to your elevated prolactin levels and haven't run into a simple solution. Assuming your diet is good and you're getting all the necessary vitamins, your best bet is probably TRT or DHT with an ai as necessary and probably a slightly lower dose.

In general I think I could probably benefit from supplemental A,E,K and calcium, so I'm going to keep working on that.

Also, I don't think prolactin would be causing any noticeable problems at my slightly elevated level if my Androgen:Estrogen ratio wasn't so low. So that's why I'm looking to androgen raising solutions.

Mike1234 said:
Franko did you ever figure out something for your prolactin?

I'm not currently using anything to lower prolactin directly, but I have started TRT with concurrent AI's and I'll eventually find out whether that will lower prolactin indirectly.

If the TRT doesn't work out, I think I'll fall back to something like AI's + Proviron. I may be wrong about this but I think of DHT — because of its association with balding — as something like a "backup" or "stress time" testosterone. Like your body recognizes that you've got low T and that most of its being aromatized but it knows you need at least some androgenic substance to keep a minimal libido and sexual function. Simplistically I think of it like this: Testosterone > DHT > Nothing. I know that Testosterone and DHT is not an either/or situation and that you need both, but yeah, that's my rationale for trying TRT in preference to DHT supplementation.

It's still too early in my TRT experiment to judge whether its working and whether it's sustainable — but I can say from the initial problems and inconveniences of injections that I would like it a lot more if it were as simple as just taking a pill.
 

Agent207

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2014-01-08
Estradiol 28.8 | 7.6-42.6 pg/mL
Testosterone 328 | 348-1197 ng/dL
Free T 12.7 | 9.3-26.5 pg/mL
Prolactin 35 | 4-15.2 ng/mL
Cortisol 25 | 6.2-19.4 ug/dL
Vitamin D 30 | 10-80 ng/mL

A 0.38% free test? Is this a typo?

Free test levels should move around 2% of total test. 65 pg/mL would be the minimum to look for.
 

Angry Bird 03

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A 0.38% free test? Is this a typo?

Free test levels should move around 2% of total test. 65 pg/mL would be the minimum to look for.

That's not really bad. Look at the reference ranges. For comparison sake, and if you think that's a bad total test to free test ratio, last November, I had a total test of 696ng/dL and my free test was at 11.3pg/mL. That's bad.... SHBG was in the 51 range and E2 was in the low 30's.

Hopefully bring the SHBG and to a lesser extent, the E2 down will help to increase free test levels along with kicking up total T while I'm at it.
 

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