HRT Gyno question

[tattoopierced1]

dr. john:

Been following you since you were on other boards and I try and have my Dr. follow your protocol. I do have one issue though and maybe you can help. I appear to have sporadic spurts of gyno popping up every now and then. I am on 100mg test cyp. week and I have followed your tamoxifen recommendation from the other forum to a "T", however, this time, it doesnt seem to want to go away. Is there any other option I can try besides surgery?

 

[pmgamer18]

dr. john:

Been following you since you were on other boards and I try and have my Dr. follow your protocol. I do have one issue though and maybe you can help. I appear to have sporadic spurts of gyno popping up every now and then. I am on 100mg test cyp. week and I have followed your tamoxifen recommendation from the other forum to a "T", however, this time, it doesnt seem to want to go away. Is there any other option I can try besides surgery?

From what I understand if it is breast tissue and Tamoxifen does not work you need to have it removed. But it can come back if you don't keep your Estradiol and Etrogen under control.
Phil

 

[tattoopierced1]

i realize all of this, i am just following said protocol from one of Dr John's articles. Was going to see if there was anything else I can do.

 

[mercedesdd]

Hey tattoo, Not sure if you ever saw this reversal protocol... I wanted to get Dr john's feedback on this gyno reversal protocol.. Nice to see ya over here Dr J.. How you been ? What do you think about this protocol Dr John?? Thanks for your feedback!!!


Here is the post on gyno reduction I posted in the past.. It is my buddys protocol and it has a good success rate at reducing gyno... It will answer your question...

I am posting this thread to help answer all of the questions regarding gyno prevention and reversal, the use of letrozole and other anti-e’s. I will go over everything in very simple easy to understand language. Also we are talking about estrogen gyno here, not progesterone (but using letro will stop progesterone related problems as well since it inhibits all estrogen anyways). Progesterone gyno will be enlargement of your nipple area, the actual aereola, not a lump under it.

Let me make this first point very clear, as I state in my signature this is from my personal experience, so whether you agree with it or not is your own issue. I have helped many people with gyno and it has worked just fine for them as well.

To first understand why you are doing what you are doing I am going to go over a few things and a few definitions:

SERM – Selective estrogen receptor modulator. These drugs work by binding to the estrogen receptors and flooding them in a sense, making it difficult (but not impossible by any means) for estrogen to bind to the receptors and thus prevent the onset of estrogen related side effects.
Most common forms: Tamoxifen (Nolvadex), Clomiphene (Clomid)
AI – Aromatise Inhibitor. These drugs work by inhibiting the aromatization of estrogen. This means that in effect AI’s prevent androgens from converting to estrogen, again, making it difficult (but not impossible) for estrogen to reach receptor sites.
Most common forms: Anastrozole (l-dex, a-dex), Exemestane (aromasin), Femera (letrozole). For our purpose of reversing gyno we are interested in Letro.

Letro and your sex drive:
Letrozole will suppress your sex drive. This is another reason why it is so important to act on preventing gyno as soon as possible. Since we all know that Test should be run in every cycle this will cancel out the effect of sex drive suppression.

Running letro to prevent gyno:
If you decide to run estrogen protection while on cycle (and I suggest you do unless you are aware that you do not require it), you can run either a SERM or an AI. Letro will be the most powerful AI you can use, it will inhibit 98+% of estrogen using a dose as low as .25mg and even lower. This is why I suggest you do not use a dose higher than .50mg while on cycle just trying to prevent estrogen related side effects.

You will want to start running the letro approximately 2 weeks before you begin your cycle to allow it to fully stabilize in your blood. I have often heard the argument that letro takes up to 60 days to stabilize, I don’t know if I buy into this for the reason that I have reversed gyno after using letro for only 1 week. Still to be safe I recommend starting it before your cycle as stated above.

If you do decide to run letro there is absolutely no need to run another AI or SERM. Do not make the mistake of thinking more is better. Think of it this way; if letro is preventing the conversion of androgens to estrogen than there is no estrogen, what would the purpose of a SERM be when there is no estrogen to bind to the receptors? Nolva will only take away from the effectiveness of letro.

This brings me to my next point. Do not listen to anyone who tells you to bump up your nolvadex to 60+mg ED if you get gyno. I have no idea where this idea started but I have seen it suggest far too many times recently. Nolvadex will do nothing to reverse your gyno…let me make that clear IT WILL DO NOTHING FOR GYNO. If you are running nolva as your anti-e and start to develop gyno than sure you can bump the dosage a small amount to try to prevent it from progressing further, but letrozole must begin ASAP.

It is very important that you begin taking letrozole immediately, the longer your wait the more risk you take in not being able to reverse it.

How do I know if I have gyno?
If you have developed gyno you will have a lump behind your nipple. It will be fairly hard, and it will be tender to touch.

Running letro to reverse gyno:
I am going to go over the three different scenarios which people could fit into. Remember regardless of what scenario you are in it is important that you begin taking the letro ASAP.

1. Already using an anti-e aside from letro.
2. Already using letro @ a dose of .25mg or .50mg ED.
3. Not running any estrogen protection.

1.
Day 1: .25mg Letro + anti-e*
Day 2: .50mg Letro
Day 3: 1.0mg Letro
Day 4: 1.5mg Letro
Day 5: 2.0mg Letro
Day 6: 2.5mg Letro **

2.
Day 1: .50mg Letro
Day 2: 1.0mg Letro
Day 3: 1.5mg Letro
Day 4: 2.0mg Letro
Day 5: 2.5mg Letro **

3.
Day 1: .50mg Letro
Day 2: 1.0mg Letro
Day 3: 1.5mg Letro
Day 4: 2.0mg Letro
Day 5: 2.5mg Letro **

*Regardless of the anti-e you are using it is important to still use it for the first day you begin letro as the letro will not have taken any effect and you by no means want your body to be without any protection when gyno is already prevalent.

** You will remain at this dose until gyno symptoms subside. Once you believe your gyno is gone it is important to stay at this dose for another 4-7 days to ensure all traces are gone. I recommend people with a bf% over 15 stay on for a week as it may be harder to judge completely whether the lump is completely gone. Once this period is over it will be important to taper letro down slowly rather than coming off it completely. Regardless of which manner you tapered up your dose you will all taper down in the same fashion.

Day 1: 2.0mg
Day 2: 1.5mg
Day 3: 1.0mg
Day 4: .50mg***
Day 5: .25mg
***You can remain at this dose or go down further to .25mg. It is really up to you at this point. They are both very common maintenance doses as an anti-e while on cycle. Personally I have stayed with .25mg and never had a problem.

Letro and the estrogen rebound:
With your estrogen being completely inhibited there is a definite estrogen rebound as your body tries to re-stabilize the testosterone:estrogen balance. We can prevent this rebound effect by supplementing further with another AI or SERM. So, I suggest that when you are coming to the end of your cycle you will more than likely be using Nolva in your post cycle therapy so just make sure that you begin taking nolva the last day you are going to take your letro and then continue on as you would with regular post cycle therapy.

This now leads us into the question of reversing gyno while not on cycle. There are a few things to remember here. You have already waited longer than you should have, and your sex drive will be shot. You can use tribulus or another natural test booster to help you in this scenario but I can’t guarantee the effectiveness. Just follow gyno reversal protocols 2 or 3. When coming off again you must taper and begin using nolvadex to prevent any rebound effect that may occur.

How much nolvadex should you use if you are not going into post cycle therapy and running this off cycle? I suggest starting at 20mg ED for a week and then lowering it to 10mg for another week and then coming off completely

 

[mercedesdd]

Bump for Dr John's input on this!!!

 

[tattoopierced1]

bump for dr. john

 

[tattoopierced1]

i'm just stating what i've tried, which have not worked for me. i really dont want to go under the knife to get rid of this, but as a last resort, I will. If you have anything else for me to try, please let me know, I am all ears.

 

[RenegadeRows]

Very interesting stuff here.
Doctor, could you comment on Raloxifene vs. Tamoxifen for gyno...Which do you recommend/prefer?

 

[mercedesdd]

Dr john , Thanks for your reply on the letro gyno reversal protocol.. I cant find your exact gyno protocol that tattoo pierced mentioned from another board can you please post it here?? Do you just suggest 20mg of nolva once per day and then taper down when symtoms subside ?? Thanks

 

[mercedesdd]

I simply do not believe it. I have had great success using 20mg tamoxifen BID until symptoms subside, then tapering down by 10mg every five days or so until gone.

And you will never completely eliminate estrogen. The body does not work that way.

And stating gyno must originate as a hard nodule is untrue. The massive glandular tissue which is evident in extreme cases did not necessarily start that way. I have seen plenty of guys with bad cases who never experienced any sort of nodule along the way.

The author is making statements--in a most definitive manner--which are simply untrue.

I am working on developing a nonsurgical treatment for extreme gyno with a colleague of mine. We have a ways to go yet.

I just wanted to say that the proof is in the pudding with this letro gyno reversal protocol. I have seen it work in tons of cases. I have spoke to my buddy who wrote this gyno reversal using letro and wanted to post what he said on his behalf since you said what he says is unture..As for it not always being a nodule , ya it is not always, but usually when it is anabolic steroids induced it will be. I mean the definition of gyno(AAS induced) is an enlargement of the mammary gland , so yea there is gonna be a lump unless you just have high bodyfat or its something else.. Nolva treatment takes a long time and is not as effective as letro. If it did than why would people who use nolva on cycle have to switch over to letro to reverse their gyno?? If nolva works so well at reversing gyno than how come people on cycle using 20mg of nolva ED still get gyno??? Not trying to argue with you DR John but how can you say this letro protocol does not work.. As a DR I think you should be open mined about treatments if you want to help people and not knock something you have not tried.. I dont want you to take this post the wrong way as I am not trying to fight about anything ..

 

[tattoopierced1]

thanks mercedesdd.. i'll ask my doc to prescribe me some letro and see if it works. The tamoxifen takes it down some, but it ends up coming back and consistantly gets worse each time it rears its head.

 

[mercedesdd]

No offense taken, Brother.

Please do not assume I have not tried this protocol. What I am saying is the author makes statements which are untrue. So are several of the comments you assert. I stand by my previous statements. And my experience in this field is equalled by very few.

Given my chosen specialty, I don't think anyone could call me "closed minded". LOL.

I'll tell you how I do this. First, I block estrogen at the mammary tissue. If that does not work, then we go all out with AI concurrent with estrogen antagonism. But the more extreme solution is guaranteed to damage health along the way, because it LOWERS estrogen so drastically, so I usually try the strong estrogen antagonism first.

So what AI do you use if just using nolva to block the estrogen at the mammary tissue does not work????

 

[Stinger124]

Maybe a dumb question, But I am gonna ask..

Whats your take on Toremifene ? Do you thnk it helps prevent gyno, and will it help to get rid of gyno if you already have it ?
I have read alot of new or pretty new post where people are taking this for there post cycle therapy , so I am not sure how well or if it will help at all with gyno..

Your response is appreicated.. Thanks

 

[Stinger124]

No problem...

 

[pistonpump]

Toremifene Citrate aka Fareston(its trademarked name). The average dose is 60mg so i think its safe to say 60mg Toremifene=20mg Tamoxifen?

I have also developed a small lump and i have had hot flashes as well the past few days. Are hot flashes a sign that gyno or excess estrogen is occuring? Im pretty sure it is a side effect of using a SERM but not 100% sure. I have been on a SERM for 1 day.

 

[mercedesdd]

No offense taken, Brother.

Please do not assume I have not tried this protocol. What I am saying is the author makes statements which are untrue. So are several of the comments you assert. I stand by my previous statements. And my experience in this field is equalled by very few.

Given my chosen specialty, I don't think anyone could call me "closed minded". LOL.

I'll tell you how I do this. First, I block estrogen at the mammary tissue. If that does not work, then we go all out with AI concurrent with estrogen antagonism. But the more extreme solution is guaranteed to damage health along the way, because it LOWERS estrogen so drastically, so I usually try the strong estrogen antagonism first.

Dr John, I do some work for signature pharmacies and it seems we know some of the same people( I know you work with them as well). You are a great HRT doc but when you make statements like and I quote you from your above post" And my experience in this field is equalled by very few." end quote. it is very unbecoming of you. I mean do you really think that other endocrinologist and compounding pharmacist do not also have extensive knowledge and experience in this field as well?? I mean the purpose of this forum is to help people not to put other people down and say that know one else in the world has as much knowledge and experience about the endocrine system and gyno as you . This is not just my opinion but also the opinion of other very professional people that you and I both know. To make the statement " And my experience in this field is equalled by very few." makes other Docs and compounding pharmacist think to themselves you are very conceited and gets them thinking is your true intention to help people or to be arrogant and more concerned about having the title the best HRT doc in the world ( not my own words but the words of the other Dr's and compounding pharmacist we both know when they saw this thread). Again this is not just coming from me but from professional people that we both know. I hope this post is not erased and this is not an attack on you by any means as I do feel you are very good at what you do but your attitude with your statement " And my experience in this field is equalled by very few." Can get in the way of your true professionalism. I am not here to argue or fight just to learn....

 

[tattoopierced1]

cant wait for this up and coming treatment dr john. Please let me know when you are all testing, I will have my dr. try what you are trying as he follows your protocol.

 

[tattoopierced1]

count me in. i can get you all my dr's info so he can oversee it for you, that wont be a problem.

 

[Stinger124]

Sounds like that could be a Big Hit !! Hope all goes well for you and your plan..

 

[mercedesdd]

Let's begin by making sure we understand each other.

You offer a post--asking my opinion of same--by a self-described "expert" ,which contains statements which are patently untrue. Then you offer statements of your own which are also patently untrue. Included are statements suggesting I am closed-minded, and that I have not tried the protocol you suggest.

When I straighten out a few of the mistatements presented, and back them up by the simple fact that I know what I know because I have personally treated literally hundreds of men for this condition--which very, very few have--you state that this is unprofessional.

Rather, it is considered wise to ask a physician how much experience he/she has with a given treatment/therapy. All patients are advised to do so.

The rest of you may be interested to know I am working with a colleague to develop a revolutionary non-surgical treatment for gyno. Stay tuned!

And I will also remind you that it is illegal for pharmacists to direct medical care. It is my experience there are a lot of people trying to pass themselves off as experts out there who posses neither the knowledge, the experience, nor the credentialling to do so. This is a huge ethical problem in our industry; more so, it is bad because it compromises the health and well-being of the public (who expect us to know what we claim to). I hope that is not what you, or your "friend", do.

I would respectfully suggest your comments are more related to your own lack of knowledge and experience in this field, as well as that of your "friend", than anything that has to do with me. I do not care who you are, or who your friend is, or who you know. Factually inconsistent statements are just that. I will do my best, within the limits imposed by my knowledge and experience, to provide the very best advice I can, at all times.

Would you go to a doctor for treatment, or medical advice, then acuse them of being "unprofessional" when they are confident of their knowledge and experience? Or when they give simple, honest answers? IOW, If you do not want to know what I think, then simply do not ask. Frankly, I am a bit surprised you would even post such things. It's kind of a silly complaint in the first place, frankly. What on earth does it have to do with the subjects at hand?

If you have interacted with those who know me, then you already know I do not give one second's consideration to what anyone thinks of me. I serve Truth; simple as that (THAT is already a full time job! LOL).

As far`as my true "intentions", I remind you that I have donated more time answering questions--for free--than any other doctor in the history of the Internet. And this is not a hobby, it is what I do for a living--all day, every day. Therefore your comment is as undeserved as it is offensive.

I will hasten to add that, in rereading this thread, that I indeed failed to answer a couple of your direct questions along the way. If you are still interested in my professional opinion--and it certainly looks as though you are not--I will be more than happy to accomodate you. My apologies for missing them previously.

Your post has not, and will not, be edited or altered in any way (at least by me). And I sincerely hope you are not offended by my observations as well. They are, after all, simple facts. But I will share with you that we are simply not going to engage in dialogue of this low nature here. We are instead spending our time here trying to help others.

I was just saying I have seen tons of cases with this letro protocol have great success and have seen very few cases of nolva work as well as letro . Even in medical studies nolva is used for like 12-18 months before it was reduced but that is just studies I am more referring to what we have personally seen ... Also did you know signature pharmacy is now compounding letro!!!! But if nolva is working that thats great as long as the gyno is getting reduced than I am good to go LOL...... Well moving on to my questions that you didnt answer that you said you will.. What AI do you use when just using your nolva protocol does not work?? You said you use nolva and an AI concurrent if just nolva treatment does not work. Also whats you take on nolva reducing the effects of type 2 AI's ?? Some studies suggest that nolva has no effect on lowing blood plasma levels of type 2 AI's and others say it does have an effect and when taking a type 2 AI and nolva in conjunction will reduce the effects of the type 2 AI up to 40%.. From what I have been researching it looks like a type 1 AI like aromasin does not need to be present to continue doings its job on the aromatase enzyme, unlike a type 2 AI, which might ( this is where I am not sure as everything is very conflicting on this) be partially eliminated by nolva and would unfortunately would need to be present to continue its aromatase inhibition . Once a type 1 does its job , the enzyme it is attached to is useless.. Whats your take on this??

 

[mercedesdd]

It looks as though we will be patenting the process, so will have to license it to others. However, we will be seeking a number of volunteers for testing the process as we go along.

Also do you mind if I ask how are you patenting your gyno reversal protocol? Are you using existing FDA approved meds or do you mean you are developing a new drug that you are trying to get FDA approved?? Thanks

 

[1cc]

" And my experience in this field is equalled by very few."

This is a statement of fact.

This is not just my opinion but also the opinion of other very professional people that you and I both know.

If your Ego is unable to accept a statement of fact, then the only one with a problem is you. That doesn't change the fact.

You are most welcome to line up in a row all the people that have extensive experience doing HRT (and I mean doing it properly). I would be delighted to have such a list of names that I can use to refer desperate people who need help. Other than Dr. John and a few other published doctors, I don't know of anyone whose experience matches Dr. John's. That is a statement of fact.

 

[mercedesdd]

Sounds good !! Lets please get off all this arguing .. I will say it again and again I think you are a GREAT HRT Doc.. I really do not want to fight with you or anyone I just want to use my knowledge to help other people and of course to always continue to learn. If you go over my post history you will see that I do have knowledge in this field also and again I would not doubt we will run into to eachother at a medical conference in the very near future and I would love to take you to lunch and pick your brain if you have time of course lol... Well I apologize if anything I said was uncalled for and would love to continue to move forward on helping many people on this board. As I have many questions I would like to get your feedback on ... cant we just get along Dr John??? LOL

I think I see where some miscommunication came in. When I say I use Nolvadex to treat gyno it is as "rescue"--not as treatment for long standing gyno. IOW, where it has come on as a direct result of changing hormone levels.

I did not invent the protocol of using 20mg BID until symptoms resolve. But what I do make sure is that we taper the SERM down afterwards, by the half-life of the drug--around 5 days--cutting it by 10mg QD each time.

Frankly, I don't consider the kind of "nipple issue" treatable by a SERM as true gyno anyway.

For treatment of already established gyno I do think you need to hit it hard, hard, hard with respect to estrogen, by inhibiting (you can NEVER completely eliminate E) its production with an AI PLUS blocking its effects with a SERM.

Of note, those who are concurrently on GH therapy must hold their GH, as same will magnify the effects of mammary tissue stimulation.

I try like heck to avoid estrogen manipulation at the beginning of TRT, while titrating same, as doing so not only clouds the picture while titrating, and you cannot draw valid estrogen assays then, but I have seen a number of cases where E actually drops after starting TRT. So E control not only would be unnecessary, as a good and proper Osteopath, I am loathe to ever prescribe a drug, or more of a drug, than is necessary.

As to all this steroidal vs. non-steroidal AI business, as well as suicidal inhibitors vs. competitive antagonists, I think the jury will be a while coming in with a verdict as to which is preferable. And studies conducted upon females--pre, peri, or post menopausal--cannot be extrapolated to conclusions about how these drugs will affect adult males. There are many, many issues to consider. In the meantime, I am continuing to use Arimidex; but this practice is, admittedly, because I am (like all docs) a creature of habit. LOL. I know how it performs as I have used it so many times. But there may very well be a better drug in this class, indeed.

I'll also add that I am not completely comfortable using any of these powerful endocrine disrupters. You all already know I do not use finasteride. In private discussions with two of my favorite docs, Drs. Eugene Shippen and Mark Gordon, we all feel the same way. In the meantime, it seems like what we have.

This might be a good time to add that Dr. Mark Gordon has asked me to preview some new work of his in controlling estrogen conversion without use of an AI. I am VERY excited about this. I'll call him and ask when we can discuss it here. Heck, maybe I can get him to appear as a "Guest Lecturer" here. He's a really great guy.

Perhaps you would be willing to explore the various AI drugs in a new thread here. It is certainly an important and very interesting topic!

 

[mercedesdd]

So dont you think letro may be a better idea than nolva when using it to treat true gyno and not as a 'rescue' to reduce it ? You say you use adex due to being a creature of habit but wont letro be a better choice when your nolva only protocol has not worked since letro is a stronger AI than adex and would accomplish almost the same thing at lowering estrogen alone rather than having to use a SERM(nolva) and an AI ( in your case adex) in conjunction??

I think I see where some miscommunication came in. When I say I use Nolvadex to treat gyno it is as "rescue"--not as treatment for long standing gyno. IOW, where it has come on as a direct result of changing hormone levels.

I did not invent the protocol of using 20mg BID until symptoms resolve. But what I do make sure is that we taper the SERM down afterwards, by the half-life of the drug--around 5 days--cutting it by 10mg QD each time.

Frankly, I don't consider the kind of "nipple issue" treatable by a SERM as true gyno anyway.

For treatment of already established gyno I do think you need to hit it hard, hard, hard with respect to estrogen, by inhibiting (you can NEVER completely eliminate E) its production with an AI PLUS blocking its effects with a SERM.

Of note, those who are concurrently on GH therapy must hold their GH, as same will magnify the effects of mammary tissue stimulation.

I try like heck to avoid estrogen manipulation at the beginning of TRT, while titrating same, as doing so not only clouds the picture while titrating, and you cannot draw valid estrogen assays then, but I have seen a number of cases where E actually drops after starting TRT. So E control not only would be unnecessary, as a good and proper Osteopath, I am loathe to ever prescribe a drug, or more of a drug, than is necessary.

As to all this steroidal vs. non-steroidal AI business, as well as suicidal inhibitors vs. competitive antagonists, I think the jury will be a while coming in with a verdict as to which is preferable. And studies conducted upon females--pre, peri, or post menopausal--cannot be extrapolated to conclusions about how these drugs will affect adult males. There are many, many issues to consider. In the meantime, I am continuing to use Arimidex; but this practice is, admittedly, because I am (like all docs) a creature of habit. LOL. I know how it performs as I have used it so many times. But there may very well be a better drug in this class, indeed.

I'll also add that I am not completely comfortable using any of these powerful endocrine disrupters. You all already know I do not use finasteride. In private discussions with two of my favorite docs, Drs. Eugene Shippen and Mark Gordon, we all feel the same way. In the meantime, it seems like what we have.

This might be a good time to add that Dr. Mark Gordon has asked me to preview some new work of his in controlling estrogen conversion without use of an AI. I am VERY excited about this. I'll call him and ask when we can discuss it here. Heck, maybe I can get him to appear as a "Guest Lecturer" here. He's a really great guy.

Perhaps you would be willing to explore the various AI drugs in a new thread here. It is certainly an important and very interesting topic!

 

[mercedesdd]

Also if estrogen is very low due to the use of a strong AI the amount of free estrogen would be very low so there would not be much floating around to bind to receptors in breast tissue so is nolva really necessary in this case to bind the receptors in breast tissue ?? Wont a strong AI like letro eliminate the need for nolva in this case?? Whats your take on this?? Thanks

 

[pistonpump]

im not goin to even say anything anymore....

 

[pistonpump]

what is the highest doses of nolva you use for your patients? How do you feel DR. on using 80mg nolva ED to reduce a tender lump and puffy nipple on left side? not sure if you posted your opinion on this before but if you could kindly answer it would be much apprieciated.

 

[pistonpump]

A dose that high might be better, I don't know. Good question.

One thing I do worry about are fatty changes in the liver with Nolvadex. That is why even at 40mg QD, I split the dose.

I have had pretty good success at 20mg BID until symptoms subside. And, as previously stated in this thread, if we have to concurrently lower E's with an AI, I don't think there's much estrogen effect left anyway; that much SERM surely will block what is left. The question that remains at that point is whether the gyno will respond.

Let's admit: we're just doing what we can to try to avoid surgery. This is a big problem, and we clearly have a long way to go here.

sorry for my ignorance but could you help me understand what you mean by QD and BID?

So you are implying that spliting doses has a better effect on the liver?

Why does nolvadex make people drowsy?

 

[mercedesdd]

Dr John I am not trying to fight with you in anyway . Sometimes it is hard to understand what is exactly trying to be said as this is the Internet and not face to face so something can come off or be misinterpreted the wrong way . and again I apologize if I said anything uncalled for.. Can I please ask your professional opinion on some questions to totally understand you view on this?? So do you agree that nolva may not be needed when using an AI by your statement quote DR John" And, as previously stated in this thread, if we have to concurrently lower E's with an AI, I don't think there's much estrogen effect left anyway;end quote .. As you just said about not much estrogen effect being left over , that is exactly what I said in my above post why nolva may not be needed when using a strong AI ... Also you agree that estrogen has to be inhibited to reduce gyno. So can you please explain why you suggest ADEX over letro for achieving this inhibition ?? Letro has been shown to be a much stronger AI than ADEX . Wouldn't that make it a better choice as it can work better at inhibiting estrogen than adex which inhibiting estrogen is key when trying to treat gyno.. And I totally agree we're just doing what we can to try to avoid surgery when using any of theses protocols.. And I will say it again I think you are a great HRT doc and hope you can give me an answer to my questions .. Thanks for your time and all that you contribute here..

 

[pistonpump]

Letro defeats the purpose of using a SERM because it downgrades the SERM's effectiveness resulting in using higher doses to get the same effect.

Mercedes no offense but it really seems as you are causing arguements just because Dr. John doesnt use Letro in his work. Im not taking sides bro just that it is kind of cluttering the thread with things that Dr. John has already addressed. I think he stated that he like most doctors are creatures of habit and he knows the effects and such with Adex so that is what he uses.

There are things that are still not understood fully about AAS, SERMS, AIs etc...even doctors dont have it fully figured out yet so even saying one protocol is better than another is false because people react differently to different drugs IMO. We can only attempt to find a standard that works for the majority.

 

[mercedesdd]

There is no conclusive evidence that nolva reduces the effects of type 2 AI's. Studies on pubmed go back and fourth . One says it does and another says it does not . So nothing is set in stone on this. And please keep in mind Adex and letro are both type 2 AI's so if nolva does reduce the effects of letro nolva would also reduce the effects of adex due to the fact that they are both type 2 AI's( nolva in conjunction with adex is the protocol DR john uses if the nolva only protocol does not work). So as far as letro defeating the purpose when using a SERM it would be the same case that adex would defeat the purpose as well.. You are correct about not being fully understood I just want to get some feedback on this topic.. Thanks for your post as I am not here to aruge with anyone.. We are all here to learn from eachother and I truly feel this is a great board with great members...

Letro defeats the purpose of using a SERM because it downgrades the SERM's effectiveness resulting in using higher doses to get the same effect.

Mercedes no offense but it really seems as you are causing arguements just because Dr. John doesnt use Letro in his work. Im not taking sides bro just that it is kind of cluttering the thread with things that Dr. John has already addressed. I think he stated that he like most doctors are creatures of habit and he knows the effects and such with Adex so that is what he uses.

There are things that are still not understood fully about anabolic steroids, SERMS, AIs etc...even doctors dont have it fully figured out yet so even saying one protocol is better than another is false because people react differently to different drugs IMO. We can only attempt to find a standard that works for the majority.

 

[pistonpump]

i'll look into that. I swear i read that even tho' they are both type 2 ai's letro acts on nolva differently. Ill see if i can find it....

 

[mercedesdd]

Dr John in response to Piston pumps question I want to get your input on this.. Wouldn't 80 mg of nolva be a very high dose?? It can reduce IGF-1 and high doses can effect the adrenal gland . And in some studies has been shown to cause blood clotting.. Is that high of a dose really safe in your opinion???

A dose that high might be better, I don't know. Good question.

One thing I do worry about are fatty changes in the liver with Nolvadex. That is why even at 40mg QD, I split the dose.

I have had pretty good success at 20mg BID until symptoms subside. And, as previously stated in this thread, if we have to concurrently lower E's with an AI, I don't think there's much estrogen effect left anyway; that much SERM surely will block what is left. The question that remains at that point is whether the gyno will respond.

Let's admit: we're just doing what we can to try to avoid surgery. This is a big problem, and we clearly have a long way to go here.

 

[pistonpump]

Dr John in response to Piston pumps question I want to get your input on this.. Wouldn't 80 mg of nolva be a very high dose?? It can reduce IGF-1 and high does can effect the adrenal gland . And in some studies has been shown to cause blood clotting.. Is that high of a dose really safe in your opinion???

That is true with the IGF-1 levels but how does it effect the adrenal gland? That is why iam so partial to this method. I have heard it is bad but suggested by many to use a dose of 60mg -80mg ED until gyno lump subsides.

 

[mercedesdd]

Piston pump, Again one study says it does and one says it does not. But both being type 2 AI's nolva would have the same effect on both of them( if it really does reduce blood plasma levels). Here ya go check this out!!

This only applies to 3rd generation AI's, Letro, Arimidex and L-Dex.

Interactions of antioestrogens and aromatase inhibitors.

Schmid P, Possinger K

Department of Oncology and Hematology, Charite Campus Mitte, Humboldt University Berlin, Germany.

Aromatase inhibitors and antioestrogens have shown substantial activity in primary and advanced breast cancer. Since they exhibit different modes of action, attempts have been made to combine them or to use them sequentially in order to potentially increase their efficacy. In preclinical studies, combined, sequential or alternating treatments with aromatase inhibitors and antioestrogens have failed to provide higher antitumoural activity. There are relevant pharmacokinetic interactions resulting in decreased plasma concentrations of third generation aromatase inhibitors when combined with tamoxifen. Several randomised clinical trials comparing single agent and combined treatment with tamoxifen and aminoglutethimide failed to show any benefit for the combination. Early results of the adjuvant ATAC trial indicate that single agent anastrozole is superior to tamoxifen or the combination of both. Several trials are ongoing which might help to further define the role of sequential or combined treatment with aromatase inhibitors and antioestrogens. However, to date, looking at the current evidence, combined treatment with aromatase inhibitors and antioestrogens does not appear to provide additional benefit compared to single agent treatment.

i'll look into that. I swear i read that even tho' they are both type 2 ai's letro acts on nolva differently. Ill see if i can find it....

 

[mercedesdd]

That is true with the IGF-1 levels but how does it effect the adrenal gland? That is why iam so partial to this method. I have heard it is bad but suggested by many to use a dose of 60mg -80mg ED until gyno lump subsides.

At high doses nolva can cause the adrenal gland to go into over drive and produces DHEA than it increases enzymatic factors and than the enzymatic factors come into play and DHEA converts to estrogen in males in females it favors testosterone production.

 

[Dwight Schrute]

It can reduce IGF-1 and high doses can effect the adrenal gland .

So what. They are not talking about MGF which is the localized growth factor associated with muscle growth.

 

[Dwight Schrute]

i'll look into that. I swear i read that even tho' they are both type 2 ai's letro acts on nolva differently. Ill see if i can find it....

Drug and hormone interactions of aromatase inhibitors.

Dowsett M.

Academic Department of Biochemistry, The Royal Marsden NHS Trust, London, UK.

The clinical development of aromatase inhibitors has been largely confined to postmenopausal breast cancer patients and strongly guided by pharmacological data. Comparative oestrogen suppression has been helpful in circumstances in which at least one of the comparitors has caused substantially non-maximal aromatase inhibition. However, the triazole inhibitors, letrozole and anastrozole, and the steroidal inhibitor, exemestane, all cause >95% inhibition. Comparisons between these drugs therefore require more sensitive approaches such as the direct measurement of enzyme activity by isotopic means. None of these three agents has significant effects on other endocrine pathways at its clinically applied doses.p Pharmacokinetic analyses of the combination of tamoxifen and letrozole have revealed that these drugs interact, resulting in letrozole concentrations approximately 35-40% lower than when letrozole is used alone.

 

[Dwight Schrute]

We must always remember this study only tells us what happens in postmenopausal breast cancer patients only--

Oh I agree. I just remembered I had that one. Its also the same when people try to associate Nolva with causing cancer...endometrial cancer....


:blink:

 

[pistonpump]

thanks Bobo for finding that, I owe you one. Just because Arimidex and Letrozole are both type 2 AI's doesnt mean that they are the same. If they were they would be the same compound! so one may have different interactions with other drugs. As far as the IGF decreasing it is overrated when compared to muscle growth.

Why are there not more studies on males? I know there are millions out there with gyno, maybe they just dont get treatment from a dr., or information is just not being kept track of. Seems like we bodybuilders are the ones experimenting and coming to our own concensus on what to do.

 

[mercedesdd]

thanks Bobo for finding that, I owe you one. Just because Arimidex and Letrozole are both type 2 AI's doesnt mean that they are the same. If they were they would be the same compound! so one may have different interactions with other drugs. As far as the IGF decreasing it is overrated when compared to muscle growth.

Why are there not more studies on males? I know there are millions out there with gyno, maybe they just dont get treatment from a dr., or information is just not being kept track of. Seems like we bodybuilders are the ones experimenting and coming to our own concensus on what to do.

Like I said there are conflicting studies on if nolva even does lower the blood plasma concentrations of certain AI's . I mean we can go back and forth on this and post stuff that shows it does and stuff that shows it does not as I stated previously in this thread nothing seems to be set in stone on that topic .... I am confused on your statement QUOTE" Just because Arimidex and Letrozole are both type 2 AI's doesn't mean that they are the same. If they were they would be the same compound!END QUOTE " Clomid and nolva are both SERMS ( Selective Estrogen Receptor Modulator) and both work by basically binding the receptor although clomid is less effective than nolva at doing this . They are both SERMS and work in the same manner but they are different drugs . They are the same in action by both stimulating LH, FSH and increasing testosterone and binding estrogen receptors but yet they are TWO DIFFRENT compounds!! Same thing goes for type 2 Ai's like letro and adex. As they both are type 2 AI's and both work in the same manner but one is more effective than the other but yet they are two different compounds . Also I am suggesting that nolva would not be needed when using a strong AI when trying to treat gyno for reasons I posted in my prior post.. As I also said before it is hard to totally understand what we are trying to communicate to eachother since this is the Internet and we are not face to face. It is easy for miscommuniation to occur .. I am not trying to come off rude or trying to offend anyone and I hope my post do not come off that way as that is not the case at all . If you new me personally you would see I am not one that likes to argue and truly get along with everyone. I just think it is the miscommuniation of the Internet that is the problem.. After all we are all here just to learn and speak about ways to help eachother and not argue about BS!!!!

 

[pmgamer18]

thanks Bobo for finding that, I owe you one. Just because Arimidex and Letrozole are both type 2 AI's doesnt mean that they are the same. If they were they would be the same compound! so one may have different interactions with other drugs. As far as the IGF decreasing it is overrated when compared to muscle growth.

Why are there not more studies on males? I know there are millions out there with gyno, maybe they just dont get treatment from a dr., or information is just not being kept track of. Seems like we bodybuilders are the ones experimenting and coming to our own concensus on what to do.

I think you will find this link a good read.
Testosterone Nation - E-Man vs. T-Man
Phil