Latest Test Interpretation?

[Andromeda]

Since 11 Sept 2006 Ive been taking 10mg of Tamoxifen (Nolvadex) daily to get rid of my gynecomastia. It has progressed, albeit slowly, and just today I had my followup Dr visit to review my ongoing treatment.
At this visit we reviewed my latest blood tests to monitor hormonal changes since starting the treatment. Now these results were stunning. My estrogen levels were actually higher than before starting the Nolvadex
At the same time testosterone was slightly higher , with bound testosterone showing itself to be even higher relative.
For those who want to see/compare raw figures I have the following.

Pre Nolva: 3 weeks Post Nolva:
Testosterone - 35
Free T: 68 69
P4: 200 300
E2: 198 300

I have recently had an ultrasound of both my testicles and chest. So far the testicles are fine, and I assume the Endo would have called if the chest results (not held at the time) came back unusual... so it seems to rule out the possiblity of an E2 secreting tumour.

Please come forward with your suggestions on how this has come about as my Dr has no idea till we see the next set of tests. I'm now taking double the amount of Nolvadex (20 mg now) with followup tests to be done again in about 3 weeks.

Any advise on this mystery would be appreciated...

Cheers in advance,

[SprintR]

It's not such a mistery at all. Nolvadex is extremely long acting and you should wait *atleast* 6 weeks after stopping it to have your blood test done. 3 weeks after ceasation, it is still very much in effect, hence your blood test results. Your estrogen is higher because your testosterone is higher & also because you didn't taper off it, which caused a rebound in estrogen production. You won't see a reduction in serum estrogen with nolvadex, since it's not an aromatase inhibitor like arimidex. Nolvadex just blocks the estrogen receptors, primarily in the breast tissue.

[pmgamer18]

Originally Posted by SprintR

It's not such a mistery at all. Nolvadex is extremely long acting and you should wait *atleast* 6 weeks after stopping it to have your blood test done. 3 weeks after ceasation, it is still very much in effect, hence your blood test results. Your estrogen is higher because your testosterone is higher & also because you didn't taper off it, which caused a rebound in estrogen production. You won't see a reduction in serum estrogen with nolvadex, since it's not an aromatase inhibitor like arimidex. Nolvadex just blocks the estrogen receptors, primarily in the breast tissue.

Your right on the money you need to be off SERM's if have this right serm's. Do a search and you will find what SWALE says about it. I test is no good.

[Andromeda]

Originally Posted by SprintR

It's not such a mistery at all. Nolvadex is extremely long acting and you should wait *atleast* 6 weeks after stopping it to have your blood test done. 3 weeks after ceasation, it is still very much in effect, hence your blood test results. Your estrogen is higher because your testosterone is higher & also because you didn't taper off it, which caused a rebound in estrogen production. You won't see a reduction in serum estrogen with nolvadex, since it's not an aromatase inhibitor like arimidex. Nolvadex just blocks the estrogen receptors, primarily in the breast tissue.

Can't believe I overlooked this point re: the fact its an SERM and not an anti E2.. Now it makes a lot of sense. Just to clarify something though - I'm 3 weeks into starting the treatment - not 3 weeks off it. Furthermore I have no plans to reduce it in the meantime because I still have the gyno which MUST GO!
Followup tests have been arranged for a further 3 weeks down the track. It seems to be that with my perfect testosterone promoting lifestyle (gym and eating regularly with lots of protein etc.) I have raised the T so much that E levels are now overly high to match.... Having said that its unusual that my body seems to be so keen to produce estrogen.... After all although my bound T was high, My Free T (the one that really matters) is still middle of the range....

I see there is another post in here about Nolvadex raising SHBG.... This might explain the high Testosterone (bound) vs Free T levels right.... is this definitely the case re: Nolva and SHBG? Note too that I tend to have high thyroid levels which I understand further promote SHBG... Perhaps i just need to eat more carbs ---> increase insulin ---> lower SHBG.... hmmm

Thanks for your ideas thus far....

[marianco]

Originally Posted by Andromeda

Since 11 Sept 2006 Ive been taking 10mg of Tamoxifen (Nolvadex) daily to get rid of my gynecomastia. It has progressed, albeit slowly, and just today I had my followup Dr visit to review my ongoing treatment.
At this visit we reviewed my latest blood tests to monitor hormonal changes since starting the treatment. Now these results were stunning. My estrogen levels were actually higher than before starting the Nolvadex
At the same time testosterone was slightly higher , with bound testosterone showing itself to be even higher relative.
For those who want to see/compare raw figures I have the following.

Pre Nolva: 3 weeks Post Nolva:
Testosterone - 35
Free T: 68 69
P4: 200 300
E2: 198 300

I have recently had an ultrasound of both my testicles and chest. So far the testicles are fine, and I assume the Endo would have called if the chest results (not held at the time) came back unusual... so it seems to rule out the possiblity of an E2 secreting tumour.

Please come forward with your suggestions on how this has come about as my Dr has no idea till we see the next set of tests. I'm now taking double the amount of Nolvadex (20 mg now) with followup tests to be done again in about 3 weeks.

Any advise on this mystery would be appreciated...

Cheers in advance,

Measuring Estradiol alone is going to be thrown off when taking Tamoxifen (name brand: Nolvadex).

Tamoxifen acts essentially as a mild estrogen. It blocks estrogen receptors in some tissues (particularly breast) so that the stronger breast-tissue growing estrogen (estradiol) cannot act on the tissue. Tamoxifen acts like an estrogen in other areas of the body (which is why it may cause blood clots and in some cases, cancer).

Measuring estradiol alone is actually a measure of all the estrogen activity, heavily weighted for estradiol - the most potent estrogen. Since Tamoxifen acts as an estrogen, it raises the measurement for estradiol.

Measuring estradiol alone when taking Tamoxifen is thus not accurate.

To measure estrogens when taking Tamoxifen, it is better to obtain Fractionated Serum Estrogens - where the estrogens are separated into the different estrogens then each is separately indentified. This will reduce the influence of Tamoxifen.

Estrogens raise SHBG. I would not be surprised that SHBG is raised by Tamoxifen, since Tamoxifen acts like an estrogen.

The brain measures the level of estrogen and testosterone to determine how much Luteinizing Hormone (LH) to produce. LH production leads to an increase in testosterone production. Estrogens are then produced from testosterone via the aromatase enzyme.

Tamoxifen - by blocking stronger estrogens in the brain - gives the brain the false impression that there is less estrogen available. The brain then raises LH production, which then raises testosterone production.

As a side note, when progesterone is available, the brain more easily senses testosterone levels.

[Andromeda]

Originally Posted by marianco

Measuring Estradiol alone is going to be thrown off when taking Tamoxifen (name brand: Nolvadex).

Tamoxifen acts essentially as a mild estrogen. It blocks estrogen receptors in some tissues (particularly breast) so that the stronger breast-tissue growing estrogen (estradiol) cannot act on the tissue. Tamoxifen acts like an estrogen in other areas of the body (which is why it may cause blood clots and in some cases, cancer).

Measuring estradiol alone is actually a measure of all the estrogen activity, heavily weighted for estradiol - the most potent estrogen. Since Tamoxifen acts as an estrogen, it raises the measurement for estradiol.

Measuring estradiol alone when taking Tamoxifen is thus not accurate.

To measure estrogens when taking Tamoxifen, it is better to obtain Fractionated Serum Estrogens - where the estrogens are separated into the different estrogens then each is separately indentified. This will reduce the influence of Tamoxifen.

Estrogens raise SHBG. I would not be surprised that SHBG is raised by Tamoxifen, since Tamoxifen acts like an estrogen.

The brain measures the level of estrogen and testosterone to determine how much Luteinizing Hormone (LH) to produce. LH production leads to an increase in testosterone production. Estrogens are then produced from testosterone via the aromatase enzyme.

Tamoxifen - by blocking stronger estrogens in the brain - gives the brain the false impression that there is less estrogen available. The brain then raises LH production, which then raises testosterone production.

As a side note, when progesterone is available, the brain more easily senses testosterone levels.

I was hoping you would review and respond to my posts at some stage. As usual you've given me some vital bits of knowledge with which to analyse my treatment and understand whats going on. It would seem that continuing to review my E2 and progesterone while on this treatment is a waste of time.

I find it interesting re: how estrogen basically lowers LH. Seems to throw out the notion that the body is all about maintaining homeostatis. ie: it seems that the lower u can get your E2 the more LH and therefore the more T you can come up with.

Re: Progesterone - do you have any additional info apart from the fact that it seems to sensitise the HPG axis..

At the end of the day I find that I have reasonable arousal levels around females, but the only times I get a proper, powerful erection that are actually pleasurable to 'deal' with are on the very rare occasion that I wake up after a couple hours sleep. I generally find that my urge to masturbate is infrequent (once every 3-4 days) and when I do its only mildly pleasurable, and the orgasm pleasure is only momentary as I feel like I tense up rather than a release of pressure. Is there an explanation for this? I'm guessing theres an imbalance in my autonomic nervous system as it seems that only when my parasympathetic branch is given the chance to become dominant (after a few hours sleep for example) that I have enough of it to kind of numb the penis so it doesnt tense up so readily in response to stimulation....

Please advise!