MESO-Rx Exclusive Peter Bond on how to treat gynecomastia

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Last week, @PeterBond wrote about the causes of gynecomastia. This week, he writes about evidence-based treatments for gynecomastia:

 
I know that AIs have been the most popular method to manage estradiol levels in recent years, but how many still prefer to use SERMs on higher test cycles? Or anyone around before AIs became widespread and affordable who relied on SERMs? What were your experiences?

A final note I would like to make in this article is about the usage of SERMs during an anabolic steroid cycle. SERMs, like tamoxifen, function as a competitive antagonist. That means that they need to “compete” with other ligands of the estrogen receptor, such as estradiol, for binding. Without going into too much detail, that means you need more tamoxifen to occupy the same number (or concentration I should say) of receptors if there’s also a whole lot more estradiol around. Which is, of course, the case when injecting large quantities of testosterone. Concentrations of over 4 times the maximum reference range aren’t unheard of. As such, tamoxifen might be required in higher quantities too to reach sufficiently high concentrations to effectively compete with the increased concentration of estrogen for binding. While under physiological circumstances 10 to 20 mg daily is plenty, one might need dosages of around 40 mg daily while on a high-dosed cycle with an aromatizing androgen. However, this is speculation from my part as there’s no good data on this. But this might help explain why sometimes during an AAS cycle, tamoxifen might not be (sufficiently) effective to prevent gynecomastia from developing.
 
When I first started gear, I did the standard
"500mg test, an oral" and had nolva on hand. I was fortunate in that I didn't notice any high estrogen sides, nor did I end up with gyno, but plenty of my friends had the opposite experience. We didn't know any better and just thought it was the nature of the beast.

Today, I cannot fathom being on any quantities of AAS without an AI as well as a SERM on hand. I feel the expression "an ounce of prevention trumps a pound of cure". In this situation, an AI preventing you from "needing" a SERM to begin with.

I'm actually going to be experimenting with raloxifene in the next upcoming weeks. A good friend of mine who did develop gyno has not had any luck shrinking it with SERMS an AI. Allegedly ralox is supposed to be the hail mary of serms and could perhaps spare him from surgery.
 
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