@mrflapcakes's TRT Q&A invitation, fact-checked

What did @mrflapcakes actually say?

One week into self-administered testosterone injections at age 18, @mrflapcakes reported water retention and attributed it to elevated estrogen. He said he's using "Premo-Bowen as an AI" (almost certainly Proviron, a brand of mesterolone, not a true aromatase inhibitor) and plans to increase his testosterone dose to "300 migs" and his Proviron to "200 migs" in week two. He also mentioned taking oral minoxidil. He acknowledged he hasn't had bloodwork done and doesn't plan to until weeks four or five. He added a token disclaimer: "don't do what I'm doing."

That disclaimer does not make the advice safe to follow, and the casual framing of dose escalation without monitoring is genuinely concerning from a clinical standpoint.

Does the science back this up?

Almost none of this reflects responsible hormone management. The claim that early water retention is caused by elevated estrogen is plausible but unverified without labs. The real problem is the proposed response: escalating both testosterone and an ancillary compound simultaneously without baseline bloodwork is how people get into serious hormonal trouble.

On aromatase inhibitors specifically: mesterolone (Proviron) is not a true AI. It binds to sex hormone-binding globulin and has weak androgenic activity, but it does not meaningfully block aromatase the way anastrozole or exemestane do. A 2012 review by Schulte-Beerbühl and Nieschlag in Andrology notes mesterolone's mechanism is distinct from aromatase inhibition. Using it as a primary estrogen management tool and then raising the dose without labs is not evidence-based practice.

Regarding age: the Endocrine Society's 2018 clinical practice guidelines explicitly recommend against initiating testosterone therapy in men whose hypothalamic-pituitary-gonadal axis has not fully matured, which in most males is not complete until the mid-20s. Starting exogenous testosterone at 18 can suppress endogenous production permanently at a stage when natural testosterone may still be rising.

What did they get wrong (or right)?

He got one thing partially right: water retention in early testosterone use is common and estrogen elevation is one plausible cause. That's textbook pharmacology. Credit given.

Everything else is a problem. First, mesterolone is not an aromatase inhibitor. Calling it "an AI" and then increasing it to 200mg to control estrogen is based on a misunderstanding of its mechanism. Second, delaying bloodwork until weeks four or five while simultaneously escalating doses removes any safety net. Hematocrit, estradiol, and LH/FSH levels matter early. Third, adding oral minoxidil to an already-altered hormonal environment without monitoring compounds the unknowns. Minoxidil affects vascular smooth muscle and has systemic effects at oral doses, including fluid retention, which he himself suspects but doesn't seem to take seriously. Fourth, and most importantly, he is 18 and self-prescribing. There is no indication of a diagnosed hypogonadal condition, no physician oversight, and no baseline labs mentioned at any point.

What should you actually know?

If you're considering testosterone therapy, the starting point is bloodwork, not a syringe. Legitimate TRT begins with confirmed low testosterone, ideally two morning serum measurements, plus a full panel including LH, FSH, hematocrit, PSA, and estradiol. The Endocrine Society guidelines (Bhasin et al., 2018, Journal of Clinical Endocrinology and Metabolism) set this out clearly.

Mesterolone is not interchangeable with anastrozole or exemestane. If estrogen management is genuinely needed, the compound used should match the mechanism required, and the decision should follow lab results, not guesswork.

Starting testosterone at 18 without a clinical indication carries real risks including permanent suppression of the hypothalamic-pituitary-gonadal axis, testicular atrophy, and infertility. A 2021 study by Ramasamy et al. in Fertility and Sterility found that exogenous androgen use was among the leading causes of secondary hypogonadism in young men presenting to fertility clinics.

• Baseline bloodwork is not optional. It is the minimum safety standard before starting any hormone protocol.
• Escalating doses in week two without any lab data is not "optimizing" a protocol. It is guessing with your endocrine system.
• A disclaimer of "don't do what I'm doing" does not reduce the influence of 25,000 viewers watching someone do it.