How much T warrants the usage of AI

[Proximal]

Been using 150 mg. per week, going on 3 months - very happy with the results/no issues. My HRT physician also has me on .5mg of Anastrozole, 2x per week. Currently my blood testosterone levels are consistently at 1200, and I am going to drop my testosterone dosage a bit to get the numbers between 1000-1100 to make the HRT physician more comfortable. Also added Semorelin every night about 4 weeks ago.

My endocrinologist who follows me for elevated prolactin levels (they recently have increased a little/could be the Semorelin) actually seemed more concerned by the usage of the Anastrozole and after trying to go through as many related threads on the forum as possible, it seems my AI usage may be a little high.

Going to do more blood work for the prolactin in a few weeks to see if the prolactin has dropped due to a bump in my cabergoline dosage, but want to ask for a test for E2 as well. Currently, my PSA and hematocrit are WNL.

Advice please on the AI usage and the E2 blood test - thank you!

[TheTaxMan]

Sorry for the hijack here

But id like to know why people get put on an AI when on a TRT dose

If TRT is to give you normal/natural test levels, why is an AI required? why isnt every male on the planet on an AI for that matter?

[Bio-Active]

You just have to adjust based on your labs. Tax this protocol is pretty common but running less test and keeping e in range with no ai is best

[TheTaxMan]

So not all TRT patients are using an AI?

[Bio-Active]

So not all TRT patients are using an AI?

No there are many that do not

[kelkel]

Did a Prolactinoma put you on TRT?
What's your free T number? Total T doesn't really matter at all.
Are you carrying excess body fat currently?

TaxMan not every one needs an AI on TRT. That said, in most cases men are restoring their levels to that of a much younger man. Not restoring it to match current age levels. Our bodies will also process things differently as we age. Meaning one set protocol over time may no longer be effective and titrations have to be made. Linear is a term that doesn't fit with human physiological processes..

[TheTaxMan]

Apart from a life commitment to pinning, TRT sounds great for older men, opportunity to feel young

im going to keep getting bloods done and as soon as i qualify im demanding TRT.

If one recovers well after cycling and doesnt need TRT, what is the likely age bracket to require TRT? 40? 50?

[Proximal]

Did a Prolactinoma put you on TRT?
What's your free T number? Total T doesn't really matter at all.
Are you carrying excess body fat currently?

Yeah the Pituitary tumor was the culprit. Have been addressing this issue for 2 1/2 years. The Prolactin numbers have steadily dropped, annual MRIs have confirmed it is shrinking.

No one (endocrinology or HRT) has ever checked me for my free-T numbers. Not arguing here, but are you saying that my total T numbers aren't in any way reflective of my response to the TRT? My T has consistently been below 200 for years, and now at 1200, I am seeing changes in the appropriate things [muscle gains, fat loss, and of course, other things as well : ) ]

I am 57 and prior to initiating the TRT, I got my fat percentage down to approximately 15% with a strict paleo diet. I'm sure it is a bit lower now as the scale and the mirror (and my wife) aren't lying to me.

AI and E2 advice?????

[Proximal]

You just have to adjust based on your labs. Tax this protocol is pretty common but running less test and keeping e in range with no ai is best

Understood, makes perfect sense. Is the E2 what I am looking for and is there something about specifying a "sensitive" assay (got this out of Crisler's book on Testosterone replacement )?

Thanks!

[kelkel]

Yeah the Pituitary tumor was the culprit. Have been addressing this issue for 2 1/2 years. The Prolactin numbers have steadily dropped, annual MRIs have confirmed it is shrinking.

No one (endocrinology or HRT) has ever checked me for my free-T numbers. Not arguing here, but are you saying that my total T numbers aren't in any way reflective of my response to the TRT? My T has consistently been below 200 for years, and now at 1200, I am seeing changes in the appropriate things [muscle gains, fat loss, and of course, other things as well : ) ]

I am 57 and prior to initiating the TRT, I got my fat percentage down to approximately 15% with a strict paleo diet. I'm sure it is a bit lower now as the scale and the mirror (and my wife) aren't lying to me.

AI and E2 advice?????

Figured it was an adenoma when your doc put you on Caber. I'm curious what dose of Caber he has you on? I mention Free T as that is what works for you. Total T is really irrelevant. You can have a 10K total T level but if all your free T is bound it serves you no purpose. Only a small percentage of test is free in our systems. That said, don't get obsessed to much with numbers if you can avoid it. Use them as a guide along with how you feel.

AI use needs to be based on your E2 Sensitive Assay if at all possible for best accuracy. Standard estradiol is geared to women and not sensitive or accurate enough for men at lower levels. The difference between the two can be significant at times.

[Proximal]

Figured it was an adenoma when your doc put you on Caber. I'm curious what dose of Caber he has you on? I mention Free T as that is what works for you. Total T is really irrelevant. You can have a 10K total T level but if all your free T is bound it serves you no purpose. Only a small percentage of test is free in our systems. That said, don't get obsessed to much with numbers if you can avoid it. Use them as a guide along with how you feel.

AI use needs to be based on your E2 Sensitive Assay if at all possible for best accuracy. Standard estradiol is geared to women and not sensitive or accurate enough for men at lower levels. The difference between the two can be significant at times.

Thanks for your assistance - greatly appreciated! I started at .25 mg twice a week a couple years back, but the prolactin levels were not dropping quick enough for the endocrinologist. Then that was bumped to .5 mg twice a week till recently. However at the last check up, my prolactin levels climbed a little, not a lot, but I'm going to do 1.5 mg per week of the caber.

Gonna check my prolactin again in 3-4 weeks. If my levels are not lower, I might drop the Sermorelin. I'm also going to request that E2 Sensitive Assay and then figure what I need to do with the Anastrozole overall. Right now, I'm going to drop that to .25 mg, twice per week till my blood test.

Again, appreciate your help - this forum has been fantastic, you guys are great, thanks!

[kelkel]

How high were your prolactin levels prior to initiating Caber? Then (if you don't mind and have the time) can you give me an idea what effect each different dose of caber had on your levels? Caber works quickly and is very effective. I'm particularly curious as I have a microadenoma myself although it did not effect my prolactin.

You may find this interesting:

Growth hormone secretion elicited by GHRH, GHRP-6 or GHRH plus GHRP-6 in patients with microprolactinoma and macroprolactinoma before and after bro... - PubMed - NCBI

[Proximal]

How high were your prolactin levels prior to initiating Caber? Then (if you don't mind and have the time) can you give me an idea what effect each different dose of caber had on your levels? Caber works quickly and is very effective. I'm particularly curious as I have a microadenoma myself although it did not effect my prolactin.

First off, let me sincerely thank you for being a veteran - I have the greatest respect for anyone serving our country.

I had no idea how severely everything was shut down exclusively due to the prolactin, which to answer your question was at 487 ng/ml three years ago. I had been dealing with a couple of orthopedic issues for years that eventually warranted surgery. They had caused me to add about 30 pounds of fat because I was limping around with a cane & had little drive to exercise. I thought it was the orthopedic issues that was sucking the life out of me. BTW, other "things" were non-existent as well, didn't think too much about it, was in too much pain anyways and my self-esteem was dropping (amongst other things unfortunately).

So when I started exercising again after surgeries, I just knew my response was horribly slow. Yeah everyone said I'm in my mid 50's, but when you are at the gym 6 days a week and killing yourself with a super clean diet, there needs to be better gains in muscle gains and fat loss. Then I went to an HRT clinic, they ran a butt-load of tests and that's when I found out about my prolactin. I say all these things so that you can get a better idea on how I responded to the caber, because I really started at rock-bottom.

The progress with caber for me was very slow. Yes, thankfully prolactin levels dropped steadily, but other changes were negligible. I was exercising and dieting hard, with a very slight improvement in muscle/fat. "Other" improvements were very minimal as well. Sorry to get super-long-winded, but ultimately: maybe it was that I started with such elevated prolactin levels and my testosterone was so low for so long - that the caber didn't show me anything, despite the changes in dosage.

My endocrinologist was very cool with me so I did not push hard for testosterone, which was in the 100's. The M.D. wanted to see if when the tumor decreased and the prolactin was lower, if I would produce more T naturally.

About a year and a half into the caber treatments and no other changes were seen except prolactin which was now close to normal, the endocrinologist put me on T-patches (4mg. per day) which helped a very little in the gym/bed. Eventually the patches caused too much skin irritation.

The only thing that has made me feel like me again was starting this HRT - I am SO psyched.

Thank you for that article! Very interesting and encouraging. I'm going to print it out for my endocrinologist.

[yettibecsuse]

Proximal i use an AI with Trt; im a well built bloke anyway; but i did find that no more than .15 to .25 and definitely not as prescribed to me; no matter what type of test depo you are prescribed it definitely peaks at the start; well for me anyway so i tested my levels every two weeks for 10 weeks to get a guide of how the test and E2 fluctuated; it was monotonous but it saves worrying and testing later; i now know for me that for the first two and half weeks my E2 needs management then it is fine until week 12.

[noseeme]

Apart from a life commitment to pinning, TRT sounds great for older men, opportunity to feel young

im going to keep getting bloods done and as soon as i qualify im demanding TRT.

If one recovers well after cycling and doesnt need TRT, what is the likely age bracket to require TRT? 40? 50?

Tax - it all depends on your physiology. I was put on TRT at 32 due to my T levels being equal to a 80+ y/o male. There is no age barrier - all dependent on your labs.

[TheTaxMan]

Yea i guess,
there are people of all ages on TRT for many different reasons

i kind of meant the normal man whos had no problems when does their test start to declining.

[kelkel]

The progress with caber for me was very slow. Yes, thankfully prolactin levels dropped steadily, but other changes were negligible. I was exercising and dieting hard, with a very slight improvement in muscle/fat. "Other" improvements were very minimal as well. Sorry to get super-long-winded, but ultimately: maybe it was that I started with such elevated prolactin levels and my testosterone was so low for so long - that the caber didn't show me anything, despite the changes in dosage.

My endocrinologist was very cool with me so I did not push hard for testosterone, which was in the 100's. The M.D. wanted to see if when the tumor decreased and the prolactin was lower, if I would produce more T naturally.

About a year and a half into the caber treatments and no other changes were seen except prolactin which was now close to normal, the endocrinologist put me on T-patches (4mg. per day) which helped a very little in the gym/bed. Eventually the patches caused too much skin irritation.

The only thing that has made me feel like me again was starting this HRT - I am SO psyched.

Thank you for that article! Very interesting and encouraging. I'm going to print it out for my endocrinologist.

Sounds like your doc was pretty much on-point. Only thing I'd disagree with is the amount of time he made you wait prior to initiation of TRT. His logic regarding reducing prolactin thus raising Test is correct, only flaw being that micro-adenomas can be multi-faceted. Meaning they are not all one-dimensional and only effecting one thing. They can be nasty little fvckers. Remember, it doesn't take much to make an impact. My pituitary is 6mm and my adenoma is 2mm so it's considered a "micro-adenoma." If it were over 10mm is would be a "macro-adenoma" and may require surgery. Mine only effected hormone production and shut me down to a 59 T level.

Exactly what is your TRT protocol at this time Proximal?

[noseeme]

Yea i guess,
there are people of all ages on TRT for many different reasons

i kind of meant the normal man whos had no problems when does their test start to declining.

WebMD cites 30 as the typical age of decline. I can tell you that I know mine started well before that, but there are a number of factors that prevented me from getting that checked. It truly is night and day for me at just a maintenance dose. My doc (urologist) is good enough to do me right and pretty flexible in the overall therapy.

I tried one of the specialist clinics first but was no comfortable in their protocol. Current doc allows me to control my dose and frequency as long as I am within range every 6 months.

[Proximal]

KelKel, started at 150 mg. per week, dropping it to 145 to get my total T numbers under 1100 to make my HRT doc more comfortable.

[Proximal]

BTW, thanks everyone again. I know there is an HRT sub-forum, but I thought that you guys would be far more knowledgeable, which is why I am posting here and appreciate your patience with my questions.