Do i need arimidex? Week 6 of TRT + lab results

[xyt]

Firstly, I'm 28 years old and have struggled with low T for the last 8-9 years since making the mistake of taking Propecia for a year (first dose at age 19, almost 20), destroying my endocrine system. I've had blood work done at least once per year since that point and my testosterone hovered around 250-350 range. So after exhausting all options, I decided to take the plunge and try out TRT.

So I started TRT last month and have so far had 6 injections of testosterone cypionate 120mg/week (very first dose was actually 150).

Anyway, I had my first followup blood work done at week 4, the day before my next injection (so day 6 of that week), and these were my results:

TT: 648 ng/dl (350-1000)
SHBG: 23.5 nmol/L (13.2-89.6)
Estradiol: 42.6 pg/ml (7.6-42.6)

I've had two injections since that blood work was done, so i'm not sure how much my estradiol has fluctuated since that point, but I was at the very top of the range. Currently I take 100mg/day of DIM to help control estrogen, but nothing else. He said estradiol of 20-30 is ideal but where i was at was okay. i told him i'd prefer to optimize, so he prescribed some arimidex. I'm now hesitant to take any as I don't want to accidentally go too low. He said take .25mg on the 3rd day after injection, just once per week. Does that sound ok or should I wait until my next blood work to determine whether or not I should start using arimidex?

Thanks

[Beethoven]

All really depends how you feel. Are you symptomatic? Be careful, Arimidex is a good AI but quite powerful. If you must, start low and work up.

[2Sox]

^^^ Good advice. And Arimidex has a substantial rebound. No fun. Your E2 is already at the upper range, so IMO it's okay to take an AI.

Consider taking generic Aromasin instead. Lots of advantages. I do and I'm very happy with the results.

Take a look at this thread:

http://forums.steroid.com/hormone-re...-protocol.html

[Heapsreal]

1/4 of an arimidex twice a week would be a good starting point.
Dropping E2 too low sux, actually it dam hurts, like to a workout from hell after not training for 12 months, every dam muscle hurts.
I guess just be weary of muscle pain symptoms could be a sign of low E2

[OingoBoingo]

He said estradiol of 20-30 is ideal but where i was at was okay. i told him i'd prefer to optimize, so he prescribed some arimidex. I'm now hesitant to take any as I don't want to accidentally go too low. He said take .25mg on the 3rd day after injection, just once per week. Does that sound ok or should I wait until my next blood work to determine whether or not I should start using arimidex?

If you're not experiencing any high E2 sides, no problem waiting until your next blood work. Up to you. But you don't want to live with high E2 for long even if you're not having acute problems.

Generally, Testosterone levels will start to peak around 24 hours after injecting Testosterone Cypionate, and stay peaked for 2 - 3 days before starting to drop off. E2 follows T, so during the Testosterone peak is when most of the aromatization should occur.

I've read that Anastrozole (Arimidex) becomes active 6 to 24 hours after taking (depending on one's metabolism and body functions), thus it makes sense to me to take Anastrozole (Arimidex) 6 to 24 hours before one's expected Testosterone peak; basically take Anastrozole (Arimidex) with injections or the day after.

It would be interesting to know your doctor's reasoning for waiting to take Anastrozole (Arimidex) until 3 days after injection.

A lot of stuff is going on when one starts TRT; parts of the body are waking up, while other parts are shutting down. Hormone levels can fluctuate as the body tries to find homeostasis. As I go through this, I'm starting to think E2 doesn't matter so much until Testosterone levels are dialed in. I'm in the process of lowering my dose from 105mg/wk to 91mg/wk, and just take Anastrozole (Arimidex) as needed.

I've heard DIM is good, but it's not available where I live, so I take Zinc.

Also a good idea to limit booze, and stop drinking beer. High BF% is bad.

[Beethoven]

I've always heard the day after you pin.

[kelkel]

If you're not experiencing any high E2 sides, no problem waiting until your next blood work. Up to you. But you don't want to live with high E2 for long even if you're not having acute problems.

Generally, Testosterone levels will start to peak around 24 hours after injecting Testosterone Cypionate, and stay peaked for 2 - 3 days before starting to drop off. E2 follows T, so during the Testosterone peak is when most of the aromatization should occur.

I've read that Anastrozole (Arimidex) becomes active 6 to 24 hours after taking (depending on one's metabolism and body functions), thus it makes sense to me to take Anastrozole (Arimidex) 6 to 24 hours before one's expected Testosterone peak; basically take Anastrozole (Arimidex) with injections or the day after.

It would be interesting to know your doctor's reasoning for waiting to take Anastrozole (Arimidex) until 3 days after injection.

A lot of stuff is going on when one starts TRT; parts of the body are waking up, while other parts are shutting down. Hormone levels can fluctuate as the body tries to find homeostasis. As I go through this, I'm starting to think E2 doesn't matter so much until Testosterone levels are dialed in. I'm in the process of lowering my dose from 105mg/wk to 91mg/wk, and just take Anastrozole (Arimidex) as needed.

I've heard DIM is good, but it's not available where I live, so I take Zinc.

Also a good idea to limit booze, and stop drinking beer. High BF% is bad.

Very well said OB!

Op, consider getting an E2 Sensitive Panel for your next test. Standard estradiol is geared toward women and not sensitive enough for males. Standard estradiol tends to run higher which can result in improper dosing and/or use of adex.

[OingoBoingo]

I've always heard the day after you pin.

Dr. Crisler's starting recommendation is day of injection.

A common theme I've read is that the body reacts more quickly to Anastrozole the longer it's taken. That would certainly argue for taking the day after injecting if one has been taking it a while.

I wonder if that has more to do with metabolism improvements having been on TRT for a while, instead of some sort of Anastrozole build up.

[Lifted1]

You've got some great advise already, but didn't get a sensitive e2 panel ran so I wouldn't take ai until next blood work that includes it. You're probably in normal range imo

[xyt]

thanks for the replies guys. Yeah, I don't necessarily feel symptomatic... i just wanted to optimize, but I think I will hold off until I get an e2 sensitive panel as some of you mentioned. I keep my bodyfat pretty low but just don't feel as shredded as i normally would feel being as strict as I've been with diet and workouts. I attributed that to elevated e2, but i'm not sure.

As for timing on the arimidex, isn't it somewhat irrelevant? It's a suicide inhibitor, meaning it will rid of estrogen that has already aromatized, right?

[Metalject]

As others said, an E2 sensitive would be a good place to start. You may easily find it 10 points lower. Even if that doesn't happen to be the case, personally I would wait on the anastrozole if you're not having symptoms and I most certainly would not say "sensitive nipples, yep symptoms." My advice, supplement with 50-75mg of zinc per day along with 2-3mg of copper. I've seen this drop E2 by as much as 10-20 points in many men and if you're in the range that it looks like you are that would be the perfect fit.

[xyt]

ok thanks. i will try the zinc/copper supplementation. what kind of zinc should i take?

[OingoBoingo]

thanks for the replies guys. Yeah, I don't necessarily feel symptomatic... i just wanted to optimize, but I think I will hold off until I get an e2 sensitive panel as some of you mentioned. I keep my bodyfat pretty low but just don't feel as shredded as i normally would feel being as strict as I've been with diet and workouts. I attributed that to elevated e2, but i'm not sure.

If that's all you got, I would probably wait on the AI.

As for timing on the arimidex, isn't it somewhat irrelevant? It's a suicide inhibitor, meaning it will rid of estrogen that has already aromatized, right?

Anastrozole is a competitive inhibitor. For the vast majority of TRT guys, that won't make a difference.

With regard to timing: Let's say injecting caused you to have crazy high E2. Now Google high E2 symptoms. If you take the Anastrozole 3 days after injecting, that might mean you get to enjoy up to 3 days of those symptoms. On the other hand, the right dose taken at the right time might save you from it all.

It's important to remember that this is TRT, and there is a very good chance you won't have such problems. Don't worry about having the highest Testosterone levels possible. Think about finding the dose that has you feeling your best. Think about finding balance.

Also remember that E2 follows Testosterone.

Maybe there's a guy out there that isn't looking as ripped as he thinks he should because a slightly high E2 level is causing him to retain some water. Which would be better; to start screwing around with AIs, or reduce Testosterone dose?

Most guys didn't need to take an AI before they had low T, so why should they need to take an AI if levels were balanced?

When I see doctors like Dr. Crisler starting new patients out at 70mg/wk, and Dr. Gordon starting new patients out at 60mg/wk, I have a funny feeling that a lot of us that started out at 100mg/wk or more, might just be taking too much and using AIs to cover the mess instead of lowering the Testosterone dose to achieve balance.

I've signed on to the idea that the upper quartile is the place to be, but I'm not so sure that top of the range is better than say the middle of that upper quartile. Or the bottom of that upper quartile.

Something to think about, anyway...

[kelkel]

Don't think anyone mentioned it yet but, splitting your test dose in half and injecting every 3-4 days would help as well. More stable T levels and less T turning to E. Less of a spike in T = less E.

[xyt]

Unfortunately i go to a TRT clinic once per week so twice per week injections are out of the question at this point. I'm glad you brought that up, though, because I feel like I'm overpaying big time. I've paid $31/week so far everytime I've gone in for an injection, despite insurance supposedly covering 80% of it. They check vitals and I get a chance to meet with the dr each week, and it includes blood tests every 3-4 weeks, but I still feel like it's a little exorbitant and the perks slightly unnecessary. I'm just not sure how to make the transition to self-injections..

[kelkel]

There's no need to go in for injections. Learn to handle it yourself. Once you do, you'll never let anyone else inject you. There are plenty of video's on line regarding injections. Or if you split your dose (I suggest you do) you can try SQ which is simple to do.

www.spotinjections.com

[Beethoven]

Don't think anyone mentioned it yet but, splitting your test dose in half and injecting every 3-4 days would help as well. More stable T levels and less T turning to E. Less of a spike in T = less E.

I'm actually going to try and reduce my test and see how it goes. Maybe even pin three or more times a week.

[kelkel]

I'm actually going to try and reduce my test and see how it goes. Maybe even pin three or more times a week.

You and 2Sox been talking?

[Machdiesel]

Your right on the border, I would do absolutely everything I could before using an AI. First off that's actually a pretty high T level concidering it's 6 days post injection. The absolute first thing I would do is split injections to twice a week anyway you could and get bloods 4 weeks later. If your E2 comes down into the 30s and you have no symptoms consider yourself lucky and hold off on the AI. If not then consider an AI. As for the price, 120$ a month for test, weekly doc visits, and bloodwork seems reasonable. The only part that would be a deal breaker for me is havin to go in every week, after a month that will get old very quicky

[Lifted1]

Unfortunately i go to a TRT clinic once per week so twice per week injections are out of the question at this point. I'm glad you brought that up, though, because I feel like I'm overpaying big time. I've paid $31/week so far everytime I've gone in for an injection, despite insurance supposedly covering 80% of it. They check vitals and I get a chance to meet with the dr each week, and it includes blood tests every 3-4 weeks, but I still feel like it's a little exorbitant and the perks slightly unnecessary. I'm just not sure how to make the transition to self-injections..

if you are already at $120 without the blood work copay Im assuming you have, I would consider switching to LowTestosterone. com for abut the same cost monthly. They provide all inclusive doctor visits, bloodwork, medications and supplies so you can do your injections yourself, in the privacy of your own home.

[Beethoven]

You and 2Sox been talking?

I must say 2Sox has been talking a long time, I'm just listening now. Lol

[xyt]

Thanks for all the help guys. I'm closing in on the end of week 6 now, and I just realized something. The past couple weeks I've been starting to feel depressed on Thursday (injection on monday) and Friday. Depression subsides a bit on saturday and sunday and then I feel much better on monday again after my injection. Is that E2 related by chance? Is it psychological? I'm not even sure TRT is doing much for me at this point. I've read that since I'm a unique case in having been messed up by propecia that TRT won't be effective for me because of destroyed androgen receptors or 5ar2 inhibitor enzymes or w/e the problem is (no one knows yet). It just feels sort of like a roller coaster and I'm not sure I feel any better on TRT than I did without it. Plus my hair is starting to thin a bit at the corners which is no bueno.

[2Sox]

If you're not experiencing any high E2 sides, no problem waiting until your next blood work. Up to you. But you don't want to live with high E2 for long even if you're not having acute problems.

Generally, Testosterone levels will start to peak around 24 hours after injecting Testosterone Cypionate, and stay peaked for 2 - 3 days before starting to drop off. E2 follows T, so during the Testosterone peak is when most of the aromatization should occur.

I've read that Anastrozole (Arimidex) becomes active 6 to 24 hours after taking (depending on one's metabolism and body functions), thus it makes sense to me to take Anastrozole (Arimidex) 6 to 24 hours before one's expected Testosterone peak; basically take Anastrozole (Arimidex) with injections or the day after.

It would be interesting to know your doctor's reasoning for waiting to take Anastrozole (Arimidex) until 3 days after injection.

A lot of stuff is going on when one starts TRT; parts of the body are waking up, while other parts are shutting down. Hormone levels can fluctuate as the body tries to find homeostasis. As I go through this, I'm starting to think E2 doesn't matter so much until Testosterone levels are dialed in. I'm in the process of lowering my dose from 105mg/wk to 91mg/wk, and just take Anastrozole (Arimidex) as needed.

I've heard DIM is good, but it's not available where I live, so I take Zinc.

Also a good idea to limit booze, and stop drinking beer. High BF% is bad.

I agree, Kel. This is very well said and it does have a person stop and think about one's dosing.

So I'll pose that question again and ask for comments: If our own body - pre-TRT - had never needed an AI to control E2 levels, why then are most of us here needing to use them? Are we in some way caught in the "more is more" mindset? Should we back off and get back to "less is more" like Beethoven is considering? How comfortable would most of us feel, cutting back our doses?

Another question, somewhat related: What is the LabCorp code for the estradiol sensitive assay? They keep on messing up the request from my doctor's office.

[Beethoven]

2Sox some good points. As for me, I'm getting tired of the sides and hoping to alleviate them this way. Looking for the lowest dosage while still feeling good.

[xyt]

I agree, Kel. This is very well said and it does have a person stop and think about one's dosing.

So I'll pose that question again and ask for comments: If our own body - pre-TRT - had never needed an AI to control E2 levels, why then are most of us here needing to use them? Are we in some way caught in the "more is more" mindset? Should we back off and get back to "less is more" like Beethoven is considering? How comfortable would most of us feel, cutting back our doses?

Ok, so you didn't need an AI pre-TRT. But obviously something wasn't right otherwise you wouldn't be on TRT in the first place. So in an effort to increase your T to a suitable level, your e2 levels will invariably increase as well. I mentioned this to my Dr. actually. My total test went from 312 to 648 while my E2 went from 21.0 to 42.6. Both numbers literally doubled, so in effect nothing actually changed, right? He said it doesn't work like that but I didn't understand why. It makes sense to me that ratios would be almost as important as the actual levels themselves.

[2Sox]

Ok, so you didn't need an AI pre-TRT. But obviously something wasn't right otherwise you wouldn't be on TRT in the first place. So in an effort to increase your T to a suitable level, your e2 levels will invariably increase as well. I mentioned this to my Dr. actually. My total test went from 312 to 648 while my E2 went from 21.0 to 42.6. Both numbers literally doubled, so in effect nothing actually changed, right? He said it doesn't work like that but I didn't understand why. It makes sense to me that ratios would be almost as important as the actual levels themselves.

I believe you misunderstood my point. I'm talking PRE-TRT - like when we were in our twenties when most of us just were functioning "normally".

To comment on another thing you said: Ratios are important in certain matters but from my observations and experience, they don't come into play in matters TRT. One of the things that will become clear to you after you have been on this forum for awhile is that everyone is different and we react differently to treatment - even though there are certain commonalities that hold true. Everything else is coincidence.

[xyt]

I believe you misunderstood my point. I'm talking PRE-TRT - like when we were in our twenties when most of us just were functioning "normally".

To comment on another thing you said: Ratios are important in certain matters but from my observations and experience, they don't come into play in matters TRT. One of the things that will become clear to you after you have been on this forum for awhile is that everyone is different and we react differently to treatment - even though there are certain commonalities that hold true. Everything else is coincidence.

I gotchya now, that makes perfect sense. So lower your dose until everything is in a suitable range as it presumably was during younger years. However, since you're taking exogenous test anyway, why not just take a little more and feel even better than you ever felt. This would likely require the use of an AI, but why not. Correct me if i'm wrong, but if you can find your sweet spot with a higher dose of test and an AI it seems like that is a better option than simply taking a very minimal dose of test alone.

[Beethoven]

I think what 2sox is pointing out is that in our mid twenties we naturally have higher test levels and our E2 values are balanced to that. As we get older and our bodies change, so to does our E2 level. In my case, after dropping an initial 25 lbs, my E2 fell. In trt, you find your optimum levels where your low t symptoms are relieved at the lowest dose. Less is more.

[2Sox]

I gotchya now, that makes perfect sense. So lower your dose until everything is in a suitable range as it presumably was during younger years. However, since you're taking exogenous test anyway, why not just take a little more and feel even better than you ever felt. This would likely require the use of an AI, but why not. Correct me if i'm wrong, but if you can find your sweet spot with a higher dose of test and an AI it seems like that is a better option than simply taking a very minimal dose of test alone.

Well, that's a matter of opinion. Most here would like to get to the point where an AI is not needed. And very often, higher doses of T lead to other difficulties - like higher hematocrit and red blood cell levels. We've all got to find a place where we are most comfortable and at optimum health. I'm seeing that it's a lot of trial and error and conclusions arrived at from our own experiences.

[kelkel]

2sox the code for E Sensitive via Labcorp is:

140244
CPT code 82670

Re the theoretical discussion above. Remember, as we age our metabolism changes. We process things differently, some more, some less. Our testosterone drops and E2 rises, SHBG creeps up as we age, thyroid issues become more prevalent, etc. Hell, the average out of shape 55 year old male has a higher estrogen level that a female the same age. Scary stuff, huh?

Polymorphisms in androgen and estrogen ... [Exp Gerontol. 2004 Nov-Dec] - PubMed - NCBI

Estradiol in elderly men. [Aging Male. 2002] - PubMed - NCBI

The role of androgens and estr... [J Gerontol A Biol Sci Med Sci. 2012] - PubMed - NCBI

Changes in androgen receptor, estrogen receptor a... [Horm Behav. 2010] - PubMed - NCBI

[2Sox]

2sox the code for E Sensitive via Labcorp is:

140244
CPT code 82670

Re the theoretical discussion above. Remember, as we age our metabolism changes. We process things differently, some more, some less. Our testosterone drops and E2 rises, SHBG creeps up as we age, thyroid issues become more prevalent, etc. Hell, the average out of shape 55 year old male has a higher estrogen level that a female the same age. Scary stuff, huh?

Polymorphisms in androgen and estrogen ... [Exp Gerontol. 2004 Nov-Dec] - PubMed - NCBI

Estradiol in elderly men. [Aging Male. 2002] - PubMed - NCBI

The role of androgens and estr... [J Gerontol A Biol Sci Med Sci. 2012] - PubMed - NCBI

Changes in androgen receptor, estrogen receptor a... [Horm Behav. 2010] - PubMed - NCBI

Thanks, Kel.

C'mon teacher! It's the weekend! Why so much homework?


(I really look forward to reading it.)

[Beethoven]

Thanks for the homework professor. The learning never ends.