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Thread: When to start anastrozole

  1. #1
    Lockout888 is offline Associate Member
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    Question When to start anastrozole

    I recently started a TRT protocol of Test Cyp (100mg per week) and HCG (250iu 3x per week). I was also prescribed ARIMIDEX if needed.

    How soon will my E2 rise to a level where the anastrozole might be needed?

    My last BW levels were a month ago while on Axiron only: Estradiol = 23.5 (7.6-42.6)

  2. #2
    AnabolicDoc's Avatar
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    IMO best time to start it is when your doc tells you to, especially as it seems that he will be basing this on blood work. You may not need an ai, particularly at 100mg ew.

  3. #3
    LowT Mike is offline HRT Specialist, P.A. - LowTestosterone.com
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    ^^^^Anabolic Doc said it!!. Only start Arimedex when the doc says. If you start having chest tenderness around the areola, tell your doc they should allow you to start on a low dose or get you in to do labs ASAP. Usually a good rule of thumb is to do labs 4-6 weeks into treatment and check E2. If E2 levels elevated start on low dose. Generally .5 once or twice per week. All TRT meds "Start low go slow" "Its not one size fits all"

  4. #4
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    I would wonder why the doc had you start it...

    Personally, I believe an AI should only be used both as needed and as a last resort.
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  5. #5
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    wrong e2 test, needs to be sensitive assay.

  6. #6
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    not to mention no word on symptoms.

    it's important to always remember that healthy estrogen levels are critical to health. we don't want to arbitrarily lower e2 without good cause. there is plenty of good evidence showing the importance of e2, especially for bone health.

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    Lockout888 is offline Associate Member
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    Quote Originally Posted by HRTstudent View Post
    Personally, I believe an AI should only be used both as needed and as a last resort.
    This is why I chose not to start it yet.

    Got labs done yesterday, for my own curiosity. I wanted to see how low my test levels were on day 7 before injection and E2 levels. I have been on test cyp for 3 weeks now, and hCG for 2 weeks.

    Should I start off by taking .25mg of my AI the day after my test injection?

    Last Labs (5/3/13) on 4 pumps of Axiron only:
    Total Test = 334 (348-1197)
    LH = <0.2 (1.7-8.6)
    FSH = 0.4 (1.5-12.4)
    Estradiol = 23.5 (7.6-42.6)
    Albumin = 4.4 (3.5-5.5)

    New Labs (6/6/13) on day 7, before test injection:
    Total Test = 534 (348-1197)
    LH = <0.2 (1.7-8.6)
    FSH = 0.5 (1.5-12.4)
    Estradiol = 49.5 (7.6-42.6)
    Albumin = 4.2 (3.5-5.5)

  8. #8
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    What did your doctor say? I imagine you'd be fine with 0.25mg 2-3x per wk but see what doctor has to say. If you don't trust him, and it sounds like you don't, then you might be better off with a new doc.

  9. #9
    Lockout888 is offline Associate Member
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    Quote Originally Posted by AnabolicDoc View Post
    What did your doctor say? I imagine you'd be fine with 0.25mg 2-3x per wk but see what doctor has to say. If you don't trust him, and it sounds like you don't, then you might be better off with a new doc.
    He hasn't seen the new labs. During the initial office visit, he mentioned that I might need an AI but didn't mention a dose. The prescription on my bottle says 1 capsule (.5mg) 3 times a week.

    I will talk to him about it more. I don't want to take too much, because I have read that anastrozole is pretty strong and can tank E2 pretty quick.

    I read that anastrozole has a half-life of about 45 hours. When is taking anastrozole the most effective to the anti-aromatization process? 1 day after injection? 2 days?

  10. #10
    Lockout888 is offline Associate Member
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    So I started taking .25mg anastrozole 24 hours after my weekly test injection, and got my E2 where I wanted it.

    My only question is shouldn't my total test be higher? Doesn't it peak 24-48 hours after injection?

    Last Labs (6/6/13) on day 7, before test injection:
    Total Test = 534 (348-1197)
    Estradiol = 49.5 (7.6-42.6)
    Albumin = 4.2 (3.5-5.5)

    New Labs (7/5/13) on day 2, 36 hours after test injection:
    Total Test = 591 (348-1197)
    Estradiol = 25.3 (7.6-42.6)
    Albumin = 4.4 (3.5-5.5)
    SHBG = 15.4 (16.5-55.9)
    Free T = 17.7 ng/dL = 2.99 %
    Bio T = 424 ng/dL = 71.7 %
    Last edited by Lockout888; 07-06-2013 at 11:30 AM.

  11. #11
    Trific's Avatar
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    How are you feeling? If you think you should be doing better it looks like you could increase your test dose since you are only showing 591 at your peak.

    I'd maybe try 120mg per week but split into 2 doses of 60mg every 3.5 days to help keep estradiol lower and try to get away from an AI, plus two weekly doses seems to use the test more efficiently.

    You could take up to 180mg a day of zinc with some copper to help keep estradiol down if you are not.

  12. #12
    Lockout888 is offline Associate Member
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    Quote Originally Posted by Trific View Post
    How are you feeling? If you think you should be doing better it looks like you could increase your test dose since you are only showing 591 at your peak.
    I feel OK - definitely better than when I was on Axiron. But I don't have that alpha feeling like I did during the first couple of weeks on test cyp. My Doctor originally said he wants my Bio T levels least 600.

  13. #13
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    Quote Originally Posted by bass View Post
    wrong e2 test, needs to be sensitive assay.
    Yes.
    I had nearly the exact e2 #s as you. E2 measured 48.5 and a month later, 24. I only took DIM. Then two months later it was at 42. All over the place. I was getting the regular estradiol test. My doc didn't know anything about the sensitive test, so I paid
    for it myself. It came back at 32. I've gotten it done two other times. All results have come back within a couple of points. My point is that the regular test may not give you an accurate assessment of where your at. And, if you are taking an ai, you really need to know where you're at. Just a thought...
    Last edited by Rusty11; 07-06-2013 at 03:26 PM.

  14. #14
    pappybay is offline Junior Member
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    Quote Originally Posted by Lockout888 View Post
    So I started taking .25mg anastrozole 24 hours after my weekly test injection, and got my E2 where I wanted it.

    My only question is shouldn't my total test be higher? Doesn't it peak 24-48 hours after injection?

    Last Labs (6/6/13) on day 7, before test injection:
    Total Test = 534 (348-1197)
    Estradiol = 49.5 (7.6-42.6)
    Albumin = 4.2 (3.5-5.5)

    New Labs (7/5/13) on day 2, 36 hours after test injection:
    Total Test = 591 (348-1197)
    Estradiol = 25.3 (7.6-42.6)
    Albumin = 4.4 (3.5-5.5)
    SHBG = 15.4 (16.5-55.9)
    Free T = 17.7 ng/dL = 2.99 %
    Bio T = 424 ng/dL = 71.7 %
    Bio T looks good for that level of MG.

  15. #15
    Trific's Avatar
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    Quote Originally Posted by Lockout888 View Post
    I feel OK - definitely better than when I was on Axiron. But I don't have that alpha feeling like I did during the first couple of weeks on test cyp. My Doctor originally said he wants my Bio T levels least 600.
    Well, it's good that you at least feel OK, but I wouldn't blame you for trying to dial it in better yet, especially when you had been doing better.

    Your numbers to me look like they could be better but that is between you and your doc.

    I've heard some guys have kind of a Honeymoon effect when they first start TRT, think it had to do with higher dopamine levels....but it's a passing phase that they can't get back to....I hope in your case this is not your story but that you can truly do better with a higher test total.

  16. #16
    Lockout888 is offline Associate Member
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    Quote Originally Posted by bass View Post
    wrong e2 test, needs to be sensitive assay.
    From Life Extension

    Estradiol, Sensitive

    Item Catalog Number: LC140244

    This test is generally NOT suggested over the regular estradiol test (LC004515).

    The only difference between this test and the regular estradiol test (offered in Life Extension panels) is better detection at the lower limits of the range. For example, the lower end of the range for estradiol is 7.6 pg/mL while the lower limit for the sensitive estradiol is 3 pg/mL. This test does not provide a more accurate result at normal ranges, it is only more accurate at very low levels of estradiol.

    Since Life Extension advocates higher levels of hormones, it would be very rare to use this test for its greater sensitivity at the low end of the range. Remember that men also need a certain level of estrogen (estradiol) and that studies are showing that if the estradiol level for a man is below the 18-20 pg/mL range there is increased risk for osteoporosis.

  17. #17
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    Then go with the regular test http://www.*************.com/forum/c...stradiol-serum

    Some think that if you are taking an ai, you want to be as precise as possible. The regular estradiol test, which is geared towards females, may not provide that precision. I just know that my level jumped around with the regular test. If your doc only offers that one, I wouldn't give it a second thought...unless you begin having sone symptoms.

    The link is a study from another forum...obviously not allowed. Sorry.
    Last edited by Rusty11; 07-07-2013 at 06:25 PM.

  18. #18
    Lockout888 is offline Associate Member
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    Quote Originally Posted by Rusty11 View Post
    I was able to find that link you meant to post, which is from 2/11. If you search a little further in his forum, you will find that Dr. Crisler found the sensitive assay was giving false low results - which is what it looks like in that link you posted. Labcorp sent a representative to Dr. Crisler to personally explain what was going on. They corrected the issue and sent Dr. Crisler corrected lab results for his patients.

    Maybe I will get both next time to compare

  19. #19
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    Quote Originally Posted by Lockout888
    X2 - normal e2 test is fine and accurate if you are within range. If not within range, you know your too high or too low, no need to sweat the small stuff.

  20. #20
    Rusty11's Avatar
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    Just re-read your posts. I misread it. I thought you were taking the ai and that it had dropped quite a bit during the month. That's why I was talking about being so precise. Didn't want to see another, "I crashed my e2" thread.

  21. #21
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    Quote Originally Posted by Lockout888 View Post
    So I started taking .25mg anastrozole 24 hours after my weekly test injection, and got my E2 where I wanted it.

    My only question is shouldn't my total test be higher? Doesn't it peak 24-48 hours after injection?

    Last Labs (6/6/13) on day 7, before test injection:
    Total Test = 534 (348-1197)
    Estradiol = 49.5 (7.6-42.6)
    Albumin = 4.2 (3.5-5.5)

    New Labs (7/5/13) on day 2, 36 hours after test injection:
    Total Test = 591 (348-1197)
    Estradiol = 25.3 (7.6-42.6)
    Albumin = 4.4 (3.5-5.5)
    SHBG = 15.4 (16.5-55.9)
    Free T = 17.7 ng/dL = 2.99 %
    Bio T = 424 ng/dL = 71.7 %

    More like 48-72 metabolism dependent. But we are all different. Like Trific said a twice per week protocol can help you minimize or eliminate the need for an AI, which should be your goal if possible. Your TT is not high but as stated, you may not have peaked yet so it could be quite a bit different a day or so later. Your FT at 2.99% is damn near perfect. Your achieving that due to your shbg being on the low (er) end.

    Now, the debate goes both ways with low shbg and how to handle it. Some top docs say your better off with once per week injections to allow it more time to rise and be at a higher level. This being due to the more frequently you inject = the more you "push" it down. Injecting test suppresses shbg. Caveat is that twice per week allows more stable T levels and helps with mitigating E2 issues. I'd opt for twice per week (IMO) and keep an eye on your shbg.

    Op it's great to see a newer member doing their homework. Keep it up.
    Lockout888 likes this.
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  22. #22
    DocMeehan is offline ~ LowTestosterone.com Physician~
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    Don't discount the benefits and power of DIM! DIM is short for Diindolylmethane. It`s a phytonutrient that occurs naturally in cruciferous vegetables like broccoli and cabbage. DIM can be purchased without a prescription; it is widely available as in nutritional supplement form.

    DIM helps metabolize and breakdown estrogen in the body. I personally like and use DIM for a broader range of purposes than anastrozole can accomplish. For example, in a world full of estrogenic molecules/phytoestrogens (food [Soy, black cohosh, caffeine, lignans, isoflavonoids and coumestans], consumer packaging, cookware, pesticides, etc.), our bodies are confronted with far more of these xenoestrogens than are healthy. Being able to breakdown and shift the production of estrogen metabolites away from the unfriendly 16-hydroxy metabolites to a more favorable 2-hydroxy metabolite is a very good thing.

    Furthermore, DIM has been shown to have favorable properties in thyroid function and protection: 3,3'-Diindolylmethane, a crucifer... [Biochem Biophys Res Commun. 2005] - PubMed - NCBI

    The effects of DIM can be quite profound and generally noticeable to someone supplementing with a high enough dosage. I typically recommend a standard dosage for men of between 200-400 mg per day (women, 100-200 mg daily). DIM's effects on estradiol levels will never be as reliable as anastrozole, however, there are plenty of other benefits to be gained from this useful supplement.
    Last edited by DocMeehan; 07-07-2013 at 09:23 PM.

  23. #23
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    ^^ Absolutely. I recommend DIM-Estro by NuMedica.
    DocMeehan likes this.
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  24. #24
    DocMeehan is offline ~ LowTestosterone.com Physician~
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    While we are on the topic of TRT and aromatase inhibition, let's not forget to cover the basics, ZINC. A good daily supplement dose is 30mg, assuming a zinc sufficient dietary intake of about 15 mg is also occurring. High doses of zinc, 100-150mg, (too high for regular use) has been shown to be a potent aromatase inhibitor. Additionally, zinc has also been shown to reduce aromatization of testosterone (via aromatase) in the rat liver[1].

    Zinc is one of the more common micronutrient deficiencies in athletes, vegetarians/vegans, and those who sweat a ton. It is an essential mineral that is involved in reproduction, immunity, and testosterone production. Avoiding a deficiency is important to maintain Testosterone levels (but superloading Zinc does not enhance testosterone levels above normal levels).

    Zinc is lost during sweat and exercise[2][3] and may be a contributing factor to why testosterone levels have been shown to be depressed after exhaustive exercise.[4][5]

    Zinc has also been noted as an inhibitor of 5-alpha reductase[6], which converts testosterone into dihydrotestosterone (DHT).

    1. Om AS, Chung KW. Dietary zinc deficiency alters 5 alpha-reduction and aromatization of testosterone and androgen and estrogen receptors in rat liver. J Nutr. (1996)
    2. Lukaski HC. Magnesium, zinc, and chromium nutriture and physical activity. Am J Clin Nutr. (2000)
    3. Campbell WW, Anderson RA. Effects of aerobic exercise and training on the trace minerals chromium, zinc and copper. Sports Med. (1987)
    4. Galbo H, et al. Thyroid and testicular hormone responses to graded and prolonged exercise in man. Eur J Appl Physiol Occup Physiol. (1977)
    5. Hackney AC, et al. Comparison of the hormonal responses to exhaustive incremental exercise in adolescent and young adult males. Arq Bras Endocrinol Metabol. (2011)
    6. Stamatiadis D, Bulteau-Portois MC, Mowszowicz I. Inhibition of 5 alpha-reductase activity in human skin by zinc and azelaic acid. Br J Dermatol. (1988)

  25. #25
    Rusty11's Avatar
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    Great to have another Dr. here.
    For someone with slightly elevated e2, would you recommend DIM or zinc? If zinc at 30 mg/day, does copper need to be supplemented?
    Thanks

  26. #26
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    Quote Originally Posted by Rusty11 View Post
    Then go with the regular test all*things*male*.com/forum/content.php?134-estradiol-serum?134-estradiol-serum
    A guy just reported these results today....sort of makes the sensitive worth it in this case....but I think the whole deal sucks and the labs should clean up their acts...

    Estradiol 48 7.6-42.6 HIGH
    Estradiol Sensitive 24 3-70
    Last edited by Trific; 07-07-2013 at 10:47 PM.

  27. #27
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    Yea. It's confusing. So, since my doc didn't know anything about it, I just paid $60 myself. It was just for my piece of mind.

  28. #28
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    Quote Originally Posted by DocMeehan View Post
    While we are on the topic of TRT and aromatase inhibition, let's not forget to cover the basics, ZINC. A good daily supplement dose is 30mg, assuming a zinc sufficient dietary intake of about 15 mg is also occurring. High doses of zinc, 100-150mg, (too high for regular use) has been shown to be a potent aromatase inhibitor. Additionally, zinc has also been shown to reduce aromatization of testosterone (via aromatase) in the rat liver[1].

    Zinc is one of the more common micronutrient deficiencies in athletes, vegetarians/vegans, and those who sweat a ton. It is an essential mineral that is involved in reproduction, immunity, and testosterone production. Avoiding a deficiency is important to maintain Testosterone levels (but superloading Zinc does not enhance testosterone levels above normal levels).

    Zinc is lost during sweat and exercise[2][3] and may be a contributing factor to why testosterone levels have been shown to be depressed after exhaustive exercise.[4][5]

    Zinc has also been noted as an inhibitor of 5-alpha reductase[6], which converts testosterone into dihydrotestosterone (DHT).

    1. Om AS, Chung KW. Dietary zinc deficiency alters 5 alpha-reduction and aromatization of testosterone and androgen and estrogen receptors in rat liver. J Nutr. (1996)
    2. Lukaski HC. Magnesium, zinc, and chromium nutriture and physical activity. Am J Clin Nutr. (2000)
    3. Campbell WW, Anderson RA. Effects of aerobic exercise and training on the trace minerals chromium, zinc and copper. Sports Med. (1987)
    4. Galbo H, et al. Thyroid and testicular hormone responses to graded and prolonged exercise in man. Eur J Appl Physiol Occup Physiol. (1977)
    5. Hackney AC, et al. Comparison of the hormonal responses to exhaustive incremental exercise in adolescent and young adult males. Arq Bras Endocrinol Metabol. (2011)
    6. Stamatiadis D, Bulteau-Portois MC, Mowszowicz I. Inhibition of 5 alpha-reductase activity in human skin by zinc and azelaic acid. Br J Dermatol. (1988)
    Music to my ears Love Zinc.
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  29. #29
    DocMeehan is offline ~ LowTestosterone.com Physician~
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    Rusty11, because I don't know about your diet, that is a hard question to answer. If you are eating a reasonable diet that contains a reasonable amount of copper containing foods (Foods highest in Copper), I don't believe you need to be overly concerned about your 30mg/day of zinc supplementation depleting your copper stores.

    Excessive zinc has been shown to reduce copper status. 100-150mg per day is what I would consider excessive. 30 mg/day is not excessive.

    The data suggesting that zinc supplements decreased copper status goes back to this study in 1984: Effect of zinc supplementation on copper status in adult man.. A more recent study of this issue, using far more sensitive biomarkers, demonstrated that reasonable levels of zinc intake had no effect on copper levels: Zinc Supplementation Does Not Alter Sensitive Biomarkers of Copper Status in Healthy Boys, Zinc Supplementation Does Not Alter Sensitive Biomarkers of Copper Status in Healthy Boys

    Eat well, supplement reasonably, and you will remain in great shape.

  30. #30
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    Doc, thanks for the reply and for that great link. I eat quite well. I'm headed over to that link to do a little research.

  31. #31
    DocMeehan is offline ~ LowTestosterone.com Physician~
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    I usually assume that an elite athlete like yourself would eat very smart and very well. However, some of the mixed martial artists with whom I work never cease to amaze me with the inadequacy of their diet. You can really tell a lot about a person's food discipline when you watch what they eat after cutting weight for a competition.

    The building of a solid foundation of good health demands that we eat healthy, clean, organic, non-GMO food. Spend your money on good food before you spend tons of money on supplements. I really like to use Nutrition facts, calories in food, labels, nutritional information and analysis &ndash; NutritionData.com to find the best combination of foods to give me the nutrients I need. I am developing a program for elite athletes that I think you will really enjoy. Stay tuned.

  32. #32
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    Quote Originally Posted by DocMeehan View Post
    Rusty11, because I don't know about your diet, that is a hard question to answer. If you are eating a reasonable diet that contains a reasonable amount of copper containing foods (Foods highest in Copper), I don't believe you need to be overly concerned about your 30mg/day of zinc supplementation depleting your copper stores.

    Excessive zinc has been shown to reduce copper status. 100-150mg per day is what I would consider excessive. 30 mg/day is not excessive.

    The data suggesting that zinc supplements decreased copper status goes back to this study in 1984: Effect of zinc supplementation on copper status in adult man.. A more recent study of this issue, using far more sensitive biomarkers, demonstrated that reasonable levels of zinc intake had no effect on copper levels: Zinc Supplementation Does Not Alter Sensitive Biomarkers of Copper Status in Healthy Boys, Zinc Supplementation Does Not Alter Sensitive Biomarkers of Copper Status in Healthy Boys

    Eat well, supplement reasonably, and you will remain in great shape.

    Those are the words to live by.....
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  33. #33
    Lockout888 is offline Associate Member
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    Quote Originally Posted by Lockout888 View Post
    So I started taking .25mg anastrozole 24 hours after my weekly test injection, and got my E2 where I wanted it.

    My only question is shouldn't my total test be higher? Doesn't it peak 24-48 hours after injection?

    Last Labs (6/6/13) on day 7, before test injection:
    Total Test = 534 (348-1197)
    Estradiol = 49.5 (7.6-42.6)
    Albumin = 4.2 (3.5-5.5)

    New Labs (7/5/13) on day 2, 36 hours after test injection:
    Total Test = 591 (348-1197)
    Estradiol = 25.3 (7.6-42.6)
    Albumin = 4.4 (3.5-5.5)
    SHBG = 15.4 (16.5-55.9)
    Free T = 17.7 ng/dL = 2.99 %
    Bio T = 424 ng/dL = 71.7 %
    I happen to get some more bloodwork done and it looks like the .25mg AI on day after weekly injection is working for me:

    New Labs (7/23/13) on day 6 after test injection:
    Total Test = 597 (348-1197)
    Estradiol = 29.4 (7.6-42.6)
    Albumin = 4.5 (3.5-5.5)

  34. #34
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    Quote Originally Posted by Lockout888 View Post
    I happen to get some more bloodwork done and it looks like the .25mg AI on day after weekly injection is working for me:

    Protocol: Test Cyp 100mg 1x week, HCG 250iu 3x week, Anastrozole .25mg on day after T injection.
    Labs (7/23/13) on day 6 after test injection:
    Total Test = 597 (348-1197)
    Estradiol = 29.4 (7.6-42.6)
    Albumin = 4.5 (3.5-5.5)
    Hemocrit = 46.4 (37.5-51)
    So since my TT was still on the lower end, my Doctor bumped my dosage to 150mg per week and wanted me to see how I felt and get new labs after a month. I didn't feel much different than when on 100mg per week, and the new labs show my TT didn't go up much. I must be aromatizing more?

    Current protocol: Test Cyp 150mg 1x week, HCG 250iu 3x week, Anastrozole .25mg day after T injection.
    New Labs (9/4/13) 7 days after test injection:
    Total Test = 586 (348-1197)
    Estradiol = 44.3 (7.6-42.6)
    Hemocrit = 52.1 (37.5-51)

    What would be a good plan of attack?
    • Donating blood for sure
    • Split my T dosage to 2x per week?
    • Increase my Anastrozole dosage to .5mg 1x per week?
    • Increase my Anastrozole dosage to .25mg 2x per week?
    • Go back to 100mg T per week?

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