prescribed Anastrozole, dosage too much?

**TESTes123** · 06-05-2015, 05:26 PM

After a year of TRT, my endocrinologist has prescribed 1mg of Anastrozole a day to battle my growing man tits and high level of prolactin. Although pleased she is open to prescribing an AI, the dosage seems like overkill based on what I've read in the forums. Thoughts?

At the time of the BW, I was taking 0.5ml of 200mg/ml Test Cyp every 7 days. She now has me at same dosage every 10 days. 33 years old.

My last BW (not on anastrozole) showed the following results (ranges):

• Total Testosterone

1269 (348 - 1197 ng/dL)

• Free Testosterone

24.6 (8.7 - 25.1 pg/mL)

• Estradiol

20.4 (7.6 - 42.6 pg/mL)

• Prolactin

25.1 (4.0 - 15.2 ng/mL)

• Cortisol

14.7 (2.3 - 19.4 ug/dL)

• CBC

can detail if you need it

• Comprehensive Metabolic Panel

can detail if you need it

• Lipid Panel

can detail if you need it

Thanks in advance for your feedback.

**Beethoven** · 06-05-2015, 05:33 PM

When was bw done in relation to your shot? Were these numbers also on 1 mg a day anastrozole? I was prescribed .5 mg every other day and crashed my estradiol.

**TESTes123** · 06-05-2015, 05:38 PM

BW was done 3 days after last shot. Haven't started anastrozole yet, was just prescribed it based on those numbers and physical symptoms.

**Beethoven** · 06-05-2015, 05:46 PM

Free test, total and estradiol aren't bad but if you're pinning at 10 days you'll be much lower at the end. Anastrozole at your numbers will crash almost certainly. Even though it's not the sensitive assay it's still good. Definitely not worth even taking an AI. Perhaps one of the more knowlgeable guys will chime in on your prolactin levels.

**TESTes123** · 06-05-2015, 05:49 PM

I hate to sound like the noob I am on these forums, but what do you mean by "anastrozole at your numbers will crash almost certainly"?

If you don't think I should take anastrozole, then how do I combat the physical effects the estrogen is having on my body?

Really appreciate your help, Beethoven.

**kelkel** · 06-05-2015, 05:59 PM

What he means is the dosage recommended will bottom out your estrogen level. This = a bad thing.
Standard estradiol, which you had tested, is not the correct test for men. It reads higher than the proper test which is a Sensitive Estrogen Assay. This "elevated" reading causes many docs to prescribe adex when it should not be, as in your case. You can bet your actual estrogen is lower than what your test shows.

Your problem more than likely lies with your prolactin level which is elevated. Were you ever tested for adenoma's prior to going on TRT? The normal course of treatment for elevated prolactin is a dopamine agonist such as cabergoline in a low dose. And like Beethoven said, a 10 day protocol is not good. If anything, maybe alter your protocol to 100 every 5 days or so.

**TESTes123** · 06-05-2015, 06:49 PM

kelkel, I greatly appreciate your insight.

So Anastrozole is only to combat estrogen, which my levels seem fine at? It doesn't have anything to do with my prolactin levels, which is where my concern should be? Here I thought my doctor was helping, but may be off track. How do I guide her towards the prolactin issue and a script for Cabergoline? I've never been tested for adenoma (not even sure I've read about that in the forums to educate myself).

My script is for 0.5ml of 200mg/ml test cyp every 10 days. You are suggesting I go to 0.25ml of 200mg/ml every 5 days? My original script was for 1ml of 100mg/ml, but no pharmacy had that in stock for months, which is why we switched to 200mg/ml and cut the dosage in half from 1 to 0.5 ml.

**Chauffeur** · 06-05-2015, 08:04 PM

I would argue that your estradiol is already too low. KelKel mentioned the inaccuracy of the standard assay, and he's spot on.

When my standard estradiol test was ~25, my sensitive estradiol test showed a value of 5...which is FAR too low to feel good. I wouldn't even think about touching Anastrozole if I were in your position.

Your main issue seems to be the prolactin though.

**TESTes123** · 06-20-2015, 03:22 PM

Thanks! I've got 90 pills of Anastrazole which I won't touch. I also reached out to my doctor about the prolactin levels and she agreed to put me on cabergoline.

**kelkel** · 06-20-2015, 05:25 PM

Originally Posted by TESTes123

kelkel, I greatly appreciate your insight.

So Anastrozole is only to combat estrogen, which my levels seem fine at? It doesn't have anything to do with my prolactin levels, which is where my concern should be? Here I thought my doctor was helping, but may be off track. How do I guide her towards the prolactin issue and a script for Cabergoline? I've never been tested for adenoma (not even sure I've read about that in the forums to educate myself).

My script is for 0.5ml of 200mg/ml test cyp every 10 days. You are suggesting I go to 0.25ml of 200mg/ml every 5 days? My original script was for 1ml of 100mg/ml, but no pharmacy had that in stock for months, which is why we switched to 200mg/ml and cut the dosage in half from 1 to 0.5 ml.

Adex is an aromatase inhibitor that suppresses estrogen.
Cabergoline (Dostinex) is a Dopamine Agonist which suppresses prolactin. It does not take much. .25 twice per week is sufficient, imho.
I was suggesting splitting your protocol from 200 every 10 days to 100 every 5 or so. Standard starting protocol is about 100 mgs per week and then check BW in about 6 weeks and adjust.

Adenoma's are small tumors (Micro or Macro) that can grow on your pituitary gland and inhibit function. One of the common types is called a Prolactinoma, which enhances prolactin levels to the point of causing testosterone suppression. These type tumors are most always benign and are more common that most think. They can do several things such as cause excessive GH secretion, TSH secretion or simply shut down your testosterone which is what occurred in my case. I'll use a personal reference to give you an example of their size. My pituitary is 6 mm with a micro-adenoma at 2 mm. It doesn't take much to make a major impact.

**TESTes123** · 06-20-2015, 06:24 PM

Originally Posted by kelkel

I was suggesting splitting your protocol from 200 every 10 days to 100 every 5 or so. Standard starting protocol is about 100 mgs per week and then check BW in about 6 weeks and adjust.

Current protocol: 0.5ml of 200mg/ml every 10 days
You are suggesting (if i understand you correctly): 0.25 of 200mg/ml every 5 days
(I can't get my hands on 100mg/ml vials, so 200mg/ml is what we have to work with)

Originally Posted by kelkel

Adenoma's are small tumors (Micro or Macro) that can grow on your pituitary gland and inhibit function. One of the common types is called a Prolactinoma, which enhances prolactin levels to the point of causing testosterone suppression. These type tumors are most always benign and are more common that most think. They can do several things such as cause excessive GH secretion, TSH secretion or simply shut down your testosterone which is what occurred in my case. I'll use a personal reference to give you an example of their size. My pituitary is 6 mm with a micro-adenoma at 2 mm. It doesn't take much to make a major impact.

Since my post above, my endo has actually ordered an ultrasound of my thyroid and a MRI of my pituitary to see what may be the root cause of my levels. I'm very glad I found her as she is fully interested in not only treatment, but also researching causes.