Coadministration of Anastrozole Sustains Therapeutic testosterone Levels in Hypogon

[char6424]

Be curious what thoughts might be on the study below. Two groups of men, one with Testosterone Pellets and one with Testosterone Pellets and 1MG/day Armidex.

The study appears to indicate that the men on Armidex + TRT had not only higher T and FT, but also higher FSH/LH. Seems like everything I've read would counter this as once you are shutdown, you are shutdown. But is it possible that reducing your estradiol stimulates FSH/LH even while on TRT?


Mechlin CW, Frankel J, McCullough A. Coadministration of Anastrozole Sustains Therapeutic testosterone Levels in Hypogonadal Men Undergoing Testosterone Pellet Insertion. The Journal of Sexual Medicine. Coadministration of Anastrozole Sustains Therapeutic Testosterone Levels in Hypogonadal Men Undergoing Testosterone Pellet Insertion - Mechlin - 2013 - The Journal of Sexual Medicine - Wiley Online Library

Introduction - Current U.S. Food and Drug Administration–approved therapies for hypogonadism involve testosterone (T) replacement. Testosterone pellets (TP) require a minor office procedure every 3 to 4 months. The need for repeated insertions increases the likelihood of a complication. Anastrozole (AZ) is an aromatase inhibitor that has been used off-label for the treatment of male hypogonadism. AZ increases T levels by lowering serum estradiol (E2) levels and increasing gonadotropin (GTP) levels.

Aim - We hypothesized that the concomitant use of AZ with TP insertions would sustain therapeutic T levels and increase the interval between TP insertions.

Methods - Men treated with TP for hypogonadism at an academic center were offered AZ (1?mg/day) at the time of TP reinsertion as a way of potentially decreasing the frequency of TP insertions. Total T (TT), free T (FT), sex hormone binding globulin, E2, luteinizing hormone (LH), and follicle-stimulating hormone FSH levels were obtained prior to T replacement and at 6 and 15 weeks from TP insertion. Men were re-implanted at 16 weeks if their TT levels were less than 350?ng/dL and their symptoms recurred. We retrospectively reviewed our records of men who underwent TP, TP, and AZ from 2011 to 2012. Demographics, TT, FT, LH, FSH, and E2 levels were recorded. Data were analyzed with anova and a Tukey's test.

Main Outcome Measure - TT level at 6, 15, or >15 weeks from TP insertion.
Results - Thirty-eight men with 65 insertions were analyzed. The TP AZ group had significantly higher TT and FT levels than the TP group at >120 days (P?<?0.05). The TP group had significantly higher E2 levels at all time points (P?<?0.01). GTP levels remained stable in the TP AZ group. Average time to reinsertion in TP AZ was 198 days vs. 128 days in the TP group.

Conclusion - Men on TP AZ maintain therapeutic T levels longer than men on TP alone and have significantly less GTP suppression

[jimmyinkedup]

Do you have the full study showing the LH and FSH levels of both groups?

[kelkel]

Main Outcome Measure - TT level at 6, 15, or >15 weeks from TP insertion.
Results - Thirty-eight men with 65 insertions were analyzed. The TP AZ group had significantly higher TT and FT levels than the TP group at >120 days (P?<?0.05). The TP group had significantly higher E2 levels at all time points (P?<?0.01). GTP levels remained stable in the TP AZ group. Average time to reinsertion in TP AZ was 198 days vs. 128 days in the TP group.

Conclusion - Men on TP AZ maintain therapeutic T levels longer than men on TP alone and have significantly less GTP suppression

At a quick glance it seems obvious that the addition of an AI to TP therapy will increase TT and FT. It's simply less turnover from T to E. They answer that themselves higher up in the original quote. I don't see anything relative to mean outcomes with LH & FSH though. If there were anything I'd be curious if it were not simply related to the slower absorption of testosterone pellets.

Like Jimmy asked, post the entire study if you have it please.

Pharmacokinetics and pharmacodynamics of testosterone pellets in man. - PubMed - NCBI

[char6424]

I can't find the full text of the article, but was able to find the charts below which outline the hormone and GTP levels for both groups. There does appear to be an impact on the FSH/LH levels when an AI is co-administered with Testosterone . I am little surprised the E2 Levels are not even more suppressed at the dose of 1MG per day of Armidex. Been doing some searching and there appears to be antedoctle evidence that running clomid on TRT maintains testicular function but nothing backed up by a study or bloodwork. Also, while these are pellets, the FSH/LH levels on the TRT only group make it clear the subjects are shut down.

What they don't seem to ask is any body composition, libido or Erectile quality questions. In other words, will taking AI alongside TRT stimulate the testes but impact quality of life issues because of the low Estradiol

[Moonjumper]

Purely based on condition of my testicles but Clomid did nothing for me when combined with injections. I was taking 25 mg two days in a row then skipped a day before repeating. Still shrank, ejaculate decreased, and sack stayed drawn up and tight continuously. A hot shower wouldn't even get it to relax any. Dropped it and switched to HCG and 3 weeks later things are almost normal again.

[kelkel]

Purely based on condition of my testicles but Clomid did nothing for me when combined with injections. I was taking 25 mg two days in a row then skipped a day before repeating. Still shrank, ejaculate decreased, and sack stayed drawn up and tight continuously. A hot shower wouldn't even get it to relax any. Dropped it and switched to HCG and 3 weeks later things are almost normal again.

Clomid won't do anything for you when on exogenous T. It won't over-ride HPTA shut down no matter how much you take.

[char6424]

Understood on clomid, but still trying to understand how armidex kept this group from shutting down. My only thought is that the T level in the T only group did not get to high so perhaps at lower end TRT levels an AI is able to lower E enough to stimulate FSH/LH production.


Edited to correct grammar

[kelkel]

It is interesting but I've never read anything (from a med source) backing that up, and it would surprise me to find something. Eventually our HPTA realizes there's no need to produce due to the exogenous T and shuts down. In all my years being involved in TRT I've never seen this contradicted. Even with someone's E being crashed it's still in the presence of exogenous T which keeps the HPTA shut down. It is interesting though as clomid basically works by making the ER in the hypo think there's no estrogen, so I do see the commonality.