Lot’s of comments, rather than addressing each post individually here are my opinions overall.

1. There is nothing wrong with AI’s. I wanted to clarify that first in case my initial responses implied that. I do believe too many tend to rely on them too much or have a false sense of security because of them.

2. 2sox, in reference to most patients being lazy or lacking in education on the matter – it’s really no different than any other topic that’s medically related. Most people do not want to dig deep into the issue and in my opinion that’s OK. If you have any condition or ailment, whatever that might be, you go to the doctor expecting him to know how to fix it or help you. Granted, TRT can be a bit different, not because it’s complicated but because many physicians don’t know how to treat this very simple condition. I do think it’s a good idea for the patient to learn at least a little but I by no means expect it. I know nothing about cars short of changing a flat tire and when I take my car to the mechanic I don’t expect or have any desire to learn – just fix my car.

3. 2sox again, in reference to your E2 levels being over 30 and the way you feel – it may have more to do with your ratio of testosterone to estradiol rather than the estradiol level itself.

4. Nipple sensitivity is not a direct indicator of gyno or E2 being too high. Yes, it can be but growth in the chest is more of an indicator. Nipple sensitivity can be an indicator of increased libido and often is. Further, I have yet to see a man develop gyno with his E2 in the 30-40 range.

5. If a man stays on TRT for a long period of time (remember, most don’t. Most men try it for 6-8 months once or run through several 6-8 month periods and stop and start.) But men who stay on for years, more often than not those that needed an AI early on need less and less and in many cases, none at all. This is very common. I do not have a good scientific answer to this, but it does seem men tend to aromatize less years later than they did in the beginning. We can make the argument that this is because many men are in better shape after being on TRT for an extended period of time, therefore carry less body fat and possibly more muscle tissue. But I am not convinced that this is the reason. I have seen very overweight men who when on TRT aromatize very little and very lean men who aromatize heavily, and on that basis body fat cannot be the primary reason. Do some men always need an AI no matter how long they are on TRT? Yes.