New thoughts on AI

[JimGainz]

I was curious if you all have seen some of the latest research, and doctors on YouTube, other forums Etc. advocating to not block estradiol i.e. do not take an AI – and that it is more beneficial and causes no harm to let estrogen reach its own level when on testosterone supplementation.

Have any of you started doing that – gave up your AI and if so what are your results? For me, at 100 mg Testosterone/wk when I don’t use an AI my estradiol gets to around 60, and when I use it I try to keep it somewhere around 30 – but it has been as low as 6 and to be honest, within all of those ranges I really don’t feel any different.

Additionally, I have also seen some new protocols not only advocating no ARI but no hCG either, unless someone is trying to preserve fertility.

All of this seems to go against what probably many of us have been told, and contradicts existing regiments, so just wanted to get some thoughts from the community if anyone has changed their protocol and dropped the AI and hCG?

 

[Vince Carter]

That line of thinking has not been really well received on this forum and those individuals that are on that "roundtable", the youtube doctors, have been well criticized here. In fact they don't come near this forum or have otherwise been banned.

You need to spend some time with the search feature...I doubt that there is going to be any new discussion on this allowed.

 

[Gman86]

Balance. Balance will always be the answer. Follow that and you’ll find optimization.

 

[JimGainz]

That line of thinking has not been really well received on this forum and those individuals that are on that "roundtable", the youtube doctors, have been well criticized here. In fact they don't come near this forum or have otherwise been banned.

You need to spend some time with the search feature...I doubt that there is going to be any new discussion on this allowed.

Thanks Vince. That’s what I thought. I wasn’t planning on giving up my protocol without checking here (and I’ll search out the posts) but - there were some folks on other forums claiming Estrogen nirvana . It never made sense to me.

 

[JimBob]

I think the jury is still out. Whether or not those Roundtable docs visit here is incidental. I'm not defending any or all of them, but, suffice it to say, the late Dr. Crisler changed, or was changing his own protocol to be more in line with the TOT doc's protocols.

 

[RLW]

I was on 0.2mg of Anastrazole MWF taken at the same time as my Testosterone injections until 3 months ago. I decided to stop and see what happens. I had labs schedule when I decided to stop so I got my labs and then stopped. My sensitive E2 on those labs was 40. Since stopping I can't say I feel any different. I'm not retaining water, don't feel emotional, EQ is great. There's no way to know what my E2 is currently but 3 months in and I feel good. Next labs are in 3 months so we will see.

This is of course anecdotal so there is no way of knowing if your results would be the similar.

 

[CoastWatcher]

Th use of an AI has never been universally advocated, nor has it ever been universally discouraged, at EM. In fact, this Forum probably had an earlier "anti-AI posture" (if you will) than certain other health communities; we certainly were more vocal in warning of the dangers of recklessly prescribing AIs than many, many doctors who ushered their patients into hormone hell by routinely walloping them with doses of anastrozole more appropriate for women fighting breast cancer.

It has certainly been prescribed too often - and an honest doctor who knows how to manage androgen replacement will acknowledge that. At the same time, anastrozole is a good, often necessary, drug that plays an important role in many, many protocols. Those who argue for unrestricted estradiol levels are no more responsible in their approach than those who initiate a TRT protocol with a large dose of anastrozole.

Why the advocates of the former have made this a personal - at times, highly unpleasant - battle is beyond me.

 

[sebastian_r]

In the past when I needed an AI to combat side effects it was from (i) long esters (ii) infrequent injections (iii) HCG (iv) DHEA (vi) too much body fat.

I feel best with frequent injections with short ester and nothing else.

I neither take AI, nor HCG, nor DHEA, nor Pregnenolone anymore.

Tested it all and for me doesn't improve the experience that I get from short ester applied frequently.

When I take long ester or HCG it's a different ballgame and I need at least an AI to feel half way good plus pregnenolone to combat brainfog.

If I still had side effects from high E2, I would try taking pregnenolone over an AI. It seems to reduce E2 for me via the progesterone pathway. But then with short ester and frequent injections I don't get there in the first place.

I have come to the conclusion if one needs AI to combat side effects, the protocol is not optimal for the person. Instead of trying to fix a suboptimal protocol with AI, the smarter move seems to be finding a better protocol. The most effective change I have found is using a short ester.

 

[Gman86]

In the past when I needed an AI to combat side effects it was from (i) long esters (ii) infrequent injections (iii) HCG (iv) DHEA (vi) too much body fat.

I feel best with frequent injections with short ester and nothing else.

I neither take AI, nor HCG, nor DHEA, nor Pregnenolone anymore.

Tested it all and for me doesn't improve the experience that I get from short ester applied frequently.

When I take long ester or HCG it's a different ballgame and I need at least an AI to feel half way good plus pregnenolone to combat brainfog.

If I still had side effects from high E2, I would try taking pregnenolone over an AI. It seems to reduce E2 for me via the progesterone pathway. But then with short ester and frequent injections I don't get there in the first place.

I have come to the conclusion if one needs AI to combat side effects, the protocol is not optimal for the person. Instead of trying to fix a suboptimal protocol with AI, the smarter move seems to be finding a better protocol. The most effective change I have found is using a short ester.

It’s too early to tell, but seems like short ester testosterone like creams and testosterone propionate, administered frequently, might be the future of TRT.

 

[YBWV]

It’s too early to tell, but seems like short ester testosterone like creams and testosterone propionate, administered frequently, might be the future of TRT.

You're correct but please don't whisper it; shout it from the rooftops!

The original introduction of the long esters of T had nothing to do with efficacy - successfully treating the symptoms of hypogonadism - and everything to do with Doctors' wish to ensure patient compliance with the protocols they prescribed.

So we got injectables designed to used from e14d to e12weeks and fundamentally flawed protocols for treating low T.

In more recent times progressive clinicians have been able to get these long esters to work for many of their patients; more frequent injections, AIs to "balance" hormones, phlebotomy (!!!) when hct gets too high.
The fact remains they're tinkering with a fundamentally flawed model.

 

[Vince Carter]

I think the jury is still out. Whether or not those Roundtable docs visit here is incidental. I'm not defending any or all of them, but, suffice it to say, the late Dr. Crisler changed, or was changing his own protocol to be more in line with the TOT doc's protocols.

May not be entirely coincidental that sequence of events either.

 

[jhperez81]

Do the roundtable guys support the use of Tamoxifen as a way to manage E2? I've seen alot of people on forums advocate the use of it but are totally against AI's. Does anyone on here use Tamoxifen to manage E2 instead of an AI?

 

[DragonBits]

In the past when I needed an AI to combat side effects it was from (i) long esters (ii) infrequent injections (iii) HCG (iv) DHEA (vi) too much body fat.

I feel best with frequent injections with short ester and nothing else.

I neither take AI, nor HCG, nor DHEA, nor Pregnenolone anymore.

Tested it all and for me doesn't improve the experience that I get from short ester applied frequently.

When I take long ester or HCG it's a different ballgame and I need at least an AI to feel half way good plus pregnenolone to combat brainfog.

If I still had side effects from high E2, I would try taking pregnenolone over an AI. It seems to reduce E2 for me via the progesterone pathway. But then with short ester and frequent injections I don't get there in the first place.

I have come to the conclusion if one needs AI to combat side effects, the protocol is not optimal for the person. Instead of trying to fix a suboptimal protocol with AI, the smarter move seems to be finding a better protocol. The most effective change I have found is using a short ester.

I have never used an AI, and only used HCG for a couple of months.

BUT the reason people use HCG doesn't change depending on ester or frequency of injection.

Any endogenous testosterone that is introduced in levels we typically want to have will shut down your testicular production.

Do you agree with that?

BUT whether this is important to an individual, IMO up to you. Outside of fertility, I don't think it's critical and you can always restart sperm production if you want to. A restart no matter how you do it will always introduce some level of inconvenience/discomfort/expense, but then again, babies also introduce a much higher level of those things.

IMO no protocol anyone as yet invented is ideal, ideal would be like it was when I was 25, higher levels of TT, FT, normal E2, good sperm production. (Let's forget that having to inject a medication either daily or every 3 months is hardly ideal.)

I know that if my E2 goes up too much, like up to 50, I gain water weight, which wouldn't be a big deal but my blood pressure also goes up. It doesn't often happen, but I have seen it under some circumstances. Higher E2 causes more and stronger allergies, but it's likely lowering your E2 to a level where go don't get an allergic reaction is going to cause other more serous problems with bones and tendons.

All this focus on E2 left me to think in the future i will use an AI for a couple of weeks a few times a year to mildly suppress E2.

BTW, I have seen a lot of opinions, but no new research on this subject, a lot of old research re-opinionated.

 

[Gman86]

You're correct but please don't whisper it; shout it from the rooftops!

The original introduction of the long esters of T had nothing to do with efficacy - successfully treating the symptoms of hypogonadism - and everything to do with Doctors' wish to ensure patient compliance with the protocols they prescribed.

So we got injectables designed to used from e14d to e12weeks and fundamentally flawed protocols for treating low T.

In more recent times progressive clinicians have been able to get these long esters to work for many of their patients; more frequent injections, AIs to "balance" hormones, phlebotomy (!!!) when hct gets too high.
The fact remains they're tinkering with a fundamentally flawed model.

It’s exciting to finally see other reasons for a protocol not working, other than blaming estrogen constantly. I honestly thought that the doctors on the roundtable were falsely exaggerating their success rates, but after recently taking a deep dive into propionate, and just short ester testosterone applications in general, I think they might just honestly have such a great rate of success due to the short ester of the testosterone cream. Again, it’s too early to make this correlation, but it just seems there’s something to using these short ester forms of testosterone, that haven’t yet been explained through ang studies. But the anectodal evidence is pretty compelling, imo.

 

[S1W]

In the past when I needed an AI to combat side effects it was from (i) long esters (ii) infrequent injections (iii) HCG (iv) DHEA (vi) too much body fat.

I feel best with frequent injections with short ester and nothing else.

I neither take AI, nor HCG, nor DHEA, nor Pregnenolone anymore.

Tested it all and for me doesn't improve the experience that I get from short ester applied frequently.

When I take long ester or HCG it's a different ballgame and I need at least an AI to feel half way good plus pregnenolone to combat brainfog.

If I still had side effects from high E2, I would try taking pregnenolone over an AI. It seems to reduce E2 for me via the progesterone pathway. But then with short ester and frequent injections I don't get there in the first place.

I have come to the conclusion if one needs AI to combat side effects, the protocol is not optimal for the person. Instead of trying to fix a suboptimal protocol with AI, the smarter move seems to be finding a better protocol. The most effective change I have found is using a short ester.

Had you tried injecting long ester test (Cyp or En) frequently, like EOD or ED? I'm curious how that compared to Prop for you.

 

[JimGainz]

Do the roundtable guys support the use of Tamoxifen as a way to manage E2? I've seen alot of people on forums advocate the use of it but are totally against AI's. Does anyone on here use Tamoxifen to manage E2 instead of an AI?

I have used it in the past but I feel it is inferior to an AI. Tamoxifen manages a major side effect of estrogen - namely nipple sensitivity/ gyno. To me this is a flawed approach - it seems more logical to stop it at the source (by using an AI) rather than manage the sides. Also, Tamoxifen has horrible side effects - worse than Arimidex in my opinion.

 

[sebastian_r]

Had you tried injecting long ester test (Cyp or En) frequently, like EOD or ED? I'm curious how that compared to Prop for you.

Yes I have tried this.

Prop beats the long esters on same frequent injection protocol by a long shot.

I don't know if I'm extra sensitive to the long esters, but especially cypionate creates big problems for me even in tiny amounts. It's like injecting side effects.

I do not understand what mechanisms are going on here. But somehow my body converts cycpionate differently than propionate which leads to side effects.

 

[sebastian_r]

I have never used an AI, and only used HCG for a couple of months.

BUT the reason people use HCG doesn't change depending on ester or frequency of injection.

Any endogenous testosterone that is introduced in levels we typically want to have will shut down your testicular production.

Do you agree with that?

BUT whether this is important to an individual, IMO up to you. Outside of fertility, I don't think it's critical and you can always restart sperm production if you want to. A restart no matter how you do it will always introduce some level of inconvenience/discomfort/expense, but then again, babies also introduce a much higher level of those things.

IMO no protocol anyone as yet invented is ideal, ideal would be like it was when I was 25, higher levels of TT, FT, normal E2, good sperm production. (Let's forget that having to inject a medication either daily or every 3 months is hardly ideal.)

I know that if my E2 goes up too much, like up to 50, I gain water weight, which wouldn't be a big deal but my blood pressure also goes up. It doesn't often happen, but I have seen it under some circumstances. Higher E2 causes more and stronger allergies, but it's likely lowering your E2 to a level where go don't get an allergic reaction is going to cause other more serous problems with bones and tendons.

All this focus on E2 left me to think in the future i will use an AI for a couple of weeks a few times a year to mildly suppress E2.

BTW, I have seen a lot of opinions, but no new research on this subject, a lot of old research re-opinionated.

Yes, I agree.

I'm not an expert on HCG.

I tested it and got nasty side effects.

Even without the side effects, injecting a female pregnancy hormone year round would be nothing I want to do.

The only way I could imagine doing it, for fertility reasons, would be a big blast maybe every 4-6 weeks. Or using it when I actual need to be fertile.

 

[tmaxey1]

Its ironic how the loudmouth guy on the TRT roundtable has had surgery to have his Gyno cut out so the most noticeable and physically deforming side effect of too much E2 can't impact him. He yells and scream how stupid people are who dont agree with him. He calls AI's toxic to the body ect. The guy is just trying to get attention and trying to be different for the sake of being different.

Show me 1 study that shows having normal levels of E2 (15-25) is harmful to our health and then I will be on board.

Should people take such high dosages of AI's to where they have E2 levels on 4 or 5? Of course not. But walking around with an E2 of 20 is better than an E2 of 60 for most men.

Not all the doctors on that round table agree with the host also. I've heard a few that back away or speak up and admit they follow a different protocol and due recommend an AI in many cases.

 

[madman]

It’s too early to tell, but seems like short ester testosterone like creams and testosterone propionate, administered frequently, might be the future of TRT.

It’s too early to tell, but seems like short ester testosterone like creams and testosterone propionate, administered frequently, might be the future of TRT.

May very well be but unfortunately it will never be mainstream as a large percentage of men would not be comfortable injecting daily.

The combination of an injectable and daily application of a cream to ones protocol may very well benefit some but definitely is not needed for all.

Regardless of daily propionate possibly providing better results for some many do just fine injecting the longer acting esters daily.

Hope you understand that transdermal testosterone whether gel/cream is not esterified.

Even when injecting daily regardless of the ester used whether propionate, enanthate or cypionate none will result in mimicking the 24 hr circadian rhythm of endogenous testosterone of a healthy young male only the patch or transdermal (once daily application) would most closely mimic this.

Even than the patch would take this title!

Testosterone propionate has been shown to elevated blood levels for up to 36 hrs before declining and if anything when injecting prop daily you will get a quicker spike due to the PK compared to enanthate/cypionate but levels are not going to decline a lot within the 24 hr period if you are injecting high enough doses.

Look over the older studies on the PKs of TP using 25 and 50 mg T (EOD).