TRT without the use of Aromatase Inhibitors

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The reason large studies of higher levels of estrogen in men are needed and anecdotal personal studies aren't very useful is the same sort of reason woman had problems on synthetic hormones. Sure they felt better but they didn't really know about the problems until a large number of women were studied for years.

Autoimmune diseases are associated with women's higher levels of estrogen, and many women who enter menopause find their symptoms reduced.

But if 5% of men after 5 years of having high estrogen develop lupus or Hashimoto’s or anyone of the 100 other autoimmune diseases, without a larger study I doubt anyone will connect the two events. Those 5% will just be unlucky to have gotten XX. I don't know it will happen, maybe T protects men from high estrogen.

All that aside, my E2 sensitive is currently 15.6 with a total T of 627 and NO AI.

Am I supposed to order some sort of E2 cream? Double my T dose to get E2 to 28?
According to Rouzier, you would benefit more from getting your E2 200 points higher than just 28. If you told him you were doing well with an E2 of 15.6 he’d probably laugh in your face.
 
Dr Crisler, I posted a thread yesterday about why you are not on the round table anymore but someone overly sensitive has deleted it...I merely stated that its prudent to have a "10th man" so to speak, and that there is so much we don't know yet. This AI debate is good for all TOT practicing doctors.
 
Much respect to the Doctor for going about this objectively. Looking forward to what finding come from this change in perspective.

As far that transition phase, we are mostly taking cypionate with its very long half life. Any changes in that dose takes 6 weeks just be steady state. Say that’s all you are taking, you still have the body reacting to that new hormone level as regarding cortisol, thyroid, esteogen, etc. It’s well documented that the effects of TRT take many months to take full effect.

We change our protocols and ignore this fact expecting nothing but ups and no downs. See a negative side and we change again.

Anastrozole has a half life of 50 hours. It’s completely out of your system in what, 10 days or so? Now aromatase has to do its thing. IME based on old blood work that takes many weeks to level off. It’s also variable. So if your protocol is to eliminate ai I think many weeks are needed to really assess.

I’m guilty of this. I’m doing better than ever going 7-10(right now longer) days before taking a spec on anastrozole based on how I feel. Never taken this much test or this little ai, and I’m feeling great.
Yes maybe its "out of your system" after 10-12 days but from personal experience it can take several weeks before u feel better if u have too low estrogen, not sure why.
 
According to Rouzier, you would benefit more from getting your E2 200 points higher than just 28. If you told him you were doing well with an E2 of 15.6 he’d probably laugh in your face.
What do I care, rouzier's just some talking head on the internet. There is a million of them on the internet. I never even heard of him before this thread.

IMO, which I consider the most important opinion, 15.6 is too low, so I will move it up by increasing my TT.

Though I am more concerned that FT was 7.9. As I said previously, it maybe due to the Life Extension's ultra prostate formula somehow limiting conversion. They claim it has "demonstrated anti-estrogen and anti-DHT effects", maybe it really does. Obviously life extension believes estrogen maybe part of prostate growth, I am not very convinced of that at all.

Too bad I didn't test SHBG, in theory that "should" have been the reason both FT and E2 fell more would be indicated by a minor drop in TT.

But if my PSA level doesn't move down, I don't see a point in continuing with the formula. It's my guess PSA won't increase any more regardless of taking this formula, but I was hoping for a decline.

I was just curious if anyone would suggest supplementing with E2.
 
Having recently started trt, firstly on gels, I had monthly blood tests so I have a raft of recent tt and e2 scores. I struggle a little with the concept of ‘treat e2 as symptoms present’ as I have never really experienced any symptoms that reading would suggest point to an e2 problem.

In this time I have had tt of 300 with e2 around 22 as well as tt over 1000 with e2 over 100. The only time I was aware of this was with the actual blood test results and not with presenting symptoms. To be fair I felt a little ‘flat’ in general (probably the very low tt!) so I knew something was going on but experienced no ‘classic’ high e2 symptoms.

I know that it’s not en vouge thinking but is there any mileage in the view that tt to e2 ratio is big factor rather than just total e2 headline? Across all tests, while on this roller coaster my tt to e2 ratio sat around 8-13%.

Admittedly, I can’t say that with an AI bringing e2 down to 30 ish while having tt over a 1000 I might have felt like Superman. But what I can say is within the similar tt to e2 ratio band I didn’t feel bad nor felt the need to hit the AI due to symptoms
 
I'm not sure if I'm following the logic here Dr. Crisler. It was my understanding that you were a proponent of going low and slow on testosterone dosage. Having trialed from say 75mg up to 200mg the patient titrates up until symptoms are relieved and finds an appropriate dosage. The option to lower the dosage is no longer there as the lower dosages didn't ameliorate testosterone deficiency symptoms.Therefore by the time you've come to a dosage that works for the patient that raises E2 levels to unnaturally high levels say greater than 50 on E2 sensitive you would prescribe an AI regardless of being symptomatic due to the unknown effects of running long term high E2 levels especially some of the metabolites which cause cancer.

What has changed with your protocol from the above?
 
Having recently started trt, firstly on gels, I had monthly blood tests so I have a raft of recent tt and e2 scores. I struggle a little with the concept of ‘treat e2 as symptoms present’ as I have never really experienced any symptoms that reading would suggest point to an e2 problem.

In this time I have had tt of 300 with e2 around 22 as well as tt over 1000 with e2 over 100. The only time I was aware of this was with the actual blood test results and not with presenting symptoms. To be fair I felt a little ‘flat’ in general (probably the very low tt!) so I knew something was going on but experienced no ‘classic’ high e2 symptoms.

I know that it’s not en vouge thinking but is there any mileage in the view that tt to e2 ratio is big factor rather than just total e2 headline? Across all tests, while on this roller coaster my tt to e2 ratio sat around 8-13%.

Admittedly, I can’t say that with an AI bringing e2 down to 30 ish while having tt over a 1000 I might have felt like Superman. But what I can say is within the similar tt to e2 ratio band I didn’t feel bad nor felt the need to hit the AI due to symptoms
I don't recall reading about experiences with e2 near the 100 range or higher on these forums. I would be interested in hearing about others who have had experiences with these levels.
 
my guess is that E is not significantly elevated. Shorter half-life of T cream, increased conversion to DHT, which does not aromatise, by scrotal application and decreased rate of change of serum T
 
So I am clear about this, it's probably time I say there may indeed be no negative consequences whatsoever from inducing very high levels of T, E and DHT. We just don't know yet.
I have been following this and other threads on this matter and I have been very surprised by your change of opinion. While others laud you for being "open minded" I am trying to understand the (convenient) change in thinking. It was just recently that you had initiated a thread complaining about a doctor who uses scrotal application of creams and raises t/e/dht to very high levels. So what changed in the interim ?

Also, the same question holds for the new found appreciation for estradiol and abhorrence of AI's,were there some new studies that came out that changed your mind ? As Nelson pointed out in a comment, none of the estradiol stuff pointed out by Dr Rouzier and/or the tot table is new and these studies have been known for a while. I believe you were on 0.5 mg 2x a week so it will be interesting to look at your new results as not taking the AI's left you "feeling like a little girl" in your own words.

I apologize if I came across as rude but frankly hearing completely different views from advice I received on a consult less than a year ago is a bit troubling to me. I'm all for a change in direction but there has to be some facts to back that up -- if the studies haven't changed then hopefully its not about falling in line with whats in fashion now.
 
I think the Rouzier stuff has been taken somewhat out of context. The video is very long and I listened to about the second half of it. He has lots of studies which is appreciated.

In what I listened to, the main points were:

Studies showing disease correlated with high E2 levels were showing patients who at baseline had high E2 (not high E2 as a result of T or E2 supplementation). While there was a correlation, the cause was other issues as these tended to be fatter patients.

He then goes on to say that studies exist where when E2 was pushed higher through supplementation (T alone, E2 alone or both) and there was less diabetes, heart attacks, etc.

The point being that E2 has been demonized because the people with high E2 at baseline are high BMI people who then have more heart disease, diabetes, cancer. The E2 is not the cause of the disease.

He goes on to mention that the lipid panel is improved with more E2 and that by removing an AI, you see HDL go up.

He does mention examples of cardiologists who supplemented with E2 and T. By adding T (no AI), the lipid panel was improved. By adding supplemental E2, CHOL was reduced to 160. That's with an E2 level of 200. I know, probably the wrong E2 test, but it probably matters much less when we're measuring such high values.

Good food for thought and I recommend listening to the video.
 
Are there reasons to believe that some fixed level of estradiol is likely to be optimal, even in an individual? By this I mean that instead could one level be best for vascular health, a different level best for sexual function, yet another level best for prostate health, and so it goes? If we were lucky these numbers would be close, but if Rouzier's ideas are right then clearly different estradiol levels are better for different things—he is arguing the higher the better for reduced mortality, but there is reasonable clinical and anecdotal evidence showing that sexual function degrades in some men at higher levels of estradiol.
 
Are there reasons to believe that some fixed level of estradiol is likely to be optimal, even in an individual? By this I mean that instead could one level be best for vascular health, a different level best for sexual function, yet another level best for prostate health, and so it goes? If we were lucky these numbers would be close, but if Rouzier's ideas are right then clearly different estradiol levels are better for different things—he is arguing the higher the better for reduced mortality, but there is reasonable clinical and anecdotal evidence showing that sexual function degrades in some men at higher levels of estradiol.
Very interesting hypothesis. I'm pretty sure this isn't how the human body would work though. The body is the way it is due to thousands of years of constantly evolving to function better. It just wouldn't make sense for it to function better at specific things, depending on certain levels of a hormone. I can almost guarantee that it functions the best, in regards to all functions, when E2 is at a certain level. This level is going to be different for every guy. Can most male's ideal level of E2 be around the same range? Yup, it's possible. Can a guy's ideal E2 be in the 200's? Maybe. But what I can almost guarantee is, every male will function optimally, in regards to all bodily functions, when his E2 is at a specific number. Mother nature just wouldn't make it so different bodily functions work better at different E2 levels. Like I said, interesting theory though (no sarcasm).
 
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