Anastrozole Monotherapy?

[Holden]

Apologies if this is clear to most, but would someone mind summarizing why some are concerned about Anastrozole? I see in some of the posts that some folks try their best not to take it.

What do you think of Anastrozole monotherapy to raise T levels for someone coming down from a pellet? Total T now 350 (348-1197), Free T 6.99 (5.00-21.00) Sensitive Estradiol 8.2 (8.0-35.0), LH 0.1 (1.7 - 8.6).

Thanks!

 

[Vince]

Why would someone want to lower their Sensitive estradiol 8.2, it may raise your T some. But you need E2, to functions properly and feel good.

 

[CoastWatcher]

Apologies if this is clear to most, but would someone mind summarizing why some are concerned about Anastrozole? I see in some of the posts that some folks try their best not to take it.

What do you think of Anastrozole monotherapy to raise T levels for someone coming down from a pellet? Total T now 350 (348-1197), Free T 6.99 (5.00-21.00) Sensitive Estradiol 8.2 (8.0-35.0), LH 0.1 (1.7 - 8.6).

Thanks!

Estradiol is NOT a waste product that men need to purge from their systems, a poison to be dreaded. It is absolutely necessary for sexual functioning, emotional well being, skeletal integrity, and cardiovascular health. It can rise too far, and thus need to be managed - not always with Anastrozole since protocol manipulation frequently does the trick, but it is not to be feared. There is plenty of excellent research documented here on the Forum that supports these assertions. The leading doctors in the field of androgen management are on record as saying (and many of our members would agree) that low estradiol is a state of unique hell - far more uncomfortable than elevated e2.

As for Anastrozole monotherapy with an estradiol/sensitive of 8.2...I can't imagine anything worse.

 

[Will Brink]

Apologies if this is clear to most, but would someone mind summarizing why some are concerned about Anastrozole? I see in some of the posts that some folks try their best not to take it.

What do you think of Anastrozole monotherapy to raise T levels for someone coming down from a pellet? Total T now 350 (348-1197), Free T 6.99 (5.00-21.00) Sensitive Estradiol 8.2 (8.0-35.0), LH 0.1 (1.7 - 8.6).

Thanks!

Mono therapy is usually a SERM, such as Clomid. What little boost in T you may get from Anastrozole will be accompanied by many potential side effects. Ergo, a very bad idea in my view.

- Will @ BrinkZone.com

 

[Holden]

@Vince @CoastWatcher @Will Brink Thanks for your comments. This was recommended by a Urologist from a top 10 urologist department. I'm just trying to be an informed patient, I don't disagree with what you're saying.

What are the side effects that you speak of?

@CoastWatcher who are the leading doctors in the field of androgen management that you allude to? I realize this forum is mostly a funnel for Defy and you and most folks here recommend Defy, and there's nothing wrong with that; but are there leading doctors who are not part of Defy? If so, who are they specifically?

 

[Vince]

https://www.excelmale.com/forum/showthread.php?2309-Role-of-Estradiol-in-Men-and-Its-Management

 

[Dr Justin Saya MD]

@Vince @CoastWatcher @Will Brink Thanks for your comments. This was recommended by a Urologist from a top 10 urologist department. I'm just trying to be an informed patient, I don't disagree with what you're saying.

What are the side effects that you speak of?

@CoastWatcher who are the leading doctors in the field of androgen management that you allude to? I realize this forum is mostly a funnel for Defy and you and most folks here recommend Defy, and there's nothing wrong with that; but are there leading doctors who are not part of Defy? If so, who are they specifically?

I can guarantee you that the top 10 Urology department you are referring to is NOT even in the top 50% of androgen replacement providers if they are considering prescribing anastrozole monotherapy for an E2 level of 8.2 while coming off of pellets. Perhaps top 10 for prostate issues? As Will stated, Clomid (a SERM) WOULD actually be useful in this scenario, but as a restart for your HPTA.

 

[johndoesmith]

Apologies if this is clear to most, but would someone mind summarizing why some are concerned about Anastrozole? I see in some of the posts that some folks try their best not to take it.

What do you think of Anastrozole monotherapy to raise T levels for someone coming down from a pellet? Total T now 350 (348-1197), Free T 6.99 (5.00-21.00) Sensitive Estradiol 8.2 (8.0-35.0), LH 0.1 (1.7 - 8.6).

Thanks!

That's not even your natural baseline though, most likely that testosterone level is entirely exogenous, so without your HPTA being back online, it's impossible to determine what kind of treatment you need.

You may be primary or secondary, chances are secondary.

To tell a guy who's literally at the low end of E2, the dangerous end, in terms of long term consequences, that he needs an AI is preposterous.

If you had E2 at the top of the range, and weren't suppressed, I'd say maybe it could work.

I don't know about "top 10" urologists, maybe top 10 for incontinence(or incompetence).

 

[Holden]

I can guarantee you that the top 10 Urology department you are referring to is NOT even in the top 50% of androgen replacement providers if they are considering prescribing anastrozole monotherapy for an E2 level of 8.2 while coming off of pellets. Perhaps top 10 for prostate issues? As Will stated, Clomid (a SERM) WOULD actually be useful in this scenario, but as a restart for your HPTA.

Thanks Dr Saya. Yes, I actually because of my numbers felt compelled to go to a doctor to try to get some advice. I'm actually signed up with Defy and have paid my money for an appointment with you, however they had told me there is a 5 week wait (that was 2-3 weeks ago). I had requested an exception for a customer who is in a situation where a restart is needed, and numbers continuing to decline, but that request was denied. Not a great first impression to be honest. I'm going to see another doctor this Friday for a second opinion.

 

[johndoesmith]

Thanks Dr Saya. Yes, I actually because of my numbers felt compelled to go to a doctor to try to get some advice. I'm actually signed up with Defy and have paid my money for an appointment with you, however they had told me there is a 5 week wait (that was 2-3 weeks ago). I had requested an exception for a customer who is in a situation where a restart is needed, and numbers continuing to decline, but that request was denied. Not a great first impression to be honest. I'm going to see another doctor this Friday for a second opinion.

5 weeks isn't too bad for a specialist.

I wouldn't be upset with them for not squeezing you in because if all the available appointments are filled there's nothing anyone can do. While it sucks to be in your situation, it isn't unique at all, so you honestly can't expect people to cancel another patient's appointment.

 

[Dr Justin Saya MD]

Thanks Dr Saya. Yes, I actually because of my numbers felt compelled to go to a doctor to try to get some advice. I'm actually signed up with Defy and have paid my money for an appointment with you, however they had told me there is a 5 week wait (that was 2-3 weeks ago). I had requested an exception for a customer who is in a situation where a restart is needed, and numbers continuing to decline, but that request was denied. Not a great first impression to be honest. I'm going to see another doctor this Friday for a second opinion.

You are indeed in a somewhat unique situation waiting for those pellets to dissolve (which can be variable). Good news is it appears they are all but dissolved at this point and if I'm calculating your timing accurately it should be about another 2 or so weeks until your consult with me. At that point there should be no roadblocks to getting on a more ideal regimen since the influence of the pellets are essentially out of your system. To be honest, even Clomid wouldn't offer much utility in that short of a timeframe especially as your system will be suppressed once again upon recommencing TRT (if that is the preferred direction). All the best and guess we'll be chatting soon.

 

[Holden]

You are indeed in a somewhat unique situation waiting for those pellets to dissolve (which can be variable). Good news is it appears they are all but dissolved at this point and if I'm calculating your timing accurately it should be about another 2 or so weeks until your consult with me. At that point there should be no roadblocks to getting on a more ideal regimen since the influence of the pellets are essentially out of your system. To be honest, even Clomid wouldn't offer much utility in that short of a timeframe especially as your system will be suppressed once again upon recommencing TRT (if that is the preferred direction). All the best and guess we'll be chatting soon.

Sounds good Dr Saya looking forward to it. Yeah, I've tried Clomid for a couple of weeks, not sure if I gave it enough time but it didn't seem to do much, and at the same time made me moody. Probably interested to see your view of subcutaneous testosterone injections + HCG. AI added only if needed. But I guess we'll see once we talk.

 

[CoastWatcher]

leading doctors in the field of androgen management that you allude to? I realize this forum is mostly a funnel for Defy and you and most folks here recommend Defy, and there's nothing wrong with that; but are there leading doctors who are not part of Defy? If so, who are they specifically?[/COLOR]

I'm sure you realize, upon reflection, that this is forum hardly a "funnel for Defy." In stating that it is you cast a shadow on the work that Nelson and his co-founders have done in creating this site, to say nothing of the efforts of all of us who turn to it regularly for discussion. Defy and its medical staff play a large role here for one reason - they know what they are doing. I can assure you that, as a moderator, I would love to be able to refer men looking for quality health care to doctors near their home, and in some instances that's been possible. However, the lack of knowledge demonstrated by so many physicians time after time results in a preponderance of the referrals made here resulting in treatment by Defy. I am not a patient, I don't live in the United States, so my opinion of Defy is not colored by any personal interest.

As to the matter of your original post, the following are some relevant citations that support the thesis that estradiol is an important male hormone.

Asian Journal of Andrology, 2016, May-June, The Role of Estradiol in Male Reproductive Function, Schulster, Bernie, et al
"Estradiol in men is essential for modulating libido, erectile function, and spermatogenesis... both estrogen and testosterone were required to increase libido, whereas neither hormone could achieve the effect alone suggesting that estrogen plays a necessary role in sexual desire in the setting of low testosterone."

New England Journal of Medicine, 2013, September 12, Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men, Finkelstein, Burnett-Bowie, et al
"As serum testosterone levels decline, there is a concomitant decline in serum estradiol levels. Nevertheless, the consequences of male hypogonadism are routinely attributed solely to androgen deficiency; the potential role of the concomitant decline in estrogens is typically ignored. It has become clear, however, that estrogen deficiency may be important in the pathogenesis of some consequences of male hypogonadism...decline in both (testosterone and estradiol) both contributed to the decline in sexual function."

American Society for Bone and Mineral Research, 2016 Annual Meeting, Claes Ohlsson, MD, The Institute of Medicine, University of Gothenburg, Gothenburg,15 Presentation September 10, 2016, "Low Oestradiol Increases Fracture Risk"

Journal of Clinical Endocrinology and Metabolism, 2016, August, Testosterone Treatment and Sexual Function in Older Men With Low Testosterone Levels, Cunningham, Stephens-Shields, et al
"Increases in total and free T and estradiol levels were associated with improvements in sexual activity and desire, however no threshold upper limit was established."

Canadian Urological Association Journal, 2015, SeptemberFazio, Gilbert, Are We Considering Low Estradiol's Presentation?"
"In the clinical situation, many men on TRT fear elevated estradiol, and doctors suppress e2 with anastrozole. Frequently such adjunctive therapy results in loss of libido, erectile dysfunction, fatigue, lethargy, and joint/muscle pain. Research has shown that it is possible to treat estradiol in to aggressive a fashion. Our own experience causes us now to hesitate prescribing an AI if other means and methods to manage e2 have not been considered."

 

[Holden]

I'm sure you realize, upon reflection, that this is forum hardly a "funnel for Defy." In stating that it is you cast a shadow on the work that Nelson and his co-founders have done in creating this site, to say nothing of the efforts of all of us who turn to it regularly for discussion. Defy and its medical staff play a large role here for one reason - they know what they are doing. I can assure you that, as a moderator, I would love to be able to refer men looking for quality health care to doctors near their home, and in some instances that's been possible. However, the lack of knowledge demonstrated by so many physicians time after time results in a preponderance of the referrals made here resulting in treatment by Defy. I am not a patient, I don't live in the United States, so my opinion of Defy is not colored by any personal interest.

As to the matter of your original post, the following are some relevant citations that support the thesis that estradiol is an important male hormone.

Asian Journal of Andrology, 2016, May-June, The Role of Estradiol in Male Reproductive Function, Schulster, Bernie, et al
"Estradiol in men is essential for modulating libido, erectile function, and spermatogenesis... both estrogen and testosterone were required to increase libido, whereas neither hormone could achieve the effect alone suggesting that estrogen plays a necessary role in sexual desire in the setting of low testosterone."

New England Journal of Medicine, 2013, September 12, Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men, Finkelstein, Burnett-Bowie, et al
"As serum testosterone levels decline, there is a concomitant decline in serum estradiol levels. Nevertheless, the consequences of male hypogonadism are routinely attributed solely to androgen deficiency; the potential role of the concomitant decline in estrogens is typically ignored. It has become clear, however, that estrogen deficiency may be important in the pathogenesis of some consequences of male hypogonadism...decline in both (testosterone and estradiol) both contributed to the decline in sexual function."

American Society for Bone and Mineral Research, 2016 Annual Meeting, Claes Ohlsson, MD, The Institute of Medicine, University of Gothenburg, Gothenburg,15 Presentation September 10, 2016, "Low Oestradiol Increases Fracture Risk"

Journal of Clinical Endocrinology and Metabolism, 2016, August, Testosterone Treatment and Sexual Function in Older Men With Low Testosterone Levels, Cunningham, Stephens-Shields, et al
"Increases in total and free T and estradiol levels were associated with improvements in sexual activity and desire, however no threshold upper limit was established."

Canadian Urological Association Journal, 2015, SeptemberFazio, Gilbert, Are We Considering Low Estradiol's Presentation?"
"In the clinical situation, many men on TRT fear elevated estradiol, and doctors suppress e2 with anastrozole. Frequently such adjunctive therapy results in loss of libido, erectile dysfunction, fatigue, lethargy, and joint/muscle pain. Research has shown that it is possible to treat estradiol in to aggressive a fashion. Our own experience causes us now to hesitate prescribing an AI if other means and methods to manage e2 have not been considered."

Thanks for your views. I'm still not clear on the answer to my original question...who do you consider to be "the leading doctors in the field of androgen management" who you reference in your first reply to my post? Are you saying the leading doctors in the field are the ones who wrote the citations above?

Also to be clear, I'm not trying to cast a shadow on this site, rather to shed some light, perhaps only to myself if no one else is wondering, on understanding the industry as a whole and why there is such a significant disconnect. As such, as a moderator on a site that is meant to help all interested in men's health, who specifically are "the leading doctors in the field of androgen management" that you reference? Thanks

 

[Vince Carter]

Dr Saya
Dr John Crisler
Dr Shippen

..other members may come along and name names but those are three major, dare i say, Pioneers, in Androgen Therapy.

 

[Will Brink]

I can guarantee you that the top 10 Urology department you are referring to is NOT even in the top 50% of androgen replacement providers if they are considering prescribing anastrozole monotherapy for an E2 level of 8.2 while coming off of pellets. Perhaps top 10 for prostate issues? As Will stated, Clomid (a SERM) WOULD actually be useful in this scenario, but as a restart for your HPTA.

That squared !

 

[Holden]

Dr Saya
Dr John Crisler
Dr Shippen

..other members may come along and name names but those are three major, dare i say, Pioneers, in Androgen Therapy.

Thanks Vince, those are the names I've seen noted as top in the field as well and probably is a great start to the list. I'd probably add Dr Mark Gordon as well. Thoughts?

 

[Will Brink]

Thanks Vince, those are the names I've seen noted as top in the field as well and probably is a great start to the list. I'd probably add Dr Mark Gordon as well. Thoughts?

His focus is on vets with TBI. I cover that HERE. Not sure if he does general TRT/HRT. Dr. Bedecs, who I work with out if his FL office is also quite good if not under the radar.

 

[Holden]

His focus is on vets with TBI. I cover that HERE. Not sure if he does general TRT/HRT. Dr. Bedecs, who I work with out if his FL office is also quite good if not under the radar.

Great article and thanks to the reference to Dr Bedecs.

 

[Will Brink]

Great article and thanks to the reference to Dr Bedecs.

See also:

https://www.excelmale.com/forum/showthread.php?9758-Age-Management-Center-and-BrinkZone-team-up