Getting dialled in, 6 months in

[NotAJedi]

As of my latest blood tests I have been on the following protocol which has been slightly adjusted over time;

• Sustanon 150mg, E5D
• Anastrozole, 0.5mg E5D

Overall feeling much better. My strength and gym progress has been phenomenal and energy is overall very good. However, sexual improvements seem to come and go... I guess the best way of describing it is I've become a bit indifferent. It will usually be several days before I'm truly "in the mood" again. I really hoped to reclaim some the sexual desire / appetite I used to have.

Another symptom is a lack of morning wood - I will have it perhaps a couple of days a week. No more.

The issue is I'm not sure whether I should be concerned my E2 is too high or too low. The estradiol test I had done is not sensitive as we don't have access to this in the UK. I did also have my CRP test which was low-normal. Which I know can have a big impact on the non-sensitive test accuracy.

In the past I have also ran no-AI; which besides some minor bloating I was generally the same as I am now. My E2 was particularly high - 283 pmol/L.

I've read several of Nelson's threads looking at T:E2 ratios - unfortunately without access to a sensitive assay I'm not sure if these are particularly helpful for me.

Bloods:

https://imgur.com/a/3q6AP2m

 

[Systemlord]

However, sexual improvements seem to come and go...

• Sustanon 150mg, E5D
• Anastrozole, 0.5mg E5D

The half life of anastrozole is 30-50 hours and you're taking it every 120 hours. This makes for a higher dose in your system initially (lower estrogen) and is cleared out of your system 5 days later (higher estrogen). This will cause your estrogen to change dramatically and affect your libido negatively.

If you had access to enanthate you could minimize T-E2 conversion by inject very small doses more frequent and could possible ditch the AI which is a drug that has side effects. The stuff murders my erections and turns me into a eunuch.

 

[NotAJedi]

Unfortunately enanthate / cypionate are not very common in the UK - at least not through prescription.

I should have added that my blood test was taken at trough - so it's interesting what you said about the AI potentially clearing out by the end of the 5 days. As I understand drug half-life though, at a 0.5mg anastrozole dosing there will still be 0.25mg active in 30-50 hours? Or is the half-life indicative of total active elimination of the drug?

 

[Systemlord]

As I understand drug half-life though, at a 0.5mg anastrozole dosing there will still be 0.25mg active in 30-50 hours?

Correct, there is probably some residual leftover. The question is when is your libido dropping off, at the beginning or as the anastrozole wears off.

Your estrogen score is at your lowest point is high by our standards, 48 pg/mL with the top of the ranges being 35 pg/mL. Considering the testing method is inaccurate nothing is certain.

You have plenty of room to decrease your T dosages, low SHBG men can achieve sufficient FT at midrange T levels, take me for instance, I only need a TT of 15-17 nmol/L to have my FT levels at the top of the ranges. Your TT is over range, this is why your estrogen is over range as well.

I one of the lucky few who see an increase in SHBG on TRT instead of a decrease.

 

[NotAJedi]

The question is when is your libido dropping off, at the beginning or as the anastrozole wears off.

To be honest I can't really pin it - the libido just sort of comes and goes as it pleases, as does erection quality. It seems neither better, nor necessarily worse at peak vs trough.

I have wondered about Free-E2 as well, given my low SHBG - I'm wondering if I would benefit from more frequent dosing of an AI.

 

[Vince Carter]

With an SHBG of 11 you should if you can afford it and it's avail to test your Free Estradiol, it can be an eye opener.
Just as a general observation because I'm less familiar with OEstradiol but if your numbers there were closer to the bottom of the lab range I think you could feel better. Your numbers are very high.

We know E follows T and that SHBG binds to E just like it does to T. So, you'll most certainly while seeing a very high level of Free T, you likely have a high level of Free E.

 

[NotAJedi]

Oestradiol is just E2 / Estradiol - a different spelling. Appears to be more common in the UK.

I tried a higher dose of AI, 0.25 EOD - haven't noticed a significant change - other than I started to look a bit flat - I was wondering if I was losing too much water? Might have just been placebo. However I am trending towards saying my libido is better towards the end of the 5 days. In other words - when my AI is at its lowest concentration.

I am now toying with 0.25mg E3D - in order to create a more even concentration.

I would be interested in having a Free E2 test - however it isn't available in the UK. I plan on visiting America at some point - maybe I'll have to get some blood tests when I'm next out that way! I am jealous of the sheer range of tests you have available across the pond.

 

[NotAJedi]

Follow up...

In the end I have tried eliminating my AI dosage completely. Following the thought that @Systemlord gave me - where I seemed to feel better when my AI was at its lowest concentration / at the end of the 5 days.

My experience...

None of the traditional symptoms of bloating or nipple soreness that you would expect if I had high E2. However, morning wood is definitely worse. Erection quality also seems a fair bit worse. Physique wise - I look fuller, at least relative to how flat I thought I was looking with the AI at higher dosages.

Libido continues to come and go - perhaps worse? I will say libido is something that takes me a long time to analyse. I am aware we all have natural 'ebbs and flows' - so I do my best to not make a blanket statement too quickly.

Seeing as this experiment with no AI has been largely a failure, I am tempted to return to either a 0.5mg / 0.25mg protocol E5D. My only concern is the long term use of an AI.

I have also considered adding a daily dose of Cialis to knock the erection quality issues on the head. Something like 5mg/daily. Which has already been suggested by my Doctor. I just don't feel like sticking a plaster over the issue if there is another cause.

I know @Nelson Vergel is a big proponent of E2 - I would be interested to know though are the long term effects of AI use, such as bone de-mineralisation and lipid effects the result of absolute serum E2 levels being too low or is this an unavoidable side-effect at any dosage irrespective of whether or not E2 is in the optimal range?

 

[Cataceous]

...
I know @Nelson Vergel is a big proponent of E2 - I would be interested to know though are the long term effects of AI use, such as bone de-mineralisation and lipid effects the result of absolute serum E2 levels being too low or is this an unavoidable side-effect at any dosage irrespective of whether or not E2 is in the optimal range?

The majority of negative effects are simply caused by estradiol being too low overall. However, @xqfq did point out a possible concern of a more direct effect on endothelial function.

 

[NotAJedi]

The majority of negative effects are simply caused by estradiol being too low overall. However, @xqfq did point out a possible concern of a more direct effect on endothelial function.

Another concern for the pile!

If the AI had a dramatic effect on me in terms of improving sexual function I would be far more inclined to roll with the potential side-effects - however because the addition of an AI only seems to result in minor improvements I am concerned that perhaps it isn't the best option.

I've never really gone above 0.5mg of Anastrozole. I still have some suspicions that my E2 could just be too high still with this dosage and hence I'm not seeing the improvements I want. One of the issues is - as I don't have access to a sensitive E2 test - I am inclined to believe my E2 isn't as high as the reading makes out.

 

[slicktop]

I'm going to sound like a broken record here, but you may want to add DIM to your protocol. Long story short as I can make it, I started TRT with test only, no ancillaries. Over responded, got sky high E2. Started taking DIM but only got a very mild reduction. Later started taking anastrozole, everything fell in line. I figured the anastrozole was the white night and discontinued DIM when I ran out of it- symptoms returned within a few days. Started taking the DIM again and kept the anastrozole, and that was the magic recipe *for me*. That was my protocol for quite some time, DIM 3x a day (morning/noon/night) and .25AI every three days or so. Disclaimer: I never had libido or ED issues as my E2 symptoms- mine were swollen finger joints, water retention, hot flashes, moodiness.

TLDR: consider DIM. It works differently than anastrozole, it's natural, almost impossible to cause a problem. Just my 2 cents. Good luck!

 

[DixieWrecked]

In my opinion people are too afraid of the AIs. I have used them for years without supplemental Test to improve my testosterone output. It works and I have ample labs to prove that. Some people are sensitive to them just like any other substance. They work differently in males than females. Depending on the person, AIs will decrease aromatization to a certain point. The type of AI seems to be more important that the dosage. For example letrozole obliterates E2 while 2 mgs a week of Arimidex will decrease it less (around 50%). Effects of Aromatase Inhibition in Elderly Men with Low or Borderline-Low Serum Testosterone Levels

This has me thinking about another tidbit I read on this forum and that is that AIs won't affect the estrogen that is created from HCG because that estrogen is produced in the testicles. I have no idea if this is true because I haven't researched it. However, using some logic, if it were true then some men that have elevated E2 due to HCG would not have to worry about tanking estrogen from an AI.

At any rate, your free T is really high. You could take 60%-70% of the T you're taking now and have E2 within normal ranges and still have high free T.

 

[Cataceous]

...
This has me thinking about another tidbit I read on this forum and that is that AIs won't affect the estrogen that is created from HCG because that estrogen is produced in the testicles. I have no idea if this is true because I haven't researched it. However, using some logic, if it were true then some men that have elevated E2 due to HCG would not have to worry about tanking the estrogen from an AI.
...

The problem here is that estradiol is also created and used locally, in tissues such as the brain, blood vessels, skin and bone. The excess estradiol produced intratesticularly might conceal the fact that you're starving these other areas of estradiol. I'm not saying this is proven, but it's an unknown to keep in mind.

 

[DixieWrecked]

The problem here is that estradiol is also created and used locally, in tissues such as the brain, blood vessels, skin and bone. The excess estradiol produced intratesticularly might conceal the fact that you're starving these other areas of estradiol. I'm not saying this is proven, but it's an unknown to keep in mind.

I think what you are implying is that it's possibe Estrogen produced inside the testicles doesn't leave the testicles? Do you get blood taken from your balls when you do labs? I don't and my E2 goes up when I am on HCG.

 

[Cataceous]

I think what you are implying is that it's possibe Estrogen produced inside the testicles doesn't leave the testicles? ...

No, I'm saying that estradiol created in the testicles raises serum levels, which may then look ok. But meanwhile perhaps the AI causes estradiol to be too low in some of these other tissues. It's just hypothetical at this point, and it doesn't stop me from taking low doses of anastrozole.

 

[DixieWrecked]

Gotcha. An AI lowers Estrogen by neutralizing the Aromatase Enzyme, not Estrogen. It does not block Estrogen or even interact with it. What you are describing sounds more like a SERM. A SERM (Selective Estrogen Receptor Modulator) like Clomid or Tamoxifen works by interacting with Estrogen receptors in certain parts of the body. Tamoxifen is particularly potent at blocking the Estrogen receptors in breast tissue. In other words, when taking an AI (or not) your bloodwork will tell you how much Estrogen you have in your body and there is no need to complicate things more than that.

 

[NotAJedi]

I'm going to sound like a broken record here, but you may want to add DIM to your protocol.

I guess really I have nothing to lose at this point. I will take a look into this. Your anecdote is appreciated given the relatively limited science on offer.

Would you mind sharing the dosage you used?

 

[slicktop]

I guess really I have nothing to lose at this point. I will take a look into this. Your anecdote is appreciated given the relatively limited science on offer.

Would you mind sharing the dosage you used?

Dang, I'm glad you asked. Made me look into it and I think I might be taking too much, but it certainly isn't hurting anything. Anyways, I started with whatever they had on the shelf at Vitamin Shoppe (desperation, ya know) and with that stuff the directions said to take 3 caps at a time for the daily dosage (whatever that was, I don't remember). So I split that into one cap morning, noon, and night instead. When I ran out of that I ordered one of the highest rated DIM supplements off Amazon that had the best price. Looking at it now, I've been take way more powerful caps at the same frequency--200mg 3x a day! But no adverse reactions. Again, it's made from like broccoli and stuff, so it's hard to imagine overdoing it. I may try lowering, but then again, if it ain't broke...

 

[Blackhawk]

Another thing to consider is titrating anastrozole dose for more frequent but potentially even lower total weekly amount. More than a couple guys on this form do this, myself included. You and I appear to have very different needs in terms of dosage and dosing frequency, but I only take 0.06mg QOD. That's equivalent of 0.21mg/week. It brings my E2 down by 5-10 points E2 sensitive LC/MS/MS, and in conjunction with T cyp QOD dosage, I no longer have fluctuation in E2 symptoms.

This kind of strategy may or may not work for you. With sustanon you have sort of a diffferent substrate for anastrozole strategy than I do.