1. #1

    TRT - negative sides, looking for possible causes

    Hey guys,


    This is a past experience, I've discontinued since but considering trying one more time. The first TRT session was with pellets, overall experience was good, mild short of breath but wanted to try injections because of the long-term scar tissue of using pellets. I was on TRT for about 2.5 to 3 months with injections, most of the experience has been very positive until up to the past couple weeks I begin to notice facial and ear redness flushing with a warming sensation then this past week a rapid heart rate during workouts and evenings I get heart fluttering or palpitations off and on. The heart symptoms didn't occur until after a dose of arimidex at .25mg, so maybe the arimidex is to blame for my heart symptoms but the symptoms did not reside after weeks of waiting. I considered splitting the dose in to two injections a week to see if that helps with my estradiol having a chance to spike if that is the issue. Side note, I gave blood (double red) to confirm my hematocrit wasn't the issue and begin taking an aspirin during the evenings.
    I workout and exercise 6 days a week.

    Looking at my labs, I thought maybe it was due to my thyroid TSH elevating but talked to an endo and he said it's an upper range but not mandatory for me to take meds. He prescribed me a baby dose of synthroid incase I do elect to take it. The only theory based on my labs is it's due to low blood sugar levels "hypoglycemic".

    Age: 36

    When reviewing my labs, please note the top ones listed are older when using pellets.


    Code:
    Pre TRT (- TESTING PERFORMED AT ASSOCIATED REGIONAL UNIVERSITY PATHOLOGISTS, INC)
    5/2/16
    Total T: 640.0 300.0-1080.0 (ng/dL)
    Free T: 83.2 47.0-244.0 (pg/mL)
    
    
    F TSH 3.4 0.5-4.7 (UIU/ML)
    F T3 TOTAL 93 60-181 (NG/DL)
    F THYROID PEROXIDASE AB 1 <9 (IU/ML)
    F THYROGLOBULIN AB <1 <4 (IU/ML)
    
    
    F ESTRADIOL 22 SEE BELOW (PG/ML) - ****** EXPECTED VALUES FOR ESTRADIOL FOR PATIENTS >18 YEARS ******
    - ADULT FEMALES
    - EARLY FOLLICULAR PHASE . . . . . . . PG/ML 46 - 143
    - LATE FOLLICULAR PHASE . . . . . . . PG/ML 143 - 557
    - LUTEAL PHASE . . . . . . . . . . . . PG/ML 74 - 212
    - PREGNANT . . . . . . . . . . . . . . PG/ML UP TO 35,000
    - POSTMENOPAUSAL . . . . . . . . . . . PG/ML </= 34
    
    
    During TRT
    2/27/17 (Pellets)
    
    
    F DIHYDROTESTOSTERONE 518 112-955 (pg/mL)
    
    
    F TESTOSTERONE 590 300-1080 (NG/DL)
    F SEX HORM BIND GLOBULIN 72.4 H 16.5-55.9 (NMOL/L)
    F CALC FREE TESTOSTERONE 7.3 4.8-25.7 (NG/DL)
    F SEX HORM BIND GLOBULIN 56.5 H 16.5-55.9 (NMOL/L)
    
    
    F ESTRADIOL 28.9 <=60.7 (PG/ML)
    
    
    Post TRT
    6/30/2017
    
    
    F Testosterone, Serum 457 348-1197 (ng/dL) MB
    - **Please note reference interval change**
    F Comment: MB
    - Adult male reference interval is based on a population of lean males
    - up to 40 years old.
    F Free Testosterone(Direct) 11.5 8.7-25.1 (pg/mL) BN
    
    
    F Sex Horm Binding Glob, Serum 59.4 H 16.5-55.9 (nmol/L) MB
    
    
    F DHEA-Sulfate, LCMS 130 (ug/dL) ES
    - Reference Range:
    - Adult Males (31 - 40y): 33 - 416
    
    
    
    
    -----------------------------------------
    
    
    Pre (Second TRT attempt)
    
    Testosterone, Serum
    Pre: 508 ng/dl 
    range: 348 - 1197
    
    Testosterone Free, serum
    Pre: 7.2 
    
    T4 Free, serum
    Pre: 1.42
    ng/dL
    
    TSH
    Pre: 2.330
    uIU/mL 0.45 - 4.5
    
    T3 Free, Serum
    Pre: 3.0 
    
    Glucose, Serum
    Pre: 89     
    
    
    During TRT Most Recent  (200mg x 1 Injections)
    
    Testosterone, Serum
    During: 801 ng/dL
    range: 348 - 1197
    
    Testosterone Free, serum
    During: 15.3 pg/mL
    range: 5 - 21
    
    TSH
    During: 3.170 
    uIU/mL 0.45 - 4.5
    
    T3
    During: 2.8 
    pg/ml
    
    T4 Free, serum
    1.19 
    ng/dL
    
    Glucose, Serum  
    During: 53 L          
    mg/dL
    Last edited by kc119; 11-12-2017 at 02:06 PM.

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  3. #2
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    When I started TRT I had the same symptoms, friends would see my face flush bright red and I would break into a sweat, then quickly return to normal. I no longer get red faced anymore or experience heat intolerance. Twice weekly injections is a great starting point. FT is low, increasing TT will alway increase free T. Your body will adjust to the increase in red blood cell which could be what's causing red flushing and heat intolerance.

    Your body's thermostat is constantly in flux, it will find a new balance. SHBG is high, you require larger injections. This is why pellets provided low free T levels. High SHBG equals low free T, large shots will decrease SHBG and increase free T. Pellets are terrible, there are better choices. How long have you been on your current protocol? 200mg is too much unless you're a hyper T metabolizer, keep an eye on your E2.

    I'm concerned about no E2 testing, a lot of doctors fail to do this. If you think you can inject 200mg without high E2 sides, you're in for a rude awakening! We see it all the time.

    https://naturalbiohealth.com/2015/05/06/shbg-critical-to-your-health/
    Last edited by Systemlord; 11-12-2017 at 02:29 PM.

  4. #3
    Pellets are the worst possible method for TRT and its around 15 years out of date. Modern protocols typically have you injecting T twice weekly along with HCG twice weekly. AI is not used unless its proven to be needed by symptoms or blood work (Not automatically given as part of a cookie cutter TRT protocol, which is unfortunately quite common)

  5. #4
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    I am 3 months in like you. I had the exact same symptoms and thought they were related to high HCT which they weren't. The reason was high E2. When I increased my dose from 100 to 160 a week, my E2 went from 32 to 105. Since starting .25mg adex 2x/wk, the sides got MUCH better but not perfect yet.
    In my opinion, since you already took an AI, take .25mg twice a week and have E2 tested in about 5 weeks.

  6. #5
    Quote Originally Posted by Systemlord View Post
    When I started TRT I had the same symptoms, friends would see my face flush bright red and I would break into a sweat, then quickly return to normal. I no longer get red faced anymore or experience heat intolerance. Twice weekly injections is a great starting point. FT is low, increasing TT will alway increase free T. Your body will adjust to the increase in red blood cell which could be what's causing red flushing and heat intolerance.

    Your body's thermostat is constantly in flux, it will find a new balance. SHBG is high, you require larger injections. This is why pellets provided low free T levels. High SHBG equals low free T, large shots will decrease SHBG and increase free T. Pellets are terrible, there are better choices. How long have you been on your current protocol? 200mg is too much unless you're a hyper T metabolizer, keep an eye on your E2.

    I'm concerned about no E2 testing, a lot of doctors fail to do this. If you think you can inject 200mg without high E2 sides, you're in for a rude awakening! We see it all the time.

    https://naturalbiohealth.com/2015/05/06/shbg-critical-to-your-health/

    E2 results from most recent test on TRT
    Estradiol, Sensitive
    20.9
    pg/mL
    - - -

  7. #6
    Quote Originally Posted by ZoomyR6 View Post
    I am 3 months in like you. I had the exact same symptoms and thought they were related to high HCT which they weren't. The reason was high E2. When I increased my dose from 100 to 160 a week, my E2 went from 32 to 105. Since starting .25mg adex 2x/wk, the sides got MUCH better but not perfect yet.
    In my opinion, since you already took an AI, take .25mg twice a week and have E2 tested in about 5 weeks.
    You had the heart palpitations? That's really what bothered me the most, with shortness of breath/winded very easily

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    Double post

  9. #8
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    Quote Originally Posted by kc119 View Post
    You had the heart palpitations? That's really what bothered me the most, with shortness of breath/winded very easily
    Yes and my BP was up too. My heart rate is hanging around 76-85 bpm and is normally under 74.

  10. #9
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    Actually, it's not really palpitations. It's a feeling of anxiety and nervousness. Feels like palpitations.

  11. #10
    Quote Originally Posted by ZoomyR6 View Post
    Actually, it's not really palpitations. It's a feeling of anxiety and nervousness. Feels like palpitations.
    Were you accompanied with severe fatigue too?
    The doc didn't think my E2 levels were very high

    Estradiol, Sensitive 20.9 pg/mL range 8.0 - 35.0 02

  12. #11
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    Quote Originally Posted by kc119 View Post
    You had the heart palpitations? That's really what bothered me the most, with shortness of breath/winded very easily
    Hi kc, This is real easy to test. Stop the AI and see if you get better.
    You can quit cold turkey.

    What about HCT ?
    Also double check your T dosing make sure you are not overdosing and
    have you considered you might be having a reaction to the Tes fluid (usually cottonseed oil).

    hth
    Last edited by FeelingLost; 11-12-2017 at 10:01 PM.

  13. #12
    its arimidex brother... I never felt any bad side effects from trt before I started messing with arimidex.. the only sides from testosterone without arimidex were bloated face, acne and maybe more sweating but with arimidex i've got all kinds of stuff.. heart palpitations, dizziness, anxiety and feeling not healthy overall.. try ditch the arimidex and you gonna be feeling great but it will take a while
    also arimidex made my blood sugar all messed up and I feel like its crashing it I don't eat every 4 hours

  14. #13
    I had the same exact experience with arimidex. It was horrible and I thought I was dying because my heart was beating fast and I had horrible anxiety. I also felt dizzy and i could not sleep to save my life. Do you think those side effects are due to the arimidex knocking down you're e2 too low or is it just a side effect of the drug itself?

  15. #14
    i see some people have these issues even with normal e2 level but are on arimidex.. labwork shows us serum level but we have no idea whats going on at receptor level. I remember there was a time I thought if you are using testosterone you should be on estrogen control (it was like a common thing back then since there wasn't a lot of knowledge about whole trt) so I never felt "right" when on estrogen control even though numbers were looking alright.. then I decided to do no AI and man so many things got better.. even my nipple tingling sensation went away after I stopped anastrozole! so many issues resolved and I felt way better but it took few months full of anxiety and some panic attacks to get there after I stopped AI.. and my e2 stabilized on itself was a bit highish (a bit over normal range) but I felt great.. it was long time ago.. then 1 year after that I started anastrozole again (I couldn't get rid of water bloat and decided to go on AI again that was bad mistake) and somehow few weeks in my whole endocrine system crashed and I stopped responding to testosterone the way I did when I was healthy.. I have no idea what happened I obiously crashed estrogen but the situation never improved

  16. #15
    Quote Originally Posted by lowe2sucks View Post
    i see some people have these issues even with normal e2 level but are on arimidex.. labwork shows us serum level but we have no idea whats going on at receptor level. I remember there was a time I thought if you are using testosterone you should be on estrogen control (it was like a common thing back then since there wasn't a lot of knowledge about whole trt) so I never felt "right" when on estrogen control even though numbers were looking alright.. then I decided to do no AI and man so many things got better.. even my nipple tingling sensation went away after I stopped anastrozole! so many issues resolved and I felt way better but it took few months full of anxiety and some panic attacks to get there after I stopped AI.. and my e2 stabilized on itself was a bit highish (a bit over normal range) but I felt great.. it was long time ago.. then 1 year after that I started anastrozole again (I couldn't get rid of water bloat and decided to go on AI again that was bad mistake) and somehow few weeks in my whole endocrine system crashed and I stopped responding to testosterone the way I did when I was healthy.. I have no idea what happened I obiously crashed estrogen but the situation never improved
    Sorry to hear this bud, so did you discontinue TRT? What's your status now? I really feel like the arimidex made things worse when I took it, or else things just took a turn for the worse at the same time

  17. #16
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    This is odd. I had the same sides as the OP BEFORE going on adex. It wasn't until that I found out my e2 was 105 (15-30) that I started taking adex and it's been relieving my symptoms
    If you truly tested 20.9 (8-35), you definitely don't need an AI. 20 is not high at all.

  18. #17
    I am on trt now but the side effects that I got from arimidex didn't go away sadly. But I overdosed on it so your situation should be totally different.. just keep it simple and take lower dose of testosterone istead of testosterone with AI and issue should resolve. I always felt bad with arimidex no matter the dose.. even 0.25mg which would put me in normal range (I was a bit over normal range usually but didn't have any bad symptoms actually felt great) but I would feel bad with it.. I have no idea why maybe my body needs more estrogen to function optimally but that was something I definitely noticed from my experience with trt. Especially the the heart palpitations from arimidex that was scary since I never had them before. It took very long time for them to dissapear after quitting arimidex. And couldn't drink much coffee because it would make it worse.

  19. #18
    for those of you that havent seen me in a while i got a new job, haven't lifted in 8-9 weeks. I got off the 500mg a week blast ive been doing for a long while. Ive been off high doses of testosterone for 8-9 weeks. Ive been doing TRT using PARAPHARM test E at 0.3ml-0.8ml INJECTING ONCE every 7-14 days the past 9 weeks to keep my balls somewhat functioning naturally. I have arimadex on hand, parapharm as well ive been using 1mg a week @.5mg every 3.5 days(which i havent used since i stopped the high dosages). these past 9 weeks my doses have been around a half ml every 2-3 weeks, with NO ARIMADEX (due to low dose test).

    9 weeks ago sitting on my couch i ran a random 135 heart rate out of nowhere, made me dizzy, heart was skipping beats at a high rate, not functioning correctly. Got sent to the er via ambulance ekg came back normal. Stayed 135bpm for 3.5 hours in the er with nitro patch on. Got blood work done no enzymes found, good thyroid, t3 free and total were in normal range.

    Fast forward 2 days ago happened again at work. Heart rate ran high around 130bpm started messing up again.
    I went to urgent care so my pcm could see for himself.
    They did 4 pages of bloodwork, total and free t3 and t4 once agsin were normal..testosterone was 198ng/dl.
    Estradiol was 5!!!!!!!! lack of estradial caused heart palpitations and abnormal heart beat.

    With .5ml testosterone every 2-3 weeks you would think with no arimadex tsken there would be some estrogen in the body. Despite not taking adex for 8-9 weeks my estradiol came back at 5. This makes no sense to me. Can someone elsborate on this?
    look here one guy had same thing going on

  20. #19
    Quote Originally Posted by lowe2sucks View Post
    look here one guy had same thing going on

    Thank you for sharing this!!! I can almost guarantee mine was a similar case, after I took that one minor dose of arimidex i felt tired as hell and had all the heart issues, I believe some people react dramatically to arimidex. I never got tested after taking arimidex but can bet my E2 flat lined...
    Last edited by kc119; 11-13-2017 at 09:34 AM.

  21. #20
    Quote Originally Posted by JayLay777 View Post
    I had the same exact experience with arimidex. It was horrible and I thought I was dying because my heart was beating fast and I had horrible anxiety. I also felt dizzy and i could not sleep to save my life. Do you think those side effects are due to the arimidex knocking down you're e2 too low or is it just a side effect of the drug itself?
    Same here, I believe in my case it was taking e2 to low for me. I really feel best with e2 around 40.

  22. #21
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    IMO if you can avoid Arimidex or any AI do it!! Daily shots did it for me..! No AI, No Hcg, No Hemoglobin or Hematocrit issues period!

  23. #22
    Sounds kind of like hot flashes, when estrogen to testosterone ratio is out of whack, usually with estrogen being too high.
    My doctors refused to prescribe arimidex, so I take herbal estrogen inhibitors. They help flush the excess estrogen out of my system through the bladder (kombucha helps sweat it out). I experience issues if my estrogen goes above 20 (brain fog, rheumatoid arthritis, sleep effectiveness drops), and Iím a hyper excreter (half-life is 1/3 what it is for a normal man; SHBG though is 15, so free testosterone is high).

  24. #23
    Very interesting thread... Pretty much what I've been feeling and I can add that regardless of the dosage of Arimidex/Anastrozole, I feel the "Heat" come on almost immediately after taking it. I was started on 0.5mg x 3 week, then 0.25mg x 3 week, now at .125mg 3 x week, (with my shots of T Cyp and Hcg), and the heat comes on just the same. I'm a walking "sebum generating furnace".

    Test Cyp: 0.25ml M/W/F (200mg/ml)
    Hcg: 0.3 ml M/W/F (300 I.U.)
    Anastr: 0.125mg M/W/F

    Recent Test results:

    T serum: 1151
    T Free: 31
    E2 Sensi: 51
    SHBG: 26

    The doctor wants me to lower my E2 by doubling Anastrozole to .25mg 3 x week. My face, neck and abdomen are "puffier" and my ankles are swollen more than usual. Over the past 3 yrs on TRT, my E2 has crashed, been <5 to high 60's depending on how much Anastrozole I was taking. I KNOW that if I get off Anastrozole, the "Heat" turns off and the chest Zits come back along with water retention... (Neither of the two MD's that have managed my TRT accept that I may possibly react to Anastrozole differently than others. I'm sure I do...) I also occasionally feel winded and have high pulse rates. My HRT started 3 yrs ago with Gel, pellets and injections. nearly 1 yr of gel that didn't work, 3 courses of pellets that were expensive and nearly 2 yrs of injections. I'm 63 and wondering if I should reduce T and HCG dosage, stop the AI or quit everything alltogether...

  25. #24
    Christer 05, can you elaborate on what you call herbal estrogen inhibitors as well as your use of Kombucha? You "Hyper excrete" T?

  26. #25
    Quote Originally Posted by kc119 View Post
    Thank you for sharing this!!! I can almost guarantee mine was a similar case, after I took that one minor dose of arimidex i felt tired as hell and had all the heart issues, I believe some people react dramatically to arimidex. I never got tested after taking arimidex but can bet my E2 flat lined...
    I agree! I still don't know what the E2 "sweet spot" might be for me, but I don't believe AI via Arimidex works for me.

  27. #26
    Quote Originally Posted by pm3405 View Post
    Christer 05, can you elaborate on what you call herbal estrogen inhibitors as well as your use of Kombucha? You "Hyper excrete" T?
    hyper excrete, meaning T half life is much shorter. Running several blood tests over a couple weeks, determined that testosterone cypionate had a half life just short of 3 days in me vs the 8-10 day average. This is supposedly due to an over abundance of certain enzymes in the body.

    In terms of herbal remedies,
    Black Tea Kombucha assists the liver in removing toxins and hormones from the body. Your body stores excess toxins in your fat until it can get rid of it. Kombucha helps your liver metabolize toxins for removal, which is dumped into your poop. Heavy metals are also removed this way. If you have a large toxin buildup, taking Kombucha can make you feel ill due to the large amount of toxins (like excess estrogen) getting flushed: they leave your fat, travel your blood stream to the liver, hormones and many toxins get deactivated, then safely get removed from the body.

    I use inhibit-E from serious nutrition solutions on Amazon. The primary ingredient that affects estrogen is Brassaiopsis Glomerulata. It’s difficult to get wholesale unless you want to buy a 25kg drum. It supposedly works similar to other inhibitors, but I’ve noticed it works differently: it appears to bind to estrogen in the blood and help remove it from the body via the liver. I haven’t noticed a decrease in estrogen production from the aromatase enzyme.

    Androsta-3,5-diene-7,17-dione is a type II estrogen inhibitor. Typically don’t use unless you can monitor your levels and you are obese trying to supplement T and get crazy high estrogen levels (or have another issue like estrogen sensitivity).

    Berberine HCL is the herbal version of metformin, with similar power, but it also reduces the enzymes that metabolize hormones like testosterone. This means increasing their half-life. It has a short half life, about 3-4 hours, so requires supplementing 2-3 times per day. Not advised if taking other drugs because it can make the dose high enough to be toxic. Operates similar to grapefruit on drug doses, but much more powerfully.

  28. #27
    Thanks Christer. I've only tried DIM + Zinc and Calcium Gluconate as an alternative to AI without much apparent benefit. I'd REALLY like to stop AI and try something else. I'm not a body builder or physically active by a long shot and I retain a lot of fluid all over from face to ankles. I read that Inhibit-E will "Dry you out"... I don't suffer from arthritis but have low back and hip problems/weakness. I'm much better after learning a few exercises from a therapist. If I can test my Estradiol as frequently as needed, how much and what would you suggest I take by itself or in combination to replace Anastrozole? (I take 250mg Metformin 2x day for blood sugar control)

  29. #28
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    Quote Originally Posted by pm3405 View Post
    Very interesting thread... Pretty much what I've been feeling and I can add that regardless of the dosage of Arimidex/Anastrozole, I feel the "Heat" come on almost immediately after taking it. I was started on 0.5mg x 3 week, then 0.25mg x 3 week, now at .125mg 3 x week, (with my shots of T Cyp and Hcg), and the heat comes on just the same. I'm a walking "sebum generating furnace".

    Test Cyp: 0.25ml M/W/F (200mg/ml)
    Hcg: 0.3 ml M/W/F (300 I.U.)
    Anastr: 0.125mg M/W/F

    Recent Test results:

    T serum: 1151
    T Free: 31
    E2 Sensi: 51
    SHBG: 26

    The doctor wants me to lower my E2 by doubling Anastrozole to .25mg 3 x week. My face, neck and abdomen are "puffier" and my ankles are swollen more than usual. Over the past 3 yrs on TRT, my E2 has crashed, been <5 to high 60's depending on how much Anastrozole I was taking. I KNOW that if I get off Anastrozole, the "Heat" turns off and the chest Zits come back along with water retention... (Neither of the two MD's that have managed my TRT accept that I may possibly react to Anastrozole differently than others. I'm sure I do...) I also occasionally feel winded and have high pulse rates. My HRT started 3 yrs ago with Gel, pellets and injections. nearly 1 yr of gel that didn't work, 3 courses of pellets that were expensive and nearly 2 yrs of injections. I'm 63 and wondering if I should reduce T and HCG dosage, stop the AI or quit everything alltogether...
    Hello pm3405 from another 63 year old. So I got to ask.
    Have you considered you are taking way too much T ( I know I just committed blasphemy on this forum. It can never be too much T it is always something else, HAHA)
    and that is the reason for your water retension and not being able to get your E2 and probably prolactin in check.

    Have you tried 6 month with a TT trough at 700-750 ng/dL LabCorp ranges?

  30. #29
    I'm taking about as much T as I did early on when I started injections except in 3 vs 2 weekly shots. But I don't feel any better than when My T serum was at 5-600. (Can't remember what my free T levels were then). But I'm seriously thinking about cutting down T if I can stay away from AI...

  31. #30
    Inhibit E dries you out because it removes estrogen from your system, which takes time to replenish. Type II inhibitors remove the aromatase enzymes themselves by binding permanently to them (arimidex is a type I, meaning it temporarily bind to the enzymes). It takes 1-2 weeks for your body to make new enzymes, so type II means longer suffering if your estrogen levels are dropped too much. I would try inhibit E first, and take it whenever you feel the fluid retention. Take one at first, see how it affects you to rule out side effects. You might end up taking a few the first couple days, then space it out after that. Once the swelling goes down, test yourself to see what your max comfort level for estrogen is. Everyone is different. Iím estrogen sensitive so I feel crappy above 20, whereas most men wouldnít feel crappy till 40-50. Also, Iím not a doctor, I just study a lot and compile my own reports. You use at your own risk and liability. If you feel worse, stop taking it.

    Then focus on keeping your body fat below 20%, preferably around 15%. Fat on the torso, especially the gut, contains aromatase enzymes, so if you slim down, it will reduce your dependence.

    DIM is from broccoli and is a weak aromatase inhibitor. White mushrooms are actually better, and are the strongest kind that comes from food. Zinc helps with testosterone production, not directly counters estrogen, neither calcium gluconate, though they help with some of the symptoms of low T.
    Estrogen causes fluid retention. Remove the excess estrogen, and water leaves too. If your estrogen is too low, your joints will feel too dry, and you will lose calcium over time, making the bones weaker. Itís recommended to take a calcium supplement if you are taking any kind of estrogen inhibitor stronger than what you find in food.

    Quote Originally Posted by pm3405 View Post
    Thanks Christer. I've only tried DIM + Zinc and Calcium Gluconate as an alternative to AI without much apparent benefit. I'd REALLY like to stop AI and try something else. I'm not a body builder or physically active by a long shot and I retain a lot of fluid all over from face to ankles. I read that Inhibit-E will "Dry you out"... I don't suffer from arthritis but have low back and hip problems/weakness. I'm much better after learning a few exercises from a therapist. If I can test my Estradiol as frequently as needed, how much and what would you suggest I take by itself or in combination to replace Anastrozole? (I take 250mg Metformin 2x day for blood sugar control)

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