Anastrozole and joint pain

Hey Guys,

Before I was on TRT I had mild joint pain. It wasn't enough to reach for pain meds, and it wasn't chronic. I treated it with taking a little extra fish oil and glucosamine tablets. Looking back I don't think those did much.
Shortly after starting TRT I noticed the mild joint pain less and less and stopped the glucosamine tabs but still use the fish oil for the multiple benefits. So I thought wow this testosterone is like oil for my joints.
After a year of TRT I switched clinics and the new clinic changed the protocol. They increased the testosterone a little and added HCG and anastrozole.
After being on this new protocol I notice joint pain, its not continuous pain it sort of comes on suddenly and then goes away. However my left elbow is significantly worse is almost continuous.
I suspect its the anastrozole causing this, if so how does this cause the pain? Does it break down the joints, will this cause arthritis?

Thanks

IF your estradiol is too low it can result in joint issues. How much Anastrozole are you taking? How much testosterone? And labs - can you provide your most recent lab values (testosterone and estradiol)?

CoastWatcher said:

IF your estradiol is too low it can result in joint issues. How much Anastrozole are you taking? How much testosterone? And labs - can you provide your most recent lab values (testosterone and estradiol)?

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Yea sure, here is the latest from LabCorp:
Testosterone total 1261
Free Test 32.9
Estradiol Sensitive 18.5

smithers said:

Yea sure, here is the latest from LabCorp:
Testosterone total 1261
Free Test 32.9
Estradiol Sensitive 18.5

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That is low estradiol. How much anastrozole are you taking/how often?

CoastWatcher said:

That is low estradiol. Was it a "sensitive" estradiol assay that was run? How much anastrozole are you taking/how often? If you aren't sure, post the range for the test and it should provide an answer.

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1 capsule twice weekly on inject days, 200mg caps

smithers said:

1 capsule twice weekly on inject days, 200mg caps

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I'm confused - nobody takes 200mg of anastrozole.

CoastWatcher said:

That is low estradiol. Was it a "sensitive" estradiol assay that was run? How much anastrozole are you taking/how often? If you aren't sure, post the range for the test and it should provide an answer.

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it says Estradiol Sensitive Result 18.5 units pg/ml Reference Interval 8.0 - 35.0

CoastWatcher said:

I'm confused - nobody takes 200mg of anastrozole.

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here is what the bottle says
Take 1 capsule by mouth twice weekly on inject days
Anastrozole 0.5/dim 200mg caps

smithers said:

here is what the bottle says
Take 1 capsule by mouth twice weekly on inject days
Anastrozole 0.5/dim 200mg caps

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Each capsule contains .5mg of Anastrozole and 200 mg of Dim. With the level of estradiol you posted, it may not be necessary for you to take an AI. Have you discussed that with your doctor?

smithers said:

it says Estradiol Sensitive Result 18.5 units pg/ml Reference Interval 8.0 - 35.0

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True but what most proficient hormone doctors are looking for is a good ratio of T to E, yours is 68-1, typical optimal is considered to be 14-20 to 1. So ideally your E should be in the neighborhood of 70ish with T approaching 1300. Clearly your E levels are suppressed, but ultimately it comes down to how you feel, and joint pain indicates you're kinda low. I just switched to .125mg twice a week, and I definitely feel better.

CoastWatcher said:

Each capsule contains .5mg of Anastrozole and 200 mg of Dim. With the level of estradiol you posted, it may not be necessary for you to take an AI. Have you discussed that with your doctor?

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haha that's a big difference , forgive my ignorance.
When I had my last consultation I mentioned the joint pain, I think it got a little worse after that consultation.
My dad has arthritis so I'm a bit nervous, could low estradiol accelerate or cause arthritis?

smithers said:

haha that's a big difference , forgive my ignorance.
When I had my last consultation I mentioned the joint pain, I think it got a little worse after that consultation.
My dad has arthritis so I'm a bit nervous, could low estradiol accelerate or cause arthritis?

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Typically, joint issues resulting from low estradiol resolve when serum levels are brought into line. I would urge you to speak with your doctor about whether you need to continue taking anastrozole, either at the level you're currently taking it, or - perhaps - eliminating it entirely.

thanks coast and max, I'll call and see if we can lower the dose.

0.5 mg twice a week is a pretty hefty dose even though it does not sound like much. I would definitely cut that at least in half if not try eliminating it altogether for 4-6 weeks and re-testing.

That's low E2 in relation to your TT...it's VERY LOW.

So many excelmale members have problems with low estrogen caused by an AI, It sure is over-prescribed. Here's a study on breast cancer women and anastrozole.

Anastrozole-Associated Joint Pain and Other Symptoms in Patients With Breast Cancer

More than a third of breast cancer patients undergoing aromatase inhibitor (AI) treatment report joint pain. We conducted a longitudinal study to characterize the course of AI-induced joint pain and other symptoms and to identify potential predictors for developing these symptoms. Patients were recruited before AI initiation. The Brief Pain Inventory, M. D. Anderson Symptom Inventory, and a joint-pain questionnaire were administered at baseline and then biweekly for 1 year. Analysis included logistic regression, Cox models, and mixed-effects models. Of 47 patients assessed, 16 (34%) reported joint pain at least once. Median time to first report of joint pain was 7 weeks (range 1–38). Baseline pain was the only predictor for both incidence of joint pain and time to first event. In the first 6 weeks, emergence of joint pain was associated with increase in general pain, fatigue, disturbed sleep, hot flashes, vaginal dryness, and decreased sexual activity. After week 6, having joint pain was associated with increase in general pain and with persistently high fatigue. Having AI-associated joint pain correlated with increase in or persistence of other symptoms likely related to AI therapy. Further research is needed to validate predictors of AI-associated symptoms.

I am slowly recovering from Aromatase Inhibitor Induced Musculoskeletal Syndrome, after being dosed at 1mg daily for 6 months and cutting the dose (not enough) myself when I realized what was happening. At first, I thought I was overtraining, but a few days off did not help. I stopped the anastrozole on Dec 8, 2015 and still have significant pain and limited motion in hands and hips. One finger in which there was pre-existing arthritis R/T trauma, was the first symptom to occur. For this entire 9 month period my LCMS/MS estradiol was below the measurable level. Part of this was my fault, because I am a retired Registered Nurse and should have known letter than to trust Physician Assistant.
Needless to say, I have a different Doc. Anyone have a similar occurence and have a faster treatment than time? My E2 a bit elevated now (51)(0-56) on the non-sensitive lab and I plan to allow that to remain until I recover.

Ta nked out E2 tends to take a bit to rebound. Stop using the non-sensitive E2 tests.

It's been about 12 weeks since I quit. NIH recommends a 3 week washout out doing a crossover study with anastrozole. My doc know it's the wrong test,but I don't think my E2 remains low. I've taken gabapentin as a pain modifier; don't want to do tricyclic antidepressants or acupuncture/ I'm alternating NSAIDs and APAP and ASA along with glucosamine. Slow recovery with some relapses, perhaps diet/CYP450 induced. Just hoped someone on this highly informative forum might know of a faster treatment than time. I read a study of women AI pain. It said 25 % recover in 6 months, 75 % have recover in 18 months, but didn't elaborate on the remaining 25%. Yes, I know many studies claimed stopping the AI stopped the pain. Different end points.