Confusing discussion about AI's with my doctor's office

You Gonna Learn Today · May 27, 2016

I reached out to Empower about a week and a half ago to see if I could get my Anastrozole refill sent to me in a .25mg dose instead of the .5mg dose. They sent a refill request with those notes to my doctor's office to see if it would be approved. I called Empower back today and they told me their faxed request has still not been approved, so I decided to contact my doctor's office directly.

After receiving a call from the nurse at my doctor's office earlier, I began mentioning my situation to her. I mentioned how I was looking to decrease my dosage because the .5mg dose was really making things worse instead than better (fatigue, no night wood, etc). Based on information I've read on this forum, I've read that it's best to only take AI's when I'm feeling symptoms (sore and sensitive nipples, night sweats, etc) and not based on numbers or labs. So that's what I mentioned to her and she asked why I wasn't taking my meds the way the doctor prescribed (.5 mg twice a week). She sounded pretty upset about what I had been doing.

I then told her that I had read where if you split the TCyp dosage and frequency, it would help eliminate the need for an AI to begin with. She said "that is absolutely not true". WHAT?!?!

I'm ready to switch to Defy and cancel my upcoming appointment with my doctor. Before I do so, though, I wanted to see if I was wrong with what I had mentioned to her.

1. Shouldn't we be taking an AI only if we feel symptoms?
2. Shouldn't splitting the dosage over 3.5 days, EOD, or even daily help REDUCE the chances of increased E2 levels and sometimes eliminate the need for an AI?

I have no issue admitting when I'm wrong, but was I wrong? Or did I misunderstand previous posts?

CoastWatcher · May 27, 2016

You Gonna Learn Today said:
1. Shouldn't we be taking an AI only if we feel symptoms?
2. Shouldn't splitting the dosage over 3.5 days, EOD, or even daily help REDUCE the chances of increased E2 levels and sometimes eliminate the need for an AI?

I have no issue admitting when I'm wrong, but was I wrong? Or did I misunderstand previous posts?

Walking away from that practice is the best thing you could do for your health (and peace of mind). An AI should be prescribed and taken when a number of factors are lined up. Is your E2, on the sensitive test, elevated? What is the T:E ratio, and - most importantly - how are you feeling? What sort of symptoms are presenting themselves? Good doctors, and well-informed patients (like you) understand that. Lower doses injected more frequently certainly can lower E2 levels. I was injecting 60mg/3.5 days and my estradiol was steadily climbing - it hit 55. I went to daily injections of 16mg and it dropped to 29.5 - I have never taken an AI.

You Gonna Learn Today · May 27, 2016

Thanks for your response, CoastWatcher. Based on my lab work taken 4 days after a 200mg TCyp injection (no HCG, at the time), my levels were as follows:

Total Testosterone = 300-1080 ng/dl : 1,309
Calc Free Testosterone = 4.8-25.7 ng/dl : 42
Estradiol = 0.5-5 ng/dl : 11

Honestly, this was my first set of labs where my Estradiol was measured so I don't know what kind of testing was done (sensitive vs regular). All I know is the range and results above are what was showing on my labs when I received them. I'm not sure if that's high, but at that time I was not feeling any nipple issues and such.

I switched to 100mg E3.5D because I was starting to lose night wood, hoping to see if that would help. After I switched to E3.5D suddenly the night wood was back with a vengeance! But then I started feeling nipple sensitivity, some nipple pain, and night sweats when I had the AC and fan on full blast. That's when I called my doctor and they put me on an AI.

I was planning on waiting until my next appointment and labs on June 17th to see how my E2 levels were and see if there was a need to move to EOD and daily injections. I don't have an issue with daily injections, so I'm ready to roll with that if I need to.

CoastWatcher · May 27, 2016

Your instincts are sound. I would caution you that nipple sensitivity in and of itself is indicative of...nipple sensitivity. I am NOT arguing that you don't need to lower your E2, nor am I saying that an AI might not be appropriate. I am confirming your impression that lower, more frequent injections of testosterone bring estradiol into line for many, many patients. The fact that your doctor didn't measure your estradiol prior to initiating therapy is a sure indication that the practice isn't as trustworthy as you'd thought. Couple that with instructions to inject 200mg (typically near the top of the HRT range) once a week...you deserve better.

ERO · May 28, 2016

Don't walk but RUN from that doctor. Your instincts are correct.

Vince Carter · May 28, 2016

A different perspective if you're otherwise happy, obviously you have more knowledge than they do on this subject. Make your own Anastrozole liquid. Using Vodka (preferrably) dissolve 1mg in 1mL of Vodka. You can custom dose that to whatever you think you need. You probably opened a can of worms there with them trying to change the dose. You're absolutely right, .5mg taken as though it's a requirement, is not a good idea and it's too much for one dose.

You Gonna Learn Today · May 31, 2016

So, I got a call back from the nurse today. She seemed to be in a much better mood than the last time we spoke. She said she spoke to the doctor and he agreed that reducing the Anastrozole dosage to .25mg would be fine. Then she said he wanted me to stick with the twice a week schedule, though, and not to deviate from it anymore.

I've got my next appointment with him on June 17th. I'll be asking lots of questions during that appointment and if I'm not satisfied with the treatment plan and his answers, I'll be switching to Defy. Right now, I'm about 85% certain I'll be switching after that appoint. At the moment, my labs are not too expensive and neither are my meds (very comparable to Defy and DiscountLabs because of my insurance), so the only difference would be the quality treatment from the doctor. If I don't like the results of this next appointment, that 85% will easily turn into 100% the very moment I walk out of his office.

Bama Boy · May 31, 2016

You Gonna Learn Today said:
I reached out to Empower about a week and a half ago to see if I could get my Anastrozole refill sent to me in a .25mg dose instead of the .5mg dose. They sent a refill request with those notes to my doctor's office to see if it would be approved. I called Empower back today and they told me their faxed request has still not been approved, so I decided to contact my doctor's office directly.

After receiving a call from the nurse at my doctor's office earlier, I began mentioning my situation to her. I mentioned how I was looking to decrease my dosage because the .5mg dose was really making things worse instead than better (fatigue, no night wood, etc). Based on information I've read on this forum, I've read that it's best to only take AI's when I'm feeling symptoms (sore and sensitive nipples, night sweats, etc) and not based on numbers or labs. So that's what I mentioned to her and she asked why I wasn't taking my meds the way the doctor prescribed (.5 mg twice a week). She sounded pretty upset about what I had been doing.

I then told her that I had read where if you split the TCyp dosage and frequency, it would help eliminate the need for an AI to begin with. She said "that is absolutely not true". WHAT?!?!

I'm ready to switch to Defy and cancel my upcoming appointment with my doctor. Before I do so, though, I wanted to see if I was wrong with what I had mentioned to her.

1. Shouldn't we be taking an AI only if we feel symptoms?
2. Shouldn't splitting the dosage over 3.5 days, EOD, or even daily help REDUCE the chances of increased E2 levels and sometimes eliminate the need for an AI?

I have no issue admitting when I'm wrong, but was I wrong? Or did I misunderstand previous posts?

This is exactly the reason I am canning my Doctor also ! I don't know a lot but I do know since I started TRT every 3.5 days 3weeks ago I can already feel a difference ! I am hopefully doing my labs this week for Defy

You Gonna Learn Today · May 31, 2016

Bama Boy said:
This is exactly the reason I am canning my Doctor also ! I don't know a lot but I do know since I started TRT every 3.5 days 3weeks ago I can already feel a difference ! I am hopefully doing my labs this week for Defy

Good luck, Brother! I may be headed that way soon, myself!

Confusing discussion about AI's with my doctor's office

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