Arimidex 0.125 mg per week too low?

[Eusung]

1 month into TRT after transitioning from HCG monotherapy:

E2 was 32 originally before TRT.

Right before my first injection, I am tested and my E2 for some odd reason is at 40…

So I was put on subq testosterone injections 0.25 mL 2X a week, HCG 500 iu 2X a week, and Arimidex 2x a week (1/8) of a tablet. I am assuming this means 1/8 of a 1mg tablet.

Blood tested about 2 weeks later and showed E2 at 24 and total test at 1300 ng/dl…so my doc told me to go back to taking the arimidex only once a week, so total 0.125 mg per week. She also told me to reduce my testosterone dosage to 0.2 mL twice per week.....I'm guessing that means 100 mg of test per week...right? Originally my certificate said Testosterone Enanthanthate (250mg/mL) 0.25 mL inject twice a week.....now that has changed to 0.2 mL....I was certain that means now I am injecting 50 mg twice a week for a total of 100 mg per week, which is pretty standard? or is that 200 per week, which is the highest therapeutic dose? I am so confused.

2 weeks later I get tested again…and now my E2 is at 40 again, and total test = 1080 ng/dl. My doc says this is in therapeutic range and to continue 1/8 of arimidex tablet once a week (total 0.125 per week).

However, I feel that I felt better with my E2 at 24 or 33 compared to 40.
The reference range is 25 to 60 pg/ml on my lab results.....but I have seen reference ranges of 10 to 40 pg/ml before. Again, I'm confused.

Do you think my doc acted prematurely in telling me to reduce to 1x a week?

It sounds like most people take 1/4 of a tablet. Or 0.25 arimidex once a week.

 

[Vince Carter]

Do you have lab tests that you can post/share? We can't assume youre getting the correct E2 testing which is a common problem. Would also need to see your SHBG result if you have it.

 

[Eusung]

The testing is done in Thailand. At this lab: N Health Asia

I don't have full labs on me but I have a screen cap of the E2 part. They only tested SHBG before starting the TRT so I don't know if it's useful. It was 46.62 nmol/L at one clinic then I went to another clinic where it was 46.2 nmol/L. One clinic run by a British doctor and the other run by an American. Follow up tests mainly tests total testosterone, blood cell counts, e2 levels.

Also I found this from a Texas based TRT clinic: Normal Estradiol Levels in Men

The Range of Normal Estradiol Levels in Men
For men, normal total estradiol levels are somewhere between 20–55 pg/mL (2.0–5.5 ng/dL) and 10-40 pg/mL (1.0-4.0 ng/dL), depending on who you ask.

The first range is based off a study of the total estradiol levels of 115 healthy men. You can read the study in its entirety here.

The same study with the same group of men found that free estradiol levels ranged between 0.3–1.3 pg/mL (0.03–0.13 ng/dL).

 

[Eusung]

2 weeks at 125 mg/ wk an HCG 1000iu/week w/ 0.25 arimidex, now 3 weeks at 100 mg/week, same HCG (500iu twice a week) but the doc told me to cut the arimidex dose in half, so 0.125 mg per week.

Total 5 weeks on TRT...before that I was on HCG monotherapy for a few months, taking aromasin 1x a week, not arimidex. The HCG monotherapy was only helping me physically, and giving me mental side effects (mood swings, agoraphobia, anxiety, being antisocial) so I switched to TRT w/HCG. I was surprised that the HCG dosage was 500iu twice a week. I thought it would be more like 300iu.

I thought it was standard to be on an AI if you are including HCG in your protocol. In fact I was thinking of asking the doctor if i could lower the HCG dosage and that way not have to worry about controlling E2 levels as much.

 

[Airborne Warrior]

I thought it was standard to be on an AI if you are including HCG in your protocol. In fact I was thinking of asking the doctor if i could lower the HCG dosage and that way not have to worry about controlling E2 levels as much.

Don't think AI's can touch E2 caused by HCG as it is aromatised in the testes.

 

[DragonBits]

Don't think AI's can touch E2 caused by HCG as it is aromatised in the testes.

That's a good question!

I read somewhere on the forum AI can cross the blood brain barrier and reduce estrogen in the brain. I believe doctor's initially thought it couldn't happen.

Not 100% sure about that either, can anyone confirm either situation?

 

[Eusung]

Don't think AI's can touch E2 caused by HCG as it is aromatised in the testes.

But HCG stimulates T production, right? Which basically raises your dosage by a bit, I thought. I was put on aromasin once a week while on HCG monotherapy and my E2 levels were lower during the HCG monotherapy compared to now. I was also on tamixofen while on the HCG monotherapy, but tamixofen is not part of my current TRT + HCG protocol.

So if an AI doesn't do anything to E2 levels from HCG....what about lowering my HCG dosage? I have heard of people injecting HCG only once a week (I'm guessing 500iu)

 

[Nelson Vergel]

The testing is done in Thailand. At this lab: N Health Asia

I don't have full labs on me but I have a screen cap of the E2 part. They only tested SHBG before starting the TRT so I don't know if it's useful. It was 46.62 nmol/L at one clinic then I went to another clinic where it was 46.2 nmol/L. One clinic run by a British doctor and the other run by an American. Follow up tests mainly tests total testosterone, blood cell counts, e2 levels. View attachment 6621

Also I found this from a Texas based TRT clinic: Normal Estradiol Levels in Men

The Range of Normal Estradiol Levels in Men
For men, normal total estradiol levels are somewhere between 20–55 pg/mL (2.0–5.5 ng/dL) and 10-40 pg/mL (1.0-4.0 ng/dL), depending on who you ask.

The first range is based off a study of the total estradiol levels of 115 healthy men. You can read the study in its entirety here.

The same study with the same group of men found that free estradiol levels ranged between 0.3–1.3 pg/mL (0.03–0.13 ng/dL).

Thanks for the great post.

This study included men that do not mimic our situation. Most had testosterone under 500 ng/dL. Since 0.3% of T is converted to E2, the range for guys with T over 500 ng/dL has a much higher upper limit.

 

[Nelson Vergel]

Also found this paragraph to validate what we have been saying for years

Comparison of total estradiol measured by immunoassay and LC-MS/MS
Of the subjects, 60 men had total estradiol measured by both the assays. The mean and median total estradiol concentrations measured by immunoassay were 3.95 ± 1.31 and 3.9 [3.1–4.8] ng/dL, respectively. In contrast, the mean and median total estradiol concentrations measured by LC-MS/MS were lower by almost half (2.16 ± 1.66 and 1.9 [0.8–3.2] ng/dL, respectively; P < 0.001 for comparison with immunoassay). The total estradiol concentrations measured by the two assays correlated only weakly (r = 0.37, P = 0.004).

 

[Gman86]

You say you felt a little better when your E2 was 24 and your testosterone was 1300. The fact that you don’t feel as good now could be due to your testosterone being lower, and have nothing to do with you E2. That’s why you never change two variables at once.

So maybe you just feel better at a higher testosterone level. Because your E2 looks really healthy at 40, especially considering your SHBG is mid 40’s. A good rule of thumb is to try and get your E2 to the same level as your SHBG.

 

[DragonBits]

But HCG stimulates T production, right? Which basically raises your dosage by a bit, I thought. I was put on aromasin once a week while on HCG monotherapy and my E2 levels were lower during the HCG monotherapy compared to now. I was also on tamixofen while on the HCG monotherapy, but tamixofen is not part of my current TRT + HCG protocol.

So if an AI doesn't do anything to E2 levels from HCG....what about lowering my HCG dosage? I have heard of people injecting HCG only once a week (I'm guessing 500iu)

HCG stimulates the tesicles to produce testosterone in men with secondary hypogonadism.

With primary hypogonadism your tesicles can't produce much testosterone because of testicular failure. So stimulate them all you want, you won't get much.

Using any LH or analog, I expect there should be a big difference between primary and secondary hypogonadism in how much testosterone is produced and therefor how much E2 can be aromatized in the testicles.

BTW, I have read that there are aromatase-negative HeLa cells that still convert Testos to estrogen even when you use an aromatase inhibitor.

 

[Eusung]

You say you felt a little better when your E2 was 24 and your testosterone was 1300. The fact that you don’t feel as good now could be due to your testosterone being lower, and have nothing to do with you E2. That’s why you never change two variables at once.

So maybe you just feel better at a higher testosterone level. Because your E2 looks really healthy at 40, especially considering your SHBG is mid 40’s. A good rule of thumb is to try and get your E2 to the same level as your SHBG.

Well I was at 1300 only after 2 weeks on exogenous testosterone so I thought whatever I would be feeling would be due to the HCG and arimidex

+I got that lab done literally one day after an injection due to some misunderstanding.

Ironically, I feel much better yesterday and today. I am now 36 days on exogenous testosterone.....2 weeks at 125 mg/week and the last 3 weeks at 100 mg/week (which is the dose I hear most doctors start patients at unless).

I know of people who had been on TRT for years who lowered their dosage and felt better.

For example, youtuber bigknowno consistently did 200 mg/week for years... It seemed to take him at least 6 months to feel significant improvement because when he started he was in a horrible state of depression and alcoholism...then finally after a full year he looked and sounded much better.

I think 6 months or a year ago he switched docs and the firsta thing his new doc did was lower his dosage from 200mg/week to around 130/150-ish. fter lowering his dosage, he said he felt the results quick (like a few weeks) and it was the best he ever felt on TRT. I think his total T now hovers around 1,000 to 1,100.

 

[Vince Carter]

That's a good question!

I read somewhere on the forum AI can cross the blood brain barrier and reduce estrogen in the brain. I believe doctor's initially thought it couldn't happen.

Not 100% sure about that either, can anyone confirm either situation?

That's been put out by one of our Drs and I'll not name him at risk of misquoting but yes, an AI is less effective in the testicular environment. Though I think and would assume in the best sense that we're talking about Anastrozole/Arimidex. I'm unsure if we could apply the same standard to one of the suicide inhibitors like Aromasin but I do attribute my change to Aromasin as something that did help me much better than Anastrozole has/did.

 

[Gman86]

Well I was at 1300 only after 2 weeks on exogenous testosterone so I thought whatever I would be feeling would be due to the HCG and arimidex

+I got that lab done literally one day after an injection due to some misunderstanding.

Ironically, I feel much better yesterday and today. I am now 36 days on exogenous testosterone.....2 weeks at 125 mg/week and the last 3 weeks at 100 mg/week (which is the dose I hear most doctors start patients at unless).

I know of people who had been on TRT for years who lowered their dosage and felt better.

For example, youtuber bigknowno consistently did 200 mg/week for years... It seemed to take him at least 6 months to feel significant improvement because when he started he was in a horrible state of depression and alcoholism...then finally after a full year he looked and sounded much better.

I think 6 months or a year ago he switched docs and the firsta thing his new doc did was lower his dosage from 200mg/week to around 130/150-ish. fter lowering his dosage, he said he felt the results quick (like a few weeks) and it was the best he ever felt on TRT. I think his total T now hovers around 1,000 to 1,100.

Ya I’ve been following him for years. As of september 2018, he was on 140mg/ week. These were his numbers at trough. Remember, this is his trough numbers on day 7, so they’re obviously much higher at peak.

Total T - 891
Free T - 251 (46.0-224.0)
E2 - 35.4

Just a quick question about him, since you’re the only other guy I’ve seen that knows about him on here. Do you think he would have much less mood swings and issues with depression and anxiety if he dialed his protocol more? I think about that when I see him struggling still. I don’t want to derail the thread, so if your answer is kind of long, feel free to private message me. I’d be curious to hear your thoughts.

But glad you’re starting to feel better though. Do you mind just posting your current protocol again, and when do you plan on getting blood work done again?

 

[Eusung]

You say you felt a little better when your E2 was 24 and your testosterone was 1300. The fact that you don’t feel as good now could be due to your testosterone being lower, and have nothing to do with you E2. That’s why you never change two variables at once.

So maybe you just feel better at a higher testosterone level. Because your E2 looks really healthy at 40, especially considering your SHBG is mid 40’s. A good rule of thumb is to try and get your E2 to the same level as your SHBG.

Well I was at 1300 only after 2 weeks on exogenous testosterone so I thought whatever I would be feeling would be due to the HCG and arimidex

+I got that lab done literally one day after an injection due to some misunderstanding.

Ironically, I feel much better yesterday and today. I am now 36 days on exogenous testosterone.....2 weeks at 125 mg/week and the last 3 weeks at 100 mg/week (which is the dose I hear most doctors start patients at unless).

I know of people who had been on TRT for years who lowered their dosage and felt better.

For example, youtuber bigknowno consistently did 200 mg/week for years... It seemed to take him at least 6 months to feel significant improvement because when he started he was in a horrible state of depression and alcoholism...then finally after a full year he looked and sounded much better.

I think 6 months or a year ago he switched docs and the firsta thing his new doc did was lower his dosage from 200mg/week to around 130/150-ish. fter lowering his dosage, he said he felt the results quick (like a few weeks) and it was the best he ever felt on TRT. I think his total T now hovers around 1,000 to 1,100.

Ya I’ve been following him for years. As of september 2018, he was on 140mg/ week. These were his numbers at trough. Remember, this is his trough numbers on day 7, so they’re obviously much higher at peak.

Total T - 891
Free T - 251 (46.0-224.0)
E2 - 35.4

Just a quick question about him, since you’re the only other guy I’ve seen that knows about him on here. Do you think he would have much less mood swings and issues with depression and anxiety if he dialed his protocol more? I think about that when I see him struggling still. I don’t want to derail the thread, so if your answer is kind of long, feel free to private message me. I’d be curious to hear your thoughts.

But glad you’re starting to feel better though. Do you mind just posting your current protocol again, and when do you plan on getting blood work done again?

Hey I tried sending you a PM through "start conversation" but I don't know if it worked.

I'm supposed to get my blood checked in about 4 weeks.

About your question, what exactly did you mean by dialing in his protocol more?

I didn't think much about how he still goes through tough moments because even then it's such a drastic improvement compared to him when he first started TRT.

I didn't realize he still struggles. In the videos I've seen him in recently he seemed to be doing fine, but I haven't watched all of them.

I do think the reason why it took a long time for him to feel the benefits of TRT was because he was on the old fashioned protocol of 2 IM injections per month, which in 2019 most of us know is not how to do it and will lead to more side effects.

Also he seemed to still be sticking to old bad habits in his first year of TRT (like drinking a lot and overeating junk food). So he gained a lot of fat in his first year on TRT

I hope I don't get a big increase in appetite. But I'm optimistic that I won't gain a lot of fat because I have pretty high metabolism naturally.

I also have issues with drinking that developed from a very stressful job that I quit months ago and currently am not working. Just hanging out in SE Asia not doing much. I'm hoping with increased energy and motivation I can go back to Korea and work better jobs with higher pay and high working hours (I was struggling recently with work because teaching is physically and mentally exhausting).

My protocol is this:

50 mg SubQ injections 2X/week (100 mg per week total)
500iu HCG 2X/week (1000 total per week)
0.125 mg Arimidex once a week

I worry about the HCG and arimidex dosage after doing some research. I plan on asking my doctor if I can lower the HCG dose to just enough to keep my system from shutting down...maybe 300IU injections instead of 500IU. Or 250 IU 3X per week because HCG has such a short half life that more frequent but smaller injections seems to lead to more a more stable mood.

It's been a little over 3 weeks on this protocol, and total 5 weeks on TRT. My first TRT protocol was:

62.5 mg subq 2X/week (125 mg per week total)
500iu HCG 2x/week (same as now)
0.125 mg Arimidex twice a week

My doctor changed my AI frequency to once a week, basically halfing the dosage after my E2 went from 40 to 23 in just two weeks. My doctor wants me steady at 40 pg/ml...but I prefer to be at 32 because that was what I tested at naturally. Also most other posters here seem to be in the low to mid 20s. This is why I wanna lower my HCG dosage or change the arimidex dosage to a middle ground between 0.125mg/week and 0.25 mg/week. Ideally I wouldn't have to take arimidex at all. I prefer aromasin as it seems less risky. I was on aromasin while on HCG monotherapy (I did a couple months of HCG monotherapy before transitioning to TRT...which is why my T levels got so high early in the therapy - the HCG monotherapy gave me a headstart in terms of total testosterone)

 

[Gman86]

Ya I did get it. I replied to it the other day. Here wash response.

I was also on HCG mono therapy at the beginning. What was your dose, and what brand of HCG did you use? And what did you levels look like while on HCG monotherapy?

What is your SHBG at? Do you feel any difference when you E2 is 40, compared to when it was 23? An E2 is actually very good. If I had an E2 of 40, I definitely wouldn't use an AI, that's just me though. My SHBG is on the higher side, usually high 40's or low 50's. A lot of guys on Excel don't have an E2 as low as you think, only the ones with very low SHBG levels. So you honestly might not even need an AI, especially if you plan on possibly lowering your HCG dose.

How do you currently feel?

But try to message me back through private message, that way we don’t derail the thread too much