Dr. Saya...AI's, estradiol management...

[JimBob]

If he's willing to respond here, I'd like to know Dr. Saya's position on the use of AI's in estradiol management. Does he try to keep men's estradiol within a narrow range...?

I ask because of something Nelson posted in another thread regarding former patients of Dr. Crisler and Defy. Defy states (emphasis mine), "…"Dr Saya had a great relationship with Dr Crisler and they learned alit from each other. Dr Crisler felt that his protocols would remain intact under Dr Saya since they are aligned with their patient treatment..." As we know, Dr. Crisler's personal protocols with AI's changed very recently, and I'm wondering if Dr. Saya is also on board as well with these recent changes in protocol, as far as his patients are concerned. Thank you.

 

[Gman86]

I’d also love to hear Dr. Saya’s input and thoughts on estrogen.

 

[BCD19800]

As a new Defy patient, I would also like to know if their treatment philosophy will change. I started treatment 6 weeks ago and was told to use an AI soon as I started.

 

[Vince Carter]

Dr Saya treats my symptoms, not the numbers or keeping me in a range he thinks is good.

 

[Pringle]

Dr Saya treats my symptoms, not the numbers or keeping me in a range he thinks is good.

My experience as well. Very intuitive and have made several effective adjustments with my protocol over past couple of years. I have transitioned through no AI, to taking a small dose, back to none all with Defy. Adjusting dosing was their direction as they learned I really was concerned taking an AI long term. It has been a great experience working with the doc to find the place I feel best......far from my prior experiences with other Doc’s!

 

[ronadams9]

I’d also love to hear Dr. Saya’s input and thoughts on estrogen. So far they have aimed to keep my estradiol below 35 and I am on a very small dose of Anastrozole. However, as every thing has been very good and I feel great I have not questioned it.

 

[JimBob]

Dr Saya treats my symptoms, not the numbers or keeping me in a range he thinks is good.

But, doesn't Dr. Saya pretty much let you call your own shots since your knowledge is at a pretty high level with egards to TRT?

 

[Sean Mosher]

They probably have very good discussions at least would be my guess.
The more you learn about this stuff the more interesting the dialogue becomes with the doc!

 

[DragonBits]

I think doctors are always calling the shots when prescribing. But they all have a range that it's up to your discretion how you want to treat, and they take input within that range. Doctors have a legal and ethical responsibility not to facilitate the patient in harming themselves.

So, no matter how knowledgeable I am, if I say I feel best at a Total T of 3000 at trough, I don’t think you will find any legitimate doctors willing to prescribe enough testosterone to get you that high.

The patient is always calling the negative shots. I can always refuse any recommended treatment.

A knowledgeable patient knows that they can ask for and what is out of a doctor’s ethical bounds to prescribe. The confusion is that each professional office has their own standards of practice that can be quite different. So, one doctor may regard a total T of 300 as not needing TRT, while another doctor will treat a total T of 400. No doctor is going to say a total T of 700 (with normal range SHBG) needs TRT / extra testosterone. And it's not always up to the doctor's personal opinion, they all operate within a legal and office framework.

I don’t know Defy policy in regards to estrogen, but I am thinking if you are at 50 pg/ml, I doubt they will allow you to order an estrogen product to get your estrogen up to 100 pg/ml even if you think that is heart protective. (I could be wrong about that, but it’s my guess).

 

[BCD19800]

I’m becoming more concerned with using AIs in general when there are several prominent TRT physicians who participate on the TRT round table YouTube series that are very anti AI. I would really like to understand the risks associated with the use of anastrazol. There are also other online TRT communities that are very anti AI. I’ve read comments that AIs are “poison” and should be used as a last resort. I’m new to this world so I suppose I’m getting confused and a little concerned.

 

[Tednacious73]

I'm also a Defy patient and am curious about Dr. Saya's opinion on AIs. I've been on TRT for about 2 months now and a couple weeks ago quit taking the prescribed 0.125mg (E3.5D) Anastrazole due to concerns stated on this forum. I wans't experiencing any negative side effects and I haven't noticed anything since stopping the AI, it will be interesting to see what my bloods show in about 1 month (I'm on 70mg test cyp and 500iu HCG E3.5D)

 

[Cataceous]

I think maybe two or three consults ago the NP said to me, in reaction to my estradiol of ~50 pg/mL, something like "We normally would target low 40s." I was doing fine at the time, so didn't do anything, and there was no pressure to start an AI. But over time my libido and such seemed to be slipping. So early this year I asked for and promptly received an AI prescription. Over the course of the year my estradiol has dropped into the low 30s, and libido and nocturnal erections have greatly improved. Of course I can't prove causality, but it's quite possible, and Dr. Saya agrees that some guys do not do as well with higher estradiol, at least with some parameters.

 

[Dr Justin Saya MD]

I posted a long post a while back summarizing thoughts on the subject. Unfortunately, it was part of a thread where a member became hostile to other members and the entire thread was subsequently deleted.

In essence it all boils down to two words: SYMPTOMS and BALANCE

Symptoms indicate and guide (to an astute and experienced practitioner) the need for any treatment (whether it be TRT in general, AI, thyroid treatment, adrenal support, etc) and balance rules the entire human body, with hormones being no exception.

We know that there is risk with too low and too high of levels for any hormone in a biological entity (is E2 the only exception in the human body?). Where is that line of too high? - no one knows and to complicate further that “line” is likely variable from patient to patient dependent on countless other variables (SHBG, prolactin, DHT, thyroid function and TBG, phyto amd xenoestrogen exposure, alcohol, genetics, receptor regulation, etc, etc).

Anastrozole is a tool in the toolbox. Some patients need it, many don’t. Sometimes it is thought it is needed and subsequently determined it wasn’t. Whereas sometimes it is thought it wasn’t needed and subsequently determined it was. Balancing hormones is a symphony, not a solo, and even the brightest minds in our field are challenged to BALANCE all of the relevant variables and moving parts.

As mentioned in a post above, after participating in the hormone dance for so long, with so many patients, often some intuition begins to develop as well (for all practitioners)...this is the “art” you here spoken of to augment the science.

Also we keep in mind the difference between a medicine and poison is a matter of dosage. Vitamins, supplements, medications, etc can virtually all present toxicities (poison) at high levels and high dosages...thus when ANY medication is used, lowest effective dosage is key (those poor guys taking anastrozole 1mg daily - or similar...).

I’m in agreement Anastrozole is over-prescribed and, worse, often in too high of doses as part of a standing protocol or “cookie-cutter” approach. In fact, even my dearly missed pal Dr John was more aggressive, in many instances, with his anastrozole (0.5mg commonly).

I don’t want to comment in too much depth on that topic, as I am still grieving personally and reconciling the loss of a friend, but everything is not always as it appears on the surface. Dr. Crisler “consulted” with me for his personal hormone treatment and it was my name on his RXs. He did most of his own personal driving, but I ultimately discussed and approved for him while, as noted, “first doing no harm”. Fact is he had been on and off of anastrozole many times in the past, for varying periods of time, only to find himself back on due to various symptoms he would convey (nipples, irritability, excessively emotional, feeling “like a little girl” as he would playfully put it). He would feel better sometimes on, then worse, sometimes better off, then worse...there were many other factors at play (as there are for all of us). The fact he decided to broadcast his most recent anastrozole variations (as opposed to the many occasions of on/off prior) was due to some outside forces (and outside sources of angst) that were troubling him. I don’t want to get any deeper on this topic, but John was troubled by some recent events in his life, which bothers me as well.

Regarding anastrozole/estradiol management - we aim to resolve symptoms, we aim to achieve balance with the hormonal symphony (more challenging in some cases than others), we aim to use our intuition when applicable, and we accept the reality that no one has all of the answers to all of the questions at this time (particularly on this topic). I love all of my patients who need anastrozole just as much as I love those who do not need it.

I will leave this thread be for now as I continue to grieve the loss of my friend and colleague, the great Dr John Crisler.

 

[Gman86]

I’m becoming more concerned with using AIs in general when there are several prominent TRT physicians who participate on the TRT round table YouTube series that are very anti AI. I would really like to understand the risks associated with the use of anastrazol. There are also other online TRT communities that are very anti AI. I’ve read comments that AIs are “poison” and should be used as a last resort. I’m new to this world so I suppose I’m getting confused and a little concerned.

From my understanding, there is zero risk(s) to taking an ai, as long as you keep E2 in a healthy range. What the doctors are stressing is the fact that anyone controlling E2 is missing out on the additional benefits of having high E2, not so much that using an ai causes harm. An ai will only cause harm if you over suppress E2.

 

[Vince Carter]

But, doesn't Dr. Saya pretty much let you call your own shots since your knowledge is at a pretty high level with egards to TRT?

Perhaps...I've been allowed to work thru my symptoms and given great latitude to find what works for me. I'm very grateful.

 

[JimBob]

From my understanding, there is zero risk(s) to taking an ai, as long as you keep E2 in a healthy range. What the doctors are stressing is the fact that anyone controlling E2 is missing out on the additional benefits of having high E2, not so much that using an ai causes harm. An ai will only cause harm if you over suppress E2.

I disagree, at least in the case of Dr. Kominiarek. He believes it does cause harm over time, regardless of dosage. He speaks of bone loss, as an example. I think he made that clear in his interview with Jay

 

[Tednacious73]

Thank you for your thoughtful reply Dr Saya

 

[Gman86]

I posted a long post a while back summarizing thoughts on the subject. Unfortunately, it was part of a thread where a member became hostile to other members and the entire thread was subsequently deleted.

In essence it all boils down to two words: SYMPTOMS and BALANCE

Symptoms indicate and guide (to an astute and experienced practitioner) the need for any treatment (whether it be TRT in general, AI, thyroid treatment, adrenal support, etc) and balance rules the entire human body, with hormones being no exception.

We know that there is risk with too low and too high of levels for any hormone in a biological entity (is E2 the only exception in the human body?). Where is that line of too high? - no one knows and to complicate further that “line” is likely variable from patient to patient dependent on countless other variables (SHBG, prolactin, DHT, thyroid function and TBG, phyto amd xenoestrogen exposure, alcohol, genetics, receptor regulation, etc, etc).

Anastrozole is a tool in the toolbox. Some patients need it, many don’t. Sometimes it is thought it is needed and subsequently determined it wasn’t. Whereas sometimes it is thought it wasn’t needed and subsequently determined it was. Balancing hormones is a symphony, not a solo, and even the brightest minds in our field are challenged to BALANCE all of the relevant variables and moving parts.

As mentioned in a post above, after participating in the hormone dance for so long, with so many patients, often some intuition begins to develop as well (for all practitioners)...this is the “art” you here spoken of to augment the science.

Also we keep in mind the difference between a medicine and poison is a matter of dosage. Vitamins, supplements, medications, etc can virtually all present toxicities (poison) at high levels and high dosages...thus when ANY medication is used, lowest effective dosage is key (those poor guys taking anastrozole 1mg daily - or similar...).

I’m in agreement Anastrozole is over-prescribed and, worse, often in too high of doses as part of a standing protocol or “cookie-cutter” approach. In fact, even my dearly missed pal Dr John was more aggressive, in many instances, with his anastrozole (0.5mg commonly).

I don’t want to comment in too much depth on that topic, as I am still grieving personally and reconciling the loss of a friend, but everything is not always as it appears on the surface. Dr. Crisler “consulted” with me for his personal hormone treatment and it was my name on his RXs. He did most of his own personal driving, but I ultimately discussed and approved for him while, as noted, “first doing no harm”. Fact is he had been on and off of anastrozole many times in the past, for varying periods of time, only to find himself back on due to various symptoms he would convey (nipples, irritability, excessively emotional, feeling “like a little girl” as he would playfully put it). He would feel better sometimes on, then worse, sometimes better off, then worse...there were many other factors at play (as there are for all of us). The fact he decided to broadcast his most recent anastrozole variations (as opposed to the many occasions of on/off prior) was due to some outside forces (and outside sources of angst) that were troubling him. I don’t want to get any deeper on this topic, but John was troubled by some recent events in his life, which bothers me as well.

Regarding anastrozole/estradiol management - we aim to resolve symptoms, we aim to achieve balance with the hormonal symphony (more challenging in some cases than others), we aim to use our intuition when applicable, and we accept the reality that no one has all of the answers to all of the questions at this time (particularly on this topic). I love all of my patients who need anastrozole just as much as I love those who do not need it.

I will leave this thread be for now as I continue to grieve the loss of my friend and colleague, the great Dr John Crisler.

I think I speak for everyone when I say thank you for taking the time to reply, and give us an abbridged version of your thoughts on E2 management. Balance is indeed the key to not only everything within the body, but also in regards to life in general. It has been difficult for me, as well, to understand the concept of E2 being this one special hormone that works outside these confines. I just don’t understand why one hormone can work outside the concept of balance, yet every other hormone, mineral, vitamin, etc. needs to be in balance.

 

[Vince Carter]

I disagree, at least in the case of Dr. Kominiarek. He believes it does cause harm over time, regardless of dosage. He speaks of bone loss, as an example. I think he made that clear in his interview with Jay

The bone loss, or problem with AI use is the constant suppression of E to at or below a subjective point. It is the low Estrogen state that is problematic. In and of itself as you've written the AI itself is NOT the problem.

 

[Gman86]

I disagree, at least in the case of Dr. Kominiarek. He believes it does cause harm over time, regardless of dosage. He speaks of bone loss, as an example. I think he made that clear in his interview with Jay

Interesting. Ya you could be right. Obviously he’s wrong if he thinks that, in regards to bone loss, but I respect everyone’s views and thoughts, including his of course. Bone loss will only occur if E2 is driven too low, not because of the ai itself.

For example, the guy they were talking about, in the episode, most likely had close to zero estrogen. His ai dose was too high. Same with every single study involving ai’s in men. They get their E2 down to zero, and then report all the negative symptoms of having zero estrogen. I’m not the smartest guy ever, but doesn’t take a genius to know that you are going to have all the symptoms of low estrogen if it is at zero.