HELP! Just prescribed anastrozole

[MG123]

Hello,

Last night something happened that has never happened to me before and I wanted to get your guy's opinions. I was recently prescribed anastrozole/DIM .25mg/200mg to be taken at the time of each biweekly testosterone cypionate injection of 50mg. I was also told to take 200mg DIM every day that I don't take the anastrozole combo. I also take 250iu hCG every other day. I just started the anastrozole last Friday but have been on TRT since the beginning of this year. 2 hours after taking the anastrozole and my T injection last night I went to have sex with my wife and was unable to maintain an erection. I was so embarrassed as this has never happened before. Any ideas?

 

[ERO]

Did you have a sensitive E2 test before it was prescribed? If so, what was your E2 level?

 

[MG123]

Yes. Off the top of my head it was 38. I have been having edema, bad irritability and moodiness. T was around 649. Both of these were trough level.

 

[CoastWatcher]

This was your second dose of the AI?

 

[MG123]

This is my 3rd dose. I take my T on Sunday morning/Wednesday evening. I received the anastrozole on Friday last week and went ahead and took a dose. I then took my dose on Sunday and then last night, Wednesday.

 

[Vince]

I would think your estrogen is too low, when you have time read over Nelson's post.
STUDY LOOKING AT THE EFFECT OF ESTRADIOL ON FAT MASS, SEX DRIVE AND ERECTILE FUNCTION


There was a recently published groundbreaking study about the role of estradiol in men. No optimal ranges of estradiol were noted but low levels were associated with increase fat and decrease in sexual desire and erectile function compared to higher levels (the highest average estradiol was 35 pg/ml unfortunately, so no conclusions can be made for levels above this).

Men had their hormones blocked by a gonadotropin releasing hormone antagonist. All of them then received testosterone supplementation with Androgel. Half were also treated with anastrozole to block estradiol conversion from the testosterone. Please refer to attached graphs.

All participants (Cohorts 1 and 2) received goserelin acetate (Zoladex, AstraZeneca), at a dose of 3.6 mg subcutaneously at weeks 0, 4, 8, and 12, to suppress endogenous gonadal steroids (testosterone and estradiol). All participants (Cohort 1 and 2) were then randomly assigned to receive 0 g (placebo), 1.25 g, 2.5 g, 5 g, or 10 g of a topical 1% testosterone gel (AndroGel, Abbott Laboratories) daily for 16 weeks. Participants in cohort 2 also received anastrozole (Arimidex, AstraZeneca) at a dose of 1 mg daily to block the aromatization of testosterone to estrogen. Participants were unaware of the study group assignments.

Findings:

Higher blood levels of testosterone decreased the percentage of body fat (P = 0.001), intra abdominal fat area (P = 0.021), and subcutaneous fat area (P = 0.029), and increased sexual desire (P = 0.045) and erectile function (P = 0.032).

Low blood level of estradiol was associated with significant increases in the percentage of body fat (P<0.001), subcutaneous fat area (P<0.001), and intra abdominal fat area (P = 0.002), and relative less improvement in sexual desire (P<0.001) and erectile function (P = 0.022). These findings provide additional evidence of an independent effect of estradiol on these variables.

"Our finding that estrogens have a fundamental role in the regulation of body fat and sexual function, coupled with evidence from prior studies of the crucial role of estrogen in bone metabolism, indicates that estrogen deficiency is largely responsible for some of the key consequences of male hypogonadism and suggests that measuring estradiol might be helpful in assessing the risk of sexual dysfunction, bone loss, or fat accumulation in men with hypogonadism. For example, in men with serum testosterone levels of 200 to 400 ng per deciliter, sexual desire scores decreased by 13% if estradiol levels were 10 pg per milliliter or more and by 31% if estradiol levels were below 10 pg per milliliter. "

Reference:

Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men
N Engl J Med 2013;369:1011-22.
https://www.excelmale.com/forum/showthread.php?2309-Role-of-Estradiol-in-Men-and-Its-Management

 

[Vince Carter]

100mg of T per week is childs play. That's what I'd work on, a trough of 649 is not good (enough). At first glance E2 of 38 isn't unreasonable but you complain of Estrogenic symptoms.

What I'd do is more T, perhaps 60mg 2x week. Or .25mg Anastrozole 1x per week. Its obvious the change was the anastrozole so I'd back off of it just a bit. BUt I totally recommend you up your T.

 

[CoastWatcher]

100mg of T per week is childs play. That's what I'd work on, a trough of 649 is not good (enough). At first glance E2 of 38 isn't unreasonable but you complain of Estrogenic symptoms.

What I'd do is more T, perhaps 60mg 2x week. Or .25mg Anastrozole 1x per week. Its obvious the change was the anastrozole so I'd back off of it just a bit. BUt I totally recommend you up your T.

This is a good point. Do you have any idea what your peak testosterone might be? I had a great peak, on twice weekly injections, 1035, but a trough in the mid 700s, a 300 point drop. More frequent injects maintain me now in the mid 900s over the course of the week. It also helped drop E2 naturally, to a comfortable level.

 

[Vince Carter]

I got off Anastrozole by going EOD (due to low SHBG). When I tested a 72 hr trough @ 800 and a 24hr peak @ 1475...that's the kind of roller coaster ride low SHBG puts a guy on. EOD injections smoothed me right out and 50mg is small enough each time that I don't get (over) aromatizing of it. I subscribed to Nelsons T:E ratio and it changed my health wellbeing, totally.

 

[James]

I subscribed to Nelsons T:E ratio and it changed my health wellbeing, totally.

Vince Carter - Would you refresh everyone on Nelson's ideal T/E ratio.

 

[Vince Carter]

T divided by E; T:E. A ratio of 14-20 is Nelsons belief. This is contrary to E2 being a number or a "sweet spot" by itself such as is common belief that E2 should be in an appx range of 20-30 irregardless of Total T. I think a lot of people want to control E2 by moderatiing their T dose (down) but I found what works for me without decreasing my TT and that was to study the ratio and stop trying to keep that E2 number down. Key here is nipple issue awareness for symptoms.
I have bloodwork this morning so I'll soon see what my ratio is but when I weaned off Anastrozole and my E2 came up (via previous testing) i felt know I felt better, looked better, was doing better. I can't say that it's cured some of my sexual dysfunction but the meds do work better in that area, more reliable and consistent effect.

 

[CoastWatcher]

T divided by E; T:E. A ratio of 14-20 is Nelsons belief. This is contrary to E2 being a number or a "sweet spot" by itself such as is common belief that E2 should be in an appx range of 20-30 irregardless of Total T. I think a lot of people want to control E2 by moderatiing their T dose (down) but I found what works for me without decreasing my TT and that was to study the ratio and stop trying to keep that E2 number down. Key here is nipple issue awareness for symptoms.
I have bloodwork this morning so I'll soon see what my ratio is but when I weaned off Anastrozole and my E2 came up (via previous testing) i felt know I felt better, looked better, was doing better. I can't say that it's cured some of my sexual dysfunction but the meds do work better in that area, more reliable and consistent effect.

My own experience supports everything that Vince wrote. In my case, I learned that my body tolerated, even did better, with a wider ratio. The only way to know is to attend to how you actually feel, and to, regularly, test (both with your doctor and on your own).

 

[MG123]

The ratio model certainly does make since. My only problem though is I was experiencing symptoms of high e2, i.e. edema, moodiness (feeling bad for myself all the time and wanting to cry), extreme irritability, etc. I guess I just need to find a dosage that works for me.

 

[MG123]

My SHBG was 29.7 on a range of 16.5 to 55.9 when I had it tested earlier this year. This was before TRT so it has probably lowered some. I think I will have it tested again on my next labs to see where it is now.

 

[Vince]

Here's a post with some studies that Nelson posted https://www.excelmale.com/forum/showthread.php?4921-T-to-E-ratio