High E2 (~50 pg/mL) on HCG/Enclomiphene/Anastrozole: Mood, Acne, Fog

[Tankeryanker123]

I'm 38, on a fertility protocol/hormone optimization (HCG 250 IU 2x/week, Enclomiphene 12.5 mg daily, Anastrozole) for 80 days. Latest blood work (May 16th 2025): T level at 1376 ng/dL, E2 at 50-55 pg/mL.

Doc said E2 was high, so they increased Anastrozole to 0.25 mg 2x/week ~2 weeks ago. Still having symptoms: low/sad mood, back/shoulder/chest acne, brain fog, some anxiety. The symptoms are somewhat mild but definitely present and noticeable. The acne symptom is heavy though. Is this normal?

I drink ~2-3 drinks (beers/shots) on 2-3 off days/week, which might be keeping E2 high Planning to cut alcohol and discuss with doc soon. Tips for managing mood, acne, fog, or lowering E2?

 

[WhiteMale]

Keep treating symptoms, those are all key E symptoms.

Body acne was a massive problem for me when my E was too high, for me, vs. what a blood test would show. In a vacuum, treat your symptoms.

Reduce enclomiphene dose or frequency, your HCG dose is miniscule as it is. Just throwing that out there. Too I doubt your alcohol intake is the root or key player.

 

[chriskchris]

Not sure I've ever seen someone on HCG and Clomid at the same time. That is a odd mix.

When I took Clomid years ago, my testosterone was high but E2 went off the charts. It was a test project to see if I was primary or secondary, I felt amazing at first and then worst then ever. The doctor at the time suggested I then take 1mg of Arimidex per day which made me feel like walking dead. I think I would have died had I contind taking his advice. Saved my the knowledge of the forums as some docs as good hearted as they are have no clue about TRT as they don't often treat it in depth.

Anastrozole can cause me nasty side effects. Not sure if it is from the drug itself or crashing E2, something I have done numerous times even in small doses. I get horrendous veritgo, achy joints, dizziness, poor penile sensation, difficulty to sleep despite fatigue and some of the worst headaches of my life.

I think it's the E2 low (crash) that does it rather then anastrozole. If I took .50 mg of anastrozole it would drive me to nearly zero even on HCG. If I take .125 of anastrozole I find my nocturnal erections come back and the 'bloating' and other high e2 symptoms go away. I can manage 1-2x dose of .125 per week on 100mg of cypionate and 300 miu x 3 of HCG. E2 can go as high as 80 on that regiment, but will fall into the 10-20 pg/ml range on as little as .125 mg of anstrozole.

I believe the consensus is that it is very hard to manage E2 on Clomid regardless because of the aromatization process.

Biggest thing I learned is that it is better only to take anastrozole when you feel the high e2 symptoms rather then take it systematically as the anastrozole is so powerful, it can crash your estradiol easily even in small amounts which is the worst feeling of all feelings from my experience.

All the best.