New medicine prescribed - anastrozole

[D0UG]

Recent blood test:
Estradiol E2. = 46.4
Testosterone = 837
PSA Ultra-Sensative = 0.16

New medicine prescribed:

anastrozole 1 mg tablet
Take 0.5 tablets (0.5 mg total) by mouth twice a week.

 

[Systemlord]

Take 0.5 tablets (0.5 mg total) by mouth twice a week.

Why are you prescribed an aromatase inhibitor?

I tell one thing, you take the prescribed dosage, you’re in for a world of hurt!

 

[D0UG]

Doctor said Estradiol was high and taking 1/2 dose twice a week should lower it. When I looked up my Estradiol number, it is a little high on some sources and within range on other sources. The pharmacist recommended taking it at night before I go to bed to lessen any adverse side-effects I may have.

Are there better medicines to lower Estradiol?

 

[Systemlord]

Doctor said Estradiol was high.

It sounds like your doctor is in the treating numbers and not symptoms. This tells you he doesn’t know how to manage hormones He’s just trying to manage numbers.

The amount of AI prescribed is crazy considering your levels aren’t that high. This dosage will likely crash your estrogen!

Men on TRT tend to run a little higher on estrogen, some guys don’t have any issues. This is why you can’t treat numbers.

 

[D0UG]

I can't argue with your presumption. She prescribed the medicine last week the day after my blood tests came back without talking to me. I saw her for the visit a couple hours ago but didn't know enough to ask her anything about the new medicine. I am on TRT. I was treated for prostate cancer Q42020 and finally got on TRT last year after having total testosterone less than 20 for 2 years.

 

[Systemlord]

I was treated for prostate cancer Q42020 and finally got on TRT

Your risk factor for reoccurrence of prostate cancer just dropped normalizing your testosterone.

 

[D0UG]

I hope so. PSA doubled about 6 months ago to 0.16 so that raised concerns among the doctors but it did not increase with the blood tests last week.

 

[jayt]

It sounds like your doctor is in the treating numbers and not symptoms. This tells you he doesn’t know how to manage hormones He’s just trying to manage numbers.

The amount of AI prescribed is crazy considering your levels aren’t that high. This dosage will likely crash your estrogen!

Men on TRT tend to run a little higher on estrogen, some guys don’t have any issues. This is why you can’t treat numbers.

my urologist prescribed it as a precaution to higher estrogen levels with TRT. I take .5 mg once a week... no issue and my estrogen levels are very low as a result

 

[Systemlord]

I take .5 mg once a week... no issue and my estrogen levels are very low as a result

The prescribe dosage is a bit on the high side. This medicine was never intended for males, and so the dosage need to reflect that.

A .125 or .250 is more inline with male dosing, however managed healthcare docs don’t have immediate access to these compounded doses.

 

[jayt]

The prescribe dosage is a bit on the high side. This medicine was never intended for males, and so the dosage need to reflect that.

A .125 or .250 is more inline for male dosing, however managed healthcare docs don’t have access to these compounded doses.

thanks, I will ask my urologist at my next visit but according to my blood tests which I get every 3 months I am right on track....T level at approximately 1100 and estrogen low. so it must be doing its deed.

 

[D0UG]

I took only .5mg once last week instead of twice as prescribed. Its not very accurate anyway because this pill is not scored so it doesn't cut cleanly.
As I understand it, my Estradiol at 46 is not really high anyway.
My testosterone was 837 at the time of this test.

 

[sammmy]

I would not bother with Anastrozole at your estradiol levels and twice weekly will be too much, just to get some lab number lower, with possible side effects.

 

[D0UG]

Are there any studies showing that level is not abnormal for patients using TRT?

The Anastrozole prescriber is an NP and will likely be reluctant to take my word for it. Right now, my insurance pays for the testosterone and lab tests except I do have a $2,700 deductible.

 

[D0UG]

I have read recently that Resveratrol may lower Estradiol. Any one here tried that?

 

[Systemlord]

Are there any studies showing that level is not abnormal for patients using TRT?

The drug was never intended for males, it’s used off label for men on hormone replacement. The 1 mg tablets were intended for females with breast cancer 1-3 mg per week.

Women typically have higher estrogen versus men.

 

[tareload]

The 1 mg tablets were intended for females with breast cancer 1-3 mg per week.

Wow, you specialize in oncology as well?

Anastrozole (oral route)

www.mayoclinic.org

DailyMed - ANASTROZOLE- anastrozole tablets tablet

dailymed.nlm.nih.gov

 

[t_spacemonkey]

the AI push on TRT folks is a true epidemic. especially when guys don't have symptoms of high e2.
a 0.5 2x week is criminal

 

[JmarkH]

I don't see a lot of support for it here, but DIM and Calcium D-Glucarate have been know to reduce E2. DIM is supposed to work in the liver and isn't an actual AI. CDG is a mild AI of sorts. YMMV. Use a tac hammer before going to the sledgehammer.

 

[Cataceous]

Are there any studies showing that level is not abnormal for patients using TRT?
...

I think it's useful to consider both absolute and relative estradiol. Your estradiol is 0.55% of testosterone. The normal range is roughly 0.3-0.6%. So no real problem here. This means there's probably nothing unusual about your rate of aromatization—that is, the rate at which testosterone is converted to estradiol. This is good, because it argues against an imbalance between estrogens and androgens.

Absolute estradiol is possibly more problematic. Because you're probably taking more testosterone than you ever could have produced naturally you are also creating more estradiol than you could make naturally. Average total estradiol for healthy young men may be around 30 pg/mL. Of course they're also sporting total testosterone of around 600 ng/dL, well under your level. In any case, your estradiol of 46 pg/mL is several standard deviations above the average. The long-term consequences of this are uncertain. For me personally, the only symptom clearly tied to higher absolute estradiol is heightened emotional responsiveness.

So what's wrong with taking an AI? First, as the others have pointed out, your initial dosing was not set responsibly. Anastrozole should probably be dosed in micrograms, not milligrams. When I was using it I maxed out at 50 mcg a day (0.35 mg/week), with 30-35 being more typical. These doses were sufficient to push estradiol down from 50s to 30s pg/mL. Regardless, a low-and-slow approach is advised to avoid over-suppression of estradiol.

Now what happens if you bring your estradiol down to ~30 pg/mL without other changes? Estradiol as a fraction of testosterone is reduced to 0.36%. That's still in the normal range, but is it normal for you? If you've lived your whole life with a somewhat higher ratio then is this shift in the balance going to be entirely benign? This is unknown.

More speculatively, does AI use lead to localized estrogen deprivation? Anastrozole is said to be more brain-friendly than other AIs. But does this suggest that if you were looking to reduce the emotional side effects of higher estradiol then you might only accomplish this by simultaneously reducing estrogen creation by too much elsewhere?

My predictable punchline is that the best approach is to reduce TRT dosing to achieve physiologically realistic levels, which will then be reflected in downstream hormones such as estradiol.

 

[MDavidW76]

Anastrozole is known for rebounding E2, its the weak sauce of AI’s… Exemestane on the other hand, it’s a real sledgehammer, took my E2 to almost single digits and was horrible, joints popping, dry skin and eyes… meh, I just let my body do what it’s supposed to do and don’t take any of it at all.