What do you do when your estradiol is too high

[HoustonTX]

I’ve been on Trt for several years, and I’ve had issues with estradiol. I was finally dialed in after going to Defy for a year. I was on .28ml of test eod, .25mg anastrozole, and 150ius of HCG daily. I felt great, my libido was very good, and erection quality was outstanding. My tt level was 1000 and estradiol in the low 20s. Jill wasn’t available, so they had me consult with another doc who thought it would be a good idea to change my anastrozole to eod at .125mg and HCG to 200 eod. I’m leaving some things out, but the end result is several months later I’m at an estradiol level of 40 in my trough. Any time I get to that level, I start having major ed. So, I talked to Jill who agreed we should put me where I had been on my old protocol and felt great. Wish I never would have agreed to change it.

Its been a month now, and every time I try to add HCG back in, my estradiol sky rockets. I can feel it and any erection quality I’ve had return goes away in about 30 minutes. So, I’m laying off the HCG for a while. But, it doesn’t seem to make sense. I had been on 150ius every day, and now I can’t even take 100ius without a huge issue. So, I’m going to lay off for a while. Any thoughts on this?

My main question, though, is how many people here would have and would recommend taking (idk) .25mg of anastrozole every day for a week just to get the levels down into a comfortable range? I’m just wary of going too low (which I’ve never had as an issue), and I don’t know how that would affect the eventual balance of my hormones. After a month, I’m growing impatient of still having the mental and physical symptoms of high estradiol....literally wearing me out. Jill has never mentioned doing this, but the other doc had mentioned he liked the .125 dose, because any time you felt like it might be high, you could just tak an extra one?

 

[Vince]

I'm sure so you know the main fear of AIs are tanking your estradiol levels. I'm really surprised at the issues you're having to get back to your former good results.

When I change my protocol it usually takes me 12 weeks to feel the results.

 

[Vince Carter]

There's a good group of us that don't like HCG, causes us some manner of problems including E, or it's use is completely transparent, as in does nothing for us. If you're not tolerating it well cut back the dose. Some guys have stopped it entirely and do better. I only use about ~200iu once per week right now and I'm fine.

If you stated this emphatically during your consult and changes were still made then that's really something to question in your medical care. With my Defy consults I will only see one person other than Dr Saya.

I felt great, my libido was very good, and erection quality was outstanding.

 

[Nashtide]

Everyone responds differently to anastrazole. I'm on record as being a proponent of anastrazole used correctly. I could not be on a successful TRT journey without anastrazole. Having said that, its a powerful drug that needs to be used judiciously. Crashing your E2 is far worse than high E2. So I can see increasing your anastrazole dose, but not by the amount you are proposing.

 

[strum]

I have used a lot of aromatase inhibitors in my medical practice. First of all, anastrozole (Arimidex) or exemestane (Aromasin) are for me about equivalent. I just use Arimidex more because more pharmacies seem to carry it. My patients on TRT (testosterone replacement therapy) often require 0.5mg (1/2 tab) twice or at most 3 times a week to keep estradiol (E2) levels < 40 (or whatever your labs lower end of normal range). You do not want E2 to be elevated since it will stimulate prolactin (PRL) production which adversely effects many functions, including libido. Please note that the functions below are focused on the man with prostate cancer and concerns re PRL.

Prolactin actions:
1) acts synergistically with LH to stimulate testosterone secretion from testicles by increasing the number of LH receptors in the testis;
2) influences adrenal androgen formation;
3) enhances testosterone uptake by prostatic cells;
4) alters intra-prostatic androgen metabolism
5) increases uPA to dissolve ECM (extracellular matrix) and facilitate spread of CA
6) enhances angiogenesis
7) decreases libido
8) decreases cognitive function

The bottom line is that in biological systems there is a need, no it goes beyond that, it is mandatory, to measure biologic endpoints or BEPs. It is like the old Campbell Soup commericial: "Is it soup yet?". You have to obtain the labs, know the doses of drug or supplement you are using (in units that make sense like mg, IU) and titrate the dose of drug and/or supplement versus the desired lab findings. The lab should be a high quality one using assay methodology that is the most accurate. Many lab tests have diurnal rhythms so obtain those tests the same part of the day consistently. If you are monitoring PSA, as you should on TRT, then no ejaculation x 48 hours prior to the blood draw for PSA.
Stephen B. Strum. MD

 

[HoustonTX]

So, it can take up to 12 weeks to fully feels as good as I did before getting back on my old protocol that was working? Jill was hesitant about me adding in hcg so quickly after my estradiol being high, but I didn't think it would take this long. Like I said I was on 150ius daily. They increased several times, because I kept saying I never felt anything. Then, when the new doc changed it to 200ius I felt it, and it increased my sex drive. But, I stayed in my old anastrozole dose until the new medication came in and I ran out of the old .25

 

[HoustonTX]

There's a good group of us that don't like HCG, causes us some manner of problems including E, or it's use is completely transparent, as in does nothing for us. If you're not tolerating it well cut back the dose. Some guys have stopped it entirely and do better. I only use about ~200iu once per week right now and I'm fine.

If you stated this emphatically during your consult and changes were still made then that's really something to question in your medical care. With my Defy consults I will only see one person other than Dr Saya.

[/COLOR]

The really frustrating part is that I did state this. The new doc thought it would be better, and I reluctantly agreed to try. Afterward I realized that I didn't want to try, because I felt great and had already been through a lot to get dialed in. I actually called back and told the staff that I had changed my mind and didn't want to change my anastrozole. They said that I'd have to schedule another consult and it had only been a day or 2. I told them that the doc said I could go back to my old protocol any time I wanted to, and they said that I'd have to schedule a consult which would be 2 weeks out. So, I figured I'd give it a try. That was a big mistake I'll never make again

 

[HoustonTX]

Everyone responds differently to anastrazole. I'm on record as being a proponent of anastrazole used correctly. I could not be on a successful TRT journey without anastrazole. Having said that, its a powerful drug that needs to be used judiciously. Crashing your E2 is far worse than high E2. So I can see increasing your anastrazole dose, but not by the amount you are proposing.

So, next week. I would normally take .25 anastrozole sunday, Tuesday and Thursday. What I am proposing more like suggesting is that I take it an additional 3x on Monday, Wednesday, and Friday just for next week to get it down from the 40s which is where it is right now to a lower amount. And then go back in my regular schedule of 3x a week the following week. I don't think that would crash my E2, but I want to get opinions before I do something unwise

 

[Nashtide]

So, next week. I would normally take .25 anastrozole sunday, Tuesday and Thursday. What I am proposing more like suggesting is that I take it an additional 3x on Monday, Wednesday, and Friday just for next week to get it down from the 40s which is where it is right now to a lower amount. And then go back in my regular schedule of 3x a week the following week. I don’t think that would crash my E2, but I want to get opinions before I do something unwise

I understand, doubling your dose is a lot. I hate to give specific dosage advice, but I'd be more inclined to increase the dose a tad and stick with the current schedule.

 

[Zooka15]

Dr. Strum.....That seems like a lot of AI, where do you like to keep your patients E2 and do you use the LC/MS test?

 

[blackebob]

The really frustrating part is that I did state this. The new doc thought it would be better, and I reluctantly agreed to try. Afterward I realized that I didn't want to try, because I felt great and had already been through a lot to get dialed in. I actually called back and told the staff that I had changed my mind and didn't want to change my anastrozole. They said that I'd have to schedule another consult and it had only been a day or 2. I told them that the doc said I could go back to my old protocol any time I wanted to, and they said that I'd have to schedule a consult which would be 2 weeks out. So, I figured I'd give it a try. That was a big mistake I'll never make again

I too fell for the switch, I will never do it again. I hope you get back there. It has been two years for me, and I am not back to original state yet.