This is the same old straw man argument. Who's claiming that crashed estradiol is healthy? What about the long-term safety of having estradiol higher than all but one in a million natural men? Unknown, right?
What’s the general consensus on AI’s here?
- Thread starter smokedsalmon
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DragonBits
Well-Known Member
What about the large group of doctors, scientist and general population of men that say with a total T greater than 264 ng/dl you don't need TRT? I don't agree, and just ignore that group, it doesn't bother me in the least to not follow a group. I am just not much of a group follower.
What I am saying is, why would anyone follow what a group of men suggest when there isn't any clear science behind it?
It should be clear there is NO general consensus on the use of AI, which generally tells me that both sides on the issue have good reasons for their stance and there isn't any clear science that tells anyone that is a danger in either using or not using an AI.
Clear danger as in there is a clear danger in using opioids long term for pain management, there is a clear danger in smoking tobacco. But we all know people that have smoked tobacco their entire life with no problems.
What is clear, over using / dosing any potent medication has clear dangers. As far as I can tell, that is universally true.
The side effects of ai's are well known in women. Does that correlate to men with smaller doses? Not known but I'm not going to take the risk.
Through my research the biggest concern with AIs in the long term is they do affect your cholesterol. Which is why I assume Dr. Crisler discontinued their use in the end. I’m strongly considering everyday injections if it would mean I don’t need to take an AI. theoretically testosterone prop ester aromatizes less than cypionate ester. and lower doses more frequently causes even less aromatizing effects.
I haven’t researched Proviron’s effect on lipids yet as it’s not available for prescription in the United States but, technically I could probably go from 200mg to 100mg of testosterone a week and still have all the benefits of TRT with an anti-estrogenic DHT based compound like Proviron without the need of an AI.
food for thought.
I haven’t researched Proviron’s effect on lipids yet as it’s not available for prescription in the United States but, technically I could probably go from 200mg to 100mg of testosterone a week and still have all the benefits of TRT with an anti-estrogenic DHT based compound like Proviron without the need of an AI.
food for thought.
Only inasmuch as they affect estradiol, and at least according to my results, only HDL is affected, not LDL. The E2-driven increase in HDL isn't necessarily all for the good according to this article.
Testosterone propionate does not lead to less aromatization than other esters. Daily small doses of any ester can potentially reduce peak estradiol compared to large, infrequent doses. Propionate is interesting because it may allow for diurnal variation in serum testosterone, somewhat mimicking natural behavior.
In theory you can replace an arbitrary amount of your testosterone dose with substances that don't aromatize, thus setting your estradiol where you want it without an AI. But I doubt this approach is going to be any healthier/safer than normal TRT and judicious use of an AI. As you note, Proviron would work on the androgen side. A SARM such as ostarine might help with anabolic activity.
Thanks for sharing that article, was a good read.
my e2 between 25-30 is the sweet spot.
I would love to try propionate ester someday, but it would cost roughly twice as much for the same dosage. I wish defy could call in the prescription to express scripts like they do empower. However, i believe my insurance will reimburse me fully, I submitted a claim recently... if it’s approved life will become much better.
xqfq
Active Member
I don't think it's just lipids. I worry about the direct effect that an aromatase inhibitor could have on endothelial function. In some studies on women with aromatase inhibitors, lipids are not necessarily impacted, but in all studies endothelial function is affected. If you google "endothelial anastrozole" you will find many studies.
We know that testosterone can be beneficial for endothelial function through aromatase directly in the endothelial cells:
https://www.pnas.org/content/pnas/99/6/4055.full.pdf
Here's the study I find most interesting:
https://www.ahajournals.org/doi/full/10.1161/01.RES.0000103633.57225.BC
This is in men, who were given a heavy dose (1mg/day) of anastrazole. But keep in mind they were not on TRT - they had a functioning HPTA axis, and thus 1mg/day of anastrazole did *not* crash their E2. Their E2 went from ~23 pg/mL to ~17.5 pg/mL. But if you look at the graph for "Effect of Anastrozole on Flow-Mediated Dilation of the Brachial Artery," you'll see they had a 50% reduction in flow-mediated dilation.
How could this be? In my bro-scientist mind, it might have to do with how the drug distributes itself throughout the body. Because it is carried in the blood stream, it would make sense that it could effect the cells in the endothelium more strongly. But that's just my own guess - I really don't know.
Does this matter for more sane AI doses? I have no idea! But I do think it gives at least one maybe-datapoint that an AI can have direct effects beyond those equivalent to lowering of E2.
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xqfq
Active Member
Also, not to get too into the weeds, but RE: that article:
- The reference to E2 raising CRP is, IMO, off base. It references a journal reply that cites the HERS data. All of the data I've looked at has said that E2 lowers CRP, see e.g. "Estradiol inhibits vascular endothelial cells pro-inflammatory activation induced by C-reactive protein". Oral estrogen can increase CRP, but injectable / transdermal doesn't (see e.g. "Effects of transdermal and oral estrogen supplementation on endothelial function, inflammation and cellular redox state.").
- RE: HERS study in general. You might find this recent podcast with the authors of the new book "Estrogen Matters" on female HRT interesting - I know I did!
- The other reference is to a study that shows a correlation (not causation) between high e2 in very sick patents with chronic heart failure and risk of death. See e.g. Testosterone treatment for men with chronic heart failure for why this is likely to be correlative and not causative.
This reference also has a potentially significant weakness in that the study used ECLIA to measure estradiol; they may have been measuring some CRP along with estradiol.
Nonetheless, with respect to cholesterol, I have not yet come across evidence that AIs cause unfavorable changes independent of their effects on estradiol.
I don't disagree with your main point: it's an open question as to whether we should be concerned about the results of AI studies using ~20 times more than typical TRT doses. But this must be balanced against the other extreme, which is males having estradiol levels basically not seen in nature. It might be tempting to say that it's probably ok because women experience high levels all the time. But there is some cellular-level research showing that in some cases male and female responses to estradiol can be quite different, with the effects on males being potentially harmful.
VacationMan
Active Member
In my case, I had high E2 - was in the mid 60s (sensitive assay). Doc put me on Anastrazole - 1 mg per week. I felt better very soon after the first dose, then began to feel awful again. In essence, 1 mg per week crashed my E2 - it went below 10 (again, sensitive assay).
Over time, I found my own sweet spot. When my E2 measures between 25 and 35, I'm good to go and feel good. The trick was finding the proper dose of Anastrazole to maintain E2 in my personal sweet spot. I ended up doing my own compounding - dissolve four 1 mg tablets in 16 ml of quality vodka (dropper bottle - shake well before dosing). I used an empty 1 ml tuberculin syringe (slip tip, no needle) to measure the dose - 1 ml in the syringe = .25 mg of Anastrazole. After many months, I finally find that sweet spot - I take .025 mg of Anastrazole 2x per week along with my 2x per week testosterone shot. That did the trick for me.
To each their own.
Over time, I found my own sweet spot. When my E2 measures between 25 and 35, I'm good to go and feel good. The trick was finding the proper dose of Anastrazole to maintain E2 in my personal sweet spot. I ended up doing my own compounding - dissolve four 1 mg tablets in 16 ml of quality vodka (dropper bottle - shake well before dosing). I used an empty 1 ml tuberculin syringe (slip tip, no needle) to measure the dose - 1 ml in the syringe = .25 mg of Anastrazole. After many months, I finally find that sweet spot - I take .025 mg of Anastrazole 2x per week along with my 2x per week testosterone shot. That did the trick for me.
To each their own.
.025mg? That actually has an effect? That's 1/40th of a 1mg pill 2x a week?
I've been all over the place (been on TRT for eight years). My Dr does not check E2 with the sensitive test...so those results are essentially meaningless. If I want a sensitive test I have to get the test done on my own for a couple of hundred bucks...which I should probably do. For years I took Arimidex. Then about a year and a half ago, I stopped (I also started injecting E3D's). Went through some major nipple itching...but then that just went away. Overall I felt pretty good, but my BP has been creeping up ever since and now I'm to the point that my Dr. just put me on an ACE inhibitor. But I can't help but wonder if it's just high E2 causing my BP to be higher?
VacationMan
Active Member
Yeah, it's made a difference for me. Anastrazole is a potent AI. Imagine trying to split that tiny tablet into a 1/40th size grain of powder...
xqfq
Active Member
The sensitive E2 test is only $43 on discountedlabs: https://www.discountedlabs.com/estradiol-sensitive-lc-ms-ms
Vince Carter
Banned
did you actually document that 1mg dose you say took you from 66 to 10?
Unless you have certain cancers, you really don't need an AI. For those that have difficulty reducing or stopping AI, it's probably because the way you are dosing your T is causing hormone spikes that are causing you to not feel well. The AI may mask the spikes, but it isn't actually helping you. I was formerly in the AI camp and even though my e2 crashed over and over again, I couldn't find a way to get off of them. It wasn't until I smoothed out my hormones enough by going to 2x daily compounded cream that I was finally able to discontinue the AI. Others may succeed simply by injecting at least EOD. My e2 sits around 80 now, but I feel the best I've ever felt on TRT. My body gets pissed if I even try zinc or calcium d-glucarate to lower e2. My e2 is where it should be at the higher level.
ForeverMuscle
New Member
you dont need them! not good for you. lower your TEST dose if E2 is a problem.
Vince Carter
Banned
ill-informed point of view.
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