Going on TRT AI Question

[Riptide]

Hi Everyone,
First, I realize there was just a thread asking who here on TRT uses an AI, so I won't repeat that and appreciated everyone who commented there...

Just had my consult with Defy which I can't say good enough things about, I loved talking to Dr. Calkins, and he seemed incredibly knowledgeable and made me feel quite comfy.

He diagnosed me with primary hypogonadism (I think thats how you say it? It's the primary one), and given my past history and labs has put me on the following protocol.

Test C 2x 70mg (.35 cc at 200mg/ml) per week (total 140 mg/week)
HCG at test injection time 500 iu 2x/week
Arimidex .125 mg 2x a week on day of injection.

Now, I'm 27, my total test is around 500 ng/dl my free test is 10.4, my E2 is 14.1, SHBG- 38.5, LH 4.2
I posted my full bloodwork the other day so I won't do so again in this space.

Point being, he noted I have low E2 (it was an ultra sensitive test) 14.2 pg/ml male <11.8-39.8, and said that when we raise free T to 25-low 30s which is his goal--a raise of 300% to my free T could potentially raise my E2 by that much which would put me in the low 40s. He said that the 20s and 30s are my friends but that the 40s and up give many people problems.

My ultimate prescription says .125 mg arimidex and to "titrate" and he gave me the symptom list of low E and high E to watch out for those things. So on the one hand common sense says stick to the protocol exactly for the 3 months and then do bloods to assess titration. However, given that he gave me the symptoms of high E to watch for , and that an overwhelming number of folks on this board and others (T Nation for ex) recommend holding off on adex at least until symptoms present (which they dont seemingly for many)--should I wait on the adex especially considering my E2 is so low right now and giving me low symptoms?

It seems from what I read that the common advice is to wait until symptoms present, and for low E2 starting guys like me there's a good chance they won't? I could get my own test/E2 bloods done in a month to see how it was going before the 3 month check up. What do you all think? Thanks!

 

[Jiu Jitsu Dude]

I would wait for the symptoms first before taking AI. But others with more experience will chime in hopefully. Good luck on your protocol

 

[Mountain Man]

Re-read the post on TRT without AI again. This protocol is the exciting one, but guys who throw three things at the problem are going to have 3 times the difficulty trying to figure things out if they have a problem. I think these doctors do these funky protocols to make themselves seem to be cutting edge and to separate themselves from other doctors and clinics that are out there. Assuming you need an AI right of the rip is an example of that. Yeah, I know it’s Defy and all that, but you should have evidence the AI is needed before throwing that into the mix. Complicated protocols are exciting, but are they really over prescribed too soon? Jay Campbell feels they are, and he has done a lot of research on the subject. I feel he’s a wack job at times, but his TRT Manual and TOT Bible are the best resources out there. As I mentioned before, Abraham Morgantaler told me the exact words I am telling you. I’d ask a lot more questions before I’d take those. All doctors seem really knowledgeable because they are. They aren’t always right and they are a business and need to have some way to separate themselves from others in the field. Thinking that the TRT, HCG, AI combo is the secret sauce is a good business practice but may not be the best protocol. I would ask why do I need an AI if we don’t even know yet how I am going to respond to TRT?

 

[Vince Carter]

I know the tiny .125mg dose is prescribed as a maybe you need it but I think as written here its been prescribed and use advised responsibly to not have enough to really question it.

 

[Riptide]

So, at this dose Vince you'd just go ahead and start? As in I shouldn't question this? I'm just making sure I understand!

I'm frustrated because I really trust these guys but at the same time it seems very little anecdotal evidence/personal experience exists to support this protocol of starting with an AI from what people have said. The Dr's reasoning was 3x the free test means 3x the estrogen which puts you in the 40s--I want you in the 20s/30s which seems to make sense. Dr. Saya has posted on here before that he never suggests guys being that high (I think he said 50s+) because even though they may feel good for now he's skeptical of the long term effects.

The Hcg Im a bit less worried about because 1. I can stop it if I want to without ill effects right? 2. It goes in the same shot and I'm not so worried about cost; 3. I tried it before without ill effects; 4. At 27, though not planning for kids right now, it's not a bad thing to preserve fertility even if not the original goal.

The adex i'm more concerned based on the sides people get here and the low E2. It just seems that if it works so quickly I could knock my E2 down even lower if I start now with an E2 of 14, I was wondering if I waited a month--say my E2 was high, then at least the adex would knock it down to a healthy level right?'

Are there any drawbacks to waiting until I have high E2 sides to start--especially if adex "works quickly" and so effectively?

 

[fifty]

A case study for you here. I started with no ai. Felt like crap (anxiety and subjective high bp). After about 2 weeks i started the ai and felt much better. My pre labs were 600/10 for total/free t and e2 23. After ~6 weeks my e2 was 47 on .125 2x/wk adex. Shbg is consistent at 65.

Was on 80mg test 500iu hcg and .125adex 2x/wk

 

[Vince]

I would follow your doctor's protocol, it will take time for you to get completely dialed in. Like everyone you make adjustments as you go along.

 

[Nashtide]

I agree that you should go with your doctors protocol. Making adjustments is just a fact of life with TRT whether you start with just Test or you start with all 3 meds.

 

[Riptide]

Hmm okay, yeah I certainly don't want to screw up future titrations/consultations--thinking I was on one thing and not taking it or whatever, so following the orders feels best to me too. However, I just wanted to double check since so many people here tend to view taking any level of AI before symptoms to be really foolish--especially given my low starting E2.

 

[Nashtide]

Not everyone is against the use of AI’s. Some prominent MD’s in this field routinely prescribe them initially because they know that the NUMBER ONE complaint that arises from new guys on TRT are high estrogen issues.

 

[fifty]

Realize that very few people post consistently over long periods of time when everything is awesome. So you get a preponderance of people posting over and over that anastrozole ruined them or hcg is the devil or that carrier oil is poison. Sqeaky wheel...

 

[Renman23]

I've used the small dose of Anastrazole (.125 mg) 3x a week
It helped and didnt crash my E2, at least I didnt get symptoms.

YMMV

 

[Riptide]

Hey thanks guys, @fifty that's a great point! I need to remember that while there's lots of help to be had--trt forums are a bit like yelp where you get a higher concentration of people who are unhappy or still ironing out their protocol. It's funny because on here (and other TRT forums) I'd say its 50/50 or 60/40 in favor of no AI, but my dr. at Defy told me that over 10,000 patients maybe 2-3% get crashed from a very low dose AI like mine, and maybe 2-3 % are underresponders and need more on that dose--but about 95% of his patients responded favorable to a low AI according to him (at least people who "said" they responded well--of course a few probably say that and don't take them, but I doubt that's a huge population). Anyhow, your idea of the data being skewed here towards side effect issues is really important!

So okay, say I'm going to take the low dose--should I wait 4 weeks or a few weeks for my E2 levels to rise a bit, or should it rise right as soon as my first shot? I'm willing to believe that a .125mg 2/week dose won't crash me on the peak of my 1200-1500 ng/dl TT levels, but with an E2 at 14 right now should I wait at least for a few shots to build up so my E2 has a chance to rise before my first Adex dose? I think the dr wanted me to start adex day 1 on shot one.

Thanks!

 

[Nashtide]

Which part of follow the doctor’s protocol are you not understanding? Lol

 

[Riptide]

Okay fair enough lol. I was just curious how long it normally takes E2 levels to rise and how quickly adex brings them down. I'm probably going to follow the exact advice, I just want to understand everything before putting anything in my body!

 

[Nashtide]

Aromitization is an enzymatic reaction, so the instant T binds to the enzyme the reaction occurs. So, the E2 rises pretty quickly after the injection.

 

[Riptide]

Huh, okay, thanks Nashtide

 

[RLW]

When I started with Defy I was prescribed low dose AI as well. I spoke with the Dr. about ordering it and not taking it unless needed and he had no issue with that. Within a couple weeks I was retaining water and feeling hot all the time even when nobody else was so I started the AI and felt completely normal. I then stopped a few weeks later and had the same experience so started again and have been feeling good since. When I started my sensitive E2 was 20 and on my follow up labs after using the AI it still went up to 40.

No reason you can't do the same. If you start noticing symptoms and then start taking the prescribed dose it shouldn't take long to resolve those symptoms. If you don't start experiencing symptoms then continue without it.

 

[Dr Justin Saya MD]

Realize that very few people post consistently over long periods of time when everything is awesome. So you get a preponderance of people posting over and over that anastrozole ruined them or hcg is the devil or that carrier oil is poison. Sqeaky wheel...

Bingo! I can’t tell you how MANY times I’ve consulted with a patient I’ve known to have been a forum member and heard “haven’t been on the forums in a long time. Not having any problems...doing well and just enjoying life”.

 

[Dr Justin Saya MD]

Riptide - Dr Calkins trained with me and has worked by my side for several years. Although every patient is unique, he doesn’t often steer patients wrong.