TRT without the use of Aromatase Inhibitors

[DragonBits]

Why? Do you feel symptomatic?

In July 2018 my Total T was 1389, free T 38 (7.7-18) and E2 sensitive 56. I gained about ~6 lbs of water weight.

I didn't feel it, but you can't gain a couple of lbs of fat a day, so it had to be water. In a few weeks it all went away, I assume my TOT T and E2 both drifted back down. The weight all went away in 2 days.

It's possible if I had tried to maintain a E2 of 56 maybe my body would adapt and I would lose the weight anyway. But having TT that high didn't seem to provide any obvious benefits, so I let it drift back down.

I suppose I could have used an AI, but why bother and it's so easy to overshoot with an AI, it will naturally resolve on it's own without my introducing another unknown. And I have never used an AI so I don't know how I would react to it.

The one thing that was interesting, it seems with much higher TT my conversion to E2 was 4% instead of the more typical for me of 3%. I didn't test SHBG so I don't know if that changed.

 

[Gman86]

In July 2018 my Total T was 1389, free T 38 (7.7-18) and E2 sensitive 56. I gained about ~6 lbs of water weight.

I didn't feel it, but you can't gain a couple of lbs of fat a day, so it had to be water. In a few weeks it all went away, I assume my TOT T and E2 both drifted back down. The weight all went away in 2 days.

It's possible if I had tried to maintain a E2 of 56 maybe my body would adapt and I would lose the weight anyway. But having TT that high didn't seem to provide any obvious benefits, so I let it drift back down.

I suppose I could have used an AI, but why bother and it's so easy to overshoot with an AI, it will naturally resolve on it's own without my introducing another unknown. And I have never used an AI so I don't know how I would react to it.

The one thing that was interesting, it seems with much higher TT my conversion to E2 was 4% instead of the more typical for me of 3%. I didn't test SHBG so I don't know if that changed.

What’s your SHBG usually at?

 

[Gman86]

Another thing to point out, doesn’t high estrogen increase thyroid binding globulin, and therefore decrease free T3? Just a thought.

 

[DragonBits]

Not sure how your comprehending this from my comments:

1) I'm not clinging onto anything, this is a discussion on not using an AI, Dr. Rouzier has a very convincing presentation that seems well backed on science on why not to use an AI and the BENEFITS of elevated estradiol. I don't know what to believe I just brought it up here for discussion.

2) Please let me know where I said someone should do this or I deffend that they do it? Again I'm presenting it for discussion, thats the point of this conversation no?

3) If you read my comment, the docs aren't prescribing it to patients but themselves for the oral E2, although in the second presentation I believe Dr. Rouzier says he uses oral E2 in men for certain conditions but I have to go back in check.

4) Acording to Dr. Rouzier your opinion is exactly the opposite of correct. The research would indicated the higher E2 is beneficial in all aspects of life. Now, just to clarify, I'm not saying this is true or not its just interesting to see all points of view to make an educated decision...

Estrogen effects the immune system. High estrogen that women have causes them to be more susceptible to autoimmune diseases.

There are at least 100 autoimmune diseases, 90% of lupus sufferers are women, women are 8 times more likely to have Hashimoto's thyroiditis. If you look at anyone of them, all the ones i see women are far more likely to have them.

Autoimmune Statistics — The Autoimmune Registry
List of Autoimmune Diseases — The Autoimmune Registry

It's not just the estrogen, it's your genes and how they are affect by estrogen.

It takes a while for these autoimmune diseases to manifest, so IF I were to be taking high levels of estrogen I might not find a problem for several years.

Just google estrogen and autoimmune and you find 100s of links.

Like MS:

MS is at least two to three times more common in women than in men, suggesting that hormones may also play a significant role in determining susceptibility to MS. And some recent studies have suggested that the female to male ratio may be as high as three or four to one.

ms female vs male

ms female vs male - Google Search


What studies can you link that show high levels of estrogen help men?

For me, the risk of heart problems I can do cardio and maintain my weight, what do I do about MS or rheumatoid arthritis or Lupus? I think the risks of high estrogen are too serious for me to want to experiment.

But I have a libertarian nature, so if other people want to triple their T levels, have an E2 of 200 or more, I am all for freedom of choice, go for it. It would be interesting if there was a long term study about this.

 

[DragonBits]

What’s your SHBG usually at?

It's been between 35-42 the 4 times I measured it, on or off TRT. No particular pattern of why it changes, but it isn't a big change.

 

[Gman86]

It's been between 35-42 the 4 times I measured it, on or off TRT. No particular pattern of why it changes, but it isn't a big change.

Has your E2 gone down at all, or have you not tested it since it was 56? Just wondering what caused the drop in water weight. I know you said you think your numbers might of just naturally lowered, was just wondering if that was speculation or if you know that for sure through labs.

 

[Gman86]

Estrogen effects the immune system. High estrogen that women have causes them to be more susceptible to autoimmune diseases.

There are at least 100 autoimmune diseases, 90% of lupus sufferers are women, women are 8 times more likely to have Hashimoto's thyroiditis. If you look at anyone of them, all the ones i see women are far more likely to have them.

Autoimmune Statistics — The Autoimmune Registry
List of Autoimmune Diseases — The Autoimmune Registry

It's not just the estrogen, it's your genes and how they are affect by estrogen.

It takes a while for these autoimmune diseases to manifest, so IF I were to be taking high levels of estrogen I might not find a problem for several years.

Just google estrogen and autoimmune and you find 100s of links.

Like MS:

MS is at least two to three times more common in women than in men, suggesting that hormones may also play a significant role in determining susceptibility to MS. And some recent studies have suggested that the female to male ratio may be as high as three or four to one.

ms female vs male

ms female vs male - Google Search


What studies can you link that show high levels of estrogen help men?

For me, the risk of heart problems I can do cardio and maintain my weight, what do I do about MS or rheumatoid arthritis or Lupus? I think the risks of high estrogen are too serious for me to want to experiment.

But I have a libertarian nature, so if other people want to triple their T levels, have an E2 of 200 or more, I am all for freedom of choice, go for it. It would be interesting if there was a long term study about this.

Good points. There might definitely be something to high estrogen and those chronic illnesses that you mentioned. Not saying correlation equals causation or anything, but it seems like there’s a possibility that estrogen is playing a role.

The other big variance between men and women is often B12. Women tend to not absorb B12 as good, and as a result have a much lower level than men. This would drastically increase someone’s risk of getting MS. Not sure if B12 would play a part in regards to arthritis and lupus though.

 

[JimBob]

Estrogen effects the immune system. High estrogen that women have causes them to be more susceptible to autoimmune diseases.

There are at least 100 autoimmune diseases, 90% of lupus sufferers are women, women are 8 times more likely to have Hashimoto's thyroiditis. If you look at anyone of them, all the ones i see women are far more likely to have them.

Autoimmune Statistics — The Autoimmune Registry
List of Autoimmune Diseases — The Autoimmune Registry

It's not just the estrogen, it's your genes and how they are affect by estrogen.

It takes a while for these autoimmune diseases to manifest, so IF I were to be taking high levels of estrogen I might not find a problem for several years.

Just google estrogen and autoimmune and you find 100s of links.

Like MS:

MS is at least two to three times more common in women than in men, suggesting that hormones may also play a significant role in determining susceptibility to MS. And some recent studies have suggested that the female to male ratio may be as high as three or four to one.

ms female vs male

ms female vs male - Google Search


What studies can you link that show high levels of estrogen help men?

For me, the risk of heart problems I can do cardio and maintain my weight, what do I do about MS or rheumatoid arthritis or Lupus? I think the risks of high estrogen are too serious for me to want to experiment.

But I have a libertarian nature, so if other people want to triple their T levels, have an E2 of 200 or more, I am all for freedom of choice, go for it. It would be interesting if there was a long term study about this.

Causes? Or, is associated with...?

 

[bkb33]

Causes? Or, is associated with...?

Like @Gman86 wrote, "Not saying correlation equals causation or anything, but it seems like there’s a possibility that estrogen is playing a role." I don't think anything has been proven. Interesting theory, though. Wouldn't wish an autoimmune disease on my worst enemy.

 

[Vince Carter]

Aren´t we done with this issue, it´s getting really boring, back and forward and the never ending non stop of speculations? E2 is related in most cases to your dosage of testo.

That's exactly right. Should be closed, it's run it's course and nothing ever get's resolved.

 

[DragonBits]

Has your E2 gone down at all, or have you not tested it since it was 56? Just wondering what caused the drop in water weight. I know you said you think your numbers might of just naturally lowered, was just wondering if that was speculation or if you know that for sure through labs.

I know for sure. But it was six weeks later.

I did the one test where I was at 1390/56 on 7/25, then the next set of labs on 9/8. Then my testos was 690 and E2 sensitive was 20.

FWIW, I recently did a test and my Total T was 627 Es sensitive 15.6 and Free T 7.9. I am a little surprised E2 went that far down, though I did stop HCG / DHEA so maybe that was it. (I am going to adjust my TT a little higher.)

 

[DragonBits]

Good points. There might definitely be something to high estrogen and those chronic illnesses that you mentioned. Not saying correlation equals causation or anything, but it seems like there’s a possibility that estrogen is playing a role.

The other big variance between men and women is often B12. Women tend to not absorb B12 as good, and as a result have a much lower level than men. This would drastically increase someone’s risk of getting MS. Not sure if B12 would play a part in regards to arthritis and lupus though.

A HUGE difference we have ignored between men and women is that females have two X chromosomes, while males have one X and one Y chromosome. This actually does help women, I think it was because a defective X chromosome can affect men much more than women. Just recalling at the top of my mind and don't want google it since maybe this thread will get shut down.

 

[OsiRuss25]

Thanks to both the Doctor and all the people who posted on here, I have learned so much. Just finishing up my 5th week of 100 mg a week, w/nothing else. Last week tried the split dose as the trough days were rough. Even with the split, having the anxiety, chest tightness, libido lower than peak days, etc. Getting blood work next week so I can see what it shows. Glad to see where people have said it takes a month to 6 weeks to level out, eases my mind a bit. Thanks again everyone.

 

[Gman86]

I know for sure. But it was six weeks later.

I did the one test where I was at 1390/56 on 7/25, then the next set of labs on 9/8. Then my testos was 690 and E2 sensitive was 20.

FWIW, I recently did a test and my Total T was 627 Es sensitive 15.6 and Free T 7.9. I am a little surprised E2 went that far down, though I did stop HCG / DHEA so maybe that was it. (I am going to adjust my TT a little higher.)

Oh ya so there was definitely a big drop. How do you feel subjectively with your levels lower? Any different?

 

[DragonBits]

Oh ya so there was definitely a big drop. How do you feel subjectively with your levels lower? Any different?

I felt ok up to 9/8, I think my workouts started to suffer the last couple of weeks. Mental focus seemed a bit off the last few weeks.

But it’s hard to separate the knowledge I have that my TT should be dropping from subjective feelings. It’s not like a big obvious change in how I feel, so I can’t say that I feel a lot different.

The biggest change for me was that I was losing weight rapidly, lost 21 lbs. in 2 months with little effort, taking Metformin and lowering carbs. Maybe 40-100 carbs per day. No effort because I wasn’t hungry at all and the fat / weight seemed to melt off, and more on point, my blood glucose dropped a lot.

Now I seemed to have plateaued on weight loss and I am more hungry. I thought it was because I reached the lower range of what my weight had been for most of my adult life when I was in my 30s. About 147 or so, though once when I was running 5 miles every other day I got down to 130 lbs., but it didn’t last long

I am 5.4 and 147 my BMI is normal and likely 23.5 % body fat, I was at 168 lbs. 4 months ago.

But maybe the change in hormones caused the slowing of my weight drop. My goal is to go down to 130-137 or so.

I was surprised my TT has held up well, very surprised FT dropped to the lowest conversion ratio I have ever seen, and E2 was a near low conversion ratio. I keep track of the ratio of FT and E2 to TOT T.

But the last 2 months I had been more focused on lowering my PSA level, it went from 2.X range to a high of 4.2, it went to 3.9 in 5 months, and from 3.9 > 4.2 the next month. Now it’s 3.9, down a little, but I feel like it might not move down any more or very little.

My analysis of my history indicated to me it was likely BPH prostate growth caused by HCG. I don’t have any symptoms like LUTS, but the rapid increase concerned Defy and my urologist. (As in the big C) Defy halted any TRT until I could get clearance from my urologist. I wasn’t concerned about cancer, but I don’t want to get urinary problems from my prostate, so it concerned me for that reason. (I have gotten “clearance” from the urologist as a SelectMDX test indicated a very slim chance of cancer. Good for him, as I didn’t want to go looking for another Doc)

I am thinking the unusual drop in FT and E2 might be due to my taking life extension’s ultra-prostate formula. I hadn’t tested SHBG which would have been informative, but I don’t want to spend gigabucks on every test possible. BUT since prostate formula is supposed to limited DHT conversion, perhaps this has an effect on FT and maybe E2?

And forum comments on what this prostate formula is likely to cause?

Total Fat 1.5g
Total Carbohydrate <1g
Protein <1g
Saw Palmetto CO2 extract (fruit) 320mg
---[std. to 85% total fatty acids]
Stinging and dwarf nettle extracts (root) 240mg
Pumpkin oil (seed) 200mg
---[std. to 85% total fatty acids]
Beta-Sitosterol 180mg
Phospholipids 160mg
Pygeum extract (bark) 100mg
ApresFlex Indian frankincense 70mg
---(Boswellia serrata) extract (gum resin) [std. to 20% AKBA*]
Graminex Flower Pollen Extract and NAX Paste 63mg
---(std. to 7% phytosterols) (from rye)
Proprietary Enterolactone Precursors Blend 20.15mg
---[Norway spruce (Picea abies) (knot wood) and flax lignan (seed) extracts]
Lycopene 10mg
---[from Lyc-O-Mato natural tomato extract (fruit)]
Boron (as Albion bororganic glycine) 3mg

Sorry for the long post, just wanted to get most details in.

 

[Dr. John Crisler]

I have now gotten myself off Anastrozole. Started this quietly over a month ago. I had to personally experience how it felt. Lowered my dose of test cyp subsequently, and I feel even better than before!

I do think AI's are over prescribed in our field. After reading the experiences of many of the guys on the forums, and talking to my esteemed colleagues, I am more than happy to take any of my patients off their AI (aromatase inhibitor), if they want to.

Of note, I am also going to start offering the addition of scrotal testosterone, either by itself, or along with test cyp/HCG injections. I was doing this many years ago, and guys just seemed kind of adverse about it, so it fell by the wayside. But with so much talk about it now, maybe it will become the new norm. Times are changing--for the better!

Anyone who wants to update their TRT protocol, just make an appointment and we will get started. As always, each patient's TRT regimen must be customized just for them.

 

[Dr. John Crisler]

Another thing to point out, doesn’t high estrogen increase thyroid binding globulin, and therefore decrease free T3? Just a thought.

Yes. How much it will actually affect how a patient will feel, or even if it will affect how they feel at all, remains to be seen.

 

[Chopsuey]

I have now gotten myself off Anastrozole. Started this quietly over a month ago. I had to personally experience how it felt. Lowered my dose of test cyp subsequently, and I feel even better than before!

I do think AI's are over prescribed in our field. After reading the experiences of many of the guys on the forums, and talking to my esteemed colleagues, I am more than happy to take any of my patients off their AI (aromatase inhibitor), if they want to.

Of note, I am also going to start offering the addition of scrotal testosterone, either by itself, or along with test cyp/HCG injections. I was doing this many years ago, and guys just seemed kind of adverse about it, so it fell by the wayside. But with so much talk about it now, maybe it will become the new norm. Times are changing--for the better!

Anyone who wants to update their TRT protocol, just make an appointment and we will get started. As always, each patient's TRT regimen must be customized just for them.

Interesting Dr. Crisler. I'm wondering if there was an adjustment period for you? Like felt bad for first few weeks but then things got better or was the benefits apparent from the get go?

Thank you

 

[Gman86]

I have now gotten myself off Anastrozole. Started this quietly over a month ago. I had to personally experience how it felt. Lowered my dose of test cyp subsequently, and I feel even better than before!

I do think AI's are over prescribed in our field. After reading the experiences of many of the guys on the forums, and talking to my esteemed colleagues, I am more than happy to take any of my patients off their AI (aromatase inhibitor), if they want to.

Of note, I am also going to start offering the addition of scrotal testosterone, either by itself, or along with test cyp/HCG injections. I was doing this many years ago, and guys just seemed kind of adverse about it, so it fell by the wayside. But with so much talk about it now, maybe it will become the new norm. Times are changing--for the better!

Anyone who wants to update their TRT protocol, just make an appointment and we will get started. As always, each patient's TRT regimen must be customized just for them.

Awesome to hear that you were able to drop the ai, and not only not notice a difference, but feel even better than before! Do you know where your E2 currently sits, compared to where it was while on the ai? And do you mind sharing your SHBG level? Just curious where things are sitting for you now that you feel even better than on your previous protocol. It’s only been a little over a month, so you probably don’t have updated labs, but if you do, I’d be interested to see where your levels are at. Thanks.

 

[dd340]

I have now gotten myself off Anastrozole. Started this quietly over a month ago. I had to personally experience how it felt. Lowered my dose of test cyp subsequently, and I feel even better than before!

I do think AI's are over prescribed in our field. After reading the experiences of many of the guys on the forums, and talking to my esteemed colleagues, I am more than happy to take any of my patients off their AI (aromatase inhibitor), if they want to.

Of note, I am also going to start offering the addition of scrotal testosterone, either by itself, or along with test cyp/HCG injections. I was doing this many years ago, and guys just seemed kind of adverse about it, so it fell by the wayside. But with so much talk about it now, maybe it will become the new norm. Times are changing--for the better!

Anyone who wants to update their TRT protocol, just make an appointment and we will get started. As always, each patient's TRT regimen must be customized just for them.

This is how you know you are dealing with a true professional. Keeping and open mind to other possibilities and not be afraid to make changes when warranted.