TRT without the use of Aromatase Inhibitors

[YBWV]

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.

An Epiphany! Precisely what we've been talking about here on Excelmale for the past several weeks.

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.

Indeed. The changes in protocols that Dr Chrisler is now proposing are precisely those that I advocated in post #7 of this thread.
I've made my point many times before to no avail so it is pleasing to know that finally change may come and that guys for whom the current protocols haven't worked will get the therapy they need.

 

[rafapark]

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: Like most of us here when we post, it'd be helpful if you could post your protocol before and after stopping AIs and your main blood markers. It'd be great to see that.

 

[Dr. John Crisler]

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

Yes, there was.

I will report on my own experiences as soon as I get a few minutes. And we want to keep in mind every-body is different.

 

[Dr. John Crisler]

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.

Very high estrogen levels can cause subclinical hypothyroidism, that may need treatment. This is well known.

 

[Dr. John Crisler]

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.

I had labs drawn last Friday, and will report them as soon as I get them back.

 

[Dr. John Crisler]

Dr. John: Like most of us here when we post, it'd be helpful if you could post your protocol before and after stopping AIs and your main blood markers. It'd be great to see that.

I will share my whole story, right here. This is a process that has gone on over the past 2 years. As many of you know, I have personally tried the protocols I use, to get the feel for them. As always, I am but n=1, but have always gained a good "feel" for what my patients might experience like this.

 

[Dr. John Crisler]

An Epiphany! Precisely what we've been talking about here on Excelmale for the past several weeks.


Indeed. The changes in protocols that Dr Chrisler is now proposing are precisely those that I advocated in post #7 of this thread.
I've made my point many times before to no avail so it is pleasing to know that finally change may come and that guys for whom the current protocols haven't worked will get the therapy they need.

You betcha! I read what you said, and was exactly why I came here to ask the good members of this forum for their experiences.

Of note, I have never prescribed an AI to a patient if they did not have symptoms of elevated E. So we need to figure out why it is some guys are just great at high levels of E, while others must be kept within normal range. But at any rate, no matter their numbers, no symptoms, no AI from me. It's always been that way.

The legendary Dr. Eugene Shippen--whom I am proud to say I got, from my position on the Planning Committee at AMMG, an invitation to speak at the Spring national conference--is going to be going into great depth on using low dose AI's in male TRT patients. To my mind, he possesses the finest mind to ever practice this area of medicine. I learned about using AI's from him, and have gotten such good results with them over the years. But I do think it's time for change.

Dr. Shippen is also going to share some amazing things he has figured out about HCG. Wait until everyone hears what he told me a couple months ago.

 

[Dr. John Crisler]

I wish to acknowledge, and thank, Nelson's provision of this forum for all of us. He is decidedly against AI use, but still, in a very open-minded way, allows free discussion of the topic. That is precisely why I came here to open this thread, as I want to hear from guys who went off their AI's, how they did it, and what their experiences were.

My strategy is now to work with my patients to drop their estrogen control, when possible. As an Osteopathic physician, less drugs is better.

 

[Nashtide]

Thanks Dr. Crisler. We appreciate your insight. I have gone back and forth with anastrazole use. When I stop using it, I have no profound issues. I would characterize them as quality of life issues. Without the AI, my sensitive E2 is in the low 40’s. With 0.1mg twice weekly my sensitive E2 runs in the high 20’s-low 30’s. I realize this is a very small difference. When I stop taking the AI, I notice several things. A slight decrease in orgasm quality, a slight decrease in overall energy and most importantly, a decrease in sleep quality. Again, not earth shattering, but not optimal either. So the way I see it, I could drop my T dose some and stop taking the AI or I can continue with my protocol as is since I feel great. My feeling is to continue my current protocol until I see clear evidence that the micro dose of anastrazole is harmful and/or that higher E2 levels are beneficial. Any thoughts would be appreciated.

 

[Dr. John Crisler]

Thanks Dr. Crisler. We appreciate your insight. I have gone back and forth with anastrazole use. When I stop using it, I have no profound issues. I would characterize them as quality of life issues. Without the AI, my sensitive E2 is in the low 40’s. With 0.1mg twice weekly my sensitive E2 runs in the high 20’s-low 30’s. I realize this is a very small difference. When I stop taking the AI, I notice several things. A slight decrease in orgasm quality, a slight decrease in overall energy and most importantly, a decrease in sleep quality. Again, not earth shattering, but not optimal either. So the way I see it, I could drop my T dose some and stop taking the AI or I can continue with my protocol as is since I feel great. My feeling is to continue my current protocol until I see clear evidence that the micro dose of anastrazole is harmful and/or that higher E2 levels are beneficial. Any thoughts would be appreciated.

Thank you.

I am wondering how long you went after stopping the anastrozole? I ask because these things can even out over time.

From what I read, you describe any negative potential effects as "slight decreases". I am wondering if they would pass after a few weeks. Also, such subjective reports are at the whim of placebo effect.

 

[Nashtide]

Thank you.

I am wondering how long you went after stopping the anastrozole? I ask because these things can even out over time.

From what I read, you describe any negative potential effects as "slight decreases". I am wondering if they would pass after a few weeks. Also, such subjective reports are at the whim of placebo effect.

I thought you might say that. The last time I discontinued the anastrazole was for 8 weeks. I really wanted my little experiment to work. The most bothersome thing was the change in sleep quality. When taking the anastrazole, I sleep soundly and have vivid dreams. When I stop taking it, the dreaming goes away after a couple of weeks and doesn’t return until I renew the anastrazole. I can see how the perceived negative orgasm changes or the energy issues could be placebo but the sleep changes seem legitimate to me. I am open minded enough to try again if you think 8 weeks isn’t long enough.

 

[user_joe]

Much respect to the Doctor for going about this objectively. Looking forward to what finding come from this change in perspective.

As far that transition phase, we are mostly taking cypionate with its very long half life. Any changes in that dose takes 6 weeks just be steady state. Say that’s all you are taking, you still have the body reacting to that new hormone level as regarding cortisol, thyroid, esteogen, etc. It’s well documented that the effects of TRT take many months to take full effect.

We change our protocols and ignore this fact expecting nothing but ups and no downs. See a negative side and we change again.

Anastrozole has a half life of 50 hours. It’s completely out of your system in what, 10 days or so? Now aromatase has to do its thing. IME based on old blood work that takes many weeks to level off. It’s also variable. So if your protocol is to eliminate ai I think many weeks are needed to really assess.

I’m guilty of this. I’m doing better than ever going 7-10(right now longer) days before taking a spec on anastrozole based on how I feel. Never taken this much test or this little ai, and I’m feeling great.

 

[rafapark]

I like your approach joe. Maybe a better approach to eliminating AIs completly would be to extend the time of usage and monitor. So for example, instead of taking 1 dose of anstrazole say 0.125 mgs twice a week, take one once a week, monitor for 8 to 10 weeks. then take one every 10 days, monitor and so on. It makes sense to me.

 

[DragonBits]

Dr. John Crisler, one of the things I am curious about estrogen in men.

Typically how high is estrogen in men that AREN'T at high levels of Total T. High being say above 1100.

Another more stringent way of asking, do you know the range of conversion of T> E2?

I am in the range of 2.3-4%. It was 4% when my Total T was 1389, once I went to a 5% conversion, but I was taking clomid. The low of 2.3 maybe because I am taking life extension ultra prostate formula, I speculate it may change the conversion. Most of the time I am around 3% conversion without any unusual supplements/hormones outside of T AND that included DHEA/HCG.

I ask because I wonder why so many feel the need to maybe take an AI. They must have a higher conversion ratio than 3% or be on higher doses of T.

 

[JimBob]

Thank you.

There are some gaping holes in the logic being used by those totally against AI use: (1) No one knows what super high estrogen levels do to a man long term, and (2) No study (I have seen) has ever proven any ill effects from lowering estrogen "just a bit". All have driven it to super low numbers, which ruined the many very important benefits estrogen gives us (that testosterone does not).

Either we care going to practice evidence-based medicine, or we aren't.

Of course, Dr. Rouzier would say, "You want to reduce the health benefits of estradiol just a little bit"?

 

[Gman86]

Of course, Dr. Rouzier would say, "You want to reduce the health benefits of estradiol just a little bit"?

Ya that was one of the most ridiculous parts about the whole interview, I thought. Just because a guy with a medical degree repeats the same thing 75 times in one interview, doesn’t make it anymore true. And then to make matters worse, every time he said it, there was his monkey in the background laughing awkwardly.

I guarantee if they did a study on very low dose ai use, that got guys into the upper range for free E2, that there would be no ill objective effects to report in regards to overall health/ bone density. Dr. Rouzier might have some completely valid points, but they were very hard to take seriously when he kept saying that, and kept trying to validate extremely flawed studies to back up his opinions on E2.

 

[Dansk]

Ya that was one of the most ridiculous parts about the whole interview, I thought. Just because a guy with a medical degree repeats the same thing 75 times in one interview, doesn’t make it anymore true. And then to make matters worse, every time he said it, there was his monkey in the background laughing awkwardly.

I guarantee if they did a study on very low dose ai use, that got guys into the upper range for free E2, that there would be no ill objective effects to report in regards to overall health/ bone density. Dr. Rouzier might have some completely valid points, but they were very hard to take seriously when he kept saying that, and kept trying to validate extremely flawed studies to back up his opinions on E2.

I had the same thoughts, I loved the information, but the way they delivered the information was condescending and arrogant.
For the older guys, I kept thinking of Muttley the dog cartoon the way jay kept laughing.

 

[Dr. John Crisler]

Of course, Dr. Rouzier would say, "You want to reduce the health benefits of estradiol just a little bit"?

No, we sure do not want to reduce any of the many, important health benefits of estrogen. I just wish we had an idea of what an optimized level would be (and is probably different for everyone, like everything else). I also wish we knew if really high levels were bad for us in any way.

But between too low and too high, it would definitely be the latter, to my mind.

 

[DragonBits]

The reason large studies of higher levels of estrogen in men are needed and anecdotal personal studies aren't very useful is the same sort of reason woman had problems on synthetic hormones. Sure they felt better but they didn't really know about the problems until a large number of women were studied for years.

Autoimmune diseases are associated with women's higher levels of estrogen, and many women who enter menopause find their symptoms reduced.

But if 5% of men after 5 years of having high estrogen develop lupus or Hashimoto’s or anyone of the 100 other autoimmune diseases, without a larger study I doubt anyone will connect the two events. Those 5% will just be unlucky to have gotten XX. I don't know it will happen, maybe T protects men from high estrogen.

All that aside, my E2 sensitive is currently 15.6 with a total T of 627 and NO AI.

Am I supposed to order some sort of E2 cream? Double my T dose to get E2 to 28?

 

[Gman86]

I had the same thoughts, I loved the information, but the way they delivered the information was condescending and arrogant.
For the older guys, I kept thinking of Muttley the dog cartoon the way jay kept laughing.

That’s literally Jay! Lol