T Nation

Advice for TRT Patients


I am not an expert and can only base my advice on my experience . I am 45 who had low t and small nuts . After months of blood work my dr concluded I had primary hypo g . Classic high LH and fsh and low t and tiny nuts . He offered injectable T to me as a solution . I took the offer and injected for 8 weeks - then I developed ED and started being moody . I read about TRT and learned that T is directly related to E levels . Since dr never prescribed an AI my T rose along with my E rising ( blood test of 63 estrodiol 8-43 normal ) . MY ADVICE TO TRT PATIENTS IS TO EXPECT TO TREAT HIGH ESTROGEN IF YOU DO TRT .


Opposite in my situation.. We are all different.


I developed Gyno on a relatively low dose of Androgel but agree with Aces that we all react differently to treatment.


Most guys on TRT really do need anastrozole. The major problem here is doctors who are ignorant of the issues and effects. The only recourse are self education, seeking a new doctor or self-medication.

If one follows the typical advice that I and others promote, then they will end up with favourable E2 levels. If one's labs indicate that a few guys do not need an AI, that is also a logical outcome of the process.

So what do we do? Suggest that all start off with a recommended dose of anastrozole that works well for most guys and some have to reduce their dose to a 4th of the expected and a hand full require none? Or suggest that not one start with AI and have most guys suffer with high E2 first? The path seems clear to me. There is no method that will provide the optimal experience for everyone.


E2 Labs should be taken prior to trt and age and body fat taken into account allong with liver function and shbg. It the person is not using hcg the AI may just not be needed. Again. Once the person has normal levels and begins to possibly lose fat or works on liver function via supplements and healthy lifestyle AI may not be needed. It may make more sence to start at half of the reccomended dose until the first set of labs and see what the outcome is and change dose accordingly.. There is no standard advice in trt, if you ask me we are all different and react different to treatment and should treat on an individual basis not some set protocol..

Why is low E better then high E??? It isn't and more damage could be do e by starving yourself of E then having a bit to much.. So really why do anything until you see the first set of labs??


We often see guys who get hit by high E2 before their followup lab work; if their doc will even look at E2. When the few who are anastrozole over-responders feel messed up from low E2, they usually know something is wrong and have read in the stickies, or have been directly advised, that they can stop taking anastrozole for 5-6 days then resume at 1/4th the expected dose and see how that feels.

Please note that if their doctor puts them on Rx anastrozole, the same events will unfold except their doc probably has no knowledge of the over-responder issue and has not provided any advice about what to look for and what to do. When a guy has very low E2, lab results may be below the reporting threshold and you do not get any lab data. In that case, one cannot then do the linear dose correction calculation to get the right dose. Note that this calculation also decreases anastrozole dosing appropriately. And this leads into dose refinement that one cannot do with 1/4mg increments by cutting the 1mg pills.

The only way to appropriately small dose increments is with a liquid products that are not generally available by Rx. However, a compounding pharmacy could make this up. For over responders, taking 1/4mg per week in EOD doses is not an easy task. We do have some who dissolve their 1mg tablets in vodka and dispense by the drop. Note the anastrozole is hydrophobic and will not dissolve in water; does dissolve well in alcohol and 80 proof vodka works well.

To do a dose calculation, one first needs get to into a reportable lab range. The over-responder needs to feel his way there. If one is not taking anastrozole and does E2 lab work, there is no dose calculation possible and the first dosing of anastrozole after E2 lab work still carries the chance that one may have low E2 as an over-responder and one then is needing to feel their way into lab range, then get E2 tested again and then the dose calculation can land a guy near target levels. In that case, two lab followup cycles with their doc can take a long time. That can be a really burden, especially those who might be depressed to begin with.

Then we get docs who Rx 1mg anastrozole per day because that is what the prescribing info states [for breast cancer].

Yes, people are different. It is amazing that that for some on TRT without an AI will report that they feel a lot worse than before. Any those events cannot all be explained away by thyroid or cortisol complicators. And the misery that guys can feel from elevated E2 can easily be shared with ones wife and kids. Coping skills can be very challenged. When I report that when I got on anastrozole years ag0, E2=37-->22, it really was like a rebirth.

The changes to brain structure created by T when one grows up makes coping with estrogen dominance very difficult, more for some than others. For those who like such reading, "The Male Brain" by Louann Brizendine is a very good read and you might also like the companion book "The Female Brain". These books explore the roles of hormones on brain and personality development, and the effects of losses of hormones. Good info on the role of neural transmitters.

These books also explore the effects on social interaction, sexual development, sexual pursuit, competition, nurturer, mental health etc. The reading of one book, makes the next book of great value as one starts to understand the differences, one vs that other. The result is greater than the sum of the parts. But such interests are really not what many will care for.


And what about when E2 goes from 22 to zero. Would this be a rebirth?

This would also cause someone to feel very badly and without labs it would be very hard to know if the problem is high E2 or low e2 as the symptoms seem to be somewhat similar..

If people can't get the right labs or treatment and don't have any knowledge on TRT at all the. Treatment can be a disaster. I think recommending someone go off lable for drugs could end up being a big mistake.. How do she know the care has been take with the dosing esp when it says right on the bottle "not for human consumption ". In my opinion this is opening up a can of worms .

If the doctor is not familiar with the endocrine system as far as E2. He should not be giving testosterone to begin with.. This could also prove to be disastrous. It's really sad how many people walk around feeling crappy and no one has answers for them.. Big pharma leaves people dependant on the drugs and the doctors are not even educated on how to use them ..

More people should try natural theropy rather then drugs.. If absolutely necessary then submit themselves to the life long commitment.. To many young guys on here trying to get the prescription with no idea what they are in for..


Well, we do have doctors who are idiots. We cannot fix that. And any time someone starts anastrozole, Rx or self medicated, E2 will go low if one is an over-responder.

I guess that you are next going to suggest that all guys start at 1/4mg per week and test drive that then ramp up and see if the keep feeling better or detect an E2 crash. These guys are realistically not going to get 4 sets of E2 labs in a short time frame.

There is nothing that will make you happy. Is your estrogen too high? You bitch about everything and I have not seen you post anything positive about anything dose related in a long time. I am seeking practical solutions. I do not see you doing that. What are your goals here?


I was saying my opinion. Not bitching..

But ur acting like a little bitch..

By the way all I said was how I felt and you go off on some long winded speach.. I didn't ask you to run your mouth did I... And I have seen many guys refer to your estrogen being to high.. Buddy ur no better then me or anyone else on this site.. Lose the god complex cause you don't know as much as you think..


I will be the first one to call bullshit on that.

KSMAN can get a little cranky, but I and many others have learned allot from him and I know I would not have been able to find this type of information and the resulting success with my treatment without him. The reality is the natural solutions you suggest do not work for many people and KSMAN describes real solutions that work.


So diet and change of lifestyle and homeopathic healing doesn't work??

It take more time to heal the body with the good things we have in nature but a lifestyle change can completely turn the whole endocrine system around if something isn't to far gone. Adrenal fatigue, subclinical thyroid problems, fatty liver and pancreas, GI problems matter of fact the whole body can be flipped around from natural healing if someone follows the right steps and stops putting the junk in their body .

I didn't say he didnt know anything I said he doesn't know as much as he thinks..

And I have no problem with you sharing your opinion....

And what exactly are you calling bullshit on?? All I said was I had E2 drop after trt and everyone is different... True

That 20 year did should try not to jump on trt and try to heal the body.. False???

ksman is acting like a lil bitch.. True..

So what exactly is bullshit??? Are we not all different and respond to treatment different?? That's all I said before the iodine pusher hopped all over it with a page long life story..

Fact: I took my E2 from 32 to 20 and felt zero difference.

Fact: I did this with life style changes and supplements.

Fact: You go to a TRT clinic they will sell you T

Fact: you see a naturopath or homeopathic doctor who uses alternative medicine they will try and find the root of the problem and fix that..

Note: just as we see with doctors there are good healers and not so good ones..

Fact : ksman believes in these doctors cause that's where he learned about iodine, not from an Endocronologist or a trt doctor...


Iw84ace, KSMAN is speaking on behalf on majority of the population. You are apart of the rare chances in which E2 goes down with TRT. The fact that your E2 goes down on testosterone does not change the fact that for the other 99% of the population E2 will go up. It is much more advisable to get 100% of the population to take an AI with TRT together at the beginning when 99% of the population will benefit from this and only 1% will not.

You do make a valid point though, you are just consistently perpetrating that what happened to you happens with everyone, which is just not the case. This is the major discrepancy here. You can't go along saying that taking Iodine is bad for everyone just because you and your friend were very unlucky with taking Iodine. It's like telling everyone to not eat peanuts because when you took them you found out your body was allergic and got really sick. It's important to state your point, but it's another when you don't rationalize your position in regards to the general consensus of issues on this forum.

You do bring up some great points on possible issues. I can contribute at least a portion of my knowledge about my issues and possible causation of these issues directly to you, which I thank.


Lol holy shit...

I did not say don't take iodine.... I said 50 mg is to much for some and should be done under the care of a doctor..

Brownstien wrote the book on iodine and I have an interview between him and mercola saved on my computer where he now recommends 12.5 mg per day..

Also many other supplements should be taken with iodine and not iodine in it own.

Many have GI issues and these should be cleared up and the body should be able to clear the toxins before getting them all loosened up..

Ksman states iodine is iodine....

Iodine is not iodine and it should be the iodine/iodide combination that is used

For the last time, I listed many links to support what high loading will or could do. Ksman had them taken down..

I can and will state my case and it isn't just me the links listed showed that..

I will leave a link on how loading should be done... Even brownstien states this stuff should be done plunder the care of a professional....

I don't need you to tell me if I have a good point cause I witnessed it first hand..

I know that T follows E in most cases I only state that its not in all cases..

I have seen many guys over respond to arimidex on this site and this is a forum where we share experiences and opinions.. Ksman acts like a baby when someone doesn't agree with everything he says..

I know very well and have stated many times ksman has helped many and knows his stuff when it comes to trt.. I have openly thanked him for this on many occasions

If you guys wanna load 50 mg go to town..

As far as E2 goes, if one has liver function problems and that indeed is the problem. If we improve liver function via supplements and life style changes we also improve clearance of E2.... When one has good testosterone levels and isn't on TRT they do not necessarily have high E2. Why then if we bring T to the normal level for that person and not beyond the normal level would they 100 percent need one.

We see alot of guys with low shbg who are hyper excreters of T.. These guys also tend to not do well on arimidex ask PKNY about this...

It is no where near 99 percent.... That's a number you pulled out of your mate

You guys are not hearing me at all...

My whole point is.... Ready for this??? Pull ur heads out of ksmans ass and listen....

Before someone makes lifestyle choices and supplement choices they should first study the heck out of those changes being considered and not just do it because someone on the Internet told them too.. They should make informed decisions based on knowledge which they gained by reading and coming to their own conclusion of what the right thing to do is!!! They should try to do things under the care of some kind of professional who is looking out for there well being...

We ARE all different..

For the record.... My E2 did not go down after staring trt I have lab work 2 months after starting where my E2 was hanging around the same spot.. I then introduced life style changes and supplementation of vitamins and herbs and lowered my E2... This has nothing to do with testosterone it has to do with lifestyle... Look up the effects of modified corn syrup... It is hidden in everything!!! It's a cheaper type of sugar and kills the liver and pancreas and just by avoiding this product I'm sure you will all see positive results..

Watch this!! If the link doesn't work look up- sugar the bitter truth on you tube...


Aces : please elaborate on some natural ways ( non rx ) to bring down E2 levels - my E2 level is 63 after 8 weeks on 100mg per week injections . After several try's with a few different drs - non will rx me Aromidex . I have a theory that by me flooding my body with 100mg weekly it causes it to aromatase into E2 because the body does not want that much T in it . But if split it in 2 doses per week of 50mg there will be less aromatase conversion . Does this idea seem right ? Also I take 100mg DIM supplement - would boosting that up help ?


Sir, you don't have labs and I know very little about you at all. You really need to read the advice for new guys sticky and make a real thread with further lab values, I think in your case without knowing anything Arimidex is the viable solution.

Bring that number down or just get off trt and start to rebuild your body..If you answer the questions ksman has provided it would be easier for people to try and help you. Because we are all individuals who have been exposed to different environmental toxins, our own DNA and genetic issues and mineral deficiencies... We become very individualistic in our treatment.

My best advice to you is to find a very good ND or wellness centre and see what issues you have and go from there. For now you need to get that E2 down so I would source out some adex somehow


Is 63 too high to be fixed without ARIMIDEX - is splitting dose a good approach or a waste of time .


Totally hijacked.


What does hijacked mean


This thread has been become dominated by disagreement when useful facts and actionable advice was called for.


KS : do you think I can bring down my E2 some by switching to a biweekly injection instead of weekly -