T Nation

AI-Monotherapy (Mid Free-T, Mid E2, Low DHT)


I have been diagnosed with secondary hypogonadism around 5/2016. At the time I was lean (72 kg / 159 lbs)), ate healthy, visited regularly at gym and was really doing everything to feel better. Still felt depressed, had ED, massive problems with insomnia. I just felt burnt out and ready to commit suicide. Free T low / under reference range. Lab results at the end of post.

Over couple of years tried following treatments with some succes:

  • Letrozole monotherapy (good free T, dead libido)
  • Tostran testosterone gel (roller coaster, bloated, limpy dick, felt like a zombie at mornings)
  • Sustanon 250, IM (high E2–> brain fog, bloat etc)
  • Sustanon 250, IM + anastrotzole (E2 crashes with (micro dosing) anastrotzole, still puffy niples day or two after injection, brain fog)
  • exemestane (Aromasin) monotherapy (low-mid free T, E2 low-mid, DHT low)

28 year old
96 kg (211 lbs)
180 cm (5’11”)

  • I have facial hair and some beard
  • hairy body, although sometimes hairs just drop when brushed
  • brows ok
  • body / genital hair has black and white sections
  • Some acne (face, chest, shoulders); painful zits when high E2
  • balding slowly, thin and dry hair
  • hard(ish) to gain muscle
  • interested in sex once or twice /week, usually not easy to stay hard
  • lethargy; no goals in life. Still working and studying. I feel happy few times a week.
  • Some days I have no energy to even stand or walk (feeling that I have no muscles at all)
  • Some days I feel even my chest muscles (like they have inflated from nowhere!)
  • I suffer from gynecomastia (only Letrozole has made difference, but it kills libido and makes impossible to come). I have (imo) notable breasts.
  • Lots of problems with tired and dry eyes; they get better with high T but following high E2 destroys everything.
  • motor coordination problems: with high E2 or low T I keep bumbing on doorways and have difficulties on grabbing handles or things.
  • memory difficulties
  • Thyroid seems ok: body temperature problems occurs when E2 or T is too low.
  • Sleep is good after treatment started, only low E2 destroys it occasionally. :slight_smile:
  • Right testicle shrinks and grows on and on daily–>lots of pain

I feel that exogenous T converts too easily to E2 on my system --> problems. I could try the slowest esther (Nebido, undecanoate), but I feel bit scared.

Medication now: Exemestane (25+0+12.5)mg daily to keep E2 low enough and T production high enough. Mild rollercoaster but better than nothing.

Supplements: D-, B-, C-vitamin and zinc.

So I was thinking what would happen if I were to introduce exogenous DHT to my system. Shutdown of HPTA and drop of TT and freeT? Or should I even be concerned about DHT?

Iron, ferritin etc ok. Liver ok.

I over-respond to AI’s as well, so I dissolve my 0.050 anastrozole in 5mls of vodka using graduated glass droppers and micro dose .2mls twice weekly.

It looks like you had decent blood results on Letrozole.

Regarding DHT, it won’t have an AI effect, but will still block estrogen signaling in the cell. I’ve seen bloodworks where doses below 5mg per day didn’t lead to suppression. Many proviron bloods out there where 12.5/25mg per day showed no suppression either, although proviron isn’t strict DHT

Yup, I felt pretty good on Letrozole. Only real issue was zero libido, worst ED ever and inability to come. And some night sweats. Took 3 weeks after quitting Letro to have orgasm.

I have been thinking about my low SHBG and low(ish) E2. So I took only 1/4 tablet of exemestane at Tuesday night and ½ tablet at morning. Aaaand I feel better and relaxed. I think my dosage will be (12,5+0+12,5)mg for next… 6 weeks? Hopefully T won’t drop.