T Nation

Anastrazole Question + HCG + TRT

Hi All!

My husband(53) was on a bad regimen of TRT for many years. He was injecting 300mg (1.5ml) once every 3 weeks. No HCG, just TRT that was his regimen. When I came into the picture, I researched and told him to get a better regimen and add HCG.

His blood work for that regimen showed crappy results:
Testosterone serum was 67 [(range: 264-916)]
Free testosterone (direct) was 5.3 [(range: 7.2 - 24.0)]
Estradiol sensitive was 7.8 [(range: 8.0 - 35.0)]
(Im only including these items and not others since my questions are about these items only)

After bloodwork, our new doc confirmed that was a bad regimen and gave new dose:

Testosterone 200mg/ml - 0.32ml IM/SQ twice weekly
HCG 350iu SQ twice weekly
No anastrazole because doc wanted to see how estradiol would react to introducing HCG.

This new regimen of injecting twice a week both TRT and HCG seem good. No bad side effects, no nipple sensitivity, no signs of gyno. Testicles are still abit atrophied though, husband reported minor mood changes. Libido is good. I dont notice any mood changes though, but I dont live in his mind LoL.

After 3 months blood tests showed better results:
Testosterone serum 504
Free testosterone direct 15.4
Estradiol sensitive 57.8

Since estradiol went up and minor mood changes, doc now suggesting anastrazole. Since testicles still atrophied doctor suggesting upping HCG. And lastly doc says testosterone did improve but maybe it should be higher than 504 and get to better levels like 800 or 900.

Doctor suggested new regimen:
increase testosterone to - 0.35ml IM/SQ twice weekly
Increase to HCG 500iu SQ twice weekly
Add anastrazole 0.25mg twice a week.
***Repeat bloodwork in 3 months.

My questions:

  1. Should HCG increase from 350IU to 500IU for better testicular size or keep taking 350IU 2x weekly and watch and wait for better size? Hes been on 350IU for 3 months so far, not sure if testes need more time. Thoughts?

  2. More important question: Is anastrazole going to cause any bad side effects? I know it will help estradiol levels not to get higher, but has anyone had any bad impact when it was introduced to their regimen? Doctor said anastra. will not cause any harm, but im worried about bad side effects. Any comfort you can give me?

  3. Is it necessary to bring testosterone higher than 500? As you can see injecting twice weekly made it jump from 67 to 504. But do we really need it to be 800-900? The husband feels fine on current dose of .32ml 2x weekly, seems like doc wants to gradually raise levels slowly. But is it (really) necessary to bring levels higher?

Thanks all!

I agree that you husband was on a bad protocol, sadly doctors are still putting men on these terrible protocols instead of tailoring treatment to the individuals biomarkers which few doctors even know how to do. These cookie cutter protocol makes it easier on doctors and rarely works out well for the majority of men.

There are a lot of anastrozole over responders on this website, myself included. I can’t take a small pinch of anastrozole without feeling extremely fatigued and jittery, aromasin is another story that is gentler on my system and acts slower and doesn’t have the E2 rebound that anastrozole does after stopping the medicine.

A 1/10 dose of aromasin makes a noticeable difference in the way I feel in a positive way. He may feel a headache behind the eyes after taking the anastrozole, this is usually a sign the dosage is high for him and may take days to notice a large drop in E2.

Losing body fat may allow your husband to remove the anastrozole from the equation after body fat is lost. I myself have high body fat and therefore this encourages the conversion of testosterone over to estrogen. You can get anastrozole compounded by Empower Pharmacy as low as .125 mg which is only a tenth of a mg, cutting up anastrozole, in pill form beyond 1/4ths is impossible.

You absolutely need to get Free T to high normal, Total T is bound to SHBG and is biounavailable, Free T is the free hormone circulating in the blood that makes all the magic happen.

An HCG dosage of 350 twice weekly may be a little weak, 500 twice weekly and even 250-300 EOD dosing can work. If fertility is of no concern, speaking for myself I would drop the HCG do to the tendency to increase estrogen.

It’s nice to see for a change that someone has actually found a knowledgeable hormones specialists.

If 500 was at his trough (before the next shot) it’s not a bad level - that would make his peak around 7-800 which is pretty optimal for most guys.

Systemlord: Thanks for your input! I dont know if he will over respond or not, like you have. Hes never been on anastrazole before. My concern is whether he will have those issues you describe like jitters, fatigue, headache and other bad impacts. Plus adding another chemical in his body is something I dont prefer. When do you think the symptoms arise? Do they happen a couple days after or a week after, etc…? Also, what happens if a person doesnt take anastrazole and lets their estrogen stay elevated? Will they start having mood swings, low libido, bad erections and other complications? The doc said upping HCG to 500IU is a choice not obligatory.

Mike12 you make a solid point. His injections were on a thursday and the blood test was on a Monday. He then injected after the blood test. So maybe the 500 level was at his trough. Perhaps his peak is 7-800. Then does it mean he should not increase his TRT and stay where he is?

  1. He should have seen an increase in testicular size by now. Usually, 250-350IU twice a week will accomplish that. HCG can increase E2 and he may want to rethink it if the only reason for taking it is for testicular atrophy. That is unless, obviously, that is an issue for him.

  2. Yes, anastrozole may cause some negative side effects. He should adjust to the E2 level and as long as the side effects of increased E2 are mild, it may be worth giving it a little more time.

  3. It is not necessary to increase total test. Free testosterone is the player. I would not think going from 128 to 140 mg per week would not have much of an effect and unless you are using an insulin syringe, .32ml or .35ml would be difficult to draw up consistently anyway. He should go with how he feels and in regards to the numbers, we are all different. For example, recent labs have me at 902 total, 220 free, 49/62 E2, with 200mg test once a week. I feel very good.

I noticed a difference in a few hours and a couple of days later I noticed joints were popping and clicking. High or low estrogen is like double edged sword, the mood symptoms are similar and unpleasant for him. Erections and libido may suffer with estrogen out of balance.

I forgot to mention another way to lower estrogen, injecting smaller more frequent doses lowers the amount of Test in the system in a given week decreasing the chance at estrogen conversion. Smaller doses make the testosterone and estrogen peaks smaller, over time estrogen will be lower than if injecting large doses less frequently.

I inject EOD for that reason as twice weekly injections estrogen is just to high, an EOD protocol lowers estrogen. I recently tried injections everyday which lowered estrogen further, but my body can’t handle daily injections for some strange reason.

He may end up doing just fine on anastrozole and if not there’s always aromasin. Some men only go on HCG when it’s time to have a kid, and then stopping the HCG until it’s time for another kid so that they don’t have to deal with the extra estrogen issues. FSH works even better than HCG to increase sperm production, but is expensive.

Thanks Highpull for the info!

  • For someone who has been taking one injection every 3 weeks for like 8-9 years, dont you think its going to take time for HCG to work and assist the testes? I dont know if 3 months is long enough for 350IU to work against atrophy. Do you think we have given it enough time? Is HCG supposed to give testes their fullness back that quick for someone who was on such a bad dose for so long?

  • His E2 while he was on the bad dose was like almost an “8” very low. Once he started injecting TRT and HCG 2x a week the E2 became 57. He didnt report any bad side effects from the estrogen jumping to 57. But if the doc wants him to bump up to 500IU of HCG im guessing the estrogen will also jump higher than 57? I guess the question is: would you rather suffer side effects from anastrazole or suffer side effects from high Estrogen? I know having high e2 isnt good and having anastrazole side effects isnt good. But which is the better of the two evils LoL? I just feel leary about anastrazole… is the normal E2 (sensitive range) supposed to be 20-25 or does it differ for others? Ive read some who said they felt fine with level of 50.

  • techinically he is in range now for his testosterone total and free, but the doc said we can make the levels look even better by gradually and slowly upping the TRT. So his reason is the level is fine now but it can be better. Should we shoot for better or be happy with being fine? I dunno the answer. He seems fine with the current regimen of TRT and HCG… the syringe is 27 gauge insulin one and he really likes it since theres no pain and feels like nothing.

Systemlord: popping joints, night sweats, headaches, fatigue…sounds brutal. Are these general issues people have when they start the anastrazole and they will go away after a couple weeks or do these things stay with the person? If they are just symptoms you have when you start and they disappear thats not a big deal but if theyre gonna stay with the person, that sucks. Do people report they go away or they stay?

He is injecting every 3rd day (mon and thur). Injecting every other day or even every day is gonna be tiresome, you know? Sounds plausible, the doctor didnt provide this as a method though. He just said anastrazole will do the job. But your idea seems less harsh on the body, which I like.

I take it that your opinion is if a male doesnt want kids or doesnt care about testes appearance he shouldnt worry about taking HCG? I read HCG has other great qualities to it, maybe im wrong? But is the only reason guys take it is to induce sperm production and help with atrophy?

I think he should have noticed something by now. I’ve been on TRT for five years, weekly injections, took hCG for six weeks this past spring. I noticed increased testicular size in two weeks, two 350IU injections per week. I felt no different with it, however.

You would think E2 would increase, but it may not. I do not think you have to resign yourself to either or regarding estrogen, high or low E2. If high E2 symptoms develop, start low with the anastrozole and see how he responds. As for the “normal” range, don’t focus on a number.

Same with testosterone, if he is feeling good and happy with the way he feels, don’t change anything, The number could be “better” i.e. higher, but he may not feel any better, and perhaps worse, as E2 will also increase. Totally his call, nothing wrong with going up if he wants to push it. Could always drop back if he crosses the line.

Good luck.

Yea highpull, I understand! I dont think the 350IU did much for his atrophy. Maybe his TRT regimen of (once every 3 weeks) was just so bad that it messed up their size. Maybe the 500IU will help with atrophy. Anyway it doesnt matter I am not worried about testicle size that much, I just want them to be fuller so that he feels better LoL.

Can we just use the “wait and see” approach? Basically follow the doc’s upped dose of .35ml TRT and 500IU HCG and see if he gets any E2 symptoms THEN if he does we can use the anastrazole. Would that be wise OR should people start on anastrazole right away?Thanks

I think wait and see is perfectly reasonable.