T Nation

Arimidex/Anastrozole Question


#1

Background - Doc put me on Arimidex/anastrozole this week. He prescribed 1mg tabs as needed, and said to take it along with the T shot which is 0.75mg dose IM every 10 days. (I've been on TRT for 18 months now, same dose)

The nurse related that my total T was around 1400 and my E2 was 300+ (not sure of the unit of measure and haven't seen the paperwork yet, but I'm going to have labcorp pull a full panel this week). The nurse also related they're not real familiar with all of this so see what happens (so I'll be taking them a copy of the stuff here to review).

Now to the question:

Reading through these threads, it appears that anastrozole is taken as a liquid, either by injection or orally (not sure and I may be reading it wrong), EOD, divided.

So, I cut the 1mg anastrozole tab in half and will take one half every third day based on what I've read here.

That said, am I starting the anastrozole right?

If not, what should I do differently?

Thanks,

Scott


#2

Anastrozole is a competitive drug and serum levels need to match T levels. Your injections every ten days are creating T levels that change vastly.

As T levels change a lot, your lab results are more a function of lab timing than dosing.

Please try this:

  • self inject 50mg T, twice a week [this is 0.25ml of 200mg/ml T]
  • take 1/2mg anastrozole at time of injection
  • always do labs 1/2way between injections

Anastrozole is not injected! You can’t fine tune anastrozole dose very well cutting tiny 1mg pills. A liquid product can be dispensed by 1 drop increments. There are liquid products on the WWW, we will not tell you where. You can make your own dissolving pills in vodka to get 1mg/ml.

Please read these stickies: [there are 7 stickies in this forum]

  • advice for new guys - note 1st paragraph
  • things that damage your hormones [if younger]
  • protocol for injections

Your goals are:

  • high normal T
  • high normal FT
  • 22pg/ml E2

You should inject 250iu hCG EOD to preserve your testes and fertility if important to you.

Sounds like your doc is workable.

Labs:
TT
FT
E2
LH/FSH from before TRT only
prolactin if younger
CBC
AST/ALT
PSA if +40/45
DRE if +40/45
AST/ALT
TSH
DHEA-S


#3

Thanks! I’ve ben reading teh stickies. A lot to absorb…

You stated:

[quote]You can make your own dissolving pills in vodka to get 1mg/ml.
[/quote]
Is vodka the only alcoholic beverage that will work with or will a whiskey work?

Scott


#4

The only requirement is alcohol content. Anastrozole does not dissolve very well in water, but oddly it is very bio-available.

Yes, there is a lot of reading. You have to know about these things, doctors rarely do. So you cannot be passive.


#5

[quote]KSman wrote:

  • self inject 50mg T, twice a week [this is 0.25ml of 200mg/ml T]
  • take 1/2mg anastrozole at time of injection
  • always do labs 1/2way between injections
    [/quote]

Just curious why you recommended 1/2 mg anastrozole with his twice a week injections, when he’s only injecting 100 mg total per week.

Wouldn’t it be safer to start with 1/4mg anastrozole with each injection, and then only if labs warrant, move to 1/2mg twice a week?
Isn’t it better to go with a little less anastrozole, than taking a chance of crashing E2?
You’re the expert, but from my experience here, most people who inject 50mg test twice a week, can keep E2 in check with only 1/4 mg anastrozole twice a week. Heck, many people don’t need any anastrozole with only 100mg test split into 2 doses per week.


#6

"Heck, many people don’t need any anastrozole with only 100mg test split into 2 doses per week. "
You mean several? Certainly not most! How many guys have you worked with doing these things?

If an anastrozole over-responder takes 0.5mg/week om 100mg T/week, they will still crash.
We could start every anastrozole candidate on 0.25mg/week to find who responds, over-responders will be close to target and can calculate a dose correction. Everyone else will need to increase dosing and do labs a second time to calculate on-target.

Most guys on 100mg T per week get close to balanced with 1.0mg/week and then labs can fine tune up/down by calculation as needed.

They could start on 0.5 mg/week anastrozole then fine tune up, but over-responders still crash E2.
Speaking of crashing, how do you think women feel with 1mg anastrozole per day and E2=zero?

You can hit every target the first shot.

If a guy is near or above lower E2=20’s before TRT, its safe to say that TRT will take them to levels that are not optimal for almost all guys."

This has worked well for years: Basically 1.0mg anastrozole per 100mg T per week.

We need to avoid the tyranny of the minority. We can’t have the few who need higher E2 levels or concerns about over-responders hijack the benefits for the majority. I also need to point out that there probably is not a better resource than what has been recommened here.

I also need to point out that “anastrozole over-responder” is a concern developed here by me. I am getting tired of these side shots pointing out my indifference to these issues. This topic covered in 3 stickies for those that bother to read them. It is very unhelpful that stickies do not have the expected identifying icons.


#7

OK, so I’m trying to find a lab to do all this. Does $500 sound right? That’s the range of quotes I’m getting for it?


#8

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#9

Here’s my particulars, thanks in advance.

TT = 607, Range 300-890 NG/DL
FT = 13.4, Range 4.8-25.7 NG/DL (Note, report says CALC FREE TESTOSTERONE)
E2 = 7.3, Range 10-42 pg/mL
Estrone = 7.8, Range 9-36 pg/mL
Estrogens total = 15.1, Range 19-69 pg/mL
SGOT (AST) = 18, Range 5-35 U/L
SGPT (ALT) = 18, Range 7-59 U/L
PSA = 2.0, Range <4.0 NG/ML
TSH = 1.1, Range 0.5-4.7 UIU/ML
DHEA-S = 100, Range 60-266 UG/DL

Data from the CBC
WBC = 9.4, Range 4.0-11.0 K/UL
RBC = 5.9, Range 4.1-5.7 M/UL
Hemo = 17.3, Range 13.0-17.0 G/DL
Hema = 48.5, Range 37-49 %
MCV = 86.8, Range 80.0-100.0 fL
MCH = 30.9, Range 27.0-34.0 PG
MCHC = 35.7, Range 32.0-35.5 G/DL
RDW = 14.0, Range 11.0-15.0 %
Neutro = 65, Range 40-74 %
Lympho = 24, Range 19-48 %
Mono = 9, Range 4-13 %
Eosin = 1, Range 0-7 %
Baso = 1, Range 0-2 %
Platelet = 195, Range 130-400 K/UL

-age = 50
-height = 5’10"
-waist = 40"
-weight = 270
-hair = full head of hair, light to average body hair, easily grow a beard
-carry fat = hydro’d at 28%, mostly belly and chest, no changes since I stated getting fat 20 years ago
-Med Hx = Diabetes type II, Hyperlipedemia, Low T, High BP (140s/90s), L4/5/S1 fusion
-Meds = Glyburide (5mg 2Xday), Januvia (100mg 1Xday), Simvastatin (40mg 1Xday), Lisinopril (10mg 1Xday) Testosterone (0.75mg every 10 days prescribed, taking 0.5mg every 7 days as suggested here), Anastrozole 1mg every 10 days prescribed, taking 0.5mg 2Xweek), Viagra as needed, OTC acetomenphen as needed
-diet = 2,000 to 2,500 cal a day, shoot for 35%pro, 35%c and 30%f, real food and supplement with protein
-training = 5/3/1 BBB program , 10th week
-testes ache? = Negative
-wood = little to no morning wood, nightly nocturnal full erections that subside quickly.

Supplements = Chromium Pic, Mag, DHEA (just started this week), Fish oil, greens drink, BCAAs, fiber, GNC Mega Men SPort vitamin pack


#10

testosterone dose is not right, you are confusing ml’s with mg’s? Please report in mg’s which will be ml x mg/ml

E2=7.3 is way too low. You should try to get close to E2=22pg/ml.

Your dose is .5mg twice a week. Change to 0.5mg X 7,3/22 = .17mg
You seem to be an anastrozole over-responder.
Dissolve anastrozole doses in vodka, 1mg/ml and dispense by the drop, noting drops per ml or dispense by volume.

When you inject T once a week your levels vary greatly. This creates two significant other problems:

  • your lab results are more a function of lab timing than protocol/dosing
  • your serum anastrozole levels never really match your serum FT or bio-T levels

You need to inject twice a week and take anastrozole at that time.

Low E2 makes blood lipids worse and might be making your joints ache.

Add 5,000iu vit-D3

Statin drugs lower CoQ10 in some reducing mitochondrial mechanism, weakening muscles, affecting heart, causing mechanics of congestive heart failure with a chronic cough. See thread “hormones and health”. Supplemental Co!10 is needed and should be exactly Ubiquinol type.

CoQ10 deficiency can also lead to fat gain, inability to loose fat, reduced insulin sensitivity, low energy.

Similar problems with low thyroid function as fT3 regulates mitochondrial metabolism and thus body temperatures.

Yes, TSH looks good, but also check oral body temperature as TSH is only part of the story:

  • when you first wake up, 97.7-97.8 is good, higher OK, 97.3 is a problem
  • also check for 98.6 mid-afternoon

Does your multi-vit list iodine and selenium? yes, but you need more that 150mcg iodine
Do you use iodized salt? Told not to use salt?

Do labs exactly 1/2 way between injections and so not vary.

Why OTC acetaminophen? Joints ache? Arthritis? Muscle pain/ache? L4/5/S1 fusion?

L4/5/S1 fusion from deterioration or trauma?

Magnesium can help with PB and muscle cramps.
Vit K1/K2 can help with arteries and BP
Vit-D3 can help with arteries and BP

Blood is getting to thick in some regards. Look to see what foods you are eating that might be iron fortified and eliminate.
Do not be dehydrated for your fasting lab work, drink water.


#11

Thanks, for reference, these labs were drawn Monday 09/14 5 days after dose

[quote]KSman wrote:
testosterone dose is not right, you are confusing ml’s with mg’s? Please report in mg’s which will be ml x mg/ml[/quote]
Yeah I messed it up, its a 10 ml vial with 200mg/ml. I was pescribed 150mg/0.75ml every 10 days. After reading all of this I started 100mg/0.5ml week.

[quote]E2=7.3 is way too low. You should try to get close to E2=22pg/ml.
Your dose is .5mg twice a week. Change to 0.5mg X 7,3/22 = .17mg
You seem to be an anastrozole over-responder.
Dissolve anastrozole doses in vodka, 1mg/ml and dispense by the drop, noting drops per ml or dispense by volume.[/quote]
Interesting on 08/07, before the Anastrozole, my estrogen was 342.2 (range was 60-190) when tested by docs lab. the labs above were drawn on 09/14 from a local AnyLabTestNow (my TT was 1,048, range 250 to 100, on the previous 08/07 test too FT and E2 not tested).

That said I will dose the anastrozole this way. Is there a max batch I can make or can I do a month, 2 months at a time using 90proof bourbon?

[quote]When you inject T once a week your levels vary greatly. This creates two significant other problems:

  • your lab results are more a function of lab timing than protocol/dosing
  • your serum anastrozole levels never really match your serum FT or bio-T levels

You need to inject twice a week and take anastrozole at that time.[/quote]
Sub-Q or IM like I’m doing now?

[quote]Low E2 makes blood lipids worse and might be making your joints ache.
Add 5,000iu vit-D3

Statin drugs lower CoQ10 in some reducing mitochondrial mechanism, weakening muscles, affecting heart, causing mechanics of congestive heart failure with a chronic cough. See thread “hormones and health”. Supplemental Co!10 is needed and should be exactly Ubiquinol type.

CoQ10 deficiency can also lead to fat gain, inability to loose fat, reduced insulin sensitivity, low energy.[/quote]
Adding Vitamin D3

Any suggestions for dose of CoQ10, I see 50mg and 100mg for sale

[quote]Similar problems with low thyroid function as fT3 regulates mitochondrial metabolism and thus body temperatures.

Yes, TSH looks good, but also check oral body temperature as TSH is only part of the story:

  • when you first wake up, 97.7-97.8 is good, higher OK, 97.3 is a problem
  • also check for 98.6 mid-afternoon

Does your multi-vit list iodine and selenium? yes, but you need more that 150mcg iodine
Do you use iodized salt? Told not to use salt?[/quote]
I have not been told not to use salt, but I also have never used much salt. I will review the Thyroid thread again and see what else I can improve.

General aches and pains from doing dumb stuff when I was younger and ending up (so far) living twice as long as I thought I would, and arthritis, weight lifting.

Trauma

[quote]Magnesium can help with PB and muscle cramps.
Vit K1/K2 can help with arteries and BP
Vit-D3 can help with arteries and BP[/quote]
Get 450mg mag daily. More?

Get 80mcgs of K1 daily. More needed?

Will add K2 and D3

[quote]Blood is getting to thick in some regards. Look to see what foods you are eating that might be iron fortified and eliminate.

Do not be dehydrated for your fasting lab work, drink water.[/quote]
Doc told me TRT can do this and to start donating blood, it was 19.2 on 08/07 and its down after 2 donations.

I had not fasted for this lab since I wasn’t worried about Cholesterol


#12

SC VS IM, whatever is comfortable for you. Best to avoid muscle damage.

Form of alcohol does not matter. 1 mg/ml will have solids ,shake before dispensing. Very stable, mix whatever amount you want.

Hard to know how much magnesium that you need. Biotest ZMA states to take 3 caps. I found that one resolved muscle cramp and tone problems for me.

Not sure what amounts of K1/K2 are needed. I just go with whatever is in a good product.

Ubiquinol is expensive, try 50mg see if you feel better. Later try 2x50 and see if any change in vitality is evident.


#13

Thank you again for all the information.

Temperatures - Do I need to trend over a few days? If not:

0500hrs, 96.9F oral
1415hrs, 96.7F oral


#14

[quote]ScotCook wrote:
Thank you again for all the information.

Temperatures - Do I need to trend over a few days? If not:

0500hrs, 96.9F oral
1415hrs, 96.7F oral[/quote]

That is horrible and a major factor in how you feel.
You are iodine deficient. Read that sticky!
Is your life very stressful or some very stressful events or medical problems?
Outer eyebrows sparse?
Get cold easily?
Thyroid sore, enlarged, asymmetrical, lumpy?


#15

Thank you again. I read the sticky again and the STTM.

Stress as we understand it generally, is not too bad. I am busy.
I do believe my outer eyebrows are a biot sparce.
Don’t get cold easy at all. In fact, I feel like I run warm. I rarely have to wear a jacket to be comfortable in the cold.
My thyroid isn’t sore, enlarged, lumpy. I do feel like I have an asymebtrical lymph note on my right side under my jaw, that swells occassionally.

So hears my plan for comment:

Changed to 50mg T-Cyp 2Xweek with .17mg Anastrozole as described.

Added daily:

  • Vit D3, 5,000U
  • CoQ10, 100mg
  • Mag, 850mg
  • Vit K1, 100mcg
  • Vit K2, 100mcg

Plus prepare for iodine supplement as described on http://www.stopthethyroidmadness.com/:

  • Vit C 3,300mg
  • Selenium, 400mcg
  • B2, 150mg
  • B3, 550mg

#16

Supplemental Co!10 is needed and should be exactly Ubiquinol type.
…!!!


#17

The CoQ10 is Ubiquinal type, 100mg,