T Nation

Briefly Stopped Arimidex B/C of Side Effects, Now Huge Fatigue Problem


#1

Brief summary: Stopped Arimidex for 10 days because I suspected it was causing persistent arthritis in hands and fingers. I expected my estrogen to spike and bring symptoms of fatigue, etc. I've been back on Adex for 2 weeks and have had SEVERE fatigue (can't wake up after normal night's rest, falling asleep multiple times a day, profound weakness and exhaustion). I had my Dr. test E2 because I figured it must be way too high or perhaps too low, but nope! The results put me in the sweet spot: 20 pg/ml (scale says < OR = 39)
WTF?!?!!?

-age: 33
-height: 5'9"
-waist: 34"
-weight: 188
-describe body and facial hair: Normal hair all around. No balding. Facial hair starting to gray in spots.
-describe where you carry fat and how changed: Mainly in stomach. No changes.
-health conditions, symptoms [history]: Diagnosed with Chronic Lyme and other co-infections ~5 yrs ago. Moderate-strong symptoms affecting almost EVERYTHING. Cognitive issues (memory, irritability, etc.), bad low back pain, fibromyalgia, daily muscle tension, muscle weakness, nerve pain, headaches, severe heat sensitivity, insomnia, etc, etc, etc.
Low testosterone detected about a year ago, started Axiron w/o much success. Found endocrinologist ~ April who started me on injections. A couple months later started HCG. Then started arimidex once E went too high.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: Opiate patch for pain (~5 years), benzos for anxiety, gabapentin for nerve pain, test cyp. 60 mg/week and HCG 500iu 2x week for low T. Arimidex .25 mg E3D. No drugs for hair loss or prostate, ever.
-lab results with ranges: I can give a brief summary since the recent full labs aren't available online till next week.
Testosterone: about 950 (range 250-100)
Estrogen: 20 pg/ml (< OR = 39) as of today. Previous bloodwork about 45 days ago indicated my levels were between 20-30, if I remember correctly.
All the other basic stuff (cortisol, psa, dhea, tsh all normal)
-describe diet [some create substantial damage with starvation diets]: Try to eat as healthy as possible, but ideal diet isn't possible due to my long-existing Lyme symptoms.
-describe training [some ruin there hormones by over training]: Used to be in great shape, but since Lyme I can only do light calisthenics ~3x week. Anything more intense isn't tolerated with my muscular pain.
-testes ache, ever, with a fever?: Used to ache before starting T injections, not anymore.
-how have morning wood and nocturnal erections changed: Fluctuates... Haven't noticed it last couple weeks because I've been so exhausted and sleeping so deeply.

Since my medical history is long and very involved, I'll do my best to keep this as on point as possible.

When I started the T injections in April I felt amazing for a couple weeks, then back to normal crappy self. Tests revealed E2 to be 48 (scale says: < OR = 39) in mid-May so I was put on Arimidex. Rx was for .5mg EOD, but I soon had severe arthritis in my upper back, arms, and hands, with painful tingling in my fingers. I lowered my dose to .25 mg every 3 days, and the side effects subsided, but not completely.

This brings me to the developments in August.
I was about to find a Dr. to help with weaning off of long term Xanax, but I thought I should try to take care of the persistent arthritis I believed the Arimidex was to blame for first. The plan was to stop it for 2 weeks to prove that it was Arimidex and not something else. I made it only 10 days in because these symptoms developed/got worse: weak morning wood, depression, anxiety, water retention, easier to get angry, tired after eating meal (insulin resistance?), larger stomach, moderate fatigue. (I'm assuming my E levels spiked since I was w/o Arimidex and developed symptoms like these) The arthritis and tingling started subsiding within days.

Ok then, sounds like the plan worked. Arimidex is causing the arthritis, and since I still need to control my E levels, I'll just resume it at my regular dose and the next time I see the endocrinologist, I'll discuss the possibility of getting a lower dose compounded. That was the plan..

Except the last 2 weeks have been a living hell. I resumed the .25mg, E3D dose of Arimidex on 8/26. The fatigue has only been getting worse since that day. Sleeping 8 hours is normally enough to feel rested, but now I wake up and it feels like I've been asleep half an hour. I've fallen asleep in the middle of reading, being on the computer, watching my kids, etc just a couple hours after waking up. The last 2 weeks I've fallen asleep in the middle of the day EVERY DAY, sometimes three times in a day. When I'm awake I have ZERO energy and am too tired to move around much or frankly to think much.

I asked the Dr. to test my estrogen levels because surely they must be too high or perhaps too low. The results came back today and it's 20 pg/ml, which from what I understand is in the ideal range (and a couple months ago when my levels were in the 20's I felt fine).

I understand what some readers might think: I have a hell of an unresolved medical history, and with all that going on the culprit is probably something else. I definitely understand that argument. But things are a little too coincidental. I felt normal in early August (normal for me, that is) then decide to stop Arimidex a short time because of side effects. 10 days in, it seems like I'm having symptoms of high estrogen, so I go back on Arimidex. Instead of those high estrogen symptoms subsiding now that I'm on Arimidex again, I'm more fatigued than I've ever been in my life, for 2 weeks straight.

I've been an appreciative lurker on this forum for months now. The advice presented here has really helped me with TRT the last 6 months. Now I'm just wondering if anyone, anywhere, has any idea what the hell might be going on with me?!

Thanks for reading!


#2

Stay the course for now to see if you stabilize. In the mean time get your cortisol and thyroid tested. Tsh, ft4, ft3 and rt3. Also take your waking and afternoon temps before any eating, drinking, showering or exercising. Post three days worth of those numbers.


#3

Thanks for the reply. I'll see if I can get ft4, ft3, and rt3 done since I don't think I ever have before. Regarding tsh, cortisol, thyroid, and temps, all that's been done earlier this summer and all was within normal ranges. I'll get to work seeing if I can dredge up some test results.


#4

Something must have changed. Typical reasons for feeling like you're going to fall asleep mid day/mid activity is usually related to low e2, low cortisol or low thyroid function. Its going to be difficult to tweeze out the issue because your multiple medications make the possibilities more complex. You may want to get new blood work done. You may also want to consider backing off the ai slightly and see if you feel more wakeful.


#5

You are probably not having Arimidex/anastrozole side effects, but have problems with E2 levels getting too low because anastrozole dose was not right for you.

Anastrozole is a competitive drug, with testosterone, at aromatase reaction sites where FT-->E2 happens and that reaction rate is modulated. For this to work properly, serum anastrozole levels need to match serum FT/Bio-T levels.

Injecting T once a week is most often not frequent enough:
* T levels rise and fall a lot
* Anastrozole dose is too high as T drops

We need FT lab results and ranges. If SHBG is elevated, T+SHBG is elevated and non-bioavailable and that can inflate TT levels.

We do not see that 60mg T cyp/eth is effective at relieving symptoms of low T.

Suggest:
* 50mg T cyp twice a week
* 0.5mg anastrozole at same time
* 500 iu hCG at same time

Inability to absorb transdermal T is often a sign if low thyroid function. You can check your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. You can have thyroid problems if not using iodized salt and/or vitamins that list iodine+selenium.

You can dissolve anastrozole in vodka, 1mg/ml and dispense by volume with a syringe or by the drop after counting drops per ml with a dropper bottle.

Most need a lot of Vit-D3. Suggest 5000iu - find tiny oil based capsules. Later you can test Vit-D25 levels. Vit-D25 is an active hormone essential for many aspects of proper gene expression in your cells. In your case, 10,000iu could be tried to see if you improve.

Please post labs and ranges in list format:
TT
FT
E2
RBC
hematocrit
serum protein
albumin
AST/ALT
prolactin
TSH
fT3
fT4
CRP
fasting glucose
fasting cholesterol - can be too low
AM cortisol
IGF-1

Were LH/FSH low before TRT?
Blows to the head?

It well known, but few know, that when TRT increases/restores metabolic demands that one can feel worse if thyroid and/or adrenals cannot keep up, one can feel worse. Even if thyroid fT3 is ideal, the active hormone, one can be in trouble if reverse T3 - rT3 is blocking fT3 from working.

rT3 can be elevated from adrenal fatigue and the factors are:
- acute or chronic illnesses
- chronic inflammation, infections or allergies
- daily stress or major stress events
- stimulant/caffeine abuse
- driving through difficulties or weaknesses with will power and adrenalin
- see the thyroid basics sticky

Thyroid fT3 controls your energy levels by regulation of mitochondria inside your cells as part of the control loop that regulates body temperature. Mitochondria make ATP, the universal currency of cellular energy.

Please see these stickies found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • thyroid basics

Arthritis: This is characterized by a cycle of persistent inflammation that damages joint tissues. It can come out of the blue. It is important to stop the process and naproxen etc does not work well. Ask for a Rx of 15mg meloxicam. You take it once a day and it can be very effective and is a very small drug load on your body. You can get a years supply for $40 at USA Walmart. It is the only thing that really got my hands under control. Pain and inflammation/redness resolved and a lot of joint swelling cleared up. So the cycle of inflammation and destruction was ended [for me].

Please work on all of the issues presented above.

Tired: Are you getting good sleep or lying awake. Do you take any sleep aids now?

Do body temperatures ASAP, the results can be very informative.

??train conductor for Canadian Pacific??


#6

Thank you for your suggestion Hostile. Thank you also KSman for the detailed response. After seeing your expertise at work elsewhere in the forums I was hoping to hear from you. I'll be sure to respond to your post in more detail as soon as I can.
First I have to ask why you think I am/was a train conductor for Canadian Pacific? I'm curious what I said in my initial post that would make you think so...


#7

Googled ltdan1776
I have background in locomotive production.


#8

Ah I didn't think of the google search. Yeah I was a conductor for CP in '06/'07 in Indiana, doing runs between Windsor, Canada and Chicago. I HATED the lifestyle, no designated days off, on call 24/7, as little as 6 hours between finishing one 12 hr shift and and then being called for another...
What I really loved though was being on the engines. They are magnificent beasts. The sheer power of those things at 60 mph was always a blast. Did you ever get to ride the engines you helped work on?

I'll update this thread as soon as I get the most recent bloodwork results from my Drs, hopefully tomorrow.


#9

It took me a few days to dig up the recent labs.
I'm posting relevant lab results going back a few draws, if available:

TT:
815 ng/dL (range: 348-1197) on 6/30 LabCorp (I had blood work drawn on consecutive days for 2 diff Drs)
1119 ng/dL (range: 250-1100) on 6/29 Quest (wow what a difference a day makes!)
979 on 5/18
248 on 4/5 ==>This was while I was on transdermal T and just before injections.
407 on 3/6
107 on 2/9

FT:
317.8 pg/mL (range: 35.0-155.0) on 6/29 Quest
277.1 pg/mL (range: 35.0-155.0) on 5/18 ==>This is why I'm only on 60 mg T Cyp. Dr. had me on 100, then 80, then 60 because my Free T was so high. I never got an explanation why my TT is good but FT is really high. I found this chart online though that seems to say that these levels are OK: http://anabolicminds.com/forum/attachments/21485d1212097013-jans-bloodtest-april13-dr-shippen-chart?stc=1
13.5 pg/mL (range: 8.7-25.1) LabCorp on 3/6
7.3 pg/mL (range: 8.7-25.1) on 2/9 Labcorp

SHBG:
15 nmol/L (range: 10-50 nmol/L) on 6/29
12 on 5/18
15 on 4/5

E2:
20 pg/mL (range:< or = 39) on 9/7
22 on 6/29 ==> I felt pretty good at this point even though the number is similar to now.
48 on 5/18 ==>This is when I started Arimidex. Fatigue was bad but not as severe as now.
<15 on 4/5 ==>I remember feeling pretty bad but not as bad as now. Also, I had NO ARTHRITIS at this point. That only started after Arimidex in May.

RBC:
5.89 mill/mcL (range: 4.20-5.80) on 6/29 Quest
5.55 x10E6/uL (range: 4.14-5.80) on 6/30 LabCorp
5.69 on 3/6
5.43 on 2/9

Hematocrit:
51.7 % (range: 38.5-50.0 %) on 6/29
48.4 % on 6/30
48.1 % on 3/6
48.1 % on 2/9

Protein, Total:
7.2 g/dL (range: 6.1-8.1 g/dL) on 6/29
SAME on 6/30
SAME on 3/6
SAME on 2/9

Albumin:
4.7 g/dL (range: 3.6-5.1 g/dL) on 6/29
4.9 on 6/30
4.6 on 3/6
4.7 on 2/9

AST:
23 U/L (range: 10-40 U/L) on 6/29
SAME on 6/30
20 on 3/6
18 on 2/9

ALT:
14 U/L (range: 9-46 U/L) on 6/29
15 on 6/30
22 on 3/6
22 on 2/9

Prolactin:
14.2 NG/mL (range: 2.0-18.0 NG/mL) on 6/29
8.0 on 5/18
(no other tests)

TSH:
2.72 mIU/L (range: 0.40-4.50 mIU/L) on 6/29 Quest
1.70 on 6/30 (almost exactly same range as Quest)
3.27 on 5/18
2.46 on 4/5
1.96 on 3/6
3.86 on 2/9

fT3:
Never tested to my knowledge.

fT4 (T4 free, right?):
1.16 ng/dL (range: .82-1.77) on 6/30
1.17 on 3/6
1.11 on 2/9

Reverse T3, serum:
18.0 ng/dL (range: 9.2-24.1) on 6/30
16.3 on 2/9

CRP (C-Reactive Protein?):
1.18 mg/L (range: 0.00-3.00) on 6/30
1.02 on 2/9

Glucose, fasting:
90 mg/dL (range: 65-99) on 6/29
84 on 6/30

Cholesterol, fasting:
174 mg/dL (range: 100-199) on 6/30
(no other tests)

Cortisol, AM:
21.7 ug/dL (range: 6.2-19.4) on 6/30 LabCorp
6.1 mcg/dL (range: 4.0-22) on 5/18 Quest
9.6 mcg/dL (range: 4.0-22) on 4/5 Quest
16.9 ug/dL (range: 6.2-19.4) on 2/9 LabCorp

Had saliva cortisol test done 8/2/15
0.9 (range: 3.7-9.5 ng/mL) Morning
3.7 (range: 1.2-3.0 ng/mL) Noon
1.6 (range: 0.6-1.9 ng/mL) Evening
1.7 (range: 0.4-1.0 ng/mL) Night

IGF-1 (not sure if this is it; bloodwork just says "insulin"):
12.9 uIU/mL (range: 2.6-24.9) on 6/30

Vit D-25:
90.4 ng/mL (range: 30-100) on 6/30
60 on 5/18
97.7 on 3/6 ==>dropped from 10,000 iu to 5,000 iu daily since this point
76.4 on 2/9

DHEA-S:
425.3 ug/dL (range: 138.5-475.2) on 6/30 LabCorp
301 mcg/dL (range: 106-464) on 5/18 Quest
356 mcg/dL (range: 106-464) on 4/5 Quest
385.9 ug/dL (range: 138.5-475.2) on 2/9 LabCorp

Iodine, urine:
56.6 ug/L (range: 28.0-544.0) (Limit of quantitation = 20) on 6/30

Ferritin:
29 ng/mL (range: 30-400) on 6/30 LabCorp
16 ng/mL (range: 20-345) on 5/18 Quest ==> started taking liquid iron for 1 month, then daily iron supplement
32 ng/mL (range: 20-345) on 4/5 Quest
29 ng/mL (range: 30-400) on 3/6 LabCorp
69 ng/mL (range: 30-400) on 3/6 LabCorp

Your questions:
1) Were LH/FSH low before TRT?
I don't believe I've ever had these tests.

2) Blows to the head?
None.

3) Quality of sleep: VERY difficult for me to fall asleep before 4am. Myriad of symptoms I mentioned in my first post interfere with getting sleepy. I've tried herbal teas, no screens at night, etc etc etc. I take 1 .25mg Xanax to calm my mind to give me a chance almost nightly.

I have a lot of other bloodwork available if you think it'd be useful. Let me know if you want me to list the names of what has been done and you can indicate if you want the numbers.

Questions:
1) If I can get my Drs OK (or even if I can't :smirk:) to do bi-weekly SubQ T injections, can I use 5/16" insulin needles?

2) Why are FT levels so high? According to that chart I linked, it looks like my FT levels are actually fine...

3) With the insomnia I can't fall asleep till very late. And now with the severe exhaustion I've been waking up very late (After noon most days). Regarding checking temps, should I check temp as soon as waking but how much later do I check "mid-afternoon" temps (since mid-afternoon for me is late evening)? How many days of body temps do you want?

4) Based on what you say on here about the importance of iodine, is mine high enough?

5) You said I'm probably not having Arimidex side effects, that it's my E2 levels going too low. However, my E2 levels were at their lowest (<15) in April and I had no arthritis or tingling at all. It started intensely within a week of starting Arimidex after the E2 result of 48 on 5/18. Given that info, do you still think it's low E2 and not a side effect? How should I proceed?

6) I get what you're saying about T levels rising and falling a lot due to only injecting once a week, but the arthritis is constant. Should I start with the assumption that I'm sensitive to Arimidex and it's causing arthritis (and therefore it's causing damage) and try to lower my dose as low as possible?

7) My next Endo appt is in a week. I will request the missing bloodwork to be completed (let me know if there's anything else I should ask for). I will ask him to do bi-weekly SubQ injections. Given my good TT and high FT, should I still try to get T Cyp increased above 60 mg a week? Anything else?

Thanks for your time!!


#10

IGF-1 is made in liver, depending on your GH levels. IGF-1 is actually a better measure of GH status than testing GH itself.

Hematocrit getting where there is some worry. Perhaps from high FT. Injecting twice a week will help reduce spikes that may be part of the problem. I have injected T with 5/15"

Sleep, ask for Rx 150mg trazodone and take 50mg [$50 per year at USA Walmart]. Find 5-6mg time release melatonin, hard to find on the shelf, keep looking for time release.

Ferritin is low. May reduce fT4-->fT3 conversion. Have you ever had an occult blood test to detect any blood loss via your guts?

SHBG is low explaining why FT is high.
SHBG getting low can suggest some other health conditions. But some guys just seen to be that way.

Go on/off Arimidex and note arthritis changes.

TSH should be nearer to 1.0
Could be from not using iodized salt.
fT4 is a bit low re mid-range.
Iodine is low, suggesting not using iodized salt.
Iodine is key part of thyroid hormones.
fT3 not tested, fT3 is the active thyroid hormone
We are looking at temperatures at low point when you wake up and trying to find what should be peak temperatures later on.

Never rode in a locomotive. Was a QA engineer dealing with production problems and vendor issues. Sort of a trouble shooter.


#11

It seems like time has helped solve this mystery. I am more inclined to think that my whole reason for posting here (profound fatigue, exhaustion) is not because of the Arimidex anymore, it's because of a flare-up of my long-term illness (Lyme, co-infections, Candida, etc). I won't get into the reasons why I think so because they have little to do with TRT, but I am still interested in ruling out other possibilities we've discussed. I'm still having the fatigue, but not as intensely and still having arthritis, but pretty much only after an intense arm workout.

I recorded my temps:
Morning temps ranged from 96.08 to 97.33, averaging 96.90 over 10 days
Afternoon temps ranged from 97.60 to 97.90, averaging 97.72 over 10 days
Any problems here?

I am still trying to pull old test results to see if I had an occult blood test.

Questions:

1) Did you look at that T chart I linked to earlier? I don't know how legit the info is on this chart, but if I'm reading it correctly it seems to indicate that if my TT is around 1000, then my FT should be between 300-350, and my SHBG should be about 15. If this chart's info is legit, then my numbers are lining up pretty much as they should be. But you say my my FT is too high and SHBG is too low. Is the chart not accurate, and if so, is there another resource you can direct me to that would indicate the ideal relationship between TT, FT, and SHBG? I intend to show this to my Dr. so he doesn't keep lowering my T Cyp dose in order to lower the FT.

2) You say my iodine is low. Is it low enough that it's worth doing your "iodine protocol" you talk about elsewhere on this site to get my levels up?

3) I see my Endo on Friday and need to request what bloodwork I want done (I wasn't able to get it done before). I intend to have him do a CBC, Comp Met Panel, TT, FT, E2, prolactin, TSH, fT3, fT4, reverse T3, CRP, fasting glucose, fasting cholesterol, AM cortisol, IGF-1, ferritin.

What else do you recommend I test, and is there anything I listed you don't need to see again? (I now pay 10% of all labs so I want to avoid unneeded tests)

4) My other Dr. had a test done on 6/30 called Creatine Kinase, Total, Serum. 363 U/L (range: 24-204). Long story short, I haven't been able to ask that Dr. what the significance of that result is. I read that it can indicate muscle disorders (which may explain my severe muscular pain issues..). Does this test mean anything to you?

Thanks again for your help.


#12

You can look up things too: https://en.wikipedia.org/wiki/Creatine_kinase
Fits in with your muscle pain.

Problem could be some abnormality in mitochondrial function. I pointed out the role in fT3 ealier, so do pay attention to thryoid. With low body temperatures, you can try iodine. Also, get supplement 100mg Ubiquinol form of CoQ10. Not ubiquinone! Important that you stay on Vit-D3 as well.

With low body temps, you need to take action to fix that.

Other than labs, have you done anything I suggested?


#13

I've read many articles re: Creatine Kinase, I was simply asking to see if you've run into it before.

I've been supplementing with 100mg Ubiquinol for a few years now, and will continue the Vit D.

Re: your recommendations, I'm not going to go on and off Arimidex again. I've done it twice now, and it takes weeks for my system to normalize. Given that the arthritis has been a good deal lessened for some reason, I'll just leave it alone. Too many other pressing health issues right now..

As far as Meloxicam for arthritis, I'm going to request it tomorrow to have on hand for flare-ups.

Trazodone for sleep: I've been on anti-depressants before and don't tolerate them well. I also have other reasons for not wanting to introduce them again.

Melatonin: tried it a few times in the past (I got a timed release on Amazon) and did not tolerate it well. Disturbing dreams, therefore disturbed sleep no matter how low a dose I started on. I'm so desperate for better sleep I think I'll give it another shot.

Regarding the twice weekly subq Test Cyp, I intend to do so but am running it by the Dr. first tomorrow.

I'm requesting the blood work I mentioned at the appointment tomorrow (and if he's opposed to doing anything in particular I have another Dr. I can request it from). Anything to that list I should add?


#14

Meloxicam is something to take every day. It reduces inflammation and swelling.

Trazodone is not a SSRI and does not rewire your brain, no sexual sides and there are no issues getting off of it. So set aside your reservations for a fresh consideration.


#15

Does trazodone require a script?
edit: never mind. I see now you saying to ask for RX.


#16

Traz really helped me a lot, so I try to pass it on as an option. Not addictive and very inexpensive.

Start with 50mg of a scored 150mg tablet.


#17

I'll look into trazodone as you suggest, but first I'll give the time release melatonin a shot again and see how I fare.

Today's appointment had some good and some bad..

I showed him the chart I found that shows the relationship between FT, TT, and SHBG so I could hopefully get him to stop lowering my Test Cyp dose. It seems to have convinced him and he's willing to raise my dose if need be based on upcoming labs.

When it came to requesting blood work, he OK'd everything except for a couple items. He said unless TSH indicated a problem there was no reason to test fT3, fT4, reverse T3. I'm assuming that's a load of BS? I can just ask my other Dr. to do it instead.

Much worse on the SubQ front... I asked him if he had experience with patients doing it and if he minded me trying it out. I showed him a few studies that showed it's effective and safe. His response was basically "no way!". Something about how he's never heard of it being done before, the FDA only approves intramuscular injections, and he suspects a likelihood of infection from infecting oil into fat.

I wanted to run it by him first, but I'm thinking of doing it anyway. Since T releases slower in fat than muscle, I'm assuming I shouldn't start doing it until after the blood work next week or the numbers might be lower than expected. Is there anything I need to be aware of so as to avoid tipping his hand that I'm doing it despite his wishes?