T Nation

Defy Medical, 'No' to Use of AI w/ TRT


#1

Below is the apparent position of using an AI while on TRT, per Defy Medical.

Studies of this nature are needed. Furthermore, E2 levels in some men treated with aromatase inhibitors decreased below 40 pmol/L, considered the threshold at which there is increased risk of developing osteoporotic changes.

"We therefore find no evidence to support the contention that relative reductions in E2 via the use of aromatase inhibitors or other agents in conjunction with TRT offer benefits beyond that offered by TRT alone.

Anecdotally, in our practice, there have been rare cases of men who failed to experience symptomatic benefits from TRT and were found to have elevated E2 concentrations. Some of these men have responded to steps to lower E2 concentrations, either by reduction in T dosage or by addition of aromatase.

However, these cases are anecdotal, and even if treatment was beneficial, the rarity of such occurrences does not justify the routine use of aromatase inhibitors together with TRT. Moreover, aromatase inhibitors may reduce E2 levels below a crucial threshold for bone health, and dual-energy X-ray absorptiometry (DXA) monitoring should therefore be considered for individuals receiving such therapy".

Nelson Vergel

Source:
Estrogens in Men:
Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency Ravi Kacker, MD,* Abdulmaged M. Traish, PhD,â?  and Abraham Morgentaler, MD* *Beth Israel Deaconess Medical Center, Harvard Medical School, Urology, Boston, MA, USA; â? Laboratory for Sexual Medicine Research, Boston University, Boston, MA, USA International Society for Sexual Medicine


#2

I am not surprised. I believe too many men believe that AI’s are a necessity in every case of TRT or are using them when they might not need to. I have been on TRT for thirteen years and have done just fine nearly the entire time (can’t say that there were no bumps in my therapy). I am currently on 100 mg of T per week with 1000 IU HCG three times per week. I do not feel any symptoms related to elevated E2, but we will see where my E2 is at next week. My doctor is checking because he recently increased the HCG from 500 IU twice per week to the current dose.

Many men do just fine with E2 being under 50 with T in the mid to high normal range ( 500 to 1000 ng/dl).


#3

Yeah, I’m no fan of AIs for routine use in TRT. Anecdotally a large number of guys using them never get good stable benefit from them. They really shouldn’t be necessary in general for testosterone replacement, which shouldn’t elevate E2 too much unless there are other problems such as obesity, in which case an AI might be justifiable until the person can lose weight; however, many guys want to use larger than replacement doses of T and want to use the AI to counter the side effects of that, which is probably not healthy in the long run.


#4

Idiots


#5

Even when my total t is around 1000 I feel the same as when my tt was around 300 when my e2 gets above 30. I’m relatively lean and feel much better with an ai and closer to 20. I inject 50 mg test cyp twice per week. While I can appreciate both of your personal experiences perhaps you’re not the norm. Many times anecdotal evidence > scientific evidence IMO.


#6

[quote]Davinci.v2 wrote:
Even when my total t is around 1000 I feel the same as when my tt was around 300 when my e2 gets above 30. I’m relatively lean and feel much better with an ai and closer to 20. I inject 50 mg test cyp twice per week. While I can appreciate both of your personal experiences perhaps you’re not the norm. Many times anecdotal evidence > scientific evidence IMO.[/quote]

If your symptoms depend on estradiol only, i wonder if you could have maybe had good results from AI monotherapy. It would have also raised your natural T as a side effect.


#7

[quote]seekonk wrote:

[quote]Davinci.v2 wrote:
Even when my total t is around 1000 I feel the same as when my tt was around 300 when my e2 gets above 30. I’m relatively lean and feel much better with an ai and closer to 20. I inject 50 mg test cyp twice per week. While I can appreciate both of your personal experiences perhaps you’re not the norm. Many times anecdotal evidence > scientific evidence IMO.[/quote]

If your symptoms depend on estradiol only, i wonder if you could have maybe had good results from AI monotherapy. It would have also raised your natural T as a side effect.
[/quote]

Pre trt I felt awful. My e2 was OK at 26 and my TT varied from 190-390.


#8

I agree with Defy, but I also realize that everyone is different. As far as my own experience, I feel better with my E2 closer to 50 vs down around 20. My E2 for the 5 years prior to TRT was always below 20. I have no idea how many years total I had low E2, but all my joints hurt, my body felt way older and worn out than it should be, and unfortunately I also wound up with Osteopenia and Osteroporosis… despite 25 years of lifting weights, having a clean diet, and going to the gym religiously I have a DEX scan every year, so hopefully things are getting better in the bone department. I will find that out in December, it will be my first DEX scan since starting TRT.

I feel fabulous with my E2 around 50, my joints don’t hurt anymore. If someone feels they must go on an AI to get to magical E=22, please pay attention to how your body actually feels, instead of being obsessed with trying get it to some magical pre dermined E2 number.


#9

Defy Medical’s statements are wrong, if only because they are so generalized and sweeping. The fact that the statements fit the few that need higher E2 levels dose not mean anything except that there are always a few exceptions.

What most males feel is best for them is a good level of testosterone dominance. This is the norm.

We can’t find the exceptions other than by what seems to them to be trial and error. They need to run their own science experiments.

I know that the concept is troubling … But wonder if Chimerism is involved with the few who do not thrive on what other males feel is a healthy E2 level. It not unusual to find chimerism in humans. Their could be some female cells in males that do not thrive on lower E2 levels.

There are variations in enzymes that are also not explained. Very evident in anastrozole over-responders. Not known if the enzymes are different or the amount of enzymes.

Variations in response to E2 levels could also be variations in receptors or receptor pathways or even differences in gene expression that influences the effects of estrogens.


#10

[quote]BrickHead wrote:
I am currently on 100 mg of T per week with 1000 IU HCG three times per week. I do not feel any symptoms related to elevated E2, but we will see where my E2 is at next week. My doctor is checking because he recently increased the HCG from 500 IU twice per week to the current dose.
[/quote]

Follow up to this previous post. I just got my lab values back for last week on this dosing for T and HCG.

T: 944
Estradiol: 47

T is taken once per week.


#11

[quote]BrickHead wrote:

[quote]BrickHead wrote:
I am currently on 100 mg of T per week with 1000 IU HCG three times per week. I do not feel any symptoms related to elevated E2, but we will see where my E2 is at next week. My doctor is checking because he recently increased the HCG from 500 IU twice per week to the current dose.
[/quote]

Follow up to this previous post. I just got my lab values back for last week on this dosing for T and HCG.

T: 944
Estradiol: 47

T is taken once per week. [/quote]

Your high dose of hCG is probably the cause of this high E2 level. When injecting, there is no need for larger amounts of hCG beyond what is required to keep the testes from shrinking. For larger T levels, injected T is way less costly than increased hCG used to get more T produced in the testes.

This is the result that I always warn about,


#12

[quote]KSman wrote:

[quote]BrickHead wrote:

[quote]BrickHead wrote:
I am currently on 100 mg of T per week with 1000 IU HCG three times per week. I do not feel any symptoms related to elevated E2, but we will see where my E2 is at next week. My doctor is checking because he recently increased the HCG from 500 IU twice per week to the current dose.
[/quote]

Follow up to this previous post. I just got my lab values back for last week on this dosing for T and HCG.

T: 944
Estradiol: 47

T is taken once per week. [/quote]

Your high dose of hCG is probably the cause of this high E2 level. When injecting, there is no need for larger amounts of hCG beyond what is required to keep the testes from shrinking. For larger T levels, injected T is way less costly than increased hCG used to get more T produced in the testes.

This is the result that I always warn about,
[/quote]

With T alone I got into the 700s and 800s consistently, with one time at 640 (100 mg per week). those are good numbers. I got on 500 IU HCG twice per week but that did not do the trick in getting sperm count up (remember, 9000 iU monotherapy failed in getting T up to mid to high normal). So doc put me on 3000 IU HCG per week for fertility reasons alone, not solely for adequate T. We will see what happens with next semen analysis. HOPEFULLY this works. Last one showed only about 700,000 sperm compared to average of 15 million! No good!

I do feel friggin’ great at the moment though.


#13

I think that 10mg EOD or 20 EOD Nolvadex would be a better option as LH and FSH would be at work. FSH is critical for sperm production. Many are OK with hCG alone. If you have demonstrated that hCG was not able to get the job done …


#14

[quote]KSman wrote:
I think that 10mg EOD or 20 EOD Nolvadex would be a better option as LH and FSH would be at work. FSH is critical for sperm production. Many are OK with hCG alone. If you have demonstrated that hCG was not able to get the job done …

[/quote]

I will bring that up at next visit if next sperm analysis fails. Thanks for the suggestion!