T Nation

Doc Prescribed 200mg TRT+HCG. Wait 2wks Before Arimidex?

Started TRT today.

T-Cyp 200 mg split into twice weekly doses of 100 mg
HCG 500 IUs 2x a week

My doc told me not to take any arimidex for the first two weeks though. He said after two weeks, I could begin taking .25 mg twice a week on injection days.

This goes against everything I’ve read and researched. HCG definitely aromatizes, and 200 mg weekly of T-cyp is a high starting dose and will probably aromatize as well. Should I really wait 2 weeks to begin arimidex?? Considering my high starting TRT dose + HCG, I feel like I’ll probably be aromatizing pretty heavily in the next week or so.

I would be curious to know if the plan is to test E2 after the two weeks to see if it is in fact high. Why guess when you can test?

He told me we would do bloodwork after 6 weeks…

You have to admit it’s pretty darn responsible for you doctor to tell you to wait for labs before possibly crashing your E2, most doctors are prescribing AI’s when there hasn’t been shown any need for them.

That’s what I was thinking too. But, it doesn’t seem to be the case. Seems like arbitrarily starting AI two weeks later and bloods after 6 weeks. Why not either start it together if doing it that way or wait until bloodwork to decide? Choose one or the other.

You misunderstood my post. He didn’t tell me to wait until labs to start the AI. He simply told me not to use it for the first 2 weeks.

Exactly what I’m thinking. No reason to wait two weeks, and definitely seems risky to wait 6 weeks until bloodwork. I’ll just start out with .25 mg on injection days.

How old are you? Height and weight? Other meds? Pre TRT labwork? Older, fatter guys aromatize more than younger in shape guys. I can’t think of one reason to wait to take the AI IF you are going to take it without labs.

Actually I’m finding that to not always be the case, I’m 45 years old 33% body fat, 6ft 230Lbs (70Ibs overweight) and I don’t even require an AI at Test-Cyp 100mg week split into two injections. Even when I was on weekly shots I didn’t have any aromatize issues.

What are your e2 levels like on that dose.

Consistently between 24-30 with a TT of 861 ng/dL.

You are the the exception which proves the rule. In general my statement is true. Older and fatter guys aromatize more than younger fit guys.

Your T levels will be high in 24-48 hours, same for FT.

Then FT–aromatase–>E2 has no time delay at all.
E2 levels will elevate in 2-3 days.

When you take a constant dose of anastrozole, because of half-life, it takes about one week for serum levels of anastrozole to reach steady state levels.

Taking anastrozole at time of first T injection or next day makes a lot of sense.

Contrary to what some guys state here, needing anastrozole is the norm, not the exception.

1/2mg anastrozole per week with 200mg/week testosterone is 1/4th the amount typically needed by normal responders, so you have a dose suited to over-responders. So crashing E2 simply is not a risk. However, having this dose will allow the first on-TRT E2 lab results to be used to calculate a dose correction based on a target E2 level and E2=22pg/ml seems to work very well for almost all guys, however there are a few who are “wired” differently and do not react the same as most.

Allowing E2 to be uncontrolled on 200mg/week T is insane. E2 will oppose the desired effects of T in the brain and liver production of SHBG is expected to increase in response to E2 even as high T levels oppose that. If one has had a hint of gyno in the past there is great risk.

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Thanks KSman, I was hoping you’d reply. I agree starting without an AI is insane. I’ll begin dosing .25 mg twice a week. If I develop any high E2 symptoms, I’ll bump it to .5 mg twice a week.

It takes a week for a dose change to reach final serum levels and for you to feel what it is doing. You need to avoid short term dose changes. If you feel great, you are close.

Duly noted, thank you. I’m assuming the HCG 500 IUs twice a week will increase aromatization as well?

I am curious in general if starting someone on the standard 100mg/week KSman if you were making the decision, would you always start with the AI protocol in the stickies? From what I have read, it seems like experience says almost everyone needs it, so starting it right off the bat makes most sense. However, there are those in the camp of not starting the AI until bloodwork proves it is necessary. That camp saying it is better to not prescribe until E2 levels say to do so.

Are there any situations you would not do the AI from the start? Or just always prefer to start it and adjust dose back for over responders?