Our own daddy of 3 @physioLojik was already on top of this. 
Dr John cristler started a thread on EM very recently and he’s still posting.
He States he dropped ai last month and feels better then B4. He will soon share what he felt during the transition.
Wow how things change. He also stated:
My strategy is now to work with my patients to drop their estrogen control, when possible. As an Osteopathic physician, less drugs is better.
On a side note he also mentioned Dr Shippen will be presenting about estrogen control and some breaking news on HCG use. He did not state what it will be.
See below from em
The legendary Dr. Eugene Shippen–whom I am proud to say I got, from my position on the Planning Committee at AMMG, an invitation to speak at the Spring national conference–is going to be going into great depth on using low dose AI’s in male TRT patients. To my mind, he possesses the finest mind to ever practice this area of medicine. I learned about using AI’s from him, and have gotten such good results with them over the years. But I do think it’s time for change.
Dr. Shippen is also going to share some amazing things he has figured out about HCG. Wait until everyone hears what he told me a couple months ago.
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He also mentioned that he will be getting back to prescribing scrotal testosterone.
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It’s crazy how much I got slammed when I first approached this topic here. Haha. I’m glad it’s finally catching on. Drugs to counter act drugs makes zero sense. Less is more.
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And remember Dr cristler had a heart attack not to long ago.
You lit the fire man. It’s starting to burn bright.
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THere are cases when ai is necessary physio. It’s not a black or white situation.
I’ll recommend daily injections before going the AI route, it would be rare that someone would need an AI on a daily protocol.
I felt amazing on a daily protocol, far better than any other protocol, sadly I could not continue. I felt no peaks and troughs, no ups and downs for the first 6 weeks.
There was a guy in Canada who has an estrogen over 400 and growing manboobs, he would be an outlier. His protocol could be improved though.
I’d have to lower my trt dose into range of TT of like 400-500 to get my e2 down. At those levels I won’t feel much from trt.
So I am going to try to keep my levels up and bring down e2 with ai.
I would do 25mg EOD, that’s a -20mg and can make a big difference. Dosing isn’t linear, once you hit a certain threshold, levels shoot up.
Example, 25mg EOD = Total T =1053 or 20mg EOD Total T =496.
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I tried going lower and felt off. Like weaker.
Just getting frustrated with never really feeling anything from trt. My e2 could be the culprit the whole time as it’s been somewhat high.
Somewhere I read that e2 should be around your shbg level.
@roscoe88. So for my patients - we fix liver first and if someone is overweight we work on that. These two things being fixed generally make it not necessary to run an AI on trt ever.
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Yes there may be cases where implementation of an aromatase inhibitor may be nessecary, but these cases are few and far between, some individuals who are obese, have abnormal liver function or have a condition such as aromatase excess syndrome (rare). Individual sensitivity also plays a factor, some may be very susceptible to gynocomastia. The majority of people who use aromatase inhibitors don’t need them, I mean I understand if a bodybuilder on 3 grams of gear/wk uses an AI, however counteracting the natural balance of T→E on a mere replacement dose of testosterone seems crazy to me.
Edit: whoops physio already replied to this, disregard my reply.
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Thanks for the response.
Anything generally you suggest for
Liver?
I’m not overweight. I’ve been bodybuilding for 25 years now. All natural before trt formtje last two years. Just a cycle or two of prohirmones years back. My bf is around 10% is guess.
Nope, no literature to back this up, SHBG should have very little, if anything to do with deciding what to do with you’re testosterone replacement protocal. If you don’t feel anything on TRT the problem may not be endocrine related (while on TRT, not saying you didn’t have hypogonadism prior to TRT), but the problem could be related to neurotransmitters (serotonin, dopamine etc). Frequently people like to blame issues on hormones/ other things when the cause is something totally unrelated. The brain, in my opinion is the most powerful when it comes to what you “feel” from TRT. It’s also the largest sex organ lol. Can’t get an erection when you aren’t attracted to you’re partner or are depressed as fuuuuccckkk.
@flipcollar I haven’t had malva pudding in many a months, but I had Nando’s yesterday, I don’t think they have that in the US, it’s like a spicy chicken/fast food place, but the chicken isn’t really spicy, even if you order extra hot. I love spicy food, for real spice I tend to go for curry, chilli (With very hot peppers) and such, but of course there’s a limit, no one wants to chow down on a ghost pepper (I have a really good anecdote about that exact situation… I took a fat bite out of a habanero without realising what it was). The moral of the story is… Malva pudding. #derailingthreadswithstoriesaboutmalvapudding
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Yeah, about a year ago I brought this up and was fucking roasted.
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@unreal24278 this. The majority of all issues come down to neurotransmitters
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@unreal24278
Estrogen increases serotonin which inhibits sex drive and erection.
Things are all
Related.
And neurotransmitters are heavily manipulated by hormones.
@roscoe88 there’s a lot more to the puzzle. It’s about the balance of these. For instance increasing serotonin In patients where their levels are low will increase sex drive and erections as it decreases anxiety. So blanket statements like that don’t work.
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Sure but a lack of estrogen crushes dopamine. It’s about ratio and whether the ratio of T→E is appropriate. When things are within ratio the body tends balances things out
Wait shit, late for this one again… It’s not too late to talk about malva pudding though
I think I’m going to make some this afternoon and probably leave a phat mess in the kitchen, I’ll try clean it up but I apparently never do a good enough job at cleaning up 
I made shortbread yesterday, I make a mean batch of shortbread
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@roscoe88 have you had a liver panel run? 100% organic real cranberry helps a ton.