High E2, Should I Keep Taking AI?

Pharma / TRT Testosterone Replacement
1

Hey guys,

I am new here and know little to nothing about how TRT works and am looking to you all for some guidance. Here are my deets…

41 y.o. male. 6’3’'. 195lbs prior to starting TRT. 20%-ish BF. Type 1 diabetic. I have had “man boobs” for years (my friends in college called me “Titties”…and only partly because i love a good set of tits if you get what i mean (yes, we were all mean to each other back then). The last few years the man boobs seem to be getting a bit worse. I am one of those “skinny fat” people you hear about…the ones that look skinny, but have a spare tire and boobs when they take their shirt off.

I went to the T doc on July 11th, 2019 and was told i would benefit from TRT (shocker, I know). Here are the numbers right before i started TRT…

7/11/2019 labs
TT: 373 (range 350-1000)
SHBG: 70.9 (range 16.5-55.9)
E2: 14.9 (7.6-42.6)
Free Test: 4.31

The T clinic put me on a 140mg injection once a week and told me to take .5mg of an AI to be taken 48 hours after injection. My clinic does not allow me to take doses on my own and must come in to them (meaning i cant split my doses up through the week). There is another clinic in town that does and i will be going to them once i get my brain around all of this.

The next few weeks were f_cking awesome. Never felt better…superman. Boners galore, best workouts of my life…

My next set of labs happened on 8/26/2019…

TT: 716 (range 350-1000)
SHBG: 66.9 (range 16.5-55.9)
E2: 41.3 (7.6-42.6)
Free Test: 9.56

When the labs came back, they told me they wanted to increase me to 160mg injection once a week, which they did. I still felt great, but the superman feeling had gone away. A week or two later, i had noticed that my ankles were swelling up a couple days after my injection and my joints felt full of fluid. I also became SUPER emotional…it was terrible. Felt like i just wanted to crawl in bed and cry. This feeling only lasted a day or two each week. I told this to my clinic and they told me to increase my AI to 1MG, which i did. I did this for a couple weeks and felt a bit better, but not the way i felt before…but tolerable. Then it was time for my last labs, which were taken on 10/21/2019. Here are those results…

TT: 597 (range 350-1000)
SHBG: 47.5 (range 16.5-55.9)
E2: 66.4 (7.6-42.6)
Free Test: 9.94

At the appointment where they went over these results with me, i had told them that the water retention was getting old. The doc told me to increase my AI to 2MG 48 hours after injection. This is where i sit today. The water retention issue seems to be under control and the moodiness i talked about earlier is gone (thank god). I have some questions i hope you all can help me with:

  1. Any idea why my TT would go DOWN (from 716 to 597) even though my dosage has gone up? Is this even important?

  2. In reading through these forums, its clear that most of you despise taking a AI. But i cannot find anything about why you all hate it so much. Can someone explain to me why they hate it so much?

  3. Is there a chance that they water retention issue i was having would have gone away on its own?

  4. Is water retention just a necessary evil of TRT?

  5. any advice on the AI? taking it at different intervals?

Last week the clinic told me that they want to increase my dosage again, but didn’t want to do it until they got my E2 under control (those were their words).

Thanks!

2

Your body from time to time will change and you will not always be on the same dosage.

AI’s are bad because they block hormones and the natural process within the body, men who have been on high doses for long periods of time now have osteoporosis. I hate it because I feel like death on it, I’m an over-responder. a 1/8th of a 0.050 is enough to ruin my knees and joints.

No, but this clinic you’ve signed on is not a necessary evil. When I’m on TRT I inject 7mg daily and don’t need an AI. It’s rare that someone will need an AI on daily injections. If this clinic prescribed daily injections, they wouldn’t be able to sell you drugs to control estrogen.

It sounds like this clinic wants to sell more product, never seen such an aggressive stance on wanting to increase the dosage with E2 out of control. It doesn’t sound like this clinic is able to manage men on TRT by allowing you to take the prescription home with you so you can optimize your protocol, profit seems more important to them.

This clinic charges you for administering the injections.

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@backspinkc
Do feel better in the beginning of the week (days right after shot) vs later in the week (farther from day off)?

That’s a shit load of AI (2mg every couple days). I can’t imagine that feels too good.

4

It can vary. Are you getting labs at the same time post injection? Five days, six, seven? 597 does seem low for 160mg given your SHBG level.

Estrogen is not all bad. Some TRT doctors never block E2. It’s good for lipids, joints, bones, even sexual function. Some have had very bad reactions to anastrozole. I didn’t feel bad with it, but do feel better without it.

Yes. Some retain water initially, but find it resolves as you adapt to new hormone levels.

No, some do not experience it.

If you need it, and some really do, you might adjust your dose dependent on how you feel (SUPER emotional, moodiness) throughout the week. The half life of anastrozole is 48-50 hours, so split dosing makes sense. Probably should take it 12-24 hours after injection and three, three and a half days later if you have to use it. Two mg in one dose is a lot. That will definitely crash E2.

5

Regarding the clinic: I pay the same fee to them monthly ($150 per month) regardless of how much test or AI i am getting. They just call the script for the AI into a walgreens. I dont really think they are trying to pull more money out of me, its the same monthly fee.

6

shot is taken every monday. Feel good monday and half of tuesday, then feel shitty until saturday. Just to clarify, I take 2mg of AI ONE TIME per week at 48 hours post shot. Not every 4 hours, just once.

7

That’s stupid. If you are going to take AI, it should never be that much all at once. Given the half life, what is happening is you hammer youe E2 down for about 2 days and then it rebounds. 1mg twice a week would make more sense. As for your T levels, initially you still have natural production, it shuts down around week 3 or 4 usually which would lower your overall T levels. It’s important that your blood draws are consistent, as in on shot day before the shot. And switching to twice a week injections would resolve most of your issues I think.
Just to be clear, I’m not advocating 2mg a week, I’m advocating split dosing if you feel that you MUST use the AI. Better to drop it and ride out the sides.

8

@backspinkc
So you feel good for 48 hrs and then feel like shit.
After 48 hrs is when you take a giant AI dose.
I’m not one them puzzle geniuses so tell me if you see any correlation here.

Stop taking giant AI doses. Spread out injections to (twice/week, EOD or daily if you want). Wait the customary month to start feeling better and then come back here to tell the world how you’ve been cured.

3 Likes
9

Lol… Classic.

Seriously, listen to @dextermorgan! Good advice!

10

an update for any of you care to know…

I took 2mg of AI for one week (the week i wrote the post). After reading your responses, i decided to lower the AI down to 1mg. I did that for a week. Then i just said F_CK it and stopped taking it altogether. 2 weeks later (8 days ago) I had my labs done and I will give you all one guess as to what happened to my E2 on my labs yesterday…yep, E2 was <5. didn’t even register a number on their lab. Talk about E2 crash.
I havent felt that bad the last couple weeks, but DEFINITELY feel better this week. The last couple weeks I just felt like the old tired self i was pre-TRT. This week is much better. Hopefully the E2 is starting to climb (the water weight i have back now tells me that this is the case).

BTW, i told that clinic to go take a hike and am now going to another place.

2 Likes
11

ok, i am going to be a little bitch here and ask for some reassurance that i am still doing the right thing. I stopped the AI two weeks ago and my E2 has gone way up. I had an E2 test this last monday and it was 70.4 (the clinic i go to ordered the E2 test because i had big time brain fog one day last week and they said they wanted to see if my E2 was still really low…it wasnt. If you read above, the E2 test a couple weeks prior was less than 5. So it went up fast.)

This week, I felt like an emotional little bitch on Wednesday, Thursday, and Friday (I get my once weekly shot of 190mg on Mondays). I felt like i was on an emotional roller coaster. One minute feeling great, 5 mins later feeling like i wanted to cry (a bit of an exaggeration, but not by much). My wife said it sounds like i was getting ready to start my period!

Saturday (yesterday) i felt a bit better. Today i feel even better. I am also carrying a ton of water weight.

I have read damn near every post on this site and understand that my body will get used to the higher test dose, but i just need reassurance that this will happen and am asking how long this usually takes?

Its all i can do to not go into my bathroom and pop one of those AI’s.

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BTW, the E2 test I had last Monday was at trough. I don’t think it was the sensitive test because it doesn’t say sensitive next to it.

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Several of us have e2 that high or higher. Nothing to worry about.

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That’s OK, assuming it was the same test you had when it was 5. Mine runs in the 70s with the sensitive test and concurrently in the mid 50s with the immunoassay. You had a big jump, your E2 was at an unhealthy level, which I think is more important than the actual number.

1 Like
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I asked the TRT dr if I should get the sensitive estradiol test and she said the regular estradiol is all she needs. Is she right? The regular test came back higher end in normal range. Slight gynacamastia is why I asked her about it.

16

The ECLIA test (aka immunoassay or IA) for E2 management is commonly used for those on TRT. It is not an incorrect test or a test for women, but simply one way to check estradiol levels. The other commonly utilized test is the LC/MS/MS method (aka liquid chromatography dual mass spectrometry, sensitive or ultrasensitive). It is the more expensive of the two. There are inherent advantages and disadvantages to each of these two methods. I have been fortunate to be able to speak with professionals who work with both methods. One is a PhD researcher for Pfizer and the other is a medical doctor at Quest. I’ll summarize their comments.

The ECLIA method is the more reliable of the two in terms of consistent results. The equipment is easier to operate thus accuracy is less reliant on the skill of the operator. If the same sample were to be tested twenty times, there would be very little, if any, difference in the results.

The ECLIA method is not as “sensitive” in that it will not pick up E2 levels below 15pg/mL. If your E2 level with this test is 1-14pg/mL, the reported result will be “<15”. Because of this, it is not recommended for menopausal women, men in whom very low levels of E2 are suspected, or children. In other words, if your levels are below 15pg/mL, and it is important to know if the level is 1 or 14pg/mL, you do not want this test. For us, this is likely moot, since if you are experiencing low E2 symptoms and your test comes back at <15, you have your answer. For a woman being treated with anti-estrogen therapy for breast cancer, it may be necessary to know if the E2 level is zero or fourteen because therapeutically, they want zero estrogen.

A disadvantage to IA testing is that it may pick up other steroid metabolites, which in men would be very low levels, but still could alter the result. Another potential disadvantage is that elevated levels of C-reactive protein (CRP) may elevate the result. CRP is elevated in serious infections, cancer, auto-immune diseases, like rheumatoid arthritis and other rheumatoid diseases, cardiovascular disease and morbid obesity. Even birth control pills could increase CRP. A normal CRP level is 0-5 to 10mg/L. In the referenced illnesses, CRP can go over 100, or even over 200mg/L. Unless battling one of these serious conditions, CRP interference is unlikely.

The LC/MS/MS method will pick up lower E2 levels and would be indicated in menopausal women and some men if very low E2 levels are suspected and it is desired to know exactly how low, children and the previously mentioned women on anti-estrogen therapy. It will not be influenced by elevated CRP levels or other steroid metabolites.

While some may believe the ECLIA test is for women, on the contrary, as it pertains to women on anti-estrogen therapy, such as breast cancer patients, the LC/MS/MS is the test for women as CRP levels are a consideration and it is necessary to know if the treatment has achieved an estrogen level of zero.

On the other side of the coin, LC/MS/MS equipment is “temperamental” (as stated by the PhD who operates both) and results are more likely to be inconsistent. Because of this, researchers will often run the same sample multiple times.

It is not clear if FDA approval is significant, but this appears on Quest’s lab reports: This test was developed, and its analytical performance characteristics have been determined by Quest Diagnostics Nichols Institute San Juan Capistrano. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes. This statement is on LabCorp’s results: This test was developed and its performance characteristics determined by LabCorp. It has not been cleared by the Food and Drug Administration.

It is unlikely that any difference in the same sample run through both methods will be clinically significant. Estradiol must be evaluated, and it should be checked initially and ongoing after starting TRT. It obviously makes sense to use the same method throughout. Most important are previous history and symptoms related to low or high E2. Those are correlated with before and after lab results. Any estradiol management should not be utilized without symptoms confirmed by lab results.

17

You are experiencing the E2 rebound effect, as anastrozole detaches from your aromatase enzymes things go a little crazy as far as aromatisation goes, but it’s temporary. I’ll never forget the experience myself and will never touch the stuff again!

1 Like
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Yes, arimidex is a nastly little drug. It binds to the aromatase enzyme, lowers E2, your body thinks it needs more E2, makes more aromatase, arimidex binds, and so on. But, unlike aromasin, which essentially destroys the aromatase enzyme, Arimidex only temporarily binds. When the drug wears off the aromatase is again available to aromatize some T to E2. This is where the rebound effect comes in…when Arimidex is discontinued completely there is more Aromatase in your body than there would be naturally…and for someone injecting T, this is a bad scenario. Aromasin should be the one choice for anyone who finds that they cant naturally control E2.

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Your once weekly shot is probably also complicating things for you. Can you split your weekly dose into more frequent administration to keep levels more stable?

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Good explanation @blizzardtest I’d always wondered why people complained about a rebound effect. Makes sense.