T Nation

Is this "No AI" Thing Really for Everyone?

What’s up guys? I’ve been following this forum for quite a while now and wanted to ask your opinion about my protocol, and whether you believe the emerging opinion of an AI never being good to use. I am a testicular cancer survivor and had my left testicle removed several years ago. I then went through several large surgeries due to metastasis, and chemotherapy which did some damage to my right testicle and my thyroid and probably some other things that I’m not so aware of. I started seeing an endocrinologist who placed me on levothyroxine and that made a world of difference for the better! However, for the last couple years I have been experiencing low-T issues. Namely, low libido, low energy, low ejaculate volume, and difficulty concentrating, among others. I know my testosterone level was in the 200s range for a couple different blood draws using the same reference range attached. My estrodial level has consistently been 35 to 38 using the reference range attached. I was told my prolactin has been twice the upper limit normal since chemotherapy, but for some reason they didn’t draw it this time. He is making sure that they will draw it from now on going forward. He wants me to get my labs drawn every 4 weeks. I only have my labs post-TRT, which I have attached here. They will always be drawn between 1:00 and 2:00 p.m… Hear me out here! LOL. I am also on an antidepressant and a opiate-based pain medication. Because of this and other things, I never wake up in the morning and feel good. Even if it’s going to be a good day, I feel like absolute s*** until at least 11am. Even on the days I felt like a god with TRT, it doesn’t start until at least 11:00 a.m. So, with that information, my endocrinologist wanted me to be able to differentiate between feeling good on lab draw days vs bad on lab draw days to help us get dialed into a proper protocol. He confirmed that the most important thing is consistency with time of day when getting labs. Anyhow, 4 weeks before these labs I started with 20mg TC ED SQ, HCG 400iu E4D (for fertility…long shot), and anastrozole (just in case). I really didn’t feel anything different the first week. Then, at the start of the second week I felt like absolute crap. Way worse than I ever did pre-TRT. Me being an idiot and not wanting to wait until my first set of the labs, I took 1/10 of 1mg anastrozole and felt way better. The next day I took the same amount and felt even better. I took the same dose on day 3 and all I can say is I was walking around like King Kong feeling like I was walking orgasm!!! I continued this regimen until the 4-

week mark when these labs were drawn. I still felt like King Kong when these labs were done so I know this is my sweet spot!! But then I came to the forum and read @dbossa and watched the videos of physicians arguing against the use of AIs, and I didn’t want to take something that was going to ruin my body long term. So, I stopped the anastrozole and continued on. Within a week I started to feel poorly again. It has been one week since and although I feel stronger in the gym I’m not really getting any of the other positive side effects right now.

I would love to hear your opinions about AIs. I hear what they are saying but it seemed like it worked wonders in my situation. If it’s absolutely not a good idea to use anastrozole, can you shed any light on protocol changes I can make to feel better given my labs? I really appreciate having this community and look forward to all you guys’ input.

Michael

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Here were all my labs (crazy I know) up until a year and a half ago. Not sure that will shed much light. I have been contemplating starting TRT for the last couple years before jumping in. the total testosterone in the 200s was measured at the end of 2019 and around June 2020. I had started an opiate-based pain medication towards the end of last year and my endocrinologist thinks this affected my hormones.

I always tell new members to start TRT in isolation, dial in and find the right protocol that works for you, then later when you are ready for kids, either start HCG and/or FSH injections and if that doesn’t work stop TRT for a short while and start clomid therapy.

If you feel better with E2 lower and you want to decrease estrogen, try lowering your T dosage, but the HCG is going to jack up your E2 then needing an AI to control whereas TRT in isolation you are adjusting your dosage to allow your body to naturally balance your hormones.

The fewer drugs and compounds you use when on TRT, the better. Also excessively high doses of exogenous T can lower HDL, so just lower your dosage.

Regarding your AI use, different parts of your body (brain, bones, joints) require different amounts of aromatase, so by using AI’s it’s blocked evenly throughout the body and you will likely pay for it later.

The aromatase does so much more than convert T to estrogen, it creates fatty esters for your cardiovascular system. Mess with the natural conversion of hormones and there’s always a price to pay.

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Sorry to hear about all you are going through. You have a lot of moving parts. It’s good to do your research and educate yourself, but ultimately, you have go with your doctors and do what works for you. We are unique, nobody’s situation compares to yours.

TRT will definitely help you and not only in the low T symptoms, but your overall health, for example, it is good for your lipids, decreasing visceral fat and increasing insulin sensitivity. If you are going to use an AI, keep an eye on your lipids and bone density, as decreasing estradiol can be detrimental to both.

Good luck moving forward.

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I think that high PRL is one case where using an AI might be advised. I’ve read a few case studies of guys with high prolactin starting TRT and not resolving symptoms without the AI to lower e2 (and in turn lower PRL)

Edit: this is in addition to using Caber along with TRT.

Edit #2: looking at your old labs PRL isn’t really elevated. How high has it actually gotten?

Thanks man. By any chance if you find the case studies can you send me a link? Those old Labs were when I was considering it leading up to May of 2019. then I kind of forgot about it and started having worse symptoms starting about 6 months ago. As recently as one month before trt started my prolactin was 50. I apologize for not having the lab print out for that one. It wasn’t checked at my 4-week post-trt lab draw. It will be checked from now on. Would you still recommend stopping the HCG like others have recommended first?

Thanks for your reply! So from your post I’m thinking it might be reasonable to stop the HCG and continue on 20 mg everyday. That would effectively be decreasing my testosterone dose, as well as the aromatization to estradiol. I believe in what you are saying about avoiding an AI, but do you think when taking microdoses of an AI it completely inhibits aromatase’s impact on non-conversion (T->E) activities, such as the creation of fatty esters as you mentioned? Or do microdoses only slightly reduce those activities evenly throughout the body so that there isn’t such a negative impact? Although I believe the research that @dbossa disseminates, we still don’t have good evidence on how AIs affect men on trt long-term compared to men on trt who don’t take AIs long-term. it’s a possibility that the long-term effects of microdosing AIs could be negligible.

Maybe you could microdose every other week and not on a consistent basis, but yeah is entirely possible to have minimal impact long term. If I were you I would have a goal to cease AI’s altogether at some point in the near future.

Usually 3mg weekly is enough to cause osteoporosis in just under one year.

I can only find information on AIs effects on osteoporosis in women. If you have any articles to support that I’d love to look them over if you send me a link. Thank you!

Here is one

Granted this guy had a large prolactinoma, but the effect is pretty substantial.

You can google search to see how TRT can raise prolactin. Can also try taking B6 or Caber alone first with your TRT

There are no articles, this is what doctors are reporting they are seeing in patients who were former ASS users.

Very interesting. So I did some more digging and you are correct that if my prolactin levels stay elevated with trt that I might need the AI. Cabergoline will not help in that situation: “Testosterone replacement-induced hyperprolactinaemia: case report and review of the literature - PubMed” https://pubmed.ncbi.nlm.nih.gov/15829128/

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And yes, TRT often increase prolactin due to the increase in estrogen. This is a big issue for many and completely kills their libido and overall TRT experience.

Get your prolactin handled if too high.

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No its NOT for everyone, just stop this nonsense already, If you FEEL better with lower estrogen, then you use AI, simple, done, it will not hurt you.

MANY MANY MANY docs stand behind the use if AI, just cause some “internet experts” online on utube tell u not to, u dont listen to them.

Use it.

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The whole point is to have less going on. So use T only in smaller doses. In 8 weeks use the AI if needed. I started cycling HCG 3 months on and 3 months off, and Im logging any differences that I notice.

I got kicked out of bossas cool kids club on facebook for asking how to tell if your estrogen was too high and what the known affects were. They couldn’t give and answer so they deleted it. Then when i asked why it was deleted i got the famous “you’re gone ta ta” whatever tf that means. Apparently questioning is unacceptable there. Well if they cant come up with an answer and you don’t let them talk circles around the topic that is.

Longtime lurker, first time posting (in years, I believe). This study has piqued my interest. I too have a prolactinoma that sent me down my path (discovered in 2007). After 3 years of treatment getting the prolactin levels down (with cabergoline), I took the plunge into TRT in 2010. I was on the “KSman regimen” for lack of a better description: 100mg/week, 250iu HCY eod, and either .5mg or 1mg Adex weekly (it’s been so long, I forget which).

At any rate, that worked great until I decided to ween myself off 18 mos later (long story short, I had anticipated losing insurance, and wanted to get myself off prior to that). From 2012-2018, things seems to be ok. My TT levels hovered in the 350-400 range (right around where they were post cabergoline treatment and pre-TRT in 2008-2010.

Last year, after my TT levels continue to decline (~200 in July of 2019) I decided to start TRT again. This time, it is T only. I started at the old dose of 100mg/weekly, but have titrated up to 120, and 140 to see what I feel best at.

Overall, everything is working well. My nuts have drawn up a bit, and my left nut tends to want to retract into me during ejaculation unless I (or my gf) keep hold of it! A little distressing the first couple of times it happened.

The reason I wanted to comment was the effect that TRT had on my prolactin levels. While all other symptoms had faded and I was feeling pretty great, my libido and erections definitely took a hit. I was nowhere near where I was back during the 2010 days with those two issues. I wondered how much the lack of HCG and an AI had any effect on that.

The T dosage I was on made my prolactin lvls jump to 2x thier previous levels (see below). I’ve upped my cabergoline dosage by 1/3rd (now on .5mg /3x weekly) and it is helping. I’m now getting diamond cutters at night and early am (though curiously, still only semis when masturbating).

Prolactin

18.60 ng/mL
Date:Nov 04, 2020 06:41 p.m. EST
Reference Range:3.50 ng/mL - 19.40 ng/mL

26.20 ng/mL
Date:Oct 28, 2020 07:46 a.m. EDT
Reference Range:3.50 ng/mL - 19.40 ng/mL

22.60 ng/mL
Date:Jun 02, 2020 06:37 a.m. EDT
Reference Range:3.50 ng/mL - 19.40 ng/mL

33.3 ng/mL
Date:Feb 27, 2020 07:51 a.m. EST
Reference Range:2.5 ng/mL - 17.4 ng/mL

16.6 ng/mL
Date:Jul 31, 2019 07:47 a.m. EDT
Reference Range:2.5 ng/mL - 17.4 ng/mL

9.7 ng/mL
Date:May 10, 2019 07:39 a.m. EDT
Reference Range:2.5 ng/mL - 17.4 ng/mL

9.3 ng/mL
Date:Dec 20, 2018 07:28 a.m. EST
Reference Range:2.5 ng/mL - 17.4 ng/mL

They ban everyone who question Bossa, I know of more than 50 guys who they have kicked. Then they say: “Everyone in our group has this experience, so it must be true!” - Yeah, maybe cause you ban everyone else.

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Hes a joke man. Him his butt buddy gil and reb or whatever the guys name is all jerking each other off. They could care less about helping anyone in reality its all for ego and “youtube videos” which they are linking to amazon products as influencers and all kinds of crap. Anything you ask they refer you to youtube. Thought the purpose of a fb group was to engage on fb. Total fkn joke Cant even answer a simple question and i knew they couldn’t/wouldn’t and knew they would dirty delete it so i screen recorded it. I have the entire convo. I was going to leave it alone then i got a notification someone commented on it today i scrolled through noticed my whole question and convo was deleted because his butt buddy reb looked stupid and had nothing to say. Total ego maniacs with a major superiority complexes. They stand in their own way of possibly learning anything new because god forbid they dont know it all and could maybe just maybe be wrong about anything. They are condescending to a majority of new people asking questions. Cocky af. They type you would love to meet not behind a screen. The funniest part is i dont disagree with a lot of their concepts which is all they really are they have zero evidence of anything they swear by. The e2 or the rbc hematocrit debate. The basically tell everyone the same thing. “Its psychological”. Its all in your head. No way. Everything has a purpose and everything affects people and things differently.

Ya Ive experienced it myself, I got banned 2 times for questioning their shit, no explanation, just banned, too funny.

He comes around here once in a while, but he cant ban anyone here so he run away quickly again being unable to win an actual debate.

Group is pathetic.

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