T Nation

Night Sweats the Night After Taking My First Anastrozole Dose

Been on TRT for 1.5 week now.

36 y/o
200lbs, 5’11"
Good muscle but carry a bit of abdominal fat.
Used to be a pretty heavy drinker but have gotten that under control.

Symptoms: Low Libido, Low erection sensitivity, Low erection quality, Low Energy, Fatigue.

Labs before starting:
Test - Serum 468 ng/dl
Test - Free 11.4 pg/ml
Estradiol 13.6 pg/ml

TRT Dosage:
200 mg Cypionate, IM in upper glute ONCE per week
1 mg Anastrozole at the time of injection

My first week I didn’t take the AI since the pharmacy had to mail it to me but got the injection in the Dr.'s office. First week felt fine, no real change in anything.

A couple of nights ago I got my Test, syringes, AI, etc and did my first at home dose and popped the 1mg AI. Went fine. Next day (yesterday) felt pretty good, seemed to have good energy. Last night (about 30-35hrs after taking my dose) I woke up in a pool of sweat. This morning I felt a bit off, irritable and a bit anxious. It seemed to subside throughout the day today.

I’m trying to figure out what might have caused this, if it was the AI that I took?

After reading extensively through this forum it sounds like I might want to do a couple things:

  • Start injecting TWICE a week vs once. 100mg each injection with .5mg AI.
  • Get bloodwork done ASAP to find out if the night sweats were from high or low E2 so I’m not guessing.

I’ve also read 2 sides of the AI story… to use it or to not use it. Some of the posts I was reading were very old so I’m still not sure what to decide. It also seems that I’m on about the maximum dosage recommended for TRT right from the jump. The biggest thing I’m trying to work on is the libido/erection issues and energy/fatigue.

I have a call in with my Dr to discuss the night sweats, get labs done and talk about moving to twice weekly injections and possibly dropping the AI but wanted to get any advice I can here first.

Am I going in the right direction with moving to twice weekly injections? And if so, what would be best as far as AI dosage or removal? Should I stop using it (I’ve only taken 1mg so far) and see how things go with frequent labs? Or drop the dosage in half which would be .25mg twice a week at the time of my injections? Or .5mg twice a week?

I also realize that my body hasn’t really normalized yet (it’s only been 1.5 wks and I haven’t really felt any changes besides last night/today). But, I’d like to get on the best path possible as early as possible so I can dial this in as soon as possible.

Any knowledge/advice would be greatly appreciated!

Without the entire labs, I think you should have started with 150mg a week. With your low E2, I would not have started anastrozole, but I lean toward the no AI camp anyway.

I’d want to see more of a trend with the night sweats before lending any significance to one episode.

Your pre-TRT labs show estrogen at 13 pg/mL, your protocol needs improvement. You shouldn’t be having to talk to your doctor about moving to twice it weekly injections, it should have already been part of the game plan. Smaller injections more frequently lowers estrogen, if your doctor spent a little more time fine-tuning your protocol you won’t even need an AI.

Your doctor’s pretty old school if he’s having you inject in the glutes, I inject using 29 gauge insulin syringes and the shoulders and quads every two days. Your TRT dose is excessive forcing you to use of AI’s to take care of estrogen excess.

Thanks @highpull

Unfortunately, those numbers + Hemoglobin (15.5 g/dl) and Hematocrit (44.7%) were the only numbers tested (via Labcorp).

Since I’m only 1.5wks into this, should I get a FULL set of labs completed? Or has that time based now that I’ve started?

I would wait until I was six weeks in. It will be interesting to see if these episodes reoccur.

Thanks @systemlord,

Would you agree with @highpull that maybe 150mg/wk is a better starting point?

I’d definitely like to try NOT to use an AI if possible.

He’s got me using a 1 inch, 25 gauge needle (I first load the test with a much larger needle then switch to 25 guage for injection). I just googled ‘29 guage insulin syringe’ and it looks like it’s much shorter… maybe half an inch or so? That’s deep enough for IM?

From what I’m gathering, I should probably push for higher frequency injections via higher guage (29) needle in quad/shoulder, lower total weekly dosage (150mg) and don’t take the AI anymore to see how that goes?

How often would you all recommend I get labs done to check for E2 to make sure it’s in the ‘sweet range’ as I continue this? Or, do I just watch how I feel and if I notice any symptoms? I guess if I did notice symptoms I could always low dose AI to bring it back down quickly?

Thanks for the help, guys.

Most guys on TRT use 1inch, 23g needles, inject once weekly. Many on this site use three plus injections per week, allowing for lower dosing and smaller needles. Maybe most on this site use twice weekly dosing.

I good starting is 100 mg 1x a week no ai.

Forums tend to lean to multiple injections a week… If you read as much as i did there are many guys that do great 1x a week.

You can always go to twice.

Must stay 6-8 weeks on same protocol to gauge symptoms and get new labs

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Interesting. So is there any reason why someone would choose to inject a 23g once a week vs a 29g twice or 3 times per week besides the simple fact that it takes less time to inject just once and makes it easier to stick to your routine, vs possibly forgetting to do more frequent dosing?

Seems to me I’d much rather stick myself twice a week with the 29g insulin and setup my calendar and reminders so I never forget a dose and also keep my levels more regular.

Is there any reason beyond these that it makes sense to only do once per week? Or using a larger needle? Does a larger needle offer any kind of benefit as far as test delivery / outcome?

If I was a doctor and you were my patient I would never prescribed an AI to you unless one of the few protocols failed to lower estrogen, I would have you inject twice weekly, and if that didn’t yield good results move you to an EOD protocol injecting smaller doses.

Honestly with your numbers I don’t think you’ll need an AI if you find tune your protocol well enough. Based off your Total T and Free T numbers, your SHBG is not that low, probably about mid-range which seems to be a buffer for your estrogen which is why it’s only 13 when Total T is about mid-range.

Two options 60mg twice weekly or 25mg EOD, either of these protocols should see estrogen around high normal. You can get higher testosterone levels unless testosterone injecting more frequently, I usually always lower my dosage 10 to 15% when moving injections closer together when trying to maintain the same T levels and lower estrogen.

Thank you @systemlord

I was just typing the following up to send to my Dr.
How does this protocol change sound to you?

  • Going to a 150mg dosage per week, spread out over 2 injections per week. This will help keep the highs and lows minimized and also estrogen lower with smaller dose.

  • Moving to a 29 guage, 1/2in insulin syringe and injecting subcutaneously for the 2x per week injections. SC provides steadier levels.

  • Stop taking the AI all together to see how I do. I’d like to get more frequent labs done to monitor E2 levels. Can always add this in if E2 goes high.

  • 250iu hCG subcutaneously, 2-3 times per week? I want to maintain my testicles and don’t want to risk infertility at all. Plan to start a family in the next 1-2 yrs.

I’m not sure on the hCG dosage but it seems if I want to make sure I don’t go infertile it’s a must with TRT. My Dr. told me just to let him know 6 months ahead of time before family planning and he’d add hCG and it shouldn’t be an issue getting pregnant at all. Maybe so, but I don’t want to take the risk if there is one with fertility on TRT without hCG.

Some believe injecting with 23g, 1in needles is more uncomfortable than the smaller, shorter needles. Considering I used 20g and 22g, 1.5in needles back in the day, 23s are painless. I pretty much only felt discomfort with the 20s.

Some find themselves more sensitive to hormonal fluctuations, testosterone and estrogen in our case, so a smaller, more frequent dosing schedule circumvents that. Most find it unnecessary, steroid hormone are slow acting, long lasting, unlike protein hormones which take effect very quickly, but need frequent dosing, like insulin.

The smaller, more frequent dosing also keeps hematocrit lower for some people. I do not think there is any downside to more frequent dosing, other than the time it takes to stick yourself every day, or whatever. I’ve thought about trying it just out of curiosity. But, I do well with once weekly so whenever I think about it the thought goes away. Still, I’d like to try it at some point.

Again, no problem with daily, every other day, twice weekly injections. I just think they are generally unnecessary.

It can, I know guys (big guys) who needed to switch to 1.5 inch needles because they were not absorbing well with the shorter needles, not getting the test deep enough and into the muscle. Should not be an issue with a 200lb guy.


Wanted to post a followup with labs and ask a question about my Estradiol number and using AI.

Date Cypionate AI Comments Test Serum (ng/dL) Estradiol (pg/mL) Test Free (pg/mL) Hemoglobin (g/dl) Hematrocrit (%)
2/5/19 1st Labs 468 13.6 11.4 15.5 44.7
2/19/19 200mg Consultation, 1st injection
2/26/19 200mg 1mg felt anxious, not good morning after
3/3/19 100mg .25mg AI was one day later on the 4th
3/4/19 2nd Labs 1,264 13 28.1 14.8 42.6
3/6/19 100mg .25mg been noticing morning wood

My serum and free T are way up which is great! My Estradiol number actually went down. I’ve switched to twice a week (100mg each injection, 200 total per week) with .25mg of AI twice a week.

Pros so far: Slight libido increase, slight daily energy increase. Hoping this keeps increasing, especially libido and erection quality.
Cons so far: Facial acne.

My question is, what do you guys think, should I continue using the .25mg of Arimidex twice a week? Should I move down to .125mg twice a week? Should I stop it completely? My Estradiol is at 13, it sounds like most guys like it around 20-22ish.

Any advice is appreciated!

I would drop the AI and see what happens if I was you

I would drop anastrozole and see how it goes. Forget about the 20-22 number and rely solely on how your feel. If you start feeling high E2 side effects, I’d cut the dose to 80-90mg twice weekly.

I’ve dropped AI completely and have gone to 100mg twice a week IM (200mg total). I’ve been on this protocol for basically only a week now. I will be adding in HCG next week (350ui twice weekly).

I’m planning on monitoring my E2 levels very strictly since I’m not using AI, I’m on a high dosage (200mg/wk) and from what I’ve heard HCG will most likely increase E2.

My questions are:

  • How often should I get labs done? Thankfully, money isn’t an issue. Every 1 week? Every 2? I want to make sure I have a correlation between the way I feel and my E2 level so I can dial this in.

  • I inject on Sun mornings and Wed evenings. When should I get labs done? The last labs I got were the day after injections when my numbers would most likely be at their peak.

  • If I start to get high E2 symptoms (and confirm with labs), what should my protocol change be? I see it as 2 options. Decrease my weekly dosage by 15% to 170mg weekly which should bring down E2. Or, add AI… say 0.125mg twice a week with injections.

Thanks for all the help!

You’re supposed to do labs no sooner than 6 weeks following a change in protocol as it takes 6 weeks for the half lives to build up in your bloodstream.

Good luck and don’t worry about estrogen until your body adapts.

You can inject more often and lower dose by a little of you have any problems.

Thanks Guys.

My biggest concern and worry about not monitoring labs is that I have a very important business meeting coming up in about 2 weeks followed up by a 2 week vacation with my girlfriend to Philippines & Vietnam. The last thing I want to do is be messed up from high E2 or whatever the case may be that I’m feeling terrible for my meeting and vacation.

Maybe I’m over thinking it but those are 2 very important upcoming events I want/NEED to feel good at.

Considering those needs, is there anything else I should be doing prior?

Your Total T and Free T numbers suggest SHBG is above midrange, SHBG can be a good buffer for estrogen, add to that your pre-TRT estrogen labs were very low.

I don’t see estrogen being a problem while on TRT as long as your dose isn’t excessive.