T Nation

Perplexed with Dr's Arimidex Protocol


#1

Currently under endo’s care on TRT
0.35 ml T-Cyp sub-q twice a week
HCG twice a week
0.5 mg arimedex every other week
Was 0.5 mg arimedex once a week but apparently I became over responsive at some point and drove e-2 to single digets a couple of times and below 20 once last blood test was at 37, my question is dosing arimedex this infrequently effective as I only do blood testevery 4 months so I don’t know where I’m at , I think I can tell when I’m in the sweet spot as morning wood and libido feel right but then go away after a few days so I feel like I’m on a roller coaster and don’t know whether I’m high or low as both symptoms are similar . I’m 55 yrs old and very athletic, been on TRT for about 6 yrs T normally sits between 800 and 1150


#2

Lower dose of T is very similar to my own protocol. I don’t really need Adex very often, but E2 seems to creep up a little after a few weeks and I can tell a difference when I take .5mg of Adex. Mainly can tell the difference in erection quality. One .5mg dose will last me about a week or more before it kinda wears off. Low E2 sucks bad. Low is worse than high E2. 70MG of T-Cyp a week will not produce a lot of aromatase in most men. I would try his plan, or half the dose and take .25mg of AI wk. If you have liquid you can take a few drops twice a week with your T shot.

You don’t want to OD on Adex. Sounds to me like your E2 conversion isn’t too bad, so you aren’t Estrogen dominant like some men. Just be careful with too much Adex. Low dose of T means you won’t need much Adex, but it will give you little boost to take it once in a while.


#3

Your suspicions are correct. Your doc has no understanding of the basics.
You need to read up.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

TT is nice, but may not be a good indication of T status if FT is low.

Labs:
TT
FT
E2
CBC
fasting glocose
fasting cholesterol
AM cortisol
TSH
fT3
fT4
AST/ALT
PSA

Anastrozole is a competitive drug, to T, and must match T levels. You need to inject twice a week to get steady T levels and take anastrozole at that time. For low dose management, use a liquid 1mg/ml solution, making your own if needed using vodka.

Changes in TT may be from lab timing artifacts hitting different times since prior injection. Try to always to labs halfway between injections. Doing labs at doc’s office at random times is not good.


#4

OK here are my latest results of blood work done 9/29/16 at Quest diagnostics all labs are fasting
Glucose: 101
AST: 22
ALT: 25
A1c: 5.4
DHT: 53
TSH: 2.96
fT4: 1.1
fT3: 4.0
DHEA: 135
PSA: 1.9
TT: 807
T free: 191.2
T Bioavailabile: 393.1
SHBG: 18
Albumin: 4.5
Estradiol, ultra sensitive 36
Total Cholesterol : 181
HDL: 43
Triglycerides: 67
Urine test for cortisol shows me to be extremely low , a.m reading was 33.3 and continues lower
thru remainder of the day leading my endo to conclude I have adrenal fatigue
Sorry I’m new to the forum and assume this reply is according to proper protocol


#5

Add ranges and units please


#6

TSH: 2.96 - too high, should be nearer to 1.0, reference ranges are useless
fT4: 1.1 - should be mid-range or a bit higher
fT3: 4.0 - midrange = ~3.2, can be elevated by rT3 - adrenal fatigue
DHEA: Need range and should be testing DHEA-S, not DHEA as it moves too much

Low cortisol and low DHEA-S suggest an adrenal problem. Low body temps when fT3 should be supporting good body temps really does suggest elevated rT3 blocking fT3 as part of adrenal fatigue. Read the thyroid basics sticky noting these terms and consider purchase of Wilson’s book on adrenal fatigue to see if he seems to be describing you.

Cortisol: In the adrenals, progesterone–>cortisol, you could try some progesterone cream applied to inner forearms. Get Rx or KAL brand [2%] via amazon. Or Rx cortisol drug.

PSA and prostate: E2 is the risk factor, not T or DHT. You need to manage E2

E2=36 WAS way too high. target is 22pg/ml. Were on anastrozole at the time? Appears not.

Anastrozole is a competitive drug, to T, and must match T levels. You need to inject twice a week to get steady T levels and take anastrozole at that time. For low dose management, use a liquid 1mg/ml solution, making your own if needed using vodka. You cannot do this splitting pills.


#7

Ok reposting labs with units
Glucose: 101 mg/dL
Hemoglobin A1c: 5.4% of total Hgb
AST: 22 U/L
ALT: 25 U/L
DHT: 53 ng/dL
DHEA Sulfate: 135 mcg/dL
PSA: 1.9 ng/mL
TT: 807 ng/dL
T Free : 191.2 pg/mL
T Bioavailable : 393.1ng/dL
SHBG: 18 nmol/L
Vit D 25 OHD3: 68ng/mL
Estradiol ultrasensitive: 36 pg/mL
TSH: 2.96 mIU/L
T4F: 1.1 ng/dL
T3F: 4.0 pg/mL
Endo has me on anastrozole 0.5mg every14 days,WP Thyroid 1grain(65mg)
every morning,DHEA 25mg daily


#8

Ranges please, you can edit your posts above directly, look for the pencil icon.

That is insane, dose at same time as T injections twice a week.

Use body temperatures to eval and adjust thyroid medication dose.
TSH on thyroid meds should come down and often needs to be below 1.0 to eliminate symptoms.
You must study the thyroid basics sticky, and get that book.

With adrenal fatigue, you are getting too much fT4–>rT3 and rT3 blocks fT3 that is the active hormone. In this state, if you take T4 meds, you get more fT4–>rT3 and you can feel worse. In that case, you need T3 only medication to drive down TSH and decrease T4 by decreasing T4 production in the thyroid. Read that book. Read my earlier posts above again.


#9

Reference ranges for thyroid panel according to Quest diagnostics
TSH: 0.40-4.50 mIU/L
FT4: 0.8-1.8 ng/dL
fT3: 2.3-4.2 pg/mL
So as per Quest I am a little above mid range on TSH, mid range of fT4 and high end of fT3p


#10

TSH should be nearer to 1.0
The lab range for TSH is useless

fT4=1.1, below midrange 1.3

The above suggests lack of iodine.
What has been your use of iodized salt?

fT3=4.0. midrange is 3.25
This suggests that rT3 may be elevated.

Really need to have your oral body temperatures as per the thyroid basics sticky.
If body temps are low with fT3=4.0, rT3 elevation is highly suspected.

rT3 can be high from stress issues as discussed in the thyroid basics sticky.