T Nation

Secondary Hypogondadism, Estradiol Out of Control

I will start by saying I have never used steroids or any type of testosterone booster before. I was diagnosed with secondary hypogonadism and was prescribed Clomid 50mg/day.

Clomid worked for testosterone levels but rose my already high Estradiol levels. So I was told to take 1mg Arimidex every other day. After two weeks of this, my results were:

Testosterone, serum: 1240 (Ref. Range: 348-1197)
Estradiol: 75.5 (Ref Range: 7.6-42.6)

After I bumped up the Arimidex to 1mg/day, my results 2 weeks after were:

Testosterone, serum: 1218 (Ref Range: 348-1197)
Estradiol: 63.3 (Ref Range: 7.6-42.6)

Then, I bumped up Arimidex to 2mg/day, my results 2 weeks after were:

Testosterone, serum: 1040 (Ref Range: 348-1197)
Estradiol: 50 (Ref Range: 7.6-42.6)

LH, FSH have been in range since treatment.

As you can see my Testosterone- Estradiol ratio is not nearly high enough. I actually feel worse now than I did before treating my low T. My doctor said he has never seen a patient be so minimally responsive to Arimidex before.

Can anyone offer insight as to why Arimidex has been so ineffective for me? I was hoping my doctor would be open to treating me with Aromasin. I just really feel that there is some underlying cause that is preventing my estradiol from being supressed. Any insight would be greatly appreciated. Thanks a lot.

Anastrozole cannot control Intratesticular Aromatization of Testosterone.

Easy, but not well known. The SERM is creating high levels of LH as indicated by your T levels. Over stimulation of the testes creates high levels of Intratesticular Testosterone [ITT]; which can be up to 80 times higher than serum T levels in young normal males, probably higher in your case. There is aromatase in the testes. With high ITT, the T–>E2 aromatization rate is high as well and this increases E2 in serum. Once E2 is in serum, an AI will not remove that. Arimidex/anastrozole is a competitive drug. It competes with T at the aromatase enzyme reaction sites.

Inside the testes, anastrozole is out numbered 100:1 and is thus ineffective. Anastrozole cannot control your testicular E2 production. As you take more, and unreasonable, anastrozole doses, you are eliminating most T–>E2 in peripheral tissues. T–>E2 also takes place in the brain for local utilization. Perhaps something is going wrong there.

I came up with this theory.

So what do you do? Cut clomid dose in half and you need to reduce anastrozole at the same time. Some feel crappy using Clomid. So I recommend Nolvadex which does not create those estrogenic sides that make some feel very unwell.

If you are taking certain drugs, OTC or Rx, this can reduce the liver’s ability to metabolize estrogens. In your case, that effect could be profound. Avoid grapefruit!

Thanks a lot, any additional help would be greatly appreciated as well! I should add I am 23 years old and always have been in good shape. I am about 6’2 187lbs. Also, I am not taking any other OTC supplements besides daily Vitamin D.

Anybody else have any insight to offer?

Try the suggestions that I made.

So I took your suggestion. After 2 weeks of 25mg/day Clomid and 1mg/day Arimidex my levels came out to:

Testosterone, serum: 1140 (Ref. Range: 348-1197)
Estradiol: 46 (Ref Range: 7.6-42.6)

I’m going to suggest to my doctor that we try maybe going 25mg Clomid every other day now and switching to another AI. Not sure if I should request Aromasin or Femara.

Or maybe request to switch over to Nolvadex as well. However, I think my doc really likes sticking with Clomid

[quote]KSman wrote:
Anastrozole cannot control Intratesticular Aromatization of Testosterone.

[/quote]

So an AI is really only effective at reducing E2 when test comes from an exogenous source? My uro told me this recently I and wasn’t sure if he was correct.

AI reduce E2 in specific tissues, but they can’t control E2 inside the testes.

Hypogo, ksman has a point and I think he is correct.

I had exactly the same issue could not get e2 down after clomid use.

Also took high dosages of anastrozole and in the end I think it just took time to come down naturally.

Have you looked into HCG monotherapy? I plan to give this a shot.

For what it’s worth I had good success with tamoxifen at 10mg daily. It was for only 2 weeks and had no impact on my e2 levels (no huge rise). But again it was only 2 weeks.

Thanks for the input. Just spoke to my doctor. He suggested we see if the Clomid jump started my system so I am going off both Arimidex and Clomid and am supposed to report back to him in 6-8 weeks to tell him how I’m doing. I asked if I had to gradually lower the Clomid dose to ween off of it and he said that I didn’t and just to stop everything immediately. Is he right about this?

Doc is totally dead wrong an uninformed. You need to slowly taper off of the SERM and land on 0.5mg anastrozole per week in EOD divided doses.

If you stop suddenly you will have your HPTA awash in estrogens and you WILL shut down.

Your high and ineffective AI dose indicates that SERM dose is too high, LH is too high, LH receptors will get desensitized. T–>E2 inside your testes is out of control because the T levels inside the testes are too high for a competitive drug to be effective. This is classic. Doctors have no idea!

Suggest that you take 10mg clomid EOD and 1mg anastrozole per week and see where that leads.

If you feel bogus, may be because of the side effects of clomid that some guys get. Nolvadex does not do that. Your doctor has no idea.

Ksman-

Thanks for the input. I figured it couldn’t hurt to taper off so that is what I am doing. I am going to lower my dosage 5-10mg every week. I had a question regarding the “estrogenic side effects of Clomid” you have mentioned. Are those symptoms directly due to the high estradiol levels or can they be there regardless of your estradiol levels? If this does not work for me I will definitely push for Nolvadex. Thanks for your help.

Clomid is chemically a form of estrogen. Most do not get problems, but the problems can be major for those affected. So why play that game?

Okay, so there’s been an interesting development in my case. Since my last post I had lowered my dosage to 12.5mg Clomid EOD and 1mg Arimidex EOD. I thought this would finally get my E2 under control. First, I should note that after 2 weeks on this dosage I felt worse than ever, significantly worse than ever. I figured maybe it was because my T had dropped below baseline. However, I just got the results back. Again, these results are after 3 weeks of 12.5mg Clomid EOD and 1mg Arimidex EOD.

Testosterone, serum: 1168 (348-1197)
Bioavailable Testosterone: 703 (128-430)

Estradiol: 45.1 (7.6-42.6)
LH: 17.4 (1.7-8.6)
FSH: 4.0 (1.5-12.4)

I understand my E2 is still high. But I have felt better when it was higher. The question is, what is going on that I felt sooo awful when I lowered my clomid to 12.5 EOD. There has to be something else going on. It looks like based on my numbers, I could go off the Clomid. But I refuse to after my last experience. I literally couldn’t even keep my eyes open on the 12.5 EOD dosage. Any input would be greatly appreciated. There has to be some other factor at play. Thanks

The high LH is the problem, keep lowering Clomid prevent the high T–>E2 inside the testes that anastrozole cannot control.

You were addicted to high T so now you feel the drop, but your levels are good. If you can get E2 controlled you will feel better even with less T.

How do you feel mental wise? Moody, depressed … ?

I don’t know how I can decrease the dosage from 12.5mg Clomid EOD. I don’t know that I can cut the pills any smaller. Unless maybe I go to 12.5mg Clomid E3D, is that do-able? I’ll have to do it very slowly since the withdrawal, if that was what was going on, was so severe I almost had to take off from work. Should I still inquire about switching to Nolvadex? I’m still unclear if Nolvadex is better simply because of less side effects or if the decreased side effects are due to the fact that Nolvadex does not usually increase estradiol as much as Clomid.

Clomid is an estrogen chemical, steroidal. Nolvadex is not. Clomid creates nasty estrogenic side effects for some. Nolvadex does not have that problem.

So I am trying to very, very slowly lower my Clomid dosage, hopefully being able to end on 12.5mg EOD. Also, I have talked to my doctor about switching AI. I now have a prescription for Aromasin. I found a lot of contradictory information on this site regarding to potency of Aromasin v. Arimidex.

Also, I wanted to know if there are any risks I should be aware of before I start Aromasin. Thanks a lot.

Hello interesting thread.

I took finasteride and now I am finasterided aka f*ked up.

When I take test it gives me a wood within an hour and first week get improvments but then worse than ever. Free e2 as mesured by siliva goes over range even on small dose of t 27.5mg test e per 3 days.

To me it seems TRT does not work because of this. Some have tried to get e2 down without any luck when some use arimidex their e2 goes higher. This points me to the testicles. I have a small nodule on mine which didnt show up on ultrasound.

What are your symptoms