T Nation

Should I Insist on Arimidex When/If I Start TRT?

May be putting cart way ahead of horse… and I apologize if this is discussed in here but I could not find it. First lab results next week along with Doc visit at aging clinic. But I am exhibiting most of the classic symptoms.

If I go on TRT, I plan to request the initial protocol of Test and hCG suggested by KSman. However I couldn’t find anything in any of the threads if you should initially start out with an AI. It would make sense, since exogenous T will raise E2 but I didn’t know if you are supposed to wait for your first set of labwork that comes 6-8 weeks after starting TRT.

Avoid use on an AI if at all possible. Don’t base any decision on using it on numbers. Rely on how you are feeling.


I replied to one of your other posts and just want to reiterate AI’s are poison, but sometimes are needed short term until a situation is under control. It’s rare that someone would need an AI while on daily dosing.

Thanks @systemlord and @highpull. Great to get input from folks with experience. Is yalls take the general consensus about no AIs if at all possible?

Another question, what if my initial labs show an E2 level over 30 or so? Would that merit starting an inhibitor? I just did bloodwork yesterday so I may not have access to my results until I meet with the doc so I want to know as much as possible how to discuss with him when I get there.

40 yrs
5’ 11”
Weight train 4/5 days a week for 3 years now
Whole food healthy diet
Very limited alcohol
Extremely difficult for me to put on any muscle whatsoever
Carry fat at love handles and belly
Low libido
Fairly easily emotional
For as hard as i train and as obsessive I am with my nutrition I just don’t look like I workout, soft and fluffy

I just finished reading a thread that included @systemlord and @physioLojik that cleared up my question about why AIs aren’t mentioned in the initial injection protocol thread.


If you are obese, perhaps with a past history of gynecomastia, AAS use, maybe start with a very low dose AI. I wouldn’t unless you’re known to be sensitive to higher estrogen. Even then, I would suggest a wait and see approach,

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Thanks for your time, looking forward to seeing my labs and starting down a path to better wellness.

AI’s cause bone pain, anxiety, popping clicking joints, poor sleep and often are always having to change dosages because what you need now isn’t what you’ll need several months down the road.

TRT in isolation is so much better long-term.

But do you agree with starting on hCG to avoid testes shutting down? @systemlord @highpull

AI’s are unnecessary for most. I’ve been onTRT for nearly eighteen years and never used one. Neither have any of my friends and family member on TRT.


@BrickHead How long did it take for most to realize a leveling out of estrogen. Is that the 6 week period as most suggest?

I am unsure. My doc is great and my friends and family member likely just didn’t pay attention to that. If there was a problem my doc would have informed them and taken care of it.

You don’t have to use HCG unless you want to become fertile. I went for many years without it. I have one kid now and another on the way thanks to HCG.

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Thanks for that. I was recently curious about fertility . Sounds like it works… we’re not totally screwed.

Really, just two reasons to use hCG while on TRT, maintaining fertility and avoiding testicular atrophy. If fertility is the issue, I would hold off unless currently trying to conceive. If not actively trying, I’d run it for about two months each year. For atrophy, I’d cycle on and off. Some feel hCG leans them out, but I’m not so sure about that.

Brick, thanks for the input. Not concerned with fertility, I’ve already got 3 kids and a vasectomy. I’m not too fond of the idea of t atrophy though

On trt for over a year. No hcg. No atrophy. They actually hang lower. My balls are not I would say big, probably average or beliw, but they are basically same size.

I wonder if us guys that had low t also got smaller balls.

I lost half testicular size as per my doctor. HCG has gotten me fertile but it has done almost nothing or nothing for atrophy.

The HPTA shutdown is going to happen whether you’re on HCG or not, the feedback loop will be disrupted, but HCG can allow the testicles to produce a small amount of testosterone and estrogen, but why complicate things since you can simply inject more testosterone to achieve higher testosterone and estrogen levels?

Using HCG may require the use of AI’s, in these cases it best to forgo HCG to stay clear of needing an AI. AI’s cannot effect E2 inside the testicles.

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Your input is fantastic and appreciated. You’ve clearly stated the case for keeping this as simple as possible, stick with solely Test as much as it is possible. One more question though:

Should I be concerned with the pregnenolone deficiency that will result from shutting down? Mood issues etc? I read that preg was the pre cursor to many other sex hormones

There are some who notice a decline in working memory a year, years later and it can be linked to a pregnenolone deficiency, some men while they have a decline in pregnenolone suffer no ill effects for the same reason some men don’t have any low T symptoms in the lower ranges.

Also there are those who have a decline in magnesium on TRT, I prefer the RBC magnesium test because it shows the magnesium levels in your cells rather than serum levels. Serum levels can be normal and cell RBC magnesium can be deficient.

Want kids down the road, inject FSH.