T Nation

Time for Arimidex?

I have been on androgel-10 mg per day for the past 4 months. My latest blood results:
Free T 10.3 range 7.2-23.0
Total T 546 range 181-758
Total serum estrogen 90pg/mL
While my doc is an excellent guy, no explanation was given about the estrogen other that it is in what is considered normal range foe a 54 year old.
No range was listed along with the E number.
From my research here and there, this is in the high normal range?

Several of you are quite knowledgeable on the subject-advice and opinions about taking arimidex on my own?

[quote]fedorov wrote:
I have been on androgel-10 mg per day for the past 4 months. My latest blood results:
Free T 10.3 range 7.2-23.0
Total T 546 range 181-758
Total serum estrogen 90pg/mL
While my doc is an excellent guy, no explanation was given about the estrogen other that it is in what is considered normal range foe a 54 year old.
No range was listed along with the E number.
From my research here and there, this is in the high normal range?

Several of you are quite knowledgeable on the subject-advice and opinions about taking arimidex on my own?[/quote]

Do you know what lab did the hormone work? The total T range does not look familiar. Ask for the original lab reports from the lab if a local medical office transcribes these things. They need to tell you the range.

Most here deal with serum E2 0-53 labs. Total estrogen is not used often and causes confusion. You can control E2 production with arimidex. Total E includes the metabolites of E2, other estrogens. If E2 is high and you reduce it, then the other estrogens should follow.

LabCorp lists total estrogen 40-115 for adult males.

Your 90 puts you at about 75% of the range. For serum E2 (0-53) guys do well at 40-50% of the range. Optimal E2 is often thought to be around 17-20 from a libido point of view.

I think that you simply have the wrong test. You want to get E2 controlled and if you do that and still have persistent E type symptoms, you might have unusual E2 metabolic products… but that is rare and you should not need to be concerned with that and deal with E2 levels and see if that improves life.

Your TT and FT levels are not high. You do not seem to be good at absorbing TDs (transdermals). TD’s do push up E more than injectables. Your T levels might be good for you, but with higher amounts of E, that T can be blunted by the E. There is a great variability in how guys react to TDs and some simply do not absorb well… and some do initially, but hormone changes alter the skin properties then they later fail to absorb. Some simply feel worse on TDs. Some react well. Note that there is a well known association of a lack of TRT TD response among those with hypothyroidism (diagnosed or not). While TDs can lead to worse E2 outcomes than injectables, E2 problems are very common or the norm with TDs and injectables.

You can ask for a serum E2 test with arimidex to take your E down to 40-50% of range. If your doc refuses to do that, go on your own. You can get E2 serum from LabCorp via LEF.org. You can do one first if you want to have the justification on file, or you can start the adex and then let your first E2 test be used for any dose alteration needed. If you an get your doctor to cooperate, you can get the script in hand then keep that at home and use a research chem. This will save major money if not covered by insurance and will also be a lot cheaper than co-pays. The liquid adex allows great flexibility in dosing that cannot be achieved by breaking up 1mg tablets. If you get a script and go the research chem route, remember to always get new script in hand when you visit your doc. You don’t want the office trying to phone in renewals or dose changes.

A typical starting dose of adex is 1mg/wk in divided doses.

You have not talked about how you feel. Just as a doctor should not be treating your lab work in isolation from your symptoms, you should not either.

Even with very high T numbers, elevated E can leave you feeling like crap. Your doc might be happy that your TD has you in the middle of normal range, but that is certainly not an optimal response.

If you lower E, then SHBG will [should] go down and FT will increase. Less T will aromatize to E, so TT will increase. What FT and Bio-T that you then have will also be more effective as there will be less interference of E at the E receptors. And less activation of E receptors will change the way that your brain and body work.

Typically the first thing that you notice when T is up and you lower elevated E with an AI is an increase in libido and often a return of morning erections. Libido is a good fast acting barometer for how TRT is improving one’s well-being. If you have any libido issues, probably E related and you have to make this known to your doc. If he does not understand or care, he is not one of the best.

Many guys have doctors who do not understand the E connection as a success factor for TRT.

What are your testes doing? Shrinking? Scrotum pulled up tight. If so, that is to be expected with TRT that is working right. You can inject HCG to restore and maintain your testes, but that then sort of makes the needle avoidance of TDs look silly. If your testes seem normal and hang down freely, most would see that as a sign that your TD TRT is not working fully… which would seem unexpected for your TT and FT levels.

Issues:

-optimal T and FT
-injected VS TD
-HCG(injected)250iu SQ EOD for health testes and mood improvement
-appropriate E test should be E2
-elevated E
-goal for E2 lab work numbers
-E symptoms, libido and persistence or return of classic hypogonadism symptoms, fat patterns and gain/loss
-arimidex to reduce E2
-prescribed arimidex or on your own
-insurance coverage of arimidex and co-pay costs
-libido as a measure of how TRT is working

[quote]KSman wrote:

Do you know what lab did the hormone work? The total T range does not look familiar. Ask for the original lab reports from the lab if a local medical office transcribes these things. They need to tell you the range.

Most here deal with serum E2 0-53 labs. Total estrogen is not used often and causes confusion. You can control E2 production with arimidex. Total E includes the metabolites of E2, other estrogens. If E2 is high and you reduce it, then the other estrogens should follow.

LabCorp lists total estrogen 40-115 for adult males.

Your 90 puts you at about 75% of the range. For serum E2 (0-53) guys do well at 40-50% of the range. Optimal E2 is often thought to be around 17-20 from a libido point of view.

I think that you simply have the wrong test. You want to get E2 controlled and if you do that and still have persistent E type symptoms, you might have unusual E2 metabolic products… but that is rare and you should not need to be concerned with that and deal with E2 levels and see if that improves life.

Your TT and FT levels are not high. You do not seem to be good at absorbing TDs (transdermals). TD’s do push up E more than injectables. Your T levels might be good for you, but with higher amounts of E, that T can be blunted by the E.

There is a great variability in how guys react to TDs and some simply do not absorb well… and some do initially, but hormone changes alter the skin properties then they later fail to absorb. Some simply feel worse on TDs. Some react well. Note that there is a well known association of a lack of TRT TD response among those with hypothyroidism (diagnosed or not).

While TDs can lead to worse E2 outcomes than injectables, E2 problems are very common or the norm with TDs and injectables.

You can ask for a serum E2 test with arimidex to take your E down to 40-50% of range. If your doc refuses to do that, go on your own. You can get E2 serum from LabCorp via LEF.org. You can do one first if you want to have the justification on file, or you can start the adex and then let your first E2 test be used for any dose alteration needed.

If you an get your doctor to cooperate, you can get the script in hand then keep that at home and use a research chem. This will save major money if not covered by insurance and will also be a lot cheaper than co-pays. The liquid adex allows great flexibility in dosing that cannot be achieved by breaking up 1mg tablets.

If you get a script and go the research chem route, remember to always get new script in hand when you visit your doc. You don’t want the office trying to phone in renewals or dose changes.

A typical starting dose of adex is 1mg/wk in divided doses.

You have not talked about how you feel. Just as a doctor should not be treating your lab work in isolation from your symptoms, you should not either.

Even with very high T numbers, elevated E can leave you feeling like crap. Your doc might be happy that your TD has you in the middle of normal range, but that is certainly not an optimal response.

If you lower E, then SHBG will [should] go down and FT will increase. Less T will aromatize to E, so TT will increase. What FT and Bio-T that you then have will also be more effective as there will be less interference of E at the E receptors. And less activation of E receptors will change the way that your brain and body work.

Typically the first thing that you notice when T is up and you lower elevated E with an AI is an increase in libido and often a return of morning erections. Libido is a good fast acting barometer for how TRT is improving one’s well-being. If you have any libido issues, probably E related and you have to make this known to your doc. If he does not understand or care, he is not one of the best.

Many guys have doctors who do not understand the E connection as a success factor for TRT.

What are your testes doing? Shrinking? Scrotum pulled up tight. If so, that is to be expected with TRT that is working right. You can inject HCG to restore and maintain your testes, but that then sort of makes the needle avoidance of TDs look silly.

If your testes seem normal and hang down freely, most would see that as a sign that your TD TRT is not working fully… which would seem unexpected for your TT and FT levels.

Issues:

-optimal T and FT
-injected VS TD
-HCG(injected)250iu SQ EOD for health testes and mood improvement
-appropriate E test should be E2
-elevated E
-goal for E2 lab work numbers
-E symptoms, libido and persistence or return of classic hypogonadism symptoms, fat patterns and gain/loss
-arimidex to reduce E2
-prescribed arimidex or on your own
-insurance coverage of arimidex and co-pay costs
-libido as a measure of how TRT is working

[/quote]

KSman, excellent post as always!

Thanks KSman, excellent info as usual.
I have ordered the a-dex and will follow your dosage suggestion.
After observing any quality of life changes(hopefully for the better) the estradiol test will be done through LEF.

[quote]KSman wrote:
TD’s do push up E more than injectables.
[/quote]

Isn’t it the other way around? The increased DHT from TD’s suppresses conversion to E.

[quote]Bri Hildebrandt wrote:
KSman wrote:
TD’s do push up E more than injectables.

Isn’t it the other way around? The increased DHT from TD’s suppresses conversion to E.[/quote]

If one has a lot of DHT from related gear and less or no testosterone, then the cycle would be ‘non aromatizing’ and then there is little T to convert to E. DHT will not aromatize to E.

If you have T and DHT, the T will still aromatize and the DHT will not prevent this at all. With gear cycles, if you use a DHT derivative, then you probably are using less T and there will be less T as fuel for the T–>E conversion engine.

Another related aspect is that a few DHT derivatives, such as Proviron, have a high affinity for SHBG. Proviron can saturate the SHBG which increases FT and the effects of T… many get a good lift in libido and spontaneous erections.

Some state that it has an anti-E effect, and it does, it also has an affinity for aromatase and binds to it. So it does also act well as an AI. So to recap, reduces effects of SHBG which leads to more FT, acts as an AI to reduce E, reduced E leads to less SHBG. Dose is 50mg/day when on gear and it is thought 25mg/day may be effective when not on gear or on TRT.

Basic DHT does not do this that I can find out, and natural DHT levels would not provide for these effects in any case. Proviron is an oral drug in Europe and elsewhere. It is not a listed drug in the US or Canada. So in some countries one could get a prescription for this as part of TRT.

Back on topic. The DHT from TRT is androgenic and helps with the physical condition of the sex organs as well as libido. Basic DHT does not bind preferably with aromatase or SHBG and will not act as an AI.

The amounts of DHT that one gets from TRT, injected or TD are relatively small. Note the amounts of proviron taken every day above. There might be some interesting effects from basic DHT, but one would then need ‘gear’ sized doses in any case.

I hope that above helps clarify things. I have not seen any profiles for DHT that go into much depth. There may be some interesting effects from high doses of DHT, but I have not found any data on that. Note that all DHT derivatives can promote hair loss for those genetically predisposed to that.

These drugs may have some negative effects on the prostate, however, it not now understood [but often not known] that E is the biggest risk factor for the prostate. So those on gear who think that they are getting by without AIs may be doing greater harm to their prostates from their elevated E levels than someone taking something like proviron.

I was looking for my source of information and found it.

Here’s a quote from Dr. Mariano

"One patient, for example, with low bodyfat was being treated with a high potency testosterone PLO cream. Despite a good enough dose, he still had no libido. Thinking the problem was excessive aromatization of testosterone to estrogen, he tried Arimidex. There was no improvement.

When lab tests were done what we found was that his total and free testosterone and DHT levels were so high, aromatization was actually impaired and he developed lower estrogen levels than before treatment. Thus the Arimidex was the wrong answer. Rather a switch to an alcohol-based testosterone gel, depo-testosterone injections and HCG injections were the solutions - since they result in more aromatization than with the cream. Testing was necessary to avoid a lot of trial and mostly error attempts."

Well, that does not make any sense at all, but TRT often does not obey expectations. Hard to know why aromatization was ‘impaired’. The low body fat might be a clue. Guys on gear have high levels of T,E and DHT and they are not having low E problems.

The testes do make E, and the HCG turned those back on.

Someone else had no libido and on 1mg/wk arimidex did not either, and E fell through the floor. He found by trial and error that he needs 1/8th mg/wk. A very strong AI responder.