T Nation

TRT Without AI = Waste of Time


I am on day 5 of liquid Arimidex, and 3 years into TRT. I can slowly feel the effects of the Arim building.

Guys, you really should try a good AI with your TRT. Doctors who won't prescribe it or won't even discuss it (like mine) are simply dooming you.


What's your T and AI dosing?

I agree, TRT must have an AI for most guys from what I've experienced and read myself.


Using an AI made all the difference for me getting where I wanted to be in every way while using Testim.


watch out for cholesterol problems. Aromasin is everything arimi is plus no negative impact on libido or cholesterol


I had T of 1469 ng/dl and E2 of 95. My free T was off the charts. (I was not 'legal' at that time, btw.) So, I began using Ana (liquid arim).

My vision seems more clear, my digestion is better, my libido is like a jackrabbit's, and I just am starting to feel better. The last time I felt this good was on 40 mg/day of Dbol.

I have done TRT, so the doctor I was going to cut my T down to TRT levels but didn't give me an AI. I felt terrible for 3 weeks. Then I started Ana.


That's a bit misleading, I think. They're both effective aromatase inhibitors but Exemesatane is a Type I inhibitor while Anastrozole is a Type II inhibitor. Type I inhibitors are steroidal and have androgenic effects that may be a problem for someone who is taking exogenous testosterone.

Notice I said "may" be a problem. Individuals taking any of these compounds definitely need to be getting regular blood work to keep track of all the factors involved and base their decisions on what is actually happening in their bodies... as opposed to published information about how these things are supposed to work.


Using adex to lower E2 into the lower 20's will not increase cholesterol levels. TRT can greatly lower cholesterol. TRT+AI will be a net improvement.

If you take too much adex or are one of the few that overreact to it, E2 can go too low and libido will quickly suffer. That is your fast reacting indicator of your E levels.

The few who react strongly to adex may end up on 1/8th mg or so once they find what works. You libido can be the only indicator. If E2 is off scale too low, that does not tell you what dose you need. One needs to experiment, then when things seem ok, do blood work and that can guide dose refinement.

E2 in the single digits is too low and creates mental changes, loss of libido, joint pain and perhaps cholesterol problems too. But you do not want to be there and what happens there will not happen if your E2 levels are where they should be.

Most guys on a typical TRT of 100mg/wk test ester will do very well with 1mg/wk of adex.


I just started TRT a few weeks back. I'm 37 years old and my Free T was in the basement. I'm on T, HCG, and HGH. Feeling a LOT better now. So what have you experienced since adding an AI in the mix? Is this something I can get prescribed to me? If not, is it easy to get an honest mix from an Internet supplier?


After some research, I've answered my own question.


ive been on trt for a year now..doing 1cc a week of test cyp. istarted feeling like shit again ,no sex drive again ,and gaining serious weight when with working out and food intake should be losing fat.i mentioned this to my dr and asked to check my estrodiol ..he said why that has nothing to do with anything ,you r taking testosterone we would only check that if u are transgender and taking female hormones...at that point i wasnt gonna argue anymore ...so what i want to know is there anything over the counter to take?

My DR left the practice and i see his replacement in january ..She is young so hopefully i can talk her into this...How what should this be taken


I am amazed and find it just plain stupid to prescribe testosterone to older men, the ones most likely to aromatize some of the testosterone into estrogen, without an AI. All this does is raise T, the body compensates with aromatase, and you're back where you started.

I propose that this is lunacy.

Now, I have to skirt the fringes of the law and treat myself. Frustration doesn't describe my 3 years on TRT.

I had two doctors refuse to even test my E2. I finally marked the bloodwork order for E2 on my own, which the 2nd doctor had given me. They weren't even going to check it!!
I had to be unethical to get a proper test done.

God I hate doctors!!!!!!!!!


I'll be discussing this same topic with my endocrinologist next week. For the longest time I thought I had a thyroid problem but while living in Canada I couldn't get any test work beyond TSH done. The TSH always came back within the 'normal' range but there's a family history of thyroid problems and I had a ton of symptoms.

I finally got the new doc to run a full thyroid panel and I fought for a testosterone test as well (fearing a pituitary problem). All the thyroid results came back within range and I got a lecture that my issues weren't medical and that I'd have to watch my diet closer (18 months of recording every morsel of food going into my mouth and training 4 days a week and I need to somehow be more mindful?).

I then asked about the testosterone results and the doc had to take back her rant. It took me about 15 minutes to convince her that my low test wasn't the result of AAS use but we ran more blood work (wouldn't run E2 for the same reasons mentioned in the other posts) and I'll have those results next week and we'll be discussing TRT.

I'll keep y'all posted on how I make out when I bring up the addition of an AI and routine monitoring of E2 in addition to the other blood work.

I think the only reason that I got any of this blood work done was that I really fought for it and presented a good argument and more importantly, I paid for the tests myself and didn't have to justify anything to an insurance company. Doctors just don't seem to be interested in anything beyond the basics.


Ok so here are my Quest Diagnostics results, can someone please tell me what this all means?

Testosterone. Free and weakly bound total=1228
sex hormone binding globulin=26
testosterone free=381
free& weakly bound=801
hepatic function panel:
protein total=7.4
albumin/globulin ratio=1.6
alkaline phosphatase=68

Maybe time for AI?


What's your Estradiol? That would tell us of you need an AI.


Well, they have a fondness for lots of Ben Franklins.


HH, you know I hate most doctors too. But I'm curious, do you see them as intrinsically more greedy than lawyers, CPA's, stock brokers, and CEO's, just to name a few? I don't, I think they're all greedy, some just worse than others. Our culture breeds greed.
Perhaps when the greed interferes with doing what they are supposed to do, this is what is most heinous. Maybe I just answered my question. Doc


Well, sir, you are an exception. My experience with doctors has been that most are there for the almighty dollar. Now, there's nothing wrong with that as long as the doctor knows what they are doing. Most don't. KSMan is FAR more knowledgeable than any TRT doctot I've ever met. Or any endo.

My last, a specialist, didn't give an older man (me) an AI. Why? Older men tend to convert T more. So, why? He got mad that I questioned his authority.

He actually is the best of the lot, and I'll probably stay with him until I find someone better. I don't like the probabilities.


That unfortunately was not on the panel, I will ask for that on the next test next month.


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I am in the suburbs east of Cleveland. I have flown to my current doc's place in another state.

Thank you for the idea, but I've pretty much accepted that I have to self-medicate. I'll kind of follow what the current guy says, with adaptations from KSMan.