I guess the next question is, is there a way I can get my doctor to prescribe Letrozole, so I can give it a shot?
It would depend so much on the individual.
It’s a shame (not really of course) that you’re not obese, because the value of letrozole for this purpose in obese men is quite adequately documented in the literature. For non-obese men, I don’t know of a study. It would not be unreasonable for a doctor to say, “Well this doesn’t necessarily apply” nor would it be unreasonable for him to be willing to try it. It would very much be an individual decision.
It could also help to PM me on this one if you want.
Common side effects (reported in the medical literature as occurring to 10% or more of users, and also happening to what seems a significant percentage of men using it) are nausea, decreased energy and weakness, bone pain, and cough.
In terms of cases known to me, other things that seemed common enough included headaches, insomnia, and depression.
Other medically known side effects are diarrhea, constipation, vomiting, loss of appetite, dizziness, dry mouth, and back pain.
The scary part is some have had some of these problems, particularly loss of energy or GI problems or both, for very many months after quitting Arimidex. For them it seems to be doing something adverse that has a long-term effect.
I’ve never been a fan of Arimidex for this reason.
Letrozole, at least at lower doses, just does not seem to have these problems. Medically, even at doses way higher than I’m recommending here, it hasn’t shown these problems either, and is considered well-tolerated.
Wow … I always heard that A-dex was the best one out there for long term use.
What kind of dosage are we talking here ??
Most of us on TRT take 1mg or less per week.
I have not heard of the nasty sides you mentioned. ( I am not saying they do not happen, just never hear about them)
Are these sides from estrogen being too low and not monitored, or the drug itself ??
What, in your opinion is the best long term solution for controling E2 ???
The medically-reported side effects and rates of side effects are almost undoubtely at the usual medical dose of 1 mg/day.
It’s not unusual in bb’ing for that to be reduced to 1/2 mg per day or 1 mg EOD, or to 1/4 mg/day.
Some, as you do, use it as low as 1 mg per week.
No doubt the rate of side effects is reduced with lower dose.
I think everyone or most everyone that myself I know had problems with it was using in the range of 1/4 to 1/2 mg/day.
I do think letrozole is a superior drug.
Those effects are at 1mg a day not the tiny dose we’re talking about. Of course 1mg a day is going to have those effects. E2 would be in the tank!
Please re-read my post: adverse effects are also seen at lower dose than 1 mg/day.
And the cause is not always if ever estrogen being too low. First, because in many of those cases estrogen was measured and was in the normal range. Second, because abnormally low estrogen, for example from doing an exclusively-non-aromatizing steroid cycle, doesn’t have that same side effect profile.
Because it has been around longer and studied more and because progress is slow.
With the doctors, it may also (don’t know in this case, but it often does) have to do with whether the “detailers” are pushing it or not.
(Detailers are pharma reps that stop by the office, are the main source for most doctors of information on drugs (sad but true), and give free samples and various free goodies, and if the doc is a good boy may give him various rewards like airline and sports tickets and so forth.)
This is one of the absolute best threads i’ve come across in a long time, with regards to hormones. I just mentioned in an Over 35 thread re SHBG, that the more I learn about SHBG, the more confusing it becomes. Not only has this thread given me a totally different perspective on it, but it’s revamped my thinking on testosterone also.
Bill, I realize what I’m asking can come across as a daunting question but, in your opinion is there any specific supplement or action one can take to create more free T? You mention Letrozole. For someone not taking steroids or TRT, what would the dosage be?
Thanks for your time.
Bumping this thread
[quote]poophead wrote:
This is one of the absolute best threads i’ve come across in a long time, with regards to hormones. I just mentioned in an Over 35 thread re SHBG, that the more I learn about SHBG, the more confusing it becomes. Not only has this thread given me a totally different perspective on it, but it’s revamped my thinking on testosterone also.
Bill, I realize what I’m asking can come across as a daunting question but, in your opinion is there any specific supplement or action one can take to create more free T? You mention Letrozole. For someone not taking steroids or TRT, what would the dosage be?
Thanks for your time.[/quote]
On letrozole, there is at least one study showing that total dosage of no more than 2.5 mg per week seemed optimal to the authors, in the context of obesity-related hypogonadal men. This often yielded supraphysiological levels of testosterone, so since the authors did not favor this, they suggested dosage may perhaps best be less than this.
This works out to, on a daily dose, to about 0.36 mg/day.
(The study dosage method, incidentally, was single dose weekly, not divided, but I doubt that that is better than daily dosing. I really see no reason to have levels fluctuate unnecessarily.)
Myself, I use (off-cycle) 9 drops per day of a solution containing 2.5 mg per 54 drops, so I use about 0.42 mg/day. I think the only reason I came up with this is irrational but typical human preference to subdivide evenly – in other words, 7 does not evenly go ino 54 but 6 does, and I didn’t consider such a small increase important. However it would have been more logical to make it 8 drops, as that works out to 0.37 mg/day. Actually now that I’ve figured this, in the future I’ll save a drop and thus get a little more mileage per bottle.
Now, Tim tells me that this is more than needed, based on other literature study that he had Cy do and also based on some medical cases he is familiar with. I agree that since it often generates supraphysiological free T even from hypogonadal men, less can certainly be “enough” but I’m unware of any adverse side effects at this dosage. I haven’t seen in the literature reports of estrogen going below normal from such dosage. For example, estrogen remained normal, though cut about in half, in this study.
One can certainly start with less if desired and evaluate results at a lesser dose. I don’t think a higher dose is called for when the purpose is increasing natural T and keeping natural estrogen in check but still within normal values.
What would the expected doseage be if one was taking 150mg T-cp per week, and currently using 1.25 mg per week of A-dex.
Could letro be used to get the same results with less chance of sides ??
Taking 150 mg test cyp per week would typically yield only normal testosterone levels, and so I would use the same dosage as described above.
If someone has been using Arimidex for some time and is quite sure that it causes him no problems, then it really can’t be that another compound, for him, has less chance of problems. However, in general I’d say it is so that letrozole has less risk of problems.
Bill - May i bump ‘Bushidobadboys’ question above in the hope you would address it in more detail?
He (and I) have a simple misunderstanding of the relationship between total T and free T.
I thought that SHBG was the main culprit for reducing total T down to the Free T amount.
Now, after reading this thread, i understand the part SHBG has to play,(and after you have had to explain it 4 time there is no need to punish you further on that count!) but if it is not reducing the total T by such an amount, how is the Free T so much lower in all cases? That is to say, is it even important what use the testosterone is being made of between the Total and Free numbers? Or is it simply how much free is available?
Is it simply that Free T is the test’rone that is going to be made into DHT via 5-a, and thus give the many of the androgenic benefits that most HRT males are looking for their medication to provide?
Or does that happen to the Total T and the free T is indicative of that? 
Thanks and i hope my question makes sense.
Brook
An exactly correct explanation is really not practical. The first part of being really correct, really has to be glossed over and presented by analogy. A physical chemistry text or many analytical chemistry texts will present it rigorously, if interested.
There is a concept and thing in physical chemistry called activity (which has very little to do with the ordinary meaning of the word) or chemical potential. It is in reference to energy of the system.
When molecules are in solution and free to move, or free to move from the solid state into a liquid solution, they on average move in such a way as to yield equal chemical potential on both sides. Kind of like how if you have two pools of water and run a hose between them, you may be sure that water will flow from the higher pool to the lower. And you may be sure that with time, assuming there’s no issue of pools overflowing, they will, if water is free to flow from one to the other, that they will reach the same level.
Similarly, with solvents containing solutes (dissolved material), where the solutes are free to move from one solvent to the other, the chemical potential of the solutes in the solvents will equalize, and rapidly so if the solutes are reasonably free to exchange between the solvents.
A cruder but still fairly close way to look at this is “percent saturation” instead of chemical potential (the two are closely related.) If for example you have a container holding both chloroform and water (they don’t mix) and some solute and you shake or stir them to give the solute the opportunity to move from one solvent to the other, if you find after this that the chloroform is say 50% saturated with the solute (that is, it could hold exactly twice as much before being unable to dissolve any more) then you would find that the water phase will also be almost exactly or maybe exactly 50% saturated.
Similarly if you have a solute – say testosterone – dissolved in the aqueous phase of the blood, that is, free in the water part of the blood, at some percentage of saturation, you would also find that the fat in the body has testosterone dissolved in it at almost exactly or exactly the same percent saturation.
Now, testosterone is probably at least 1000 times more soluble in fat than in water, so the concentration in the fat would be 1000 or more times higher, but not the percent saturation, which would be the same.
The same is true with regard to that which is bound by substances such as SHBG or serum albumin. They will be at the same percent of their saturation as the water is (or extremely close to it) but because their ability to solvate testosterone is vastly greater per milligram, the absolute quantity bound to such substances can be far beyond what is solvated free in the water.
So the reason free testosterone is a relatively small value while the amount bound to serum albumin is considerably higher, and the amount bound to SHBG is far higher, is because with testosterone being at the same chemical potential in each phase or substance (and it will be or extremely close to it at any time, as if it is not, it will rapidly move in such a manner as to equalize the chemical potential) the properties of serum albumin, SHBG, or for that matter fat, are such that the concentrations of testosterone in these or bound to thse are far higher than what is the case in the aqueous phase of the blood.
In terms of evaluating the pharmacology of testosterone, or any other substance in the blood, every single equation for every single phenomenon related to receptor binding or rate of enzymatic conversion depends only on the free concentration. The amounts sitting around in fat cells, or bound to SHBG, or serum albumin, aren’t even in the equations. The chemical potential is what is relevant, and is fully known by the free testosterone figure.
Knowing how much T is bound to SHBG is no more important than knowing how much T is stored in fat cells or total in the body, for example. That is to say, not important at all. (A fat person, for same free T, has far more testosterone stored in the body, by the way, but that fact does not result in more biological effect, though it likely has relevance to clearance of injected steroids.)
On knowing the free value, further information on total or “free and weakly bound” adds absolutely zero further useful knowledge. The exception is if one is interested in cellular signalling effects of SHBG itself, and one does know more about the amount of SHBG if knowing the amount of total teststerone after knowing the amount of free testosterone, as an indirect way of figuring amount of SHBG. But the anabolic relevance is zero.
Doctors, in general, do not understand this (or at least those that are not well versed in physical and/or analytical chemistry generally do not, and there are extremely few that are because they really don’t need to know it) and there are countless examples in the medical literature, as well as other articles, that rely instead on what seems to be common sense. But what seems common sense just is completely off in this case.
[quote]Bill Roberts wrote:
Common side effects (reported in the medical literature as occurring to 10% or more of users, and also happening to what seems a significant percentage of men using it) are nausea, decreased energy and weakness, bone pain, and cough.
In terms of cases known to me, other things that seemed common enough included headaches, insomnia, and depression.
Other medically known side effects are diarrhea, constipation, vomiting, loss of appetite, dizziness, dry mouth, and back pain.
The scary part is some have had some of these problems, particularly loss of energy or GI problems or both, for very many months after quitting Arimidex. For them it seems to be doing something adverse that has a long-term effect.
I’ve never been a fan of Arimidex for this reason.
Letrozole, at least at lower doses, just does not seem to have these problems. Medically, even at doses way higher than I’m recommending here, it hasn’t shown these problems either, and is considered well-tolerated.[/quote]
Bill, awesome information here.
Well, that’s a little concerning about Arimidex. Okay, so Letrozole doesn’t have “these” problems - however, in the literature or in your experience what side effects HAVE you seen with Letrozole? (There must be at least minimal side effects, right?) Is there any reason to think that Letrozole is safe in the long term? Also, how would you go about switching - taper off liquidex until it’s out of your system first?
Also, as long as we’re discussing AI alternatives, what’s your current opinion on Aromasin - especially using it as an AI-only type therapy.