T Nation

Which AI?

I have been using TRT (5mg AndroGel) for a while now. Still had libido. Thanks to KSman’s suggestion, went and got tested for E. Normal for total E = 115, my total E = 262.

Soon, I’ll be seeing the Endocrinologist again who has told me that he wants to prescribe Tamoxifen.

Also, what are the long term consequences of using AI (if any)? I’ve heard it can lead to osteoporosis (spelling?).

Below are some AI’s that I’ve found on the web. Do you know which are more effective? Which have bad side-effects?

  • letrozole (Femara)
  • Urtica Dioica (Stinging Nettle root extract)
  • Chrysin * Soy Isoflavones
  • Zinc
  • Pygeum extract
  • Bioflavonoids
  • Anastrazole
  • tamoxifen

[quote]Eric3141 wrote:
I have been using TRT (5mg AndroGel) for a while now. Still had libido. Thanks to KSman’s suggestion, went and got tested for E. Normal for total E = 115, my total E = 262.

Soon, I’ll be seeing the Endocrinologist again who has told me that he wants to prescribe Tamoxifen.

Also, what are the long term consequences of using AI (if any)? I’ve heard it can lead to osteoporosis (spelling?).

Below are some AI’s that I’ve found on the web. Do you know which are more effective? Which have bad side-effects?

  • letrozole (Femara)
  • Urtica Dioica (Stinging Nettle root extract)
  • Chrysin * Soy Isoflavones
  • Zinc
  • Pygeum extract
  • Bioflavonoids
  • Anastrazole
  • tamoxifen[/quote]

What are your T levels now? 5gr of gel rarely is enough and can make things worse for some. For some they simply get high E. high SHBG and shut down with lower FT than they started with… feeling like crap.

The transdermals also increase E more than injections. You might be a poster-boy for that :wink: Consider injections.

Femara is way to harsh from the point of view of being too uncontrollable. Anastrozole is predicable and self-limiting, meaning that it will not take your E levels dangerously low.

Tamoxifen will not lower your E, but will selectively reduce the sensitivity of the HPTA and breast tissue to the effects of E. It is a female cancer drug, as is anastrozole… some insurance will not cover this [without a fight].

Femara, anastrozole, clomid, tamoxifen are all available as research chems if you cannot get otherwise.

Zinc is a good supplement, but it and the herbals will not be effective by themselves! You need a drug, not minor effect. When on an AI, the herbals would be a waste of money.

Do not forget to do E2 tests in the future.

SERMs like tamoxifen will not reduce E, but often increase E. Best to reduce the aromatization problem then blind some tissues to the effects of E.

Anastrozole is your best bet. SERMs are good if you have some signs of gyno. In that case, you will want to use anastrozole forever and the SERM until the gyno issues are dealt with.

Never stop using a SERM alone (without AI) suddenly as the body would then be exposed suddenly to elevated E.

With TRT T dosing, I do not know how a SERM alone, with high E levels, would effect libido, ED or performance.

Clomid makes some men emotional crybabies. Otherwise acts like tamoxifen. Some report that they shoot bigger loads on clomid.

By the way, I meant to say in my post that I had LOW libido even with the TRT.

[quote]KSman wrote:
What are your T levels now? 5gr of gel rarely is enough and can make things worse for some. For some they simply get high E. high SHBG and shut down with lower FT than they started with… feeling like crap. [/quote]

A month ago I went to see endocrinologist when I found out I have high E. At that time I was using 5g AndroGel per day and had total T level = 750. At that time I don’t know what free T or SHBG were.

Endo doc says elevated E is coming from either a tumor or aromatization. He said likely aromatization but can’t be sure unless I went off TRT for a month. At the end of the month (which is now, by the way) if I still have elevated E then I likely have a tumor producing it. If not then aromatization is the culprit as there will be less T to convert to E.

I’ll get more bloodwork this coming week which should provide more answers. I had no libido before and have very little now. Had headaches and mood swings as hormone levels fell as I went cold turkey on TRT. Then for 2 weeks felt wonderful with respect to emotions - peaceful, content. Then I noticed my testicles had again descended slightly in my scrotum (instead of being all drawn-up close to my body due to atrophy) and the headaches and mood swings started back… I’m assuming testicles again producing some limited T which is being converted to E.

Main complaints are weight gain, lack of libido, and mood swings – all of which endo doc assures me that E can cause.

The doc wrote me a script for lab work which included checking total E, E2, total T, and free T. I requested he also check SHBG and prolactin (I figured I was having blood drawn anyway so might as well have this checked) and aromatase enzyme levels - he basically refused to add these last 3 to the lab slip which pissed me off. I’m going to ask again that he check these - especially the SHBG. If he won’t do it then I’ll ask the family practice doc to do so – I want to know all this stuff so I know what I’m dealing with.

[quote]KSman wrote:
The transdermals also increase E more than injections. You might be a poster-boy for that :wink: Consider injections.
[/quote]

I thought about that. However, I had injections for 1.5 years which elevated TT and FT to normal levels with no gain in libido. So I wonder if I had high E then. Also, if I use TD and AI then will I notice the difference? I mean if the AI kills the E production then would it matter if I use TD? Of course, if I use TD and AI and still have elevated E then I’d want to try injections + AI.

[quote]KSman wrote:
Femara is way to harsh from the point of view of being too uncontrollable. Anastrozole is predicable and self-limiting, meaning that it will not take your E levels dangerously low.
[/quote]

I’ve seen internet info. that says Anastrozole can cause joint problems including arthritis. My mom didn’t have arthritis before taking it and after taking it (she had breast cancer) now she does. This concerns me. From www.drugs.com: “More common side effects may include: …arthritis…”

[quote]KSman wrote:
Tamoxifen will not lower your E, but will selectively reduce the sensitivity of the HPTA and breast tissue to the effects of E. … SERMs like tamoxifen will not reduce E, but often increase E. Best to reduce the aromatization problem then blind some tissues to the effects of E.
[/quote]

What?! Tamoxifen doesn’t lower E? Then why in the world does endo doc want to treat high E with Tamoxifen? Just to get my body to ignore the E? Ugh, I definitely want the E reduced!

[quote]KSman wrote:
Anastrozole is your best bet. SERMs are good if you have some signs of gyno. In that case, you will want to use anastrozole forever and the SERM until the gyno issues are dealt with.
[/quote]

Thanks a bunch for the clarification. I have some slight breast tissue enlargement on right side. Want that gone so will pursue Tamoxifen for that.

Q: What is SERM?

[quote]Eric3141 wrote:
By the way, I meant to say in my post that I had LOW libido even with the TRT.

KSman wrote:
What are your T levels now? 5gr of gel rarely is enough and can make things worse for some. For some they simply get high E. high SHBG and shut down with lower FT than they started with… feeling like crap.

A month ago I went to see endocrinologist when I found out I have high E. At that time I was using 5g AndroGel per day and had total T level = 750. At that time I don’t know what free T or SHBG were.

Endo doc says elevated E is coming from either a tumor or aromatization. He said likely aromatization but can’t be sure unless I went off TRT for a month. At the end of the month (which is now, by the way) if I still have elevated E then I likely have a tumor producing it. If not then aromatization is the culprit as there will be less T to convert to E.

I’ll get more bloodwork this coming week which should provide more answers. I had no libido before and have very little now. Had headaches and mood swings as hormone levels fell as I went cold turkey on TRT. Then for 2 weeks felt wonderful with respect to emotions - peaceful, content. Then I noticed my testicles had again descended slightly in my scrotum (instead of being all drawn-up close to my body due to atrophy) and the headaches and mood swings started back… I’m assuming testicles again producing some limited T which is being converted to E.

Main complaints are weight gain, lack of libido, and mood swings – all of which endo doc assures me that E can cause.

The doc wrote me a script for lab work which included checking total E, E2, total T, and free T. I requested he also check SHBG and prolactin (I figured I was having blood drawn anyway so might as well have this checked) and aromatase enzyme levels - he basically refused to add these last 3 to the lab slip which pissed me off. I’m going to ask again that he check these - especially the SHBG. If he won’t do it then I’ll ask the family practice doc to do so – I want to know all this stuff so I know what I’m dealing with.

KSman wrote:
The transdermals also increase E more than injections. You might be a poster-boy for that :wink: Consider injections.

I thought about that. However, I had injections for 1.5 years which elevated TT and FT to normal levels with no gain in libido. So I wonder if I had high E then. Also, if I use TD and AI then will I notice the difference? I mean if the AI kills the E production then would it matter if I use TD? Of course, if I use TD and AI and still have elevated E then I’d want to try injections + AI.

KSman wrote:
Femara is way to harsh from the point of view of being too uncontrollable. Anastrozole is predicable and self-limiting, meaning that it will not take your E levels dangerously low.

I’ve seen internet info. that says Anastrozole can cause joint problems including arthritis. My mom didn’t have arthritis before taking it and after taking it (she had breast cancer) now she does. This concerns me. From www.drugs.com: “More common side effects may include: …arthritis…”

KSman wrote:
Tamoxifen will not lower your E, but will selectively reduce the sensitivity of the HPTA and breast tissue to the effects of E. … SERMs like tamoxifen will not reduce E, but often increase E. Best to reduce the aromatization problem then blind some tissues to the effects of E.

What?! Tamoxifen doesn’t lower E? Then why in the world does endo doc want to treat high E with Tamoxifen? Just to get my body to ignore the E? Ugh, I definitely want the E reduced!

KSman wrote:
Anastrozole is your best bet. SERMs are good if you have some signs of gyno. In that case, you will want to use anastrozole forever and the SERM until the gyno issues are dealt with.

Thanks a bunch for the clarification. I have some slight breast tissue enlargement on right side. Want that gone so will pursue Tamoxifen for that.

Q: What is SERM?

[/quote]

A SERM is a Selective Estrogen Receptor [Modifier?Modulator]. It docks in some receptors but does not trigger action, just interferes with E activating the receptors. The SERMs are estrogens themselves and can have extrogenic effects in some parts of the body.

Don’t forget that what you read and hear about AIs in use for women is that they are used to lower E levels as far as possible in situations where there is a estrogen responsive cancer. You are only going to be lowering your E levels to those of a young lean male [17-20]. Those males do not have joint problems. You will be using a fraction of the AIs that women use for cancer and their side effects are not something that will happen to guys who use the proper amounts.

As KSMAN says your dosage will be very low. And besides look at this FAQ:

http://www.healthtalk.com/otherconditions/askthedoctor/041105.cfm

Question:
Can the use of Arimidex cause or advance arthritis?

Dr. Gadi:
One of the most prominent side effects of Arimidex [anastrazole] and all the other drugs in this class of medicines is joint pain, also called arthralgia. Many individuals taking Arimidex also experience arthritis, or inflammation of the joints. While bothersome, it is generally considered to be a nuisance more than a danger for patients taking the drug. If the symptoms are very troubling, you’ll want to talk with your doctor about the possibility of switching to a different drug.

[quote]e-loo wrote:
As KSMAN says your dosage will be very low…

If the symptoms are very troubling, you’ll want to talk with your doctor about the possibility of switching to a different drug.
[/quote]

I think the point KSman and you have made is a good one - the literature about AI causing arthritis is all about cancer victims using AI to drive E to nearly non-existent levels. As KSman said, my target E2 levels would be those of a young adult’s.

As far as seeking other meds if arthralgia is a problem (as the article you gave mentioned)… I would think all AI’s would likely act in a similar way. But as I said, I think I’m going to risk taking the AI. I have slight gyno so will also request Tamoxifen to reduce that.

In the last 2 years I went to see 1 family practice doc, 1 internal med doc, 2 urologists, and 3 psychiatrists – told all of them the same symptoms: mood swings, low libido, difficulty concentrating. None of them even thought of high E… It was this site where I became aware of it! Urologist thought I was nuts when he ordered the test for high E! I’m just saying all of this because I have no idea how good the endocrinologist will be. At least now I’m armed with some facts and am not blindly trusting him!

Thanks for the info.

Eric