Anastrozole 2mg EOD and Normal AST and ALT

Pharma / TRT Testosterone Replacement
1

Summary:
48 years old, 6â??1â?? 197 lbs low body fat, good shape, been on TRT for a little over a year.

Testosterone dose has remained steady at 100 mg/week for the first 9 months, 250 ius HCG and arimidex .25 mg EOD.

Estradiol went from 26.9 pg/mL to 24.7 to 27.1 to 28.5 to 36.7 even as I steadily increased my arimidex dose up to 1.25 mg EOD.

My TT and Free T dropped to 567 ng/dL total and 178 pg/mL free and my estradiol went to 36.7 pg/mL back in May of 2010 which I attributed to subQ testosterone injections and to much Soy milk. I went back to shallow IM injections with a 5/8 inch needle and increased my dose to 40mg of testosterone cypinate EOD and increased my arimidex dose to 1.0 mg EOD.

In July my blood test showed total testosterone of 1086 ng/dL, free testosterone of 399 pg/mL but Estradiol of 38.9

I kept my testosterone dose at 40mg EOD but increased my arimidex to 2 mg EOD for two weeks to see if my level would go low and then let it go back up. I thought it did so I stopped taking it for a week and eventually settled on 1.8 mg EOD. I have felt good and had good to ok morning wood with good libido but have been using fenrugeek and yohimbie root (donâ??t know if they do any good but the yohimbie will keep you awake)

So at the recommendation of KSman I asked for liver function test (AST and ALT) with my latest blood test.

My last test was 785ng/dL total testosterone, 281.3 pg/mL free testosterone and 23.7 ph/mL Estradiol. AST was 26 iu/L and ALT was 28 iu/L. The range for AST is (10-42) and the range for ALT is (10-60).

So the big question is obviously what is causing such high levels of E2. Maybe it does not matter but if it was not for being about to purchase anastrozole as a research compound Iâ??d be going broke. I also just started using the research compound so the test results over the last year were from using arimidex.

I have also been keeping my alcohol consumption below 5 oz a week so I donâ??t think that could be it.

On another note, Iâ??ll be seeing a Endo this January at Johns Hopkins so if anyone has any recommendation for what to ask, Iâ??m all ears.

2

Try hCG 100iu EOD or quit for a while and see how E2 responds. Competitive AI’s are not able to control testicular T–>E2

This is very unusual.

3

I didn’t know that AIs can’t prevent aromatisation in the testes. I remember reading something about a blood testicle barrier (like the blood brain barrier) which is part of the reason why atrophy can occur if there isn’t testosterone production in the testes (the locally produced test stays in the testes and causes spermatogenisis).

I think exemestane could lower estrogen to a lower percentage. It permanently deactivates the enzyme so it’s more effective and has a longer half life than regular AIs. I don’t know if it’s indicated for HRT, but if a doctor won’t prescribe it, liquid products are an option. Letrozole is another option. 2.5mg will lower estrogen down by 98%. The hcg idea makes sense, but I think that most of the estrogen is coming from aromatization of the 140mg per week.

Arimidex has a maximum dosage. After a certain point it can’t lower estrogen further and a stronger AI is necessary. I read adex has a maximum effect of lower estrogen by 40%, exemestane 80%, and letrozole 98%

4

This is interesting. I don’t see the harm in lowering the the HCG to 100ius EOD. Don’t really want to see my ball disappear. I have to say, they still appaear a bit smaller and more contracted than before TRT but something is better than nothing.

I was reading on the Allthings Male forum that DHEA being to high can contribute to higher E2. The discussion was regarding pregenolone and progesterone and controling cortisol with either. The end result was an increase in Testosterone. I now wondering if my 50mg a day of DHEA is contributing to the elevated E2.

The next question is what else to test for on my next labs and what are the down side of the stronger AI like exemestane or letrozole. I don’t think dropping E2 really low is a good idea. Or what is the down side of 1mg of anastrozole every day besides the cost. Actually not that bad as a research compound. I really hated paying the price for arimidex. That was just robbery.

5

My guess is that .5mg of letrozole per day will lower you estrogen to where it needs to be. You could take a lower dose if that lowers your estrogen too much.

6

Thanks for the advice I’ll look into it. Any down sides to letrozole. Right now I’m up to 1mg per day and I’ll see where I’m at after my next blood test. If the cost is much less then I’d probably consider it. The only down side is then I’m back to playing the game of dosing then testing then changing dose. It’s taken me a year to get my E2 down. I’ll do some price checking and more reading. I guess if 1mg a day does not do it for me on the arimidex I’ll have to try something else or lowere my testosterone dose.

7

The dose/cost/performance of exemestane often makes it a poor choice VS anastrozole. All the hype about “permanently deactivates the enzyme” seems to be nothing more than hype.

T levels inside the testes, intratesticular testosterone [ITT] can be up to 80 times higher than serum levels in normal young males. With hCG, that ratio could be higher. The serum levels of a drug are not high enough to get the job done inside the testes. When you see data, most of that will be for women, and often in a post menopausal context. So you really need to be skeptical. There is no good data for men using gear or TRT.

When you see reports for lab results for body builders, if they are not using hCG or a SERM at the time, their testes are shut down and the issue of testicular T–>E2 is not a factor and then the issue of AI drugs not able to control testicular E2 production is not a active limitation in achieving very low E2 levels.

When you see data that came from research studies, the dose of the AI drug may have been intervenous. That bypasses issues of whether a drug absorbs well or not. The results may not be achievable with oral drugs. Those studies are never intended to be clinical in terms of response or dose. You will often find such data been misrepresented, sometimes with a deliberate intent to deceive or sell, or out of ignorance. You need to develop your own abilities to see past that crap.

For TRT, we are modulating E2 levels, not eliminating. The goals are very much different from treating breast cancer or extreme body building.

Bob: You should not be changing your AI drug and hCG at the same time, that will not provide the data that you need.

8

Thanks KSman:

I’ll keep things where they are at until after my next blood tests and then try dropping the HCG to 100ius without changing anything else. I want to see if I can finally get results that are similar for two consecutive events.

Your lack of comment on the DHEA suggests you donâ??t think it could be contributing to my elevated E2

9

Some do seem to have abnormal E2 levels when taking DHEA. Again, changing two things at once does not make sense. We really need to know your DHEA-S levels and lab range. Yes, 50mg might be too much for you. Some absorb DHEA via the gut quite well, some very poorly. So cookie cutter DHEA doses may not be good for some.

10

[quote]KSman wrote:
The dose/cost/performance of exemestane often makes it a poor choice VS anastrozole. All the hype about “permanently deactivates the enzyme” seems to be nothing more than hype.

T levels inside the testes, intratesticular testosterone [ITT] can be up to 80 times higher than serum levels in normal young males. With hCG, that ratio could be higher. The serum levels of a drug are not high enough to get the job done inside the testes. When you see data, most of that will be for women, and often in a post menopausal context. So you really need to be skeptical. There is no good data for men using gear or TRT.

When you see reports for lab results for body builders, if they are not using hCG or a SERM at the time, their testes are shut down and the issue of testicular T–>E2 is not a factor and then the issue of AI drugs not able to control testicular E2 production is not a active limitation in achieving very low E2 levels.

When you see data that came from research studies, the dose of the AI drug may have been intervenous. That bypasses issues of whether a drug absorbs well or not. The results may not be achievable with oral drugs. Those studies are never intended to be clinical in terms of response or dose. You will often find such data been misrepresented, sometimes with a deliberate intent to deceive or sell, or out of ignorance. You need to develop your own abilities to see past that crap.

For TRT, we are modulating E2 levels, not eliminating. The goals are very much different from treating breast cancer or extreme body building.

Bob: You should not be changing your AI drug and hCG at the same time, that will not provide the data that you need.[/quote]

Very interesting. This has been on my mind for a bit now as a similar-ish scenario was brought to my attention about 2 months ago with an acquaintance of mine who’s been on cycle for the 2 years or so (moderate/low by bodybuilder standards at 500 mg/week but still a superphysio dose). He’s had the same issues with having to steadily increase the arimidex dose to achieve “good” horny feelings.

Granted he hasn’t done the blood work, but when I asked him about his adex doses he said he understood the need but he was poor. He’d started at about 0.5mg ED feeling fine, good mood, good morning wood, very stable and very…ah…lusty :). Over time he got to the point where .5 mg/Day wasn’t enough to keep morning wood and eventually he got itchy nipples, and modulated the dose higher. He is now to the point that he is at ~ 1.4mg/Day arimidex for morning wood and good libido to occur on same dose of Test.

For what it’s worth, I know he uses the liquid variety, mixed himself from base powder at 1 mg/mL in plain but drinking safe ethanol.

I know it’s not your forte KSman, but when I stumbled across this thread I had to ask if you had any clue as to what I could tell him to do. I’m not a big advisor or anything, I just have been puzzling over it because I like puzzles :). That and he’s a nice dude I’d like to steer in a good direction if I stumble across anything.

I was wondering if it might be just the shelf life of the arimidex mixed with strong alcohol, possibly breaking down (I have no knowledge of decay rates of adex in alcohol, I just know it is freely soluble).

Aside from that possible issue–pretend it’s perfectly good adex–do you have any further idea of what might be going on?

Sorry for the hijack OP! —didn’t mean to do that, stumbled across this thread by accident…but I figured it was pretty well related to your stated problem and I didn’t want to start a new thread for the same problem :).

11

How often does he inject? If once a week, that exaggerates E2 levels and changing T levels make anastrozole dosing impossible to be right. As he should, as a rule, be needing 5mg/week, his dose of 9.8 does sound high. He might have an exaggerated aromatization rate or compromised liver function.

So he probably will not pay for lab work. His TT&FT will be over reporting range and that will be a waste of money. He could get E2 tested:

12

Said he likes Test Cyp 250 mg twice a week. Based on the half life of Cyp, that should be frequent enough, don’t you think?

Why do you mentioned compromised liver function? Are you thinking directly due to the high dose of arimidex causing extensive processing by the liver, or are you thinking of somehow liver function impairment causing a need for a higher dose of adex (never heard of that)?

Also, when you say “exaggerated aromatization rate” do you mean a natural variability, or are you thinking a sort of gradual acclimation to the adex drug dose used over long periods of time? Could you unpack that briefly? (sorry, can’t think of the right words right now, missing my coffee hah!)

If i can convince him to test his E2 levels and they come back high, do you recommend switching to letro or some other inhibitor? Clearly he can’t go on increasing the dose and he probably will laugh at a suggestion to “come off”.

I forgot, he says he’s pretty sensitive to estrogen related sides. This isn’t his first cycle and he told me he noticed right away on his first go-round that he needed an anti-aromatase because he was on only about 300mg a week with itchy nips and other easily felt sides (I told him he should have had adex on hand THEN, because blood levels were going to be higher than normal regardless of how he felt, but it does seem pretty out of the ordinary for bodybuilders to physically feel that messed up on that low a dose.).

13

The liver clears estrogens from the blood, a liver condition or other chemicals that load and compete for the same enzyme pathways can lead to higher E2 levels. This can be weed, alcohol, Rx/OTC drugs etc.

If T twice a week, dose anastrozole twice a week at the same time.

Some will aromatize more than others, some exaggerated. Perhaps he has an exaggerated response to what E2 he has. All guess work until he gets labwork.

14

As mentioned before I bet you his phase II is moving faster then phase I liver detoxification.
As soon as the drug enters the body it is being transported right out. So manipulation of enyzmatic pathways would be the way to handle this issue. Idenitifying where the imbalance is then going from there would resolve this issue most likely.

15

I left all thing unchanged from Novembers test results to January testing.
My last test was 785ng/dL total testosterone, 281.3 pg/mL free testosterone and 23.7 ph/mL Estradiol. AST was 26 iu/L and ALT was 28 iu/L. The range for AST is (10-42) and the range for ALT is (10-60).
This was after taking 2mg of anastrozole EOD and 40mg of test cyp EOD and 250ius HCG.
I left everything the same until my January testing to see if things remained steady but they did not.
Estradiol = 32.4 pg/mL
TT = 538 ng/mL
FT = 158.2 ng/mL
The TT and FT might have been lower because I think I might have waited past my EOD injection schedule by a day. I donâ??t know if that is enough time for levels to drop off so maybe something is going on there also.
So clearly 2mg of anastrozole was no longer keeping up with the aromization. This has been the case since I started 1.5 years ago. I have had to continuously increase the anastrozole dose to try and control my E2.
I increased my anastrozole dose to 2.25 mg EOD and lowered my HCG to 100 ius EOD. I had a blood sample pulled yesterday for E2 only and then changed over to Exemestane. Iâ??m pretty sure my E2 levels was going to be high again but I could be wrong. In either case it does appear that the anastrozole may not be the ideal product and the cost of Exemestane may not be higher depending on what dose I need.
So this is the question, I have bumped my HCG back up to 250 ius EOD, Test Cyp is still 40mg EOD and Iâ??m now trying 12.5mg of Exemestane ED. Iâ??ll post my E2 results from yesterdays testing as soon as I get them.
I understand the difference between the compounds and realize if I go low Iâ??ll be low for a couple of weeks before I recover but I guess that is a chance I just have to take. Iâ??m hoping that I will not have to deal with a steady increase in the Exemestane as I did with the anastrozole. My thought is that since Exemastane actually removes the aromatase enzyme it should control it much better than the anastrozole which was just trying to bind with the enzyme that might be steadily increasing.
Is there any way to test for how much of the aromatase enzyme is present.
As a side note and maybe I should make a new post. My trip to Johns Hopkins hospital to see Dr. Adrian Dobbs did not work out well. I was really surprise that she was not on board at all with what we consider standard practice even with respect to testing. My wife asked me to go so I did an after seeing that she was well published on the subject I had high hopes. Turned out to be a waist of $500

16

Even at the “best” facilities, male TRT is still widely unknown. From what I have seen, lots of “old school” thoughts still around the issue. Find a doc that will work with you, regardless of specialization.

17

My GP is wonderful. She is very cooperative regarding what I am doing. She has writen prescirptions for all three and I don’t doubt that she would wright a scrip the exemestane if I asked. Unfortunately she is not able to suggest any help for the E2 issue. I’m considering going to Mich. to see John Crisler. For now I’m still working from my own research and knowlageble members like KSman. Thanks to all that have provided input. I try to do the same when I can.

18

Just an update, i got my lab results back yesterday and was at 33 ng/mL. That was all I had run. So I stopped the 2.25mg of anastrozole and when to 12.5 mg ED of aromasin. Any thoughts on that dose.

19

I think you have a major malabsorption issue or your liver is just chewing up the adex because you have a hyper detoxification pathways for the drug. These are the issues I would be checking deeper into.

20

One more thing to consider is that the liquid Adex is underdosed or outright fake. I’ve seen vastly different responses to the “research chem” product and the real thing. i know that the OP was originally on the prescription tablet but I did want to bring up this issue since it hasn’t been discussed. I can almost assure you that the research chem products would not test well for potency at an independent lab.