So my total testosterone on 200mg test cyp and 250iu hcg a week is 760 and I take .25 mg of Arimidex 2 times a week which brought estrodial (e2) to 23).
I got evaluated by another endocrinologist that said this concerned him because estrogen is crucial for bone density and he thinks taking arimidex consistently will create long term bone problems.
If estrogen is 23 (prior to treatment it was similar) then what should I be worried about. Does arimidex itself cause bone problems or just estrogen levels?
My understanding is that bone density is a concern when women are taking high doses (1mg/day) for breast cancer treatment. The idea behind that treatment is to completely suppress estrogen as they want to eliminate breast tissue developement. There are no long term studies that I know of (i have searched extensively) that suggest long term use of Anastrozole in a TRT protocol (in order to control estrogen) is harmful.
The reason I have searched this topic to such a degree is that my Endo has the same concerns and will not prescribe Adex for this reason. There are no long term studies on the use of low dose Anastrozole to control (not eliminate) estrogen in men. Every clinical study I have come across shows the benefits of it’s use in a TRT protocol. My Endo will still not prescribe Adex for this reason.
Women with low E2 have bone loss. And they do not need anastrozole to have that.
Women who have breast cancer take anastrozole to get E2–>0, again, bone loss.
Men with low-T get bone loss.
Anastrozole in a TRT context is for E2 modulation and the results are in normal range. There is no bone loss as anastrozole itself has no direct effects on bone density. Your doc doe not know how to think about things in a functional medicine perspective. We are talking about 1/7th of the dose used for estrogen positive cancers!
Note that female bone loss is also from the effects of loss of their T levels. In a catabolic state, the collagen matrix degrades and that is the foundation for mineralization.
You are seeking the E2 levels of a young normal virile lean male - healthy!
It seemed pretty basic to me that if I kept my estrogen at the same level as prior to treatment that bone density should be the same.
It is truly amazing how many high ranking doctors/endocrinologists have no critical thinking at all in regards to such an important subject.
My latest endocrinologist suggested that she would put me on 100mg a week and doesn’t check estrogen or provide estrogen blockers because it is not a “common practice to her”. When I explained that 100mg only brought my testosterone up to 400, she said any higher is unsafe. I proceeded to challenge her and say if naturally men are 700ng/dl and I use testosterone to get to that level is there a difference in how the testosterone reacts to the body (in negative context).
I have been to over 10 endocrinologists that shrugged off my issues because of age and many recommended that I quit working out so hard to control cortisol. THANK GOD I found the clinic I am at today that is knowledgable, works with me week to week and adjusts doses based on how I feel.
I am currently using 180mg test cyp once a week cycling 6 weeks on 6 weeks off of a low dose of HCG administered 2 times a week (250 iu)
I appreciate all of your input, it verifies what I thought
You don’t “cycle off” TRT. You’ll do better with multiple dose in a week (2 minimum - divide your dose in 1/2 and take it twice). Most of us here end up with RC adex, very difficult to get prescribed as you have seen.
[quote]catfish74 wrote:
You don’t “cycle off” TRT. You’ll do better with multiple dose in a week (2 minimum - divide your dose in 1/2 and take it twice). Most of us here end up with RC adex, very difficult to get prescribed as you have seen.[/quote]
I’m sorry I didn’t write that correctly. I cycle off of HCG but always stay on testosterone and adex
The problem with blood E2 levels is that they give an average of E2 produced in all tissues.
Blood E2 may look fine because the AI suppresses aromatase appropriately in an excessive amount of fat tissue (if you are overweight, for example), but that leaves open the possibility that aromatase is being suppressed too much in bone at the same time, so your bones may theoretically be starved of E2 even through you can’t see that with a blood test.
We can’t really compare a male dose of an AI with the female dose and call it safe because it is much less, because men make less estrogen than women in the first place. Also, who says women wouldn’t lose bone even on smaller doses?
Much of what is written on the safety of the use of AIs in TRT is based on speculation, not studies. Nobody can really say for sure.
The concerns aren’t limited to bone. The cardiovascular system can also be adversely affected if we accidentally reduce E too much in the relevant tissues. AGain, a serum estradiol test wouldn’t tell us if that is happening.
The issue with female bone loss with Arimidex has nothing to do with Arimidex. The issue is very low E2 levels. In a male TRT context, Arimidex/anastrozole is used to modulate E2 within normal ranges. Bone health also involved testosterone as the collagen matrix in bone is a protein structure and a catabolic state with low-T leads to male bone loss. For females, loosing T and estrogens is a double disaster.
When women become [totally] menopausal, there estrogens and T levels both crash, bone loss can be rapid. Collagen loss accelerates and skin tone and structure rapidly decline. Full dose Arimidex basically does the same thing. Menopausal women can take SERM’s. If the HPOA is working, SERM’s increase ovarian hormones which is not where cancer treatment needs to go.
When women have a hip fracture, they seem to be able to heal and become functional again. When men have hip fractures, their one year mortality rates are grim. Bone loss is much more dangerous to men than women.
The suggested E2=22pg/ml target is what you could find in lean young men who are growing and building solid dense bones. [I think that my bones used to be very dense as I could not float in sea water - sank like a stone.]
The alternative is higher E2 levels leading to:
endothelial dysfunction
decreased insulin sensitivity and diabetes
loss of libido
loss of energy
mood and depression issues
problems with sexual performance
fat gain or reduced ability to loose fat
prostate enlargement that seems to be a path to cancer
The biggest problem with Arimidex/anastrozole in a TRT context is the few doctors who Rx 1mg/day!
Yes, very low E2 levels also are dangerous to men and women and lipid profiles can become adverse. We have seen this in bodybuilders who do stupid things to get to extremely low body fat levels. But that is completely not an issue with the suggested E2 targets. We should not be focusing on the results of stupidity or cancer context of E2–>zero.