For those who know him, Dr. Rand McClain is a renowned TRT doctor with many happy patients. His protocols on the use of Anastrozole always made me wonder though. If I can crash my estrogen on as little as .1mg eod, how is it that he prescribes 1mg Anastrozole EOD without all his patients running back complaining about low libido, achy joints, etc.
Well I think I’ve found the answer from the linked paper. If you take enough AI you maintain enough gonadotropin release to keep your LH normal and get a normal amount of E2 typically around 15-20.
Dr. McClain has frequently stated that his patients E2 stays around that 15-20 number.
I wonder if he’s ever bothered checking LH when patients are on his protocol.
He’s in Beverly Hill so I doubt the fee is a problem. And that can be flipped the other way. He must be really good if people are willing to pay $1200 for a consult.
AFAIK, he starts guys at 200mg week. That’s pretty typical.
how is it that he prescribes 1mg Anastrozole EOD without all his patients running back complaining about low libido, achy joints, etc.
I can tell you from very painful first-hand experience that he does have patients who crash their e2 on this protocol, do have symptoms (many of which are far worse that you listed), and have complained.
To his credit, he has become more open minded about using lower AI doses over the years. I don’t know if he’s still starting new patients on the 1mg EOD protocol. I sincerely hope not for their sake.
Another thing I’ve been thinking about in regards to Dr. McClain’s protocol. He likes a once weekly shot of about 200mg. And then he wants 1mg Anastrozole every other day.
That would seem to be a recipe for disaster. Sure the 1mg Anastrozole at the time of the shot wouldn’t be out of the ordinary. But the subsequent 1mg for the rest of the week would crush almost anyone’s e2. Now, he wouldn’t have any patients if he’s crushing everyone’s e2 so…
There has to be something to the idea that taking 1mg Anastrozole EOD keep the balls making T which is then converted to E2 and keeps patients happy in the E2 15-20 range.
Note, the article cited above, the protocol was for 1mg Anastrozole every day and e2 was in the normal range.
Thanks for the feedback. Do you know if he tests LH when on his 1mg EOD protocol? If the article I posted is true, it might just be that you need a lot Anastrozole to keep the LH in the normal range and E2 in the 15-20 range.
Maybe his patients did some basic googling and take the 200mg of test he gives them while throwing the AI in the trash. Perhaps the ones with the bad sides are the ones actually following his protocol.
Maybe a percent would. But the guy treats tons of athletes and I’m guessing most would just follow the doctor’s orders.
If anyone know Dr. McClain would love to know if he’s tested LH from those he’s sure are on his protocol as prescribed.
Geez, if it turns out all along that people have been screwed up on trying to micro-dose the AI while all along all you had to do is make sure you took enough to stimulate the balls to make LH I’m going to be annoyed.
He never tested LH. Not even as a new patient. But this was years ago. He is a smart guy, and is constantly learning and evolving his opinions, so hopefully he includes it now at least in the initial bloodwork.
Perhaps nowadays he keeps people in that range. I certainly hope so. That was not the case when I was a patient years ago. His opinion then was that you wanted e2 as low as possible. I was well below 10.
Ok thanks a bunch for the info. I believe he thinks that merely following the 1mg EOD is enough to keep E2 between 15-20pg/ml. How long were you able to stick to his protocol?
His protocol is fine for postmenopausal women with early breast cancer. In any other case, especially for TRT in men, the side effects from anastrozole, from fucked up lipids, arthritis, bone pain, weakness, sleeplessness, etc… it’s not worth it.
That assumes that the dosage is crushing E2. From the study I posted, it seems if you give enough AI, LH will stay in the normal range as will E2.
Paradoxically, that would mean that .2 a week might give you all the symptoms you mention whild 1mg EOD would give none of them. All depends on if LH is in the normal range.
I stuck with it for 6 months before I found another doctor. It took me about 6 more months to recover.
Funny thing is the new doc took the opposite extreme and took me off the AI completely. His attitude was the higher your e2 the better, with no upper limit.
I eventually educated myself and ignored their protocols completely, and now only use the docs to get the meds I need and use my own protocol to get me where I need to be.
No, since my LH has been suppressed by exogenous testosterone I never tested it. I wish I had before starting though so I could know if I was primary or secondary.
One other thing to note that may help others who go through this: With the second doc I stopped the AI completely, putting my e2 well above range, and I continued to have low e2 symptoms during that time. It wasn’t until I re-started the AI at a lower dose and got my e2 in the 20-30 range that I recovered. I recovered immediately once I got into that range.
Now I may have recovered given enough time with excessive e2 (as my second doctor believed). But it may be possible that excessive e2 is not the answer to crashing your e2, and may even delay recovery. For me, as soon as I got into the 20-30 range I recovered quickly.