I forgot who but months ago I remember someone telling systemlord to keep his month shut about his issues he writes about in here cause defy may drop him… That they can figure out who it is…So someone is watching…
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No, what can they do to your lipids?
What do you mean by protocol. I haven’t been here much and most are using the same insider lingo (not that that’s bad, by the way). Dosing is highly individualized, based partially on size and activity level. The 50 kg celibate librarian needs far less than the 120 kg laborer with 2 active girlfriends.
If a patient has an extremely low endogenous level, the practitioner may choose to raise their dose slowly, particularly if gh is low. When that is the case (and only in this case) personality lability should be monitored.
I was in your same position 2 months ago, started with Defy, protocol similar to yours. Same questions, reading everyone’s opinions, their views ect. During consult I mentioned concern about ai. I was told he prescribes it because a big portion of patients will have problems with elevated e2 side effects when starting T and hcg. Not everyone does but more often they will. Which to me makes sense, my opinion. I was told if I was concerned don’t take it and we will look at my follow up labs and go from there. He also said he will prescribe it but I don’t have to fill it if I don’t want to. Seems like he left it up to me completely what I want to do. The argument over ai has two sides, both sides make a good points but I see no clear winning side as of yet.
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I understand what you and saying and agree. I get the doc bashing but don’t agree with some of this. Anyone prescribing a med to manage E understands why.
I don’t want to get into numbers because the purpose of lab monitoring is not to fine tune dosages.
I do know and have seen the studies indicating that 20-30 pg/ml is protective in men (E2). Above and below this level is a statistically significant increase or mortality and morbidity.
If your E is in that range, fine you don’t need it. How many guys at 300 plus mg per wk of T cyp are in this range - Not many. If your food intake is perfect, you don’t have a varicole, you aren’t wearing tight britches and your genetics are in line, then more power to you. I am ardently opposed to lowering T just to avoid managing estrogen. There is no evidence to support this. Please advise if you have something, I would really like to see and pass on.
To be clear, no reasonable, thoughtful doc, just adds meds because (getting back to this concept of a protocol). First interview and exam, including lab work. Therapy starts with appropriate meds as necessary. On the first follow up, if E is a problem, discuss and manage including aromatase inhibitor if necessary.
If estrogen isn’t managed, either high or low, there will be significant side effects (far more than the inhibitor) and in some cases can increase the probability or mortality.
Who, pray tell, disagrees with this approach?
What is Defy?
Could you tell me as a TRT novice what high E2 symptoms are or feel like? If you say water weight and sore nipples you will be wrong. You see knowing what high E2 feels like is tricky.
Many peeps have crashed their E2 thinking water and nipples were the clues and they in typical boy fashion start eating AI like they are candy. That is why AI have a bad rep around here.
There are other mens TRT/health forums where this is not the case. So in your research you need to find other forums without all the group think we have around here. By the way there are two forums the Defy docs and staff post on. So there’s your challenge find them.
Good luck
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I have a couple more quick points that I hope give you something to consider (by the way, these discussions provide all of us the opportunity to chat about something we are palatinate about and refine our opinion based on evidence - none of what I say is meant ot sound condescending, arrogant or anything else other than helpful). The more I learn here (I certainly don’t think I know it all) the more I can pass on others and apply. I get that we can become opinionated. My goal is to try and keep this based on fact and not culture or opinion.
As a side note, one of the more serious problems in science today is this ridiculous concept of scientific consensus. There is no such thing as consensus in science. It either is or is not. We don’t vote and it certainly doesn’t matter how many “scientists agree”. The second cousin to this is the fallacy of authority (or similar description) where the point of argument relies on the authority of an individual as proof rather than the evidence – for example Dr so and so said thus and such, therefore it must be true.
My comments: Unlesss something has been developed recently, the lab test kits for DHT are not very accurate. I rarely, if ever test for DHT (I’m close to 15 years in).
A far better option (if avail at your lab) is serum AG (androstanediol glucuonide), a major metabolite of DHT, indicating DHT’s activity and one of the best markers of androgenic action.
DHT only indicates the precence of the molecule not activity.
DHEA. The only thing I ever see with this is acne. I am referring to myself and others.
I believe another active forum member has posted this study here before, but this study published in 2016 talks about benefits of Estrogen in Men:
In the section labeled " Role of estradiol in hypogonadal men treated with testosterone supplementation therapy", there is an interesting excerpt that reads -
" In 2013, Finkelstein et al . looked at the effects of testosterone and estrogen on male sexual function. They found that the administration of testosterone with and without aromatase inhibitors markedly impaired sexual function when aromatization was inhibited"
And a little further down -
“Clinically, the dependence of libido in hypogonadal men on both testosterone and estrogen indicates that a cautious approach to the use of aromatase inhibitors is warranted and that the T/E ratio has an impact.”
I admit, I had to read it a couple of times since reading studies isn’t something I do often, but it’s clear that Estrogen is important for a lot of things, libido and sexual function included.
And as a side note, I only take 140mg a week of test cyp, nothing else…thought I had “High E2 Symptoms” the end of last year, had an E2 test and it came back at 25.6…which I wouldn’t consider high.
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Estradiol is an incredibly important hormone in both men and women. When I started looking into this almost 20 years ago, one of the most suprising facts I learned about Estradiol is that it is the most important hormone related in libido in both men and women.
This is one of the many reasons why estradiol must be actively managed. That means we ideally shoot for levels in the 20 to 30 pg/mL range.
John Crisler just passed as many of you know. Apparently he had heart disease. Oddly his Facebook page indicates he secretly stopped the AI on 16 Jan. Please note that I am not in any way relating the recent events to this.
I don’t think that will ever happen. This forum promotes or at least allows the discussion of the recreational use of testosterone.
They have no interest in that. Many of their patiences have migrated here, like me, because we enjoy the hobby of mens health and lets face it the other forum are dead with little to no activity. The same old farts post the same old shit.
Yes that’s what I noticed. Also why I didn’t post there. I don’t want the doctors here that watch over our care. I need to be able to discuss my issues freely.
Show me the study that says 20-30 range is backed up by studies and fact. It is not. The majority do not fit into the range.
Lowering dose from 200 to 180 is not a big change. Small changes supposably can make all the difference in the world. Going from 200 once weekly to eod could benefit as well. I did not say lower dose. Only if there are symptoms. I wouldn’t be surprised if many folks came of ai and didn’t have so many symptoms. Because they never treid.
You haven’t been researching and reading the industry news. You would of found tons of supporting information backing up the old 20-30 is false and wAs never based on real data.
Currently in the process of traveling from airport to airport. Once I get free I’ll find some of the information I’ve been reading. I’m sure other fellas here like nhwatts and physio Charlie and such can help with clarifying this.
Until then please find the study where they say 20-30 Is protective. I haven’t seen that. I found that e2 is vastly different based on dose. If I’m at 800/20free t maybe my e2 is 25. I go to 1500 and 25 free t I would naturally be higher. Should not have to lower that number to fall within 20-30 if no symptoms.
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Please cite studies for anything over 30 increasing mortality and morbidity. I agree with below 20 but have seen no such studies indicating that higher E2 is anything but protective.
Why did you mention Dr. Crisler if you aren’t relating it the cessation of AI? Dr. Crisler commited suicide.
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I’ve not seen many studies on high E2’s effects. But over the last 4 years of reading several mens TRT/health forums most guys reporting with blood tests are saying they feel best when their E2 is in the range of 20-35. Many guys have reported loss of libido and ED with high E2. That happens to me. 6 months ago Defy changed my protocol from 80 to 120 with no AI and my Feb blood test came back E2 sens at 42. I’ve asked to go back on a low dose of anastrozle for a short while to get it back in the low 30’s where I feel best.
On a second note. High E2 does not seem to effect guys with high SHBG as much as guys with low SHGB. My theory is low SHGB guys have a crap load of Free E2 and that make one moody and extra sensitive and in some cases it increases anger. High SHGB and it all bound up and you pee it out.
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It would be interesting to see their TT and FT numbers. At 120mg a week what is your TT?
And this was after 6 months at that dose hrdlvn? Where was your E2 after 6 months at 80mg?
Gentlemen (and Ladies),
To be clear, cultlure here seems to suggest that it’s best to avoid inhibiting aromatase activity. I don’t care which side prevails in this discussion, only that it obvious. I am also fine with posting studies discussing etc. My view is that the goal should be that each of us refine/alter/update or pass on this information to help others here.
My background is as a professional scientist. My eldest university aged. I have been studying this material for decades and think I have a solid understanding of the basics in an area that is interesting to me outside of what I do for a living.
When is started looking into this area of investigation I did what most people do, try and find the most useful information in periodicals, on the web, in books as well as reviewing the various professional medical societies standards of practice.
What I found was limited and in many cases incorrect. Hold onto your hats. Cortisol is one of the most important hormones in the human body and impacts much of what we do. For example, if a hypothyroid patient begins thyroid therapy and and also has a cortisol deficiency, then there will be excessive conversion of thyroid from T4 to T3. This can be uncomfortable or intolerable as it can increase heart rate and body temperature.
Ok, the studies. I have thousands that are organized by category. For example I have a number of studies that provide the cutoff serum total testosterone for various disease states that are likely to occur if levels drop below the stated level. For example, loss of vigor and loss of libido at increased risk below 432 ng/dl; 15 nmol/l. Zitzman M, Faber S, Nieschlag E. Associateion of specific symptoms and metabolic risks with serum testosterone in older men. J Clin Endocrinol Metab. 2006 Nov; 91(11):4335-43
I have 5 studies that address importance of lowering estradiol in men. I will list a couple and see how this goes.
Leder BZ, Rohrer JL, Rubin SD, Fallo J, Longcope C. Effects of aromatse inhibition in elderly men with low or borderline low serum test. J Clin Endo Metab 2004 Mar; 89(3):1174-80