Unbalanced Arimidex/Anastrozole dosing?

Pharma TRT
1

Hi all, I’m a 47Y.O who has been on trt for about 2 months. My T level was 300 when I started and my estradiol was 39. After one month on a topical gel (12mg x 2td)My levels moved to just over 400 and my extradiol levels jumped to 54. ( Very top of the Quest range) My doc switched me over to 150mg test/c weekly injections and .5mg Anastrozole 2x per week. I have been doing the injections for 1 month. I take .5mg of anastrozole the morning of the injection and .5mg 3 days later.

What I have noticed is that my Libido seems to hit a major peak sometime after the midweek anastrozole. My theory is that weekly injections cause a somewhat linear decline in T levels and that most of the estrogen conversion takes place shortly after the injection when levels are at their highest. I am guessing that the second dose of A is effective because there is a lot less E to deal with. My question is: would it be beneficial to increase the portion of the weekly anastrozole dose on the day of the injection and a smaller portion of the 1mg nidweek? Say .6mg on injection day and .4mg 3 days later?

I would switch to 2x per week injections but my doctor filled my prescription with the pins already filled.

2

In some USA States, you can get insulin syringes without a script. Suggest 0.5ml [50iu] #29 1/2". You can get 100 for $12.60 at Walmart or Sam’s Club [their relion house brand]. Read the protocol for injections sticky.

3

Thanks Ksman. I read the sticky and the Canadian SubQ study. I think in FL I can buy up to 20 syringes without a script. I was hesitant about switching the injection schedule because I was a little worried about the sterility of transfering the T from one syring to the other. Should I just pull the plunger from the insulin syringe and shoot the proper amount in the tube? I have cypionate; should I shoot IM in the thigh with the 1/2" needle or stay in the glute which would be subq on me? I appreciate your advise!

4

Load the insulin syringe directly from the vial. Takes time. I hang my vial upside down with the syringe inserted and the plunger pulled back and do something else for a few minutes as the syringe fills. The benzyl alcohol in the oil boils out and later condenses back into the oil as the syringe fills.

Injection times are reasonable as the small plunger can develop up to 200PSI. It is important to use 0.5ml syringes, not 1.0, to develop the higher injection pressures and faster injection times.

If you mean the inner leg when you say thigh, that is absolutely dangerous; too many large vessels and nerves there. Inject into the google[vastus lateralis wiki]. No need at all to inject into your glutes.

5

My Doc filled my script with 12 pre-loaded syringes, each containing 150mg Testosterone cypionate. I didn’t get a vial. Will it be safe if I fill the insulin pins from the back by just pulling the plunger out and squirting the Cypionate into the new syringe?

6

If your technique does not cause contamination. Where will you put the plunger, when backfilling, that will not contaminate it? Suggest that you remove the plunger and discard, backfill then remove plunger from another syringe and put that into the first.

With the prefilled syringes, you can swab, inject part of the load, swab the needle and recap for the next injection.

What size are the needles?

Tell the doc that you want to inject with insulin needles from your own vial. He will not believe that one can inject with insulin needles. So you will have to tell him that you have been doing that. And you can have a loaded insulin needle with you and pull that out and say “watch this” and inject yourself.

Doc is filling needles and charging how much for 10ml 200mg/ml equivalent?

7

Good idea on discarding the plungers. They are cheap enough enough until I get a script for a vial.

I haven’t been at this long enough to know if I could safey reuse the pins I have now. They are 28g 1", so not too much bigger than the insulin pin but the surface of the plunger is much bigger. I believe he told me they fill them with a larger needle and then attach the 28g. He charged me $160 for the 3 month supply @150mg per week. The Anastrazole cost me $100 for 20x.5mg. They are capsules however so I’m not sure I could accurately break up the doses. I’m not sure if all of the little micro beads inside the capsule are all anastrozole or if there is some filler.

I have an appointment on Wednesday to review the latest labs, I will try to get some syringes and demonstrate that it works.
He has not put me on Hcg yet, so I am also going to try to get a script for that. Depending on my labs, I would think that adding Hcg and dropping 50mg per week would be a good starting point.

Thanks again for all of your information. I have read hundreds of threads in this forum and feel pretty confident about your protocol.

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I met with my Doc today to go over my labs taken last week. He was very supportive of switching to twice a week injections vs 1x week. He also prescribed Hcg at 250iu per week. He did not lower my T dosage to 100mg from 150mg per week. On a side note, my blood pressure was way up today. 160/110. It had been just about perfect before starting on anastrozole. Any correlation?

Will adding Hcg to the program raise my hormone levels even further?

My labs were taken 4 days after my last injection of 150mg. I took my second weekly dose of anastrozole 1 day prior to the labs. Labs were taken on a 12 hour fast. I am assuming that since it was 4 days after injection and a day after the second half of the weekly anastrozole dose, that my estradiol level of 36 is probably indicitive of the lower range for my weekly fluctuation. This would explain why the libido picks up after the second dose of anastrozole.

Any guesses as to what will happen to the estradiol by switching to twice weekly injections and twice weekly .5mg anastrozole? Should I take the anastrozole at the same time as the injections?

Quest Diagnostic Labs-
total testosterone was 902 range= 250-1100 (A huge increase over the topical)
Free Testosterone - 261.5 range= 35-155 ( will it hurt to be this far over the range)
Free Testosterone %- 2.88 range= 1.5%-2.2%
Estradiaol - 36 range= 13-54
Total cholesterol = 204
HDL = 33
Triglicerides= 235
LDL= 124
Hematocrit- 49.3 range= 38.5-50.0
Hemoglobin- 16.6 range= 13.2-17.1
AST= 39 range= 10-40
ALT= 78 range= 9-60 *this has been high for several years. Had MRI and found cyst on liver.

The labs he ordered did not have many of the items listed on the sticky like thyroid, FSH/LH, etc. There is a lot of stuff on the report that I do not see on other labs like Sodium, Albumin, chloride,carbon dioxide, calcium, protein, globulin, bilirubin, alkaline Phosphate, white cell count, red cell count, MCV,MCH,MCHC,RDW,platelet count, absolute neutrophils,absolute lymphocytes,absolute monocytes,absolute eosinophils,absolute basophils, neutrophils,lymphocytes,monocytes,eosinophils,basophils.

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There is no reason to check LH/FSH when on TRT as they will be zero with HPTA shutdown.

Take anastrozole at same time as your injections, this will work well and makes for a good routine. You would be better off taking anastrozole EOD, but that does not fit what your are doing. You do need better E2 management. Using E2=36, your dose should be 1.5mg/week, better if you take 0.5mg 3 times per week. You might feel a lot better. By rule of thumb, with 150mg/wk, your dose would be 1.5, which is a good sanity check.

One reason to inject EOD is to facilitate anastrozole EOD. But tablets limit ones options.

You need to increase HDL. Fish oil, high B-vit potency multi-vit, niacin if you can tolerate it.

You need to be testing PSA and get a DRE.

Yes hCG can increase T levels somewhat. Depends on health of your testes. My TT increased 17%.

Your Hematocrit is at the upper limit. Your high T dose is doing this. hCG will probably take you higher. You can reduce your dose on your own, you are in control of the injections. You will need to reduce your anastrozole dose by the same % reduction in your T dose. That ignores the influence of hCG, but that is what the E2 labs are for.

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[quote]KSman wrote:
There is no reason to check LH/FSH when on TRT as they will be zero with HPTA shutdown.

Take anastrozole at same time as your injections, this will work well and makes for a good routine. You would be better off taking anastrozole EOD, but that does not fit what your are doing. You do need better E2 management. Using E2=36, your dose should be 1.5mg/week, better if you take 0.5mg 3 times per week. You might feel a lot better. By rule of thumb, with 150mg/wk, your dose would be 1.5, which is a good sanity check.

One reason to inject EOD is to facilitate anastrozole EOD. But tablets limit ones options.

You need to increase HDL. Fish oil, high B-vit potency multi-vit, niacin if you can tolerate it.

You need to be testing PSA and get a DRE.

Yes hCG can increase T levels somewhat. Depends on health of your testes. My TT increased 17%.

Your Hematocrit is at the upper limit. Your high T dose is doing this. hCG will probably take you higher. You can reduce your dose on your own, you are in control of the injections. You will need to reduce your anastrozole dose by the same % reduction in your T dose. That ignores the influence of hCG, but that is what the E2 labs are for.[/quote]

Thanks for the quick response KSman.
My PSAs have been .4,.4,.6 on my last three labs. I have not had prostate issues at all prior to the therapy and everything appears to be working correctly since. I have not had a DRE in a couple of years.

I take 900mg of Fish oil and a high potency vitamin daily. I will get some niacin today. Should I up the quantity of fish oil?

Can the high hematocrit levels cause high blood pressure? They want me to chart my BP and bring in a log on friday. I want to avoid any HPB medication if at all possible.

I feel like the right thing to do is to drop the Testosterone to 100mg per week, Keep the Azole at .5mg each injection day when I start the Hcg.

Would it be worthwhile for me to try one week of 150mg T + 1.5mg Azole or would that not be enough time to notice a difference in the e2 levels?

Thanks again for your help.

11

Yes, hematocrit can increase BP, reduce blood flow, headaches and other issues. More of a problem combined with hardening of the arteries.

Your T levels have increased, keep an eye on PSA. Elevated E2 is prostate hostile as well.

Check vitamins for B-vit potency.

You could take more fish oil, balances off non-EFA fat intake.

Anastrozole absorbs and takes action almost instantly, but the body takes its time to then reach a new balance. You might notice in one week. If you go to 100mg and land on E2 near 22pg/ml, that might not feel like a drop.

You can try 150 + 1.5, but if that feels really great, it might feel like a let down to then do 100 + 1.0.

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jrm850,

sounds like KSman has you on track with TRT, great advice there. i, however, would like to offer my two cents as a wellness consultant and naturopathic doctor candidate. your triglycerides being 235 is a MASSIVE concern. total cholesterol is not correlated with CVD but triglycerides/HDL is. right now you are 235/33 = 7. those in the top 25% have a 16-fold risk of CVD! you are in the high risk group.

the TRT will help you in that your insulin levels should be more moderate but, probably because of diet/lack of exercise, you are in the SUPER high risk range, above 2 is not good but above 4 is serious. this is a ratio conventional medicince is ignoring right now.

often the main reasons for high tryglerides is too much total dietary carbohydrate especially high fructose and lack of exercise. in my practice, i have seen tri’s plumet (and all lipids, with HDL increasing) when clients get their carbs down to around 75-100g a day, mostly from vegetables with some fruit and maybe oatmeal at breakfast, in concert with 2-3 days weight training and 2-3 additional days cardio.

you have got to cut back on the grains, if not cut them out 95% of the time. this protocol is not to “treat” high tri’s, rather this is the body’s biological requirement (low or no grains and daily rigorous exercise are two ways we express our ideal health). the product is normalized tri’s (and all other markers).

KSman is right on as far as increasing omega 3’s; 3000-5000mg daily is ideal, it will balance the inflammatory omega 6’s, but you have got to address the tri’s and get more regular exercise (if you do not already).

make sure you get the triglyceride form (no relation to serum or blood triglycerides) as most fish oils are the ethyl ester which is not metabolized efficiently, lower absobancy and the liver must cleave the ester off and convert it to a triglyceride for cells to be able to use which causes chronic low level hepatic stress (as does daily toxins from food and drugs if any, esp NSAIDs).

yes, studies show the ethyl ester is “proven” but i would err on the side of millions of years of triglyceride intake from whole foods.

TopSirloin

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[quote]TopSirloin wrote:
jrm850,

sounds like KSman has you on track with TRT, great advice there. i, however, would like to offer my two cents as a wellness consultant and naturopathic doctor candidate. your triglycerides being 235 is a MASSIVE concern. total cholesterol is not correlated with CVD but triglycerides/HDL is. right now you are 235/33 = 7. those in the top 25% have a 16-fold risk of CVD! you are in the high risk group.

the TRT will help you in that your insulin levels should be more moderate but, probably because of diet/lack of exercise, you are in the SUPER high risk range, above 2 is not good but above 4 is serious. this is a ratio conventional medicince is ignoring right now.

often the main reasons for high tryglerides is too much total dietary carbohydrate especially high fructose and lack of exercise. in my practice, i have seen tri’s plumet (and all lipids, with HDL increasing) when clients get their carbs down to around 75-100g a day, mostly from vegetables with some fruit and maybe oatmeal at breakfast, in concert with 2-3 days weight training and 2-3 additional days cardio.

you have got to cut back on the grains, if not cut them out 95% of the time. this protocol is not to “treat” high tri’s, rather this is the body’s biological requirement (low or no grains and daily rigorous exercise are two ways we express our ideal health). the product is normalized tri’s (and all other markers).

KSman is right on as far as increasing omega 3’s; 3000-5000mg daily is ideal, it will balance the inflammatory omega 6’s, but you have got to address the tri’s and get more regular exercise (if you do not already).

make sure you get the triglyceride form (no relation to serum or blood triglycerides) as most fish oils are the ethyl ester which is not metabolized efficiently, lower absobancy and the liver must cleave the ester off and convert it to a triglyceride for cells to be able to use which causes chronic low level hepatic stress (as does daily toxins from food and drugs if any, esp NSAIDs).

yes, studies show the ethyl ester is “proven” but i would err on the side of millions of years of triglyceride intake from whole foods.

TopSirloin[/quote]

Wow, I had no idea I was in any kind of danger zone. Thank you!

A little background on me might be helpful… I’m 47 6’/237lbs. I’ve been pretty much sedentary for the last 10 years. Before that, I was athletic, lifted and played organized sports several times a week. My body changed from a muscular 190 to lean as a baby whale 240. I started feeling horrible during the day, especially crashing after lunch and decided that I needed to do something about it. I suspected I was either pre diabetic and having insulin issues, or I was having some liver problems. (I have had a couple of MRIs on the liver because I was feeling some minor pain. They said it was a cyst and the only real worry was that if it grew it could create some hypertension in the liver) So 3.5 months ago, I got a treadmill and started running and weight training. Unlike before, the weight was just hard to lose. I didn’t lose a pound during the first 5 weeks. Because of the way I was storing the fat and how hard it was to lose I started thinking about my estrogen levels. I went to a men’s health center and after my first set of labs, they recommended Trt. My triglicerides were 322 when I started. They have not tested my thyroid. I started agressively lifting only and dropped the cardio 2 months ago. My goal was to put on as much calorie burning muscle mass as possible before I attempted to diet again. I was told by lots of body builders on other forums that the cardio would impede the muscle growth and slow recovery between workouts.

I thought I was doing pretty well on my program, but It looks like all of that has changed as of today. My blood pressure spiked when I switched to injections from topical and today my trt clinic told me that I should probably start taking HBP meds at least until I lose the weight. Now reading your excellent advise on the same day, it points to me changing my plan to agressively targeting the diet and weight issues. On a side note, I have dropped my body fat percentage 7% over the last 3.5 months but my weight has remained reltively unchanged. If the Bio Impedance fat checker can be believed I have added 13-14 lbs of lean body mass.

What I am planning starting tonight is to lower the intensity of the weight training a bit so that I can do that 3 days a week. I will run on the treadmill on the off days and give myself the weekend for muscles to recover. Im not sure exactly what my diet should look like but what I am thinking is this… as you suggested, lean meats and lots of veggies. I will only eat carbs on weight days and not after 3pm. I am thinking that 2000 calories would be a good starting point. My suppliments will be Fish Oil, GNC Mens sport vitamin, arginine, niacin, saw palmetto, and whey protien pre and post workout on weight days only.

I took KSman’s advice on the trt and switched to 2x week injections. My first half dose was yesterday and my BP is already a bit lower today than when I did the last 1x week injection. I feel like I should keep an eye on the BP over the next week to see if this helps the BP issue. Something else to think about with the BP issue is that I just started Anastrozole 2 weeks ago which may correspond to the spike in BP. My BP was perfect when I was on the topical and no Anastrozole. Substantially higher test levels, reduced E2 levels, upper end hematocrit%… Which is to blame?

You guys have no idea how much I appreciate your help!

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I can’t find out if the fish oil I am taking is the ethyl esther or trigliceride type. The label doesn’t give me much information and google doesn’t turn up anything other than people that sound like commercials selling the product. Its from GNC -Triple Strength Fish Oil. The label says 647mg EPA and 253mg DHA. Can anyone recommend a good brand?

I wanted double strength but then I saw triple strength and thought to myslef that it must be better. :wink:

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jrm850,

i am an exercise physiologist and own/run a personal training gym (100 clients per week). here is the info you need regarding your health. YOU DO NOT NEED CARBS to build muscle! this is a complete myth… current tribes and our ancestors did not have tons of carbs yet they would put us all to shame in all catagories. if you are not a professional bodybuilder get your health in check first, forgot the bulk/cut BS you have been fed. i have seen clients reduce carbs by 80% and gain 10lbs of LBM in 6 months, while dropping body fat 10%. they are not gifted, they just got good solid advice. if you were already lean, by all means get after the lean mass and at that point, yes you might need some carbs to quickly replete glycogen, but carbs are KILLING you. lean folks that workout hard have very good insulin sensitivity so they can afford a FEW carbs… you cannot, at least not yet.

forgot the carbs on workout days. eat the same healthy diet of lean meats, veggies, some fruit, get your EFA’s from nuts and fish oil and fats like olive oil and coconut oil. my other guess (my average client is EXACTLY you BTW) is that you are severely, although on the decline since you started working out again (good for you), insulin resistant. studies show that if you eat a lot of carbs, esp within 2 hours post workout, your insulin sensitivity takes a shit. read, bad for you. you want the absolute best insulin sensitivity you can get. again, the TRT will help as you should have less circulating insulin. but you must go low carb - but not as a fad diet, as a lifesyle. the only way to get and stay lean, without training like michael phelps, is low carbs. the term low carb is relative since we eat a shit ton of carbs in our culture (which is toxic no matter if you are skinny, fat or a pro bodybuilder); low carb IS the standard genetic diet of humans.

think about it… if all you could do is hunt or gather your food, how much bread/pasta/rice would you eat? none. agriculture is a new thing in the span of human history. i have studied lots of anthropological data and studies that show this. average ancestor walked 80mi A WEEK. men burned 3000-5000 calories every other day hunting; women carried two kids 700mi over two years. we are meant to move and move some more, plus eat what we could hunt and gather, not plant and harvest. i know this sounds like my religion and granted it is, but i am all science… plus i used to be 6 feet, 310, at 40% BF. for 10 years i’ve maintained 225 at 12-15% BF. i started TRT about 1 year ago, as i saw my weight climb even though i had near perfect diet/exercise. so, it will def help you but there is a lot more you need to be doing. cudos though for dropping your tri’s 100 points… you had gravy going through your system!

as for the weights, lift as HEAVY as you can, regardless of goal. do full body traning, 3X week, like M-W-F. i highly recommend you get into metabolic circuits. sample routine: sets of 5 reps on SQ, BP, pull (pull down if you cannot do a pull up), ham lift like a leg curl and an ab movement but at higher reps. keep the lifts that are more dangerous (SQ , BP) early in the set because you will get your ass kicked. perform these in a circuit with 2-3 min rest. then, if your knees are up to it, hit some HIIT (sprint intervals) outside. for non-impact hit the ellyptical or bike. hit these for 10-15 min AFTER your weights. outdoor sprints should be sets of 10-15 sec, 2 min rest. machine intervals are around 1:3, sprint to recovery. on non weight training days, do some low impact cardio like an hour bike ride, fast walk, hike, swim, etc, etc. remember bro - you are NOT trying to lose weight! you are just doing what your genes require… the SIDE EFFECT will be reduced weight, normalized blood markers, feel better, libido, etc, etc.

okay… i just gave you advice that my cients pay A LOT of money for so don’t ignore it. let me know if you have any questions.

TopSirloin

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[quote]jrm850 wrote:
I can’t find out if the fish oil I am taking is the ethyl esther or trigliceride type. The label doesn’t give me much information and google doesn’t turn up anything other than people that sound like commercials selling the product. Its from GNC -Triple Strength Fish Oil. The label says 647mg EPA and 253mg DHA. Can anyone recommend a good brand?

I wanted double strength but then I saw triple strength and thought to myslef that it must be better. :wink:
[/quote]

They are mos def ethyl ester. 1 reason is because they are enteric coated to help the product not break open in your stomach… the only reason for this is because you might expect “fish burps” because the ethyl ester oxidized rapidly and is already rancid. 2nd reason is because they concentrated the fish oil. tryglyceride forms are usually just straight fish oil - they do not adulter it besides purification. sometimes purification means they distill it into the ethyl ester as the toxins bind to the triglyceride molecules, but then they return it to the triglyceride form. 3rd reason is because they are from GNC, a retail shop. rarely will you find any supps in their correct molecular form retail.

you can easily test them at home. simply break open a capsule. if it has a very strong fishy smell or even of rancid fish, it is ethyl ester. you can chew the caps of triglyceride fish oil because in the natural form they tend not to get rancid. still, most put a natural flavor to further flatten out the taste.

i’ve spent years researching products. there are only a few i have found who are ethical in their manufacturing. nordic naturals, carlson’s (but only their “the very finest fish oil”) and innate choice. BTW, the doctor that developed innate choice is hands down the #1 wellness practicioner in the world. i have studied many experts and this guy is heads above everyone. check out his work if you really want to live to the fullest.

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You can bet that this advice has not fallen on deaf ears. I will stick to the diet, excersise and trt protocol routine that you two have outlined. The diet is right up my alley, and the exercise routine is basically what I have been doing for a couple of months other than the frequency. I am just going to cut out the cheats, forced reps, and negatives to shorten the recovery time. My Routine will be Full body workout, lots of compound exercises, 1 set to failure using good form, and minimal time between excersises.

I’ll add the sprints too; it sounds like fun. Shouldn’t I be worried about my max heart rate on the sprints? It’s going to get really high doing this until I get in shape again.

My BP is already showing some improvement for whatever reason- smaller T dose, no salt, more fish oil…

I do have one last question… My quad is mildly sore a few inches below my last injection site. The last time I injected into my glute, it got sore and had a pronounced lump around the injection site in the muscle. The soreness shows up several days after the injection. Is this normal or could I have some kind of allergy to the oil?

18

Jrm850,

Because of the nervous system load you do not want to go to failure on most sets. Maybe here and there if you are feeling really on your game that day. Since you will be cutting cals (by cutting carbs) and training at high intensity, failure reps can quickly over-train you.

As far as injections, my first ever TRT shot was last thursday, lateral quad. Painless injection but just today (sunday) it is FINALLY not sore! I don’t know if I hit a nerve or if that is just standard. Then, I found a Canadian study that showed the same blood levels of TRT using subcu (under skin, in fat, aka SC). My second round of shots was HCG SC in abdomen and test cyp SC front, upper quad (ther upper tends to have a “fat pad” vs middle/lower). ZERO injection pain, ZERO soreness… I will never do another IM unless some legit scienc shows there is a sig dif from IM.

As for the lump, I do felt a slight lump and the soreness radiated out as the oil dispersed. I suppose you could be allergic but my feeling is that it would be much more pronounced of a reaction.

FYI, I’m doing 200mg/week, 250IU/week HCG and 2.0mg Adex/week, all doses are EOD. With SC pinning EOD is a breeze… if I had to keep doing IM I would push it out as far as possible.

19

About SC injections: These can cause bleeds that create bruises. After you inject, immediately press on the injection site for 10-15 seconds. This will allow any broken vessels to close off and you will not get bruises.

SC in the abdominal fat created sore lumps for me, but not over the quads, vastus lateralis. So some may find some locations work better for them than others. Some also report that there are fewer nerve endings over their quads. But if you hit a vein or nerve, you will feel that. If the needle immediately creates an electric pain, pull out and go back in off to one side. If the pain feels like an ache that extends up and down, but does not seem to really have a location, that is probably from hitting a larger vein.

A rare few are hyper metabolizers of T and need 300mg/week to get to higher range normal. One reported that SC made him feel like crap and IM worked better. He had switched back and forth. So in some rare cases, it appears that some may process T SC differently than T IM.

20

Today was the first day I injected with the 29g 1/2" needle you suggested. I injected IM in the opposite (left) quad and feel no pain or swelling yet. The little 29g goes in a lot better than my old needles and the injection speed was fine. The pain in the right quad is about gone.

I may try SC after my next labs or if I have continued pain IM, but I don’t want to change all of the variables all at once. I will be very interested to hear how the SC is working for you numbers wise, how you feel etc.

The BP is still comming down. the diastoic has dropped to around 80 on average but the systolic is still in the 135 range.