Aromatase Inhibitors for guy on TRT?

[Mesomorphin]

I've been on TRT for 3+ years. I am using a topical application (Andogel 1.62 - 3 squirts). Because my hormone profile was unusual and my regular doctor didn't know what to make of it, I was referred to an endocrinologist. Although he ultimately prescribed TRT, he seems to be WAY on the conservative end when it comes to TRT.

Early on, my prescribed dose brought me within the lab reference ranges, but both last year and again this year, my levels have fallen below the reference range. (This year total T was 292 ng/dl and freeT was 4.8 pg/ml). All of the other lab results (CBC/PSA) were well within reference ranges.

Last year's labs were pretty similar (301 total; 4.3 free), but when when I sought permission to boost my dose last year, the endo balked. Although I am not as bad off as I was before I started TRT (not currently experiencing brain fog or perceptual distortions like before), the TRT just doesn't seem to be as effective as when I started. I am hoping to get some adjustment to boost my T levels when I see the endorsement in about a week, but I'm not optimistic based on past experience.

I am curious whether adding an AI to exogenous T would boost either total or free T without magnifying potential risks. (No one has ever measured my estradiol levels, so if that is a prerequisite for AI's, he'll probably balk at that too.)

Any experienced folk with advice? I'd like to see if I can't kick my total and especially free T up a notch or two.

 

[2temptu]

My endo added clomid when my levels didn't raise like he wanted on just test alone. Clomid got me in the upper range of normal

 

[Mesomorphin]

Thanks. I'll see what my guy says, though he doesn't seem to care about getting my T above 300. If he does nothing, I may want to get another consult or see if there are any supps that could give me at least a little boost.

 

[sammpedd88]

Thanks. I'll see what my guy says, though he doesn't seem to care about getting my T above 300. If he does nothing, I may want to get another consult or see if there are any supps that could give me at least a little boost.

If your endo doesn't want your levels above 300 then find another dr. This sounds like my urologist I WAS going to. He wanted my levels at 300 as well. I now go to an integrative medicine dr.

 

[C Dub805]

If your endo doesn't want your levels above 300 then find another dr. This sounds like my urologist I WAS going to. He wanted my levels at 300 as well. I now go to an integrative medicine dr.

Agreed! Find a TRT doctor (plenty of them out there) who wants your levels up in the high end of the normal range. Mine are just under 900 (TT) and I'm on 200mg per week of cypionate with no AI. My bloodwork indicates everything is fine. As a matter of fact, my cholesterol and glucose have even improved significantly. I, personally, think those gels are ****. You're better off pinning test right into your ass (zero pain) twice per week.

 

[kenpoengineer]

There is information about how pinning is so much better than gels on excelmale dot com and PeakTestosterone dot com sites. I'm with the guys above on getting another doctor.

 

[Mesomorphin]

Thanks for the input. If things don't change with my current guy, I'm happy to consider switching doctors. I have put it off so far because I feel like I had to go through a lot (many appointments, lab tests over several months) to get this far, and I have been reluctant, given professional responsibilities, to take that on again. Sadly, I DON'T know how to distinguish up front medical practices with a more liberal philosophy -- except for the overt "life extension" places which I suspect my insurance won't cover.

I am definitely not needle phobic, so I would be cool with injections-- assuming they teach self administration so you don't have to constantly go to the doctor's office. However, I have gotten the sense a lot of guys run into doctors who want to spread injections out too far, so even on the injectible side it seems like it might be hit or miss to find a doctor who "gets it".

 

[kenpoengineer]

On excelmale there is a recommended Doctor list. You can call your local compounding pharmacy and ask for Doctor names that prescribe injections. Lots of information on these sites.

 

[Mesomorphin]

Thanks for the excelmale cite. So far, I got one list with nothing in my area (MD/DC), and I found another attachment that doesn't seem to open on android devices. I'll check it out later once I get access to my PC.

 

[kenpoengineer]

If so inclined, join and post up on the Testosterone Replacement Therapy Discussion FB group.

 

[kisaj]

You need to be straight with the endo and tell him that if he is not going to address your symptoms and move you within normal ranges that you'll be seeking another doctor. You don't state what testing was done originally or why he ultimately put you on TRT, but it sounds like they didn't quite know what they were doing. I'd say that it is borderline negligent to have someone on hormone therapy that isn't focused on correcting issues presented because of an unwarranted personal concern about moving you into normal ranges.

If you don't feel comfortable being blunt- simply ask if his stance is to keep patients at the very bottom of the physiological range or to treat the cause and symptoms of low test. His answer should be able to tell you if he is a quack or legit.

There are many bad doctors and specialists out there. I saw 2 specialists before finding one that was actually interested in his patients and understood hormone therapy.

 

[Mesomorphin]

I had numerous rounds of testing originally. It was long enough ago that I don't remember all the details I know all tests showed low free T. Most tests showed below reference range on total T, though at the beginning of the process I think I had one test that scraped the bottom of the low end of the reference range. I no longer remember the details, but some of the other results seemed odd to the urologist. Things that are normally elevated together or suppressed together went in opposite directions in my case. (Might have been FSH and LH?). Anyway, that led to a referral to the endocrinologist, who did several additional rounds of testing. Eventually, he reluctantly allowed me to start TRT when my total T levels had fallen to a little below 250 ng/dl -- but only because I was getting pretty desperate at that point due to major "brain fog" episodes making my job (legal work) hard, and some perceptual distortion issues that were beginning to make me nervous about driving.

When I first started topical application, I think I got total T levels around 450 ng/dl and it was enough to bring relief from symptoms, and even restore some lean mass I had lost over the years. Gradually, though, the TRT seemed to be a little less effective to me, though I have not yet experienced a return of "subhuman" feeling that I had before I started.

I am confident from prior meetings with the endo that he aims toward the low end of the reference range. He did not balk when I was around 450, but it was pretty clear that he did not want to see it higher. Last year when I came in at 300 and low free T, and told him I didn't think it was working as well, he rejected my requested to up the Androgel to 4 squirts. I don't think the guy is a quack, but he seems way more focused on treatment risks than benefits. It was almost like because my red cell count and other values were in the normal range that was a reason not to increase the dose.

 

[kisaj]

There is nothing wrong with being conservative on TRT and is actually preferable, but there is also being cautious to the detriment of your patients. I would have the discussion with him and then prepare to find a new doc if he won't work with you. While I would never recommend anyone going to an anti-aging clinic, remember that it is another route available.

 

[Mesomorphin]

kisaj - I'm inclined to agree generally that the conservative approach makes sense. Although one part of me would love to experience life at the higher end of the T scale, I'm confident I can avoid my major complaints if I get back to the mid range.

I'll know in another week or so what my current doc will do, and maybe I'll get another opinion if he leaves me where I am.

 

[C Dub805]

kisaj - I'm inclined to agree generally that the conservative approach makes sense. Although one part of me would love to experience life at the higher end of the T scale, I'm confident I can avoid my major complaints if I get back to the mid range.

I'll know in another week or so what my current doc will do, and maybe I'll get another opinion if he leaves me where I am.

What Kisaj was getting at was in terms of TRT, conservative is your best approach, but not conservative to the extent that it's detrimental to the patient. TRT is essentially an indefinite path; meaning, you get on TRT with the intention of staying on indefinitely so you want to be conservative in your approach. The objective of TRT is to restore your levels within a healthy, normal range so that you can feel better and attain better health. The typical dose given to restore your levels within a healthy, normal range is 100mg to 200mg per week. Now, we are all individuals so what works for one man may not work exactly the same for another man. I'm on 200mg per week and my levels are just under 900. They were under 200 before I started TT. I'm right where my doc wants me to be. He will not increase my dose. If my doc was happy with me being on the low end of the normal range, I would find a new doc.

 

[Mesomorphin]

I'll wait until after my next appointment, but I could well be looking for a new doc soon. I think I probably should have done that last year, but I'm not confident about my ability to efficiently find someone good.

 

[C Dub805]

I'll wait until after my next appointment, but I could well be looking for a new doc soon. I think I probably should have done that last year, but I'm not confident about my ability to efficiently find someone good.

It's not as challenging as you may think. Here is my advice though: educate yourself on the subject matter; read, read and read. Ask questions and challenge claims. You will find that for every suggestion there is a counter. Heck, many doctors are in disagreement as to what constitutes the best approach. There isn't a single doctor out there who knows everything there is to know about this stuff. As a matter of fact, many patients know more than their doctors because these patients become sponges and educate themselves to degrees beyond what their doctors care to do. At the end of the day, you have to invest in your health and decide what the best approach is for you and as long as it's reasonable, then don't overthink it too much because again, one piece of advice can and will be countered with another piece of advice. There is a stigma associated with steroids; to include TRT. And most of the information you read on these forums or advice you get from people is parroted with zero scientific basis behind any of the claims. You have to sift through it all and just educate yourself on the basic foundation (how the endocrine system works) and then go from there. There are some knowledgeable guys on here for sure. Pick their brains and don't be afraid to challenge what they claim either as that is all part of the learning process.

 

[Mesomorphin]

Thanks, CDub 805. I did a lot of reading back before I started on TRT. That was some time ago, and I have not retained much of the info, so I will have definitely have to redo my homework. (I should have kept copies of the studies and reports I assembled back then.)