E2, Arimidex and a TRT doc's position

[Primordial949]

So, a TRT doc who I had been seeing had this to say when I asked him why he never had my E2 levels checked on my bloodwork and why he never considered putting me on an AI (Arimidex) when he put me on 200mg testosterone cypionate per week and 25mg DHEA-S daily:

"E2 does not competitively bind with testosterone so it would have no effects on the results as far as testosterone goes. I generally discourage the use of Arimidex because there is good data that shows (unless you are symptomatic - nipple and breast tenderness) that lowering estradiol levels is harmful and good data to support levels in the 75-100 range are very protective to your heart, bones and brain. FYI: E2 levels in young men fall in the 75-100 range. 53 is high for your age only because of decreased testosterone production in men our age."

Ok, I was under the impression that high E2 was not good (mine is at 53) and that high E2 can interfere with testosterone binding to androgen receptors, which is why an AI would be used; not only to prevent the increased testosterone from converting to estrogen, but to allow the free testosterone to bind to androgen receptors so as to experience the benefits of the testosterone therapy??????

 

[kenpoengineer]

So much is still unknown concerning TRT. From my reading, too low estrogen and libido drops, bone mass drops and joints start to have problems. Too high estrogen and prostrate problems occur plus the possibility of gynecomastia (breast tissue formation) may occur. I suggest visiting PeakTestosterone dot com or excelmale dot com.

http://www.excelmale.com/showthread.php?2309-Role-of-Estradiol-in-Men-and-Its-Management

 

[kisaj]

Your TRT doc is not very good, sorry to say. First of all, you would not start on a 200mg a week protocol and automatically go on DHEA, then be fed misinformation on e2 levels. He essentially set you up to have elevated e2 and then is discouraging you from addressing it. High e2 is bad for us and to subscribe to the theory that levels in the 75-100 levels are healthy is just plain wrong and yes, we need estrogen, but most lab ranges for men will run in the <40 range on the high end. For reference, my doc likes to see me in the 20-30 range and I am most comfortable in the low 20s.

 

[Primordial949]

I agree with you. Everything I have read suggests optimal E2 range for men is 20-30 and yet mine is at 53 and he claims that isn't high and that it's protective of bone, heart and brain. I just read studies indicating high E2 is associated with cardiovascular disease, enlarged prostate and a host of other issues. When he said 75-100 is healthy, he must have been referring to women and not men, but he is dealing with a male patient (me) so that is irrelevant. The fact he never even checked my E2 levels before putting me on hormones is another issue! I went and had them checked after being on test (200mg per week) for 7 weeks and not really feeling any different than before. Alas, my estrogen was high. Interestingly enough, I also read somewhere that taking an AI doesn't reduce your E2, but rather, just prevents the available testosterone from converting to E2. And all this talk about taking an AI and then E2 levels crashing below 20 seems rather suspect to me. Perhaps these people's E2 levels were already within optimal range or low to begin with, but I don't see how taking 1mg of Arimidex per week could drop an E2 level of 53 down below 20. That just doesn't make sense to me.

 

[kisaj]

An AI does lower e2, it blocks aromatase- that is the purpose. Some people are more sensitive to the effects and need to play with dosage or try other AIs, but it is very possible to drop e2 30pts with Arimidex.

 

[Primordial949]

There is just so much conflicting information out there and probably because no long term use studies have been done. There is another forum where a moderator, who seems very knowledgeable in all this too, claims there isn't enough data to support what exactly is an unhealthy, high E2 level.........at any rate, what I do know is I ran 200mg of test cyp per week (dosed twice per week @ 100mg) for 7 weeks and did not feel jack **** in terms of benefits. I did not experience any positive change in mood, libido, strength, bodyfat reduction, etc etc. My diet was clean and I incorporated cardio. What can I attribute this too? Too high E2? Meaning, the available testosterone wasn't binding to androgen receptors? And what is with these TRT docs and subscribing DHEA? WTF does that do other than potentially convert to more E2?

 

[kisaj]

We know nothing about your history, symptoms, tests done before going on TRT, steps to address before going on, etc.There is no way for anyone to even guess what is happening other than a (good) specialist.

DHEA and pregnenolone are an important piece of hormone replacement and can have a large impact on libido, energy, fat loss, and mood. You should be tested though to know your levels so a proper dosing schedule can be determined. Yes, it can convert to e2, therefore testing and dose needs to be monitored.

 

[kenpoengineer]

Agree with kisaj on all points. My doctor has me shooting for a one to one ratio of free testosterone to E2. That puts me at about 24 for E2. I'm researching where this "ratio" treatment came from but it puts me in the right ballpark for E2. More reading:

http://www.excelmale.com/showthread.php?4206-Elevated-Estradiol-During-TRT-To-Treat-or-Not-To-Treat