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question from a user

Is anastrazole typically prescribed at a starting dose of 1mg? Or specifically for me, .5mg 2x per week? Is this too high a dose to start out with? What is your strategy with AI's, and do you immediately reach for an AI with E2 only barely high? (62 on my last lab)? For context, the AI was prescribed for a sudden onset of fatigue after week 4, which I now understand is common based on the great breakdown of symptoms you provided to others in previous posts on TRT weeks 1-8. Due to my fears of blowing up all estrogen, I quartered the pill and took approximately .125mg-, which rendered me slightly elevated heart rate, flushing, profuse sweating, and body odor. Although my energy levels shot back up, I've been hesitant to try taking it again for fear of being a little too amped feeling, almost as if I took a stimulant. I also had erection issues right after as well. I'm hoping to lose weight and bring down e2 naturally, but worried the AI might be necessary now to offset current symptoms.

AlphaMD's Answer


We typically start with zero AI because we look at a man's TT & can usually use therapeutic doses of 120mg-160mg to provide an ideal range with high benefits & low side effects. At these doses it's only 1 out of 4 men who may need an AI, but it does vary person to person. Going any higher than that or any history of high Estrogen symptoms & we may start with an AI.

The thought process is very much "wait & see" since it's the minority who need it & if you don't need it, your natural Estrogen can be tanked which is bad for mood, libido, and metabolism.

When dosing we go with 0.5mg once a week or 0.25mg twice a week to start when needed, then go up from there. Very very rarely will we go above 1mg total a week, though 2mg a week would be our "max".

If you wanted to be more sure you could always run an Estrogen test to check your general levels to make sure it's not an adrenaline or anxiety influence.

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