question from a user
My e2 was a little elevated and the doc suggested doing .25 after every injection (EOD, so it’s a little less than 1mg/wk) to knock it down a bit but there’s a very vocal crowd who treat even small doses like they’re poison. There’s entire groups on Facebook of people who are vehemently against them and preach it like it’s the gospel. Are there any studies or anything you guys are aware of that look at longer term use of drugs like anastrozole in men or are those of us who choose to take it the long term case study, so to speak? Glad you guys think we will be alright though, that’s comforting. I always forget about it, then get reminded and panic for a bit because there’s no local clinics and healthcare where I live is abysmal.
AlphaMD's Answer
We live in a world where there are still very few good long term studies on men’s health. In the case of AI’s there are exactly zero studies on AI use in men in TRT. All of the “data” are based off of studies in women with hormone sensitive breast cancer. In addition, those poor women also have to take much, much higher doses, because they have a lot more aromatase to inhibit.
So what this means is that in that population, the goal is to get these unfortunate women with cancer to have an undetectable estrogen level in order to increase their survival. But survival in this case comes at a cost. You know what happens when you have no estrogen at all? Low bone density, terrible cholesterol levels, emotional lability, hair loss, dry skin.
Those are all the scary things men who say AI’s are the devil are listing could happen if you use them. The problem is you can’t quote from studies that have different goals (survival from hormone sensitive breast cancer) in a different population (women) that use different dosing (minimum 7mg/wk or greater).
The goal of AI use in men on TRT is not to drop estradiol levels to zero. It is to manage symptoms of levels that are a bit too high with very small doses. In over 8 years of treating men with AIs, I have never met one who had any of the problems listed by their detractors.
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