Adex longterm : what to look for and when to stop

[synonymous]

I'm waiting impatiently for some blood work (check my prevoious post) and I have time so I wanted to ask: Are there longterm side-effects to using Adex weekly with HRT? Right now I have to go in for my shots, which is a pain. Doing my own shots 2x or 3x a week might reduce E2 but right now that's not an option unless I get UGL gear (legal in Japan). So is there something(s) I should look out for or specific labs I should get? Sides to watch out for etc?

 

[Daniel_IMT_Staff]

Hello,

Anastrozole has been used long term in males without complications. The main worry would be to make sure you are dosing it properly so that you don't bring your e2 down too low. As with any medication, if you notice any negative side effects or if your labs are outside reference range you should consult you doctor. Sometimes with TRT less is more, find you sweet spot with the Testosterone and then adjust e2 as needed.

 

[Gossamer]

Hello,

Anastrozole has been used long term in males without complications. The main worry would be to make sure you are dosing it properly so that you don't bring your e2 down too low. As with any medication, if you notice any negative side effects or if your labs are outside reference range you should consult you doctor. Sometimes with TRT less is more, find you sweet spot with the Testosterone and then adjust e2 as needed.

Daniel,

Could you post some studies that back up what you're saying about arimidex having no complications for trt use long term? This was a concern I had/have. And I tried to research long term effects of arimidex use with trt, and I found absolutely no long term tests. I'd love to see your info. Taking any med long term concerns me.

Thanks

 

[synonymous]

Daniel,

Could you post some studies that back up what you're saying about arimidex having no complications for trt use long term? This was a concern I had/have. And I tried to research long term effects of arimidex use with trt, and I found absolutely no long term tests. I'd love to see your info. Taking any med long term concerns me.

Thanks

Yeah...I tried looking but couldn't find anything. Thus the post. So any links would be much appreciated!

 

[STAUNCHED427]

I'm not sure what you are looking for fellas, a study saying Adex is completely safe? I don't recall saying many if any studies that a medication is just safe. Rather, go out and find a study pointing the negatives which if you do so you will find whatever negative comes from adex, is from 1mg taken for years for breast cancer treatment to literally crush estrogen... The negatives come from the lowered e2 itself, not the adex.

We aren't females with breast cancer using 1mg Adex ED trying to kill of all e2, we are simply using small doses (.25mg E3D for example) to control estrogen levels to keep them in check.

I don't think it is dangerous long term. What would be dangerous is having elevated e2 levels/crushed e2 levels from improper use of adex/lack of AI use.

 

[DreDay187]

Adex is a medication that's generally very well tolerated in patients. As Daniel pointed out the main issue is getting the right dosage while avoiding taking your estrogen levels to either extreme.

 

[Gossamer]

I'm not sure what you are looking for fellas, a study saying Adex is completely safe? I don't recall saying many if any studies that a medication is just safe. Rather, go out and find a study pointing the negatives which if you do so you will find whatever negative comes from adex, is from 1mg taken for years for breast cancer treatment to literally crush estrogen... The negatives come from the lowered e2 itself, not the adex.

We aren't females with breast cancer using 1mg Adex ED trying to kill of all e2, we are simply using small doses (.25mg E3D for example) to control estrogen levels to keep them in check.

I don't think it is dangerous long term. What would be dangerous is having elevated e2 levels/crushed e2 levels from improper use of adex/lack of AI use.

"I don't think it is dangerous long term", is not what the OP was looking for. I haven't found ANY actual studies on the long term effects of arimidex, used with trt.

Now Daniel says it has been used long term without any complications. Since he is in the business of trt, he must have info on studies that I can't find online. I've found plenty of info on long term effects of testosterone, but nothing on arimidex.

Some people want more security than "I don't think..."

 

[Alpin]

I've had Endos' put the fear of God in me to stop ADEX while on TRT....
"Stop we can't prescribe this, we don't know the long term effects"....
They don't even test for Estradiol in their TRT patients.

 

[Megatron28]

I've had Endos' put the fear of God in me to stop ADEX while on TRT....
"Stop we can't prescribe this, we don't know the long term effects"....
They don't even test for Estradiol in their TRT patients.

I don't believe there are any longterm arimidex studies for men using it. It isn't even approved by the FDA for use by men. When prescribed to men it is "off label".

Don't get me wrong. I use Arimidex for TRT. I take .50mg/week. But I am aware of it being used off label.

 

[Alpin]

I don't believe there are any longterm arimidex studies for men using it. It isn't even approved by the FDA for use by men. When prescribed to men it is "off label".

Don't get me wrong. I use Arimidex for TRT. I take .50mg/week. But I am aware of it being used off label.

If TRT sticks around...
as the years go on. I foresee the FDA needing to approve a form of medication to control E2.
Just like the FDA male form of clomid that is soon to come out: Androxal.
Technically clomid is "off label" but is generally safe and well tolerated by men.

 

[Daniel_IMT_Staff]

"I don't think it is dangerous long term", is not what the OP was looking for. I haven't found ANY actual studies on the long term effects of arimidex, used with trt.

Now Daniel says it has been used long term without any complications. Since he is in the business of trt, he must have info on studies that I can't find online. I've found plenty of info on long term effects of testosterone, but nothing on arimidex.

Some people want more security than "I don't think..."

There is plenty of studies out there, I don't know what you consider long term. You need to be able to read the studies and extrapolate the information correctly. This is the root of a lot of misinformation.

What specifically are you looking for? Read the pharmacodynamics/kinetics of the drug first so you understand what it is modulating. That way you can separate whether it is a primary drug action or result of the drug being misused as the causation. Even the following study isn't quite accurate for the purpose request as their anastrozole dose is way too high although it does demonstrate the safety of the drug on certain values.


Effects of aromatase inhibition in hypogonadal older men: a randomized, double-blind, placebo-controlled trial.
Effects of aromatase inhibition in hyp... [Clin Endocrinol (Oxf). 2008] - PubMed - NCBI

Abstract
Objective: To assess the effects of sustained aromatase inhibition in older hypogonadal men.

Design and patients: In a 1-year randomized, double-blind, placebo-controlled trial, 88 men, aged 60 and older with testosterone levels between 5.2 and 10.4 nmol/L on a single measure or between 10.4 and 12.1 nmol/L on two consecutive measures, and symptoms of hypogonadism were recruited. Subjects received either anastrozole 1 mg daily or placebo.

Measurements: Changes in gonadal steroid hormone levels, body composition (by computerized tomography (CT) and dual x-ray absorptiometry (DXA)), strength, prostate specific antigen (PSA), symptoms of benign prostatic hypertrophy (BPH), hematocrit and lipid levels were assessed.

Results: Testosterone levels increased from 11.2 +/- 3.3 nmol/L at baseline to 18.2 +/- 4.8 nmol/L at month 3 (p < 0.0001 vs. placebo) while bioavailable testosterone levels increased from 2.7 +/- 0.8 nmol/L at baseline to 5.4 +/- 1.7 nmol/L at month 3 (p < 0.0001 vs. placebo). Testosterone and biotestosterone levels peaked at month 3 and then declined by month 12 (though they remained significantly higher than baseline and greater than placebo). Estradiol levels decreased from 55.8 +/- 15.4 pmol/L at baseline to 42.2 +/- 13.6 pmol/L at month 3 and then remained stable (p < 0.0001). Body composition and strength did not change, nor did PSA, BPH symptoms, hematocrit or lipid levels.

Conclusions: Anastrozole administration normalized androgen production in older hypogonadal men and decreased estradiol production modestly. These alterations did not improve body composition or strength.

 

[Mprtz]

Very interesting study (thanks Daniel!).

I guess I don't understand why those guys' E2 didn't drop more

 

[Megatron28]

When you are NOT taking exogenous testosterone the adex has a different effect since the feedback loop is still open.

 

[Daniel_IMT_Staff]

Very interesting study (thanks Daniel!).

I guess I don't understand why those guys' E2 didn't drop more

No problem!

When you are NOT taking exogenous testosterone the adex has a different effect since the feedback loop is still open.

Yes, it will increase testosterone production however any effect on lipids/BMD which may cause a problem from AI(or low estrogen) wasn't found in that study. Low estrogen is the issue people have with the arimidex the drug mechanism will be the same where testosterone is present or not. More importantly, it is typically drug dosage that is too high reducing e2 too low which causes complications. Once again, I believe the testosterone aspect is irrelevant here, and an increase in testosterone such as from TRT would only help the outcome of the study as it would have a positive effect on BMD.

In my humble opinion!

 

[Gossamer]

Daniel wrote:
There is plenty of studies out there, I don't know what you consider long term. You need to be able to read the studies and extrapolate the information correctly. This is the root of a lot of misinformation.

What specifically are you looking for? Read the pharmacodynamics/kinetics of the drug first so you understand what it is modulating. That way you can separate whether it is a primary drug action or result of the drug being misused as the causation. Even the following study isn't quite accurate for the purpose request as their anastrozole dose is way too high although it does demonstrate the safety of the drug on certain values.

If trt is for life, then I would consider 10, 20, 30 plus years as long term. I haven't seen any studies done that are that long term.

If there are plenty of studies out there, could you post a few for us?
I think we all understand that anastrozole works. But we just don't know the long term cost, of the short term positive effects.

 

[DreDay187]

If trt is for life, then I would consider 10, 20, 30 plus years as long term. I haven't seen any studies done that are that long term.

If there are plenty of studies out there, could you post a few for us?
I think we all understand that anastrozole works. But we just don't know the long term cost, of the short term positive effects.

Long-term efficacy and safety of anastrozole for adjuvant treatment of early breast cancer in postmenopausal women

Results of safety and efficacy of anastrozole from the ATAC Trials. Not studied in men specifically but women and the median time of the analysis is 100months

Long-term efficacy and safety of anastrozole for adjuvant treatment of early breast cancer in postmenopausal women

Again in women

Lancet Oncol. 2006 Aug;7(8):633-43.
Comprehensive side-effect profile of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: long-term safety analysis of the ATAC trial.
Arimidex, Tamoxifen, Alone or in Combination Trialists' Group, Buzdar A, Howell A, Cuzick J, Wale C, Distler W, Hoctin-Boes G, Houghton J, Locker GY, Nabholtz JM.
Author information

Abstract
BACKGROUND:
The Arimidex (anastrozole), Tamoxifen, Alone or in Combination (ATAC) trial was designed to compare the efficacy and safety of anastrozole with tamoxifen as adjuvant treatment for postmenopausal women with early-stage breast cancer. After an extended follow-up beyond the 5 years of treatment, we aimed to assess the safety, tolerability, and risk-benefit indices of these compounds.
METHODS:
We analysed postmenopausal women (mean age 64 years [SD 9]) with localised breast cancer randomly assigned to anastrozole (n=3125) or tamoxifen (n=3116). Efficacy measures, including death and risk-benefit indices, were analysed by intention to treat. Safety analyses were based on treatment first received (n=3092 for anastrozole and n=3094 tamoxifen). We calculated a risk-benefit analysis using the two global indices for the Women's Health Initiative and for Disease-Free Survival and Serious Adverse Events. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN18233230.
FINDINGS:
At median follow-up of 68 months (range 1-93), treatment-related adverse events occurred significantly less often with anastrozole than with tamoxifen (1884 [61%] vs 2117 [68%]; p<0.0001), as did treatment-related serious adverse events (146 [5%] vs 277 [9%]; p<0.0001) and adverse events leading to withdrawal (344 [11%] vs 442 [14%]; p=0.0002). Patients given anastrozole had significantly fewer overall events for the Global Index of the Women's Health Initiative (744 [24%] vs 851 [27%]; hazard ratio 0.85 [95% CI 0.77-0.94], p=0.001) and the Global Index of Disease-Free Survival and Serious Adverse Events (1453 [46%] vs 1594 [51%]; 0.88 [0.82-0.94]; p=0.0004).
INTERPRETATION:
Anastrozole is tolerated better than tamoxifen by postmenopausal women with early-stage breast cancer, and results in fewer serious adverse events. Furthermore, it has a more favourable overall risk-benefit profile and lower recurrence rate than tamoxifen.
Comment in
Anastrozole had a better risk-benefit profile than tamoxifen as adjuvant treatment for breast cancer in postmenopausal women. [ACP J Club. 2007]
PMID: 16887480 [PubMed - indexed for MEDLINE]

Another 120month analysis on anastrozole and safety

Background
The Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial was designed to compare the efficacy and safety of anastrozole (1 mg) with tamoxifen (20 mg), both given orally every day for 5 years, as adjuvant treatment for postmenopausal women with early-stage breast cancer. In this analysis, we assess the long-term outcomes after a median follow-up of 120 months.
Methods
We used a proportional hazards model to assess the primary endpoint of disease-free survival, and the secondary endpoints of time to recurrence, time to distant recurrence, incidence of new contralateral breast cancer, overall survival, and death with or without recurrence in all randomised patients (anastrozole n=3125, tamoxifen n=3116) and hormone-receptor-positive patients (anastrozole n=2618, tamoxifen n=2598). After treatment completion, we continued to collect data on fractures and serious adverse events in a masked fashion (safety population: anastrozole n=3092, tamoxifen n=3094). This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN18233230.
Findings
Patients were followed up for a median of 120 months (range 0***8212;145); there were 24 522 woman-years of follow-up in the anastrozole group and 23 950 woman-years in the tamoxifen group. In the full study population, there were significant improvements in the anastrozole group compared with the tamoxifen group for disease-free survival (hazard ratio

---

0·91, 95% CI 0·83***8212;0·99; p=0·04), time to recurrence (0·84, 0·75***8212;0·93; p=0·001), and time to distant recurrence (0·87, 0·77***8212;0·99; p=0·03). For hormone-receptor-positive patients, the results were also significantly in favour of the anastrozole group for disease-free survival (HR 0·86, 95% CI 0·78***8212;0·95; p=0·003), time to recurrence (0·79, 0·70***8212;0·89; p=0·0002), and time to distant recurrence (0·85, 0·73***8212;0·98; p=0·02). In hormone-receptor-positive patients, absolute differences in time to recurrence between anastrozole and tamoxifen increased over time (2·7% at 5 years and 4·3% at 10 years) and recurrence rates remained significantly lower on anastrozole than tamoxifen after treatment completion (HR 0·81, 95% CI 0·67***8212;0·98; p=0·03), although the carryover benefit was smaller after 8 years. There was weak evidence of fewer deaths after recurrence with anastrozole compared with tamoxifen treatment in the hormone-receptor-positive subgroup (HR 0·87, 95% CI 0·74***8212;1·02; p=0·09), but there was little difference in overall mortality (0·95, 95% CI 0·84***8212;1·06; p=0·4). Fractures were more frequent during active treatment in patients receiving anastrozole than those receiving tamoxifen (451 vs 351; OR 1·33, 95% CI 1·15***8212;1·55; p<0·0001), but were similar in the post-treatment follow-up period (110 vs 112; OR 0·98, 95% CI 0·74***8212;1·30; p=0·9). Treatment-related serious adverse events were less common in the anastrozole group than the tamoxifen group (223 anastrozole vs 369 tamoxifen; OR 0·57, 95% CI 0·48***8212;0·69; p<0·0001), but were similar after treatment completion (66 vs 78; OR 0·84, 95% CI 0·60***8212;1·19; p=0·3). No differences in non-breast cancer causes of death were apparent and the incidence of other cancers was similar between groups (425 vs 431) and continue to be higher with anastrozole for colorectal (66 vs 44) and lung cancer (51 vs 34), and lower for endometrial cancer (six vs 24), melanoma (eight vs 19), and ovarian cancer (17 vs 28). No new safety concerns were reported.
Interpretation
These data confirm the long-term superior efficacy and safety of anastrozole over tamoxifen as initial adjuvant therapy for postmenopausal women with hormone-sensitive early breast cancer.

---

 

[Daniel_IMT_Staff]

Hello Gossamer,

Thanks for your response. However you ignored my query of what you specifically wanted "proof" of? What are you most concerned with? Moreover, can you please post a study which have been conducted on females that would be extrapolated to men? In the medical community long term is considered a year and the AI's have been around a little more than 20 years. Here is a couple more but please do more research to help yourself better understand the drug, I can help show you studies but if you are not reading and understanding them it is of no use.

The Effects of Aromatase Inhibition and Testosterone Replacement on Sex Steroids, Pituitary Hormones, Markers of Bone Turnover, Muscle Strength, and Cognition in Older Men
The Effects of Aromatase Inhibition and Testosterone Replacement on Sex Steroids, Pituitary Hormones, Markers of Bone Turnover, Muscle Strength, and Cognition in Older Men - Full Text View - ClinicalTrials.gov


Aromatase inhibitors in men: effects and therapeutic options
Aromatase inhibitors in men: effects and therapeutic options

Background
Over the past 15 years it has become evident that in men estradiol is responsible for a number of effects originally attributed to testosterone. Estradiol has an important role in gaining and maintaining bone mass, closing of the epiphyses and the feedback on gonadotropin secretion. This fact became particularly evident in men with aromatase deficiency. Aromatase is the enzyme responsible for conversion of androgens to estrogens. Men with estrogen deficiency caused by a mutation in the CYP19 gene suffer from low bone mineral density (BMD) and unfused epiphyses, and have high gonadotropin and testosterone levels [1]. Estrogen excess in turn has been associated with premature closure of the epiphyses, gynecomastia and low gonadotropin and testosterone levels. Lowering estrogen levels in men has emerged, consequently, as a potential treatment for a number of disorders including pubertas praecox, the andropause (also referred to as late-onset hypogonadism) and gynecomastia. Aromatase inhibitors were proven to be safe, convenient and effective for the treatment of hormone sensitive breast cancer in women although their use is associated with a modest increase in bone resorption [2,3]. This review will discuss the potential targets and the evidence for the use of aromatase inhibitors in men and adds more recent data to the text of an earlier review on this subject [4].

Conclusion
Over the years compelling evidence has accumulated that in men estradiol has an important role in gaining and maintaining bone mass, closing of the epiphyses and feedback on gonadotrophin release. Aromatase inhibitors, mostly combined with agonists of gonadotrophin-releasing hormone proved effective for the prevention of premature epiphysial closure in boys with pubertas praecox of various etiologies. There is also evidence that aromatase inhibitors can be used in boys with idiopathic short stature and boys with constitutional delay of puberty to increase adult height. Aromatase inhibitors are not effective for the treatment of gynecomastia in pubertal boys and have limited efficacy for the prevention of gynecomastia in bicalutamide-treated men with prostate cancer. Although aromatase inhibitors increase FSH levels, there is no consistent evidence for a beneficial effect on spermatogenesis. In older men with so-called late-onset hypogonadism, aromatase inhibitors may emerge as an attractive alternative for traditional testosterone supplementation to improve testosterone levels. The long-term benefits of higher testosterone levels in older men remain controversial, however. Moreover, it is questionable whether aromatase inhibitors are able to stimulate testosterone production sufficiently in men with truly low testosterone levels for whom testosterone treatment is currently recommended. Although most of the recent studies with aromatase inhibitors in boys and adult men do not show major detrimental effects on bone long-term skeletal safety remains an issue of concern.

 

[Gossamer]

Daniel wrote:

Thanks for your response. However you ignored my query of what you specifically wanted "proof" of? What are you most concerned with?

Huh? I never said I wanted proof of anything. I was just looking for studies of long term (years, decades) effects of anastrozole, when it's used as an AI in trt.
You said, "Anastrozole has been used long term in males without complications." So, I thought you may have based that assertion on long term studies that you have knowledge of.

What are you most concerned with?

As far as this topic, I'm concerned about the effects of anastrozole, with long term use. I may be using the drug for decades.

Moreover, can you please post a study which have been conducted on females that would be extrapolated to men?

Why? It has nothing to do with what I'm looking for.

In the medical community long term is considered a year and the AI's have been around a little more than 20 years. Here is a couple more but please do more research to help yourself better understand the drug, I can help show you studies but if you are not reading and understanding them it is of no use.

Well, one year isn't what I'm looking for if I may be using anastrozole for decades. Thanks for the studies, but I'm familiar enough with the drug to know how it will benefit me NOW. I can find plenty of info about anastrozole, and how it works as an AI.

I'm simply, and specifically looking for info about the long term effects of the drug when used as an AI in a trt protocol. And since there are no long term studies available, maybe you could just tell me what you base this assertion of yours on:

Anastrozole has been used long term in males without complications.

If you are simply stating that by "long term", you mean a year, then I guess you can't help me. A year is simply not "long term" enough, when I may have to use it for decades.

Thank you for taking the time to answer my questions. I do appreciate your time.

 

[Alpin]

Hello Gossamer,

Thanks for your response. However you ignored my query of what you specifically wanted "proof" of? What are you most concerned with? Moreover, can you please post a study which have been conducted on females that would be extrapolated to men? In the medical community long term is considered a year and the AI's have been around a little more than 20 years. Here is a couple more but please do more research to help yourself better understand the drug, I can help show you studies but if you are not reading and understanding them it is of no use.

The Effects of Aromatase Inhibition and Testosterone Replacement on Sex Steroids, Pituitary Hormones, Markers of Bone Turnover, Muscle Strength, and Cognition in Older Men
The Effects of Aromatase Inhibition and Testosterone Replacement on Sex Steroids, Pituitary Hormones, Markers of Bone Turnover, Muscle Strength, and Cognition in Older Men - Full Text View - ClinicalTrials.gov


Aromatase inhibitors in men: effects and therapeutic options
Aromatase inhibitors in men: effects and therapeutic options

Background
Over the past 15 years it has become evident that in men estradiol is responsible for a number of effects originally attributed to testosterone. Estradiol has an important role in gaining and maintaining bone mass, closing of the epiphyses and the feedback on gonadotropin secretion. This fact became particularly evident in men with aromatase deficiency. Aromatase is the enzyme responsible for conversion of androgens to estrogens. Men with estrogen deficiency caused by a mutation in the CYP19 gene suffer from low bone mineral density (BMD) and unfused epiphyses, and have high gonadotropin and testosterone levels [1]. Estrogen excess in turn has been associated with premature closure of the epiphyses, gynecomastia and low gonadotropin and testosterone levels. Lowering estrogen levels in men has emerged, consequently, as a potential treatment for a number of disorders including pubertas praecox, the andropause (also referred to as late-onset hypogonadism) and gynecomastia. Aromatase inhibitors were proven to be safe, convenient and effective for the treatment of hormone sensitive breast cancer in women although their use is associated with a modest increase in bone resorption [2,3]. This review will discuss the potential targets and the evidence for the use of aromatase inhibitors in men and adds more recent data to the text of an earlier review on this subject [4].

Conclusion
Over the years compelling evidence has accumulated that in men estradiol has an important role in gaining and maintaining bone mass, closing of the epiphyses and feedback on gonadotrophin release. Aromatase inhibitors, mostly combined with agonists of gonadotrophin-releasing hormone proved effective for the prevention of premature epiphysial closure in boys with pubertas praecox of various etiologies. There is also evidence that aromatase inhibitors can be used in boys with idiopathic short stature and boys with constitutional delay of puberty to increase adult height. Aromatase inhibitors are not effective for the treatment of gynecomastia in pubertal boys and have limited efficacy for the prevention of gynecomastia in bicalutamide-treated men with prostate cancer. Although aromatase inhibitors increase FSH levels, there is no consistent evidence for a beneficial effect on spermatogenesis. In older men with so-called late-onset hypogonadism, aromatase inhibitors may emerge as an attractive alternative for traditional testosterone supplementation to improve testosterone levels. The long-term benefits of higher testosterone levels in older men remain controversial, however. Moreover, it is questionable whether aromatase inhibitors are able to stimulate testosterone production sufficiently in men with truly low testosterone levels for whom testosterone treatment is currently recommended. Although most of the recent studies with aromatase inhibitors in boys and adult men do not show major detrimental effects on bone long-term skeletal safety remains an issue of concern.

Where are the results for the first GOV study listed ?

 

[Daniel_IMT_Staff]

Hello Gossamer,

Thanks for your response. What I am basing it on is a long list of studies which have been conducted on males/females and extrapolated that information to patients currently on TRT. Basically, if you read all information that is available, you should be rest assured that this is the conclusion. You cannot depend on one study to prove one thing. There are so many studies out there that prove/disprove a statement. So you have to see the whole picture, analyze it and extrapolate relevant info. That is what I have done when I say "Anastrozole has been used long term in males without complications." Personally I don't know anybody who have used it for 10 or 20 years continuously and since your request seems to be aimed towards that. I can just say that all information points toward that there should be no complications.

You should be concerned with a lot of the long term studies done on women as well although you state that "It has nothing to do with what I'm looking for" because it actually does and if you could try to look at the bigger spectrum of things you may be able to find your own conclusions.

From my knowledge on the drug the main concern would be to avoid dragging your e2 too low. That would be it, sometimes anastrozole has been pointed out to affect lipids negatively, however it may be misusing the drug which causes that.

If a drug has been used long term, which is defined medically as long term such as a year, you can draw many conclusions from that data. If you expect a certain value to change during the course of between a year and a decade I would understand that. But understand as well that the IRB will not consent to many studies progressing over 1 year for this matter neither which is why you see a lack in data. For example, I am concerned with my lipids over the course of a decade or estrone(e1) being too low.