Trying to understand aromatase inhibitors (etc) mechanism

[cloentine]

I have a very specific question about the various "adjunct" medications used alongside testosterone replacement therapy (TRT) -- for example aromatase inhibitors. First, a little background.

My symptoms are ADD-ish fogginess, lack of energy, and I'm a bit overweight. I'm 47. A recent lab showed my T level as 316. My doc is recommending I use testosterone replacement therapy (TRT). HOWEVER, this is not the first time. About two years ago, he prescribed cypionate and it did indeed get my levels up to a healthy 800 - 1100. However, despite doing that for about 6 months, I experienced zero subjective benefits. No increase in alertness or energy, and no discernible difference as I worked at the gym. No difference to morning wood either. So I told him I didn't want to do it any more and he agreed. I decided instead to simply work on my weight since I'd heard that being fat can pull down T levels too. I was *very* overweight then, but I've now lost a chunk. No improvement on the T levels though, as the recent lab showed, nor on the energy or fogginess.

Now that first time, *all* I did was the cypionate, but now he's talking about adding aromatase inhibitors and a few other things he mentioned that I didn't pick up on. I really don't mind trying it again, but only if there's a point.

So, here's my question. Notice that when I used it before my T levels did genuinely improve a lot, up to what I assume is a healthy level (800+). So does that not mean that I wouldn't get any benefit from aromatase whatchmacallthems? Isn't the sign showing that AIs could be useful simply the fact that despite using cypionate (or whatever) the person's levels do *not* go up.

But my levels *did* go up. So what's the point of AIs?

What exactly are AIs *for*?

(I hope that's all clear.)

 

[Megatron28]

I have a very specific question about the various "adjunct" medications used alongside TR- for example aromatase inhibitors. First, a little background.

My symptoms are ADD-ish fogginess, lack of energy, and I'm a bit overweight. I'm 47. A recent lab showed my T level as 316. My doc is recommending I use testosterone replacement therapy (TRT). HOWEVER, this is not the first time. About two years ago, he prescribed cypionate and it did indeed get my levels up to a healthy 800 - 1100. However, despite doing that for about 6 months, I experienced zero subjective benefits. No increase in alertness or energy, and no discernible difference as I worked at the gym. No difference to morning wood either. So I told him I didn't want to do it any more and he agreed. I decided instead to simply work on my weight since I'd heard that being fat can pull down T levels too. I was *very* overweight then, but I've now lost a chunk. No improvement on the T levels though, as the recent lab showed, nor on the energy or fogginess.

Now that first time, *all* I did was the cypionate, but now he's talking about adding aromatase inhibitors and a few other things he mentioned that I didn't pick up on. I really don't mind trying it again, but only if there's a point.

So, here's my question. Notice that when I used it before my T levels did genuinely improve a lot, up to what I assume is a healthy level (800+). So does that not mean that I wouldn't get any benefit from aromatase whatchmacallthems? Isn't the sign showing that AIs could be useful simply the fact that despite using cypionate (or whatever) the person's levels do *not* go up.

But my levels *did* go up. So what's the point of AIs?

What exactly are AIs *for*?

(I hope that's all clear.)

You are not thinking about it correctly. But it is good you are asking!

Testosterone aromatises (converts) into estrogen. The higher your testosterone, the more of it that is likely to aromatise. Your body does this to try and find the right balance. So when you got your T up to 800-1000 there is a very good chance your estradiol (the "evil" form of estrogen) shot up. Start reading posts on this forum and you will see the #1 problem guys on testosterone replacement therapy (TRT) have is related to estradiol.

An aromatase inhibitor (AI) will stop your testosterone from converting to estradiol. When your estradiol gets too high -- or too low -- it makes you feel horrible. It can often feel similar to having low T. And when you inject test cyp you start off at a high level. But if it is aromatising, that means your Total T and Free T are pretty low at the time you do your next injection. Aromatisation can magnify the roller coaster effect between injections.

It is good that your doctor is aware of this now and want to help you manage your estradiol along with your testosterone. This will help make treatment successful.

Losing weight can sometimes help, but it depends on whether you have primary or secondary hypogonadism. Which were you diagnosed with?

You need to treat your Low T. Even if you don't feel symptoms, there are serious life threatening issues with prolonged Low T. Think of it like high blood pressure or high cholesterol. You can't feel their symptoms, but left untreated they will shorten your life.

Tell us more about your past protocol and lab results and maybe the guys on the forum can help you more. And read as much as you can on here.

 

[willnorthwest]

It's used to prevent the excessive build up of Estrogen in your body. When you raise your Testosterone, you will almost indefinitely raise your Estrogen level as well. Estrogen is important to the body, in the right amount. Typically you want your Estrogen to be in the low-mid 20's n/mol based on a Estradiol Sensitive Assay. If your estrogen gets to high, then you can and will develop a littany of problems, such as gynecomastia, anxiety, bloating, sexual side effects, among many others. AI's are used to help prevent the excessive rise of this hormone. Now, keep in mind that having low E2(Estrogen) is just as bad as having high Estrogen, so AI's need to be used at the lowest possible dose that produces results within range.
If you are planning on getting back on Testosterone, please do more research on this very important aspect of Testosterone Replacement Therapy. Good luck to you

 

[cloentine]

Thanks Megatron and Will:

...when you got your T up to 800-1000 there is a very good chance your estradiol (the "evil" form of estrogen) shot up. ... when you inject test cyp you start off at a high level. But if it is aromatising, that means your Total T and Free T are pretty low at the time you do your next injection. Aromatisation can magnify the roller coaster effect between injections.

So is the fact that I felt nothing -- not good but not bad either -- when on the cypionate consistent with the aromatising effect you describe? The cypionate pushes my T levels up, but the estradiol counters whatever good that was supposed to do, leaving me not necessarily worse off, but merely the same as I was pre-TRT?

As to primary versus secondary, I don't know yet. I'm due for a chat soon. I just happened to get the basic T measurement from the nurse over the phone. Once I meet with my doc and get more details, I'll bring some numbers to the forum.

Thanks again!

 

[Megatron28]

Thanks Megatron and Will:



So is the fact that I felt nothing -- not good but not bad either -- when on the cypionate consistent with the aromatising effect you describe? The cypionate pushes my T levels up, but the estradiol counters whatever good that was supposed to do, leaving me not necessarily worse off, but merely the same as I was pre-TRT?

As to primary versus secondary, I don't know yet. I'm due for a chat soon. I just happened to get the basic T measurement from the nurse over the phone. Once I meet with my doc and get more details, I'll bring some numbers to the forum.

Thanks again!

High estradiol usually makes you feel pretty bad as Will pointed out. Fatigued too. That bad feeling from high estradiol generally is not countered by the positive effects of raising your T.

Didn't you go on Test Cyp the first time because you were feeling bad? Usually guys have symptoms when their T is low, but not always.

Try to dig up your original blood work too from the first time your started testosterone replacement therapy (TRT). Thw more trends and numbers you can share the better.

 

[cloentine]

Didn't you go on Test Cyp the first time because you were feeling bad? Usually guys have symptoms when their T is low, but not always.

Not so much "bad" as foggy. I actually was diagnosed with ADD, but it's a probabilistic diagnosis (i.e. I have a "75% chance" of having ADD) and so when ADD meds had no effect, my doc suggested we measure my T levels and it began from there. When I say "foggy" though, I don't want to underestimate the effect. The difference between my mental acuity when I'm at my best, versus most of the rest of the time, is *huge*.

I also have a weight problem (improving) and severe obstructive sleep apnea. My docs opinion seems to be it's one big vicious circle. Obesity can cause apnea which makes me sluggish and lacking in energy which can lower T which can make me sluggish which can cause obesity which ... bla bla. To be honest, I do have a definite feeling of guilt associated with things like apnea, ADD, and being fat, given that they're all very "first world problem" ish. When there's folk out there starving or suffering from guinea worm etc, it can make this stuff seem unimportant. OTOH, we're all inclined to die of heart attacks and strokes, so everyone's kinda getting it in the neck I suppose

Try to dig up your original blood work too from the first time your started testosterone replacement therapy (TRT). Thw more trends and numbers you can share the better.

Will do.

 

[Megatron28]

Not so much "bad" as foggy. I actually was diagnosed with ADD, but it's a probabilistic diagnosis (i.e. I have a "75% chance" of having ADD) and so when ADD meds had no effect, my doc suggested we measure my T levels and it began from there. When I say "foggy" though, I don't want to underestimate the effect. The difference between my mental acuity when I'm at my best, versus most of the rest of the time, is *huge*.

I also have a weight problem (improving) and severe obstructive sleep apnea. My docs opinion seems to be it's one big vicious circle. Obesity can cause apnea which makes me sluggish and lacking in energy which can lower T which can make me sluggish which can cause obesity which ... bla bla. To be honest, I do have a definite feeling of guilt associated with things like apnea, ADD, and being fat, given that they're all very "first world problem" ish. When there's folk out there starving or suffering from guinea worm etc, it can make this stuff seem unimportant. OTOH, we're all inclined to die of heart attacks and strokes, so everyone's kinda getting it in the neck I suppose



Will do.

He's right. They are all inter-connected. Sounds like you have a good doc. Hopefully you are using a c-pap. And get back on the T so you can put muscle back on, recover faster from exercise, remove the fog, not feel as fatigued, etc. I can tell you from my experience that you don't realize how much of a funk you are in because it was a gradual process over years to get there. For example, I was tired all the time but I didn't realize just how much until I started feeling better. And all of a sudden I was chasing my wife around the house like I was a 17 year old again. And so on.

If you aren't getting exercise, find a sport to start playing. Join a gym. Once you are on T and get things balanced out you will actually feel strong again and recover quickly.