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Author Topic: AI only?  (Read 701 times)

Flyingfool

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AI only?
« on: July 06, 2018, 01:32:33 pm »
Just wondered if anyone has done or what would be a good candidate (if one even exists) for AI mono therapy?

If estradiol is high? Could AI only work to cause an increase in free T and thus eliminate or reduce symptoms of low T?

Please see my lab levels below.

I have mild symptoms and wondered if I could lower Estradiol to say 20, if that is all I would need.

FYI. I lowered estradiol from 41 to 30 taking DIM 100mg. I only recently started taking 200mg (100mg twice a day) and will re-rest in 6-8 weeks.

The DIM however raised total t but also SHBG so that my free T remained essentially unchanged (actually free T decreased 1%)
52 year old, 5’-7” and 165 lbs.
exercise:swim 3x/wk & marrial arts 2x/wk

Blood tested 9/19/18

Total = 580 ng/dL (250-827) 59.9%
Free T= 6.87 (4.6- 22.4) 12.8% (10.8 calc)

SHBG= 39 10.0-50.0) 72.5%

Bio-avail= 14.2 (110-575) 8.0%

DHES =not tested %

Estradiol = 22 (<39)

DHES =231 (38-313) =45.5% tested 2/14/18

Currently on 50mcg Synthroid (T4)
TSH = 0.99
Free T4 = 1.30 (0.80 - 1.80)  =50.0% of range
Free T3 = 3.3 (2.3-4.2) = 52.6% of range
Current protocol: 100mg DIM once per day. Reduction back from 200 mg. For 12 weeks. raised total T, freeT remained basically unchanged due to increases SHBG. Estradiol decrease from 30 to 22. Felt no better and maybe worse than at 100mg DIM so going back starting 9/25/18

oldolylifter

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Re: AI only?
« Reply #1 on: July 06, 2018, 03:16:12 pm »
J Clin Endocrinol Metab. 2001 Jun;86(6):2869-74.
The effect of aromatase inhibition on sex steroids, gonadotropins, and markers of bone turnover in older men.
Taxel P1, Kennedy DG, Fall PM, Willard AK, Clive JM, Raisz LG.

Abstract
There is evidence that estrogen decreases bone turnover in men as well as women. We therefore hypothesized that older men would show increased bone resorption in response to inhibition of the aromatase enzyme, which converts androgens to estrogen. Fifteen eugonadal men over 65 yr were treated for 9 weeks with 2.0 mg/day of anastrozole, an aromatase inhibitor. After 9 weeks of treatment, there were significant decreases in estradiol, estrone, and sex hormone-binding globulin levels by 29%, 73%, and 16%, respectively, and total testosterone increased significantly by 56%. Despite the limited decrease of estrogen and the increase in testosterone, C-telopeptide of type 1 collagen showed a progressive significant increase of 11%, 24%, and 33% (P for trend = 0.033) above baseline at 3, 6, and 9 weeks, respectively. N-telopeptide of type 1 collagen values were highly correlated with C-telopeptide of type 1 collagen, but the change in N-telopeptide of type 1 collagen was not statistically significant. Bone-specific alkaline phosphatase and N-terminal type I procollagen peptides showed significant decreases of 8% and 11% of baseline at 9 weeks. Osteocalcin decreased significantly by 30% at 18 weeks. We conclude that aromatase inhibition can reduce estrogen levels in older men, but this effect is limited, perhaps because of feedback stimulation of testosterone production, and that endogenous estrogen derived from aromatization of testosterone plays a role in bone metabolism of older men by limiting the rate of bone resorption.

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Re: AI only?
« Reply #1 on: July 06, 2018, 03:16:12 pm »


oldolylifter

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Re: AI only?
« Reply #2 on: July 06, 2018, 03:17:50 pm »
Effects of Aromatase Inhibition in Elderly Men with Low or Borderline-Low Serum Testosterone Levels
Benjamin Z. Leder  Jacqueline L. Rohrer  Stephen D. Rubin  Jose Gallo Christopher Longcope
The Journal of Clinical Endocrinology & Metabolism, Volume 89, Issue 3, 1 March 2004, Pages 1174–1180

These data demonstrate that aromatase inhibition increases serum bioavailable and total testosterone levels to the youthful normal range in older men with mild hypogonadism. Serum estradiol levels decrease modestly but remain within the normal male range. The physiological consequences of these changes remain to be determined.

oldolylifter

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Re: AI only?
« Reply #3 on: July 06, 2018, 03:20:00 pm »
Reprod Biol Endocrinol. 2011; 9: 93.
Published online 2011 Jun 21. doi:  10.1186/1477-7827-9-93
PMCID: PMC3143915
PMID: 21693046
Aromatase inhibitors in men: effects and therapeutic options
Willem de Ronde1 and Frank H de Jongcorresponding author2
Author information ► Article notes ► Copyright and License information ► Disclaimer
This article has been cited by other articles in PMC.

Abstract
Aromatase inhibitors effectively delay epiphysial maturation in boys and improve testosterone levels in adult men Therefore, aromatase inhibitors may be used to increase adult height in boys with gonadotropin-independent precocious puberty, idiopathic short stature and constitutional delay of puberty. Long-term efficacy and safety of the use of aromatase inhibitors has not yet been established in males, however, and their routine use is therefore not yet recommended

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Re: AI only?
« Reply #3 on: July 06, 2018, 03:20:00 pm »


Joe Sixpack

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Re: AI only?
« Reply #4 on: July 06, 2018, 04:00:03 pm »
J Clin Endocrinol Metab. 2001 Jun;86(6):2869-74.
The effect of aromatase inhibition on sex steroids, gonadotropins, and markers of bone turnover in older men.
Taxel P1, Kennedy DG, Fall PM, Willard AK, Clive JM, Raisz LG.

Abstract
There is evidence that estrogen decreases bone turnover in men as well as women. We therefore hypothesized that older men would show increased bone resorption in response to inhibition of the aromatase enzyme, which converts androgens to estrogen. Fifteen eugonadal men over 65 yr were treated for 9 weeks with 2.0 mg/day of anastrozole, an aromatase inhibitor. After 9 weeks of treatment, there were significant decreases in estradiol, estrone, and sex hormone-binding globulin levels by 29%, 73%, and 16%, respectively, and total testosterone increased significantly by 56%. Despite the limited decrease of estrogen and the increase in testosterone, C-telopeptide of type 1 collagen showed a progressive significant increase of 11%, 24%, and 33% (P for trend = 0.033) above baseline at 3, 6, and 9 weeks, respectively. N-telopeptide of type 1 collagen values were highly correlated with C-telopeptide of type 1 collagen, but the change in N-telopeptide of type 1 collagen was not statistically significant. Bone-specific alkaline phosphatase and N-terminal type I procollagen peptides showed significant decreases of 8% and 11% of baseline at 9 weeks. Osteocalcin decreased significantly by 30% at 18 weeks. We conclude that aromatase inhibition can reduce estrogen levels in older men, but this effect is limited, perhaps because of feedback stimulation of testosterone production, and that endogenous estrogen derived from aromatization of testosterone plays a role in bone metabolism of older men by limiting the rate of bone resorption.
2MG PER DAY!!!  Wow that's a monster dose.
Age: 55, Ht: 5'08", Wt: 155 lbs
Protocol: 25 mg T Cyp + 25 IU HCG M,W,F + 2 clicks T Cream + 15mg DHEA + 15mg Pregnenalone daily.
12/2018 test results: TT: 1054 ng/dL (264-916), FT: 17.2 pg/mL (7.2-24), E2: 21.6 pg/mL sensitive (8.0-35.0)

Cataceous

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Re: AI only?
« Reply #5 on: July 06, 2018, 05:57:56 pm »
J Clin Endocrinol Metab. 2001 Jun;86(6):2869-74.
The effect of aromatase inhibition on sex steroids, gonadotropins, and markers of bone turnover in older men.
...

What I've found odd about this study is that estradiol decreases by only 29% in spite of this massive dose of anastrozole. Is testicular (AI-resistant) production of estradiol really that dominant? The test method is RIA. I'm not sure how this compares to the direct immunoassay methods that are known to have problems.

Here's a similar study: https://www.ncbi.nlm.nih.gov/pubmed/15001605 [Never mind, this is the second study referenced by oldolylifter]
« Last Edit: July 06, 2018, 07:28:10 pm by Cataceous »
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 57, Ht: 5'10", Wt: 158 lbs
Protocol: 18 mg T enanthate subQ qod, 250 IU hCG subQ qod, 70 mcg anastrozole qod, 6.25 mg DHEA orally bid
7-12/2018 test results: TT: 800 ng/dL, E2: 31 pg/mL LC/MS-MS, DHEA-S: 264 ug/dL (49-344)—SHBG ~30 nmol/L

Flyingfool

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Re: AI only?
« Reply #6 on: July 06, 2018, 06:38:24 pm »
So what does all the techno gargon mean in mere mortal human english?

My OP I am not looking to crash Estradiol. Only lower it to say 20 and hope to get free T up a bit. Can AI alone possibly do this?

How does SHBG react to AI if at all?

Does anyone know what controls or has a response to raise or lower SHBG?
52 year old, 5’-7” and 165 lbs.
exercise:swim 3x/wk & marrial arts 2x/wk

Blood tested 9/19/18

Total = 580 ng/dL (250-827) 59.9%
Free T= 6.87 (4.6- 22.4) 12.8% (10.8 calc)

SHBG= 39 10.0-50.0) 72.5%

Bio-avail= 14.2 (110-575) 8.0%

DHES =not tested %

Estradiol = 22 (<39)

DHES =231 (38-313) =45.5% tested 2/14/18

Currently on 50mcg Synthroid (T4)
TSH = 0.99
Free T4 = 1.30 (0.80 - 1.80)  =50.0% of range
Free T3 = 3.3 (2.3-4.2) = 52.6% of range
Current protocol: 100mg DIM once per day. Reduction back from 200 mg. For 12 weeks. raised total T, freeT remained basically unchanged due to increases SHBG. Estradiol decrease from 30 to 22. Felt no better and maybe worse than at 100mg DIM so going back starting 9/25/18

Cataceous

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Re: AI only?
« Reply #7 on: July 06, 2018, 07:46:29 pm »
It could work, but presumably there's a reason why it's an uncommon therapy. It may simply be that most guys drive estradiol too low and give up. So the best chance would seem to be with a low-and-slow approach, i.e. if anastrozole, start with doses in the tens of micrograms, monitor estradiol with LC/MS testing, and only increase the dose a little at a time if estradiol is still abundant.

The first study cited by oldolylifter showed a 16% decrease in SHBG, so I wouldn't expect anything too dramatic there.

Ways to modify SHBG mentioned here:
http://www.peaktestosterone.com/Low_SHBG.aspx
http://www.peaktestosterone.com/High_SHBG.aspx
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 57, Ht: 5'10", Wt: 158 lbs
Protocol: 18 mg T enanthate subQ qod, 250 IU hCG subQ qod, 70 mcg anastrozole qod, 6.25 mg DHEA orally bid
7-12/2018 test results: TT: 800 ng/dL, E2: 31 pg/mL LC/MS-MS, DHEA-S: 264 ug/dL (49-344)—SHBG ~30 nmol/L

txmx

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Re: AI only?
« Reply #8 on: July 07, 2018, 07:07:00 am »
As Gene Devine always says, if it were that easy, everyone would be doing it :)

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Re: AI only?
« Reply #8 on: July 07, 2018, 07:07:00 am »