STEP 8: If you are high estradiol, consider pharmaceutical solutions to high estradiol (with your physician of course):
What if I told you there was a relatively inexpensive pill that any low testosterone man could take that would likely double his bioavailable testosterone and increase his total testosterone by around two thirds? One study looked at men over 60 years old found an increase in testosterone of 62% and a decrease in estradiol, the “bad estrogen”, of 24% for a net improvement in the testosterone-to-estradiol ratio of 115%.  It took their total testosterone levels up from an average of 330 to 535 ng/dl.
Another study on infertile men with a T/E ratio less than 10 and total testosterone under 200 ng/dl found even more impressive results: total testosterone was increased by an average of 95%.  (Another similar drug (Femara or letrozole) produced spectacular results and other studies have shown that Teslac (testolactone) also does very well) 
Personally, I don’t think this kind of Arimidex Monotherapy is a good idea for several reasons:
1. Less Sexual Improvements. Some study work indicates that Arimidex Monotherapy does not improve libido and sexual function significantly, even though testosterone and estradiol levels are improved. 
2. The Current State of Testing. One quandary that physicians and their patients are facing right now is coming up with a target range for estradiol levels. The big labs are now emphasizing LC-MS/MS estradiol tests for men, which makes sense, because LC-MS/MS is the best practical technology to read the low levels of estradiol that a male has. However, the results for the LC-MS/MS appear to be a little lower than the old assays, due to decreased cross reactivity with other molecules, making the old target ranges from previous study work probably invalid.
3. Risk of Osteopenia / Osteoporosis. Some physicians do not properly monitor or use the wrong estradiol test. This could lead to a man ending up with bone loss.
4. Possible Risk of Clotting. Some experts believe that Arimidex, even low dose, could increase of clotting in some men.
Now what is curious is that Arimidex (anastazole) actually works by binding to the infamous aromatase enzyme that converts your testosterone into estrogen. Thus it effectively inhibits or blocks this conversion. So one might expect estrdiol (E2) to be affected more proportionately than testosterone, but notice that it was T that was affected more than E in the above study. (For other ways to affect your proportion of T to E, see my Natural Ways to Improve Your Testosterone-to-Estrogen Ratio link.
Some of the more forward thinking doctors are now prescribing Arimidex in conjunction with HCG. HCG, of course, stimulates the testes to produce testosterone and is used primarily to avoid testicular shrinkage, but it can also cause estradiol problems downstream. One of the more famous “internet hormone doctors” is Dr. Eugene Shippen and one of our Peak Testosterone posters went to him. Dr. Shippen’s overall protocol for this man, whose testosterone was 296 ng/dl, was as follows:
“He sent back a letter and a prescription for Clomid. (for 7 day stimulation test) My results showed I had Secondary Hypogonadism. My T had risen to 541, My E2=47, and DHEA was below the bottom of normal and D3 was low. On May 30th I went to Pa. to meet with him, he spent over 2 hours going over all my test results and did a physical that included a prostate check. He order[ed] the following meds: HGC, Arimidex, and 25mg DHEA oral supplement. I must have a followup blood test in 3 weeks for T, E2, and DHEA-S. Then in 6 weeks a full blood workup for Endocrine testing. He wants me to take D3 4000mg daily and drink Pomergranate juice plus Vit. C 1000mg.” 
Of course, in this case Arimidex was used in conjunction with HCG, but it is also often used by itself. Look at what one of the men on the Peak Testosterone Forum experienced:
“Having said that, Arimidex has done wonders for me in the 2 months i’ve been taking it, and my E2 was only 48 after a few months on hcg. the doc prescribed me 0.5mg ED, which is higher than what most people I read about on msg boards take. I tried that at first, felt nothing for about 10 days, then all of a sudden I started waking up with the biggest erections I had experienced in many years. and libido came back and now I think about sex all the time. just the hcg alone wasnt doing it for me even though it did raise my T levels. i have now cut back to 0.5mg EOD, which is still higher than most people seem to take, but it seems to be working for me. I read a comment on another more steroid oriented forum where a guy was saying to calibrate the Arimidex dosage based on morning wood, because if it gets too low you wont have it, but if it’s just right it will be huge and powerful.” 
NOTE: Arimidex is not the only way to clinically lower estradiol. There are other aromatase inhibitors, such as letrozole (Femara), for example. There are also irreversible aromatase inhibitors. See my page Suicide Inhibitors for some background information.
Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..
Arimidex also has a big advantage for younger men wanting to possibly have kids: it does a much job at preserving fertility than traditional testosterone therapy. Classic HRT (Hormone Replacement Therapy) will generally significantly decrease fertility, making childbearing difficult to impossible. In fact, the new 6-week testosterone therapy injectable, Nebido, is actually being used as a quasi-contraceptive by some men. And there is considerable research going on to find the best way to use HRT to achive a reliable male contraceptive. One research summary even wrote that “current hormonal combinations completely suppress spermatogenesis without severe side-effects in 80 90% of men, with significant suppression in the remainder of individuals. Recent trials with newer, long-acting forms of testosterone combined with progestogens have yielded promising results and may soon result in the marketing of a safe, reversible and effective hormonal contraceptive for men..” 
The aromatase inhibitors (AI’s) can sometimes bypass that concern. (Confirm with your doctor, of course.) In fact, Arimidex will actually improve some fertility parameters. One recent study looked at Arimidex and found that, besides delivering a nice boost in testosterone, FSH was largely unchanged and sperm density was increased by 78%.  For these reasons, fertility doctors will sometimes use Arimidex to treat male fertility issues. For example, you might be started on Clomid for a few months and, if your testosterone is too high, Arimidex (anastrozole) may be prescribed in combination. Or some men are started with both immediately and then monitored. Again, I’m not a big fan of Arimidex due to the above four concerns, but some physicians do make use of it.
These types of fertility treatments for men are much more common than generally realized: male fertility is probably impacting up to a fourth of all troubled pregnancies. Fertility doctors also tend to be much more cutting edge when it comes to boosting testosterone than many traditional doctors, such as urologists, endocrinologists and primary care physicians. Why? Fertility specialists have been treating men for over a decade with alternative treatments and are interested in preserving libido, which requires good testosterone levels, along with boosting sperm parameters. Thus, they have on average built up a lot more experience than most other specialities.
However, I should point out that some physicians are now using low dose HCG in conjunction with testosterone therapy in order to maintain fertility. For those interested, see a fertility specialist familiar with Dr. Lipschultz’s work. 
When I first started cypionate injections at an HRT clinic, they put me on low Arimidex just a couple of months later. This really surprised me, because I really did not want to have to “medicate my TRT.” The argued that the dose was very low compared to, say, a cancer patient, and it has no real side effects when done properly, i.e. estradiol is not sent overly low.
So for a few months I took .5 mg twice a week. I then pushed them to let me lower it to .25 mg twice per week. Both of these doses are pretty common for men on testosterone, and I see it quite often on the Peak Testosterone Forum. But I did everything in my power to get off of Arimidex and used a threefold approach to actually accomplish the task:
- 1. Lower Your Dosage. I lowered my dosage of testosterone cypionate to 100 mg/week.
- 2. Lower Your Body Fat %. I have worked on getting my body fat down from around 15% to around 10.5% (per my Tanita bioimpedance scale).
- 3. More Frequent Injecting. 2 X / week (subQ) injections with a target testosterone level that is not too high. (This does not apply if you are doing topicals / transdermals.
This allowed me to get off of Arimidex completely. My testosterone levels are still very solid and in the 700-800 ng/dl range. And in my opinion almost every guy on TRT should endeavor to do the same, because this will generally be more physiological, or natural. Plus, the cautions and risks cited above for Arimidex Monotherapy also apply here as well.
Of course, Arimidex is often used by steroid users to decrease over-aromatization from driving their testosterone into supraphysiological zones, i.e. way above normal, which in turn leads to elevated estradiol. They aslo use it post-cycle period when they are desperately trying to get their testosterone jumpstarted – sometimes unsucccessfully I might add. As strange and annoying as this is, steroid users and fertility doctors were some of the early pioneers of Armidex usage.
CAUTIONS: However, Arimidex is not something that should be used unless it is under a doctor’s supervision, primarily because estradiol, the E2 estrogen, needs to be monitored. One of the problem’s with Arimidex is that one can easily push estrogen levels too low. In the short term this can lead to joint pain. Scientists are not sure why, but, when estrogen gets too low on Armidex, the joints can begin to be very painful.
Even more dangerous, though, would be long term damage fromm overly low estrogen levels. Low E2 will eventually lead to bone mass loss, i.e. osteopenia and ultimately osteoporosis. See my link on Why Men Need Estrogen for more details.
Arimidex can also negatively effect libido. The thinking is that if estradiol gets driven too low that sex drive goes with it. Again, estrogen in males has a fairly tight therapeutic range with too much or little decreasing sexual desire. (It can also send libido thorugh the roof!)
3) Clin Endocrinology, 2009, vol. 70(1)”116-123, “Effects of aromatase inhibition in hypogonadal older men : a randomized, double-blind, placebo-controlled trial”
4) https://hrt-rx.com/2012/06/05/ arimidex-vs-femara-for-increasing-testosterone-in-men-hrt/
5) Fertility and Sterility, Jul 2012, 98(1):48-51, “Changes in hormonal profile and seminal parameters with use of aromatase inhibitors in management of infertile men with low testosterone to estradiol ratios”
6) Molecular and Cellular Endocrinology, 16 May 2006, 250(1-2):2-7, “Hormonal approaches to male contraception: Approaching reality”
7) The Journal of Urology, Feb 2002, 167(1):624-629, “AROMATASE INHIBITORS FOR MALE INFERTILITY”
8) J Sex Med, 2012 Jun, 9(6):1681-96, “Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency”
9) J Urol, 2013 Feb, 189(2):647-50, “Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy”