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On the matter of timing of dosing for an AI

Discussion in 'Random Thoughts from Dr. John' started by Dr. John Crisler, Dec 19, 2014.

  1. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Aromatase Inhibitors (AI) help prevent the conversion of testosterone to estrogen. As you would expect, as T levels rise, more E is subsequently produced. We must give some thought to the timing of the AI compared to the administration of the TRT. And the form of TRT you use.

    For Arimidex (anastrazole), just figure it's good for two days.

    If you are using a T gel, more consistent administration of the AI is necessary, because you must apply the gel every day. For shots, it's a different story.

    When do you feel the estrogen, compared to when you take your shot? The T shot peaks in about 48 hours. That would then be when you want the AI doing its best work as well. OTOH, there is something about rising estrogen levels which bothers many men, so they need to take their AI at the same time as their shot.

    As always, every-body is different.

    Even though the anastrazole is pretty much worn off by the third day, some guys only have E issues right after their shots. So they may take the AI sometime around their shot (same day, day after, whatever they have found works best for them). So it may be only once per week.

    For those on twice per week split dose regimens (which tends to lower E anyway), they might take their pill each time they have a shot.

    Then there is the interplay of the SHBG in all this, as always. More on that later.

    Just knowing what your options are is a big help; this is why the assistance of a properly trained medical professional is necessary for so many.
     
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  2. pmgamer18

    pmgamer18 Prince of the Forums

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    Dr. John,

    Thank you for this post it's been long over due.
     
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  3. BadassBlues

    BadassBlues Super Moderator Staff Member Super Moderator

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    This has the potential of becoming a permanent thread as this is one of the most frequently asked questions on this forum. Great post Doc...
     
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  4. KYinchampaign

    KYinchampaign Member

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    Hello Dr. Crisler.

    I've noticed over the years that you have continually (with good reason I'm speculating) mentioned Arimidex as part of E2 control.

    Is there reason you prefer Arimidex over other AI's?

    Thanks
     
  5. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Good question.

    It is a competitive inhibitor, is more available around the country.....and I am used to it.
     
  6. bgnb

    bgnb Active Member

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    Dr. Crisler, regarding gels and AI's -- can you comment on the idea of splitting Androgel doses (eg: 4 pumps a.m. and 4 pumps p.m.) and the potential effect on estradiol levels?
     
  7. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Sure. Splitting the dose lowers estrogen.
     
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  8. PLatinum46

    PLatinum46 New Member

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    Thoughts about timing of an AI and HCG monotherapy? I tried .25mg twice a week after my EOD HCG regimen which only brought down my e2 by about 10 or so. Now I'm lowering my HCG dose in hopes to get my e2 under control.
     
  9. torrential

    torrential Member

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    PLat, in another thread you mentioned the anastrozole you are taking is in troche form. Is that still the case, and if so...why?
     
  10. PLatinum46

    PLatinum46 New Member

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    Hey Torrential, yes you are correct. It was suggested to me by my doctor. I did some research on Anastrozole in general and assumed that was the regular way it was prescribed. Less beneficial?

    Also, I stopped taking it about a month ago. I was experiencing a lot of anxiety and blamed it on that. But since my last labs I'm considering taking it again for a short time to lower e2 while also lowering my HCG dose.
     
  11. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    You will probably need to take the AI at intervals less than twice per week.
     
  12. PLatinum46

    PLatinum46 New Member

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    Thanks Doc,I will try taking the adex once a week and see if that helps. Do you think since I'll be taking less I should raise the dose then? Instead of .20mg maybe take two (.40mg)?
     
  13. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    "Intervals less than twice per week" means more doses each week.
     
  14. PLatinum46

    PLatinum46 New Member

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    I'm sorry but could you clarify what you mean?
     
  15. JanSz

    JanSz Well-Known Member

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    To describe amount of medicine one is taking, one can think of amount over time.
    Amount is usually described as mg, ml, iu, mcg, (weight, volume, or units, eventually all must be converted to volume if dealing with injections)
    Time is described as once per:
    month, day, (EOD, every other day), (E3D, every three days), (2x/week, twice weekly)

    When changing protocol it is useful to think of average dose per week.
    Sometimes we want to take same amount on average but at different intervals.
    Example: someone is taking testosterone, 200mg injections once every two weeks
    so he is taking on average 100mg/week
    doctor may decide to tell him to change to 100mg shots once per week, that will not change his average dose, but will change how he will respond to new protocol,
    or
    he may tell him to inject 50mg twice per week, same story
    but
    he may tell him to inject 30mg EOD
    that is 30*7/2=105
    now his dosing is not only more frequent but also his average weekly dose got little higher
    ---------------------
    If you would observe our discussions for the last say 10 years, you would note that
    average doses are tending to either stay the same or getting smaller
    frequency of delivery is raising

    If one deals with injections, less frequent injections mean larger volumes.
    To deliver larger volumes one needs large and long needles (to keep the stuff inside and prevent it from leaking out).
    Someone who enter the world of injections can put up with infrequent large injections.
    Then,
    when he is advised to use smaller volumes more frequently, at the beginning the tendency is to use same hardware, same large long needles.
    All kind of reasoning is employed why that is the right way to go.
    Doctors often think of patient's compliance, breaking old habits may be too much change for some. There is also peer pressure.
    After 10+ years it sink in that it is ok to use the smallest needles and smallest syringes.
    We are not there yet.
    At this time 29Ga 1/2" long needles are favorites.
    But I use 31Ga 5/16" since 6/2007 and smalest available 3/10cc syringe.

    Not many people like injecting them selves. Less injections is better.
    Some people do many injections, so far that means lots of poking thru skin.
    testosterone(oil), HCG, GHRP, GHRH, MT2, vitB12 (water) all that adds up.

    Using very tiny needle the worst part is to fill up syringe with testosterone oil.
    That can be done in spare time in batches of 20-40 syringes. They can be stored at room temp.
    At the time of the injection draw peptides, shake the syringe and instead of many injections there is only one.

    Insulin syringes are made in sizes 3/10cc, 1/2cc, 1cc.

    .

    ////
     
    Last edited: Mar 18, 2015
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  16. MarkLA

    MarkLA Member

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    Dr. John,

    After making a change in AI dosing, how long do you usually wait for E2 to stabilize before having the patient do followup labs?

    Thanks,
    MarkLA
     
  17. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    At least a month, Mark.

    It takes a while for the medication to work its way deep into the tissues, especially the brain (as you know, we talk more about how the patient feels than what his numbers on labs say).
     
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  18. KYinchampaign

    KYinchampaign Member

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    Speaking of tissue.

    Dr. Crisler. Is there any area that you may know of that an aromatase inhibitor may not permeate; i.e, Accessory organs, accessory and endocrine glands, peripheral tissue?

    Thanks
    Kirk
     
    Last edited: Jun 8, 2015
  19. SuckarMycket

    SuckarMycket Member

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    I have the unfortunate to be on nebido currently every 6 weeks but about to move down to 5 week between injections and i have found that even if anastrazole is only active for a few days the effects of it remains longer especially at the end of an injection when total testosterone is 400ng/dl, the first 2 weeks a minimum of 0.25mg twice a week is needed but the last 2 weeks may require 0.25mg sometimes even less.

    1 year ago i was on 12 weeks injections, 10 days after injection estradiol was 49.58 pg/ml, due to how public healthcare works over here(sweden) its the only test i have and it was sensitive, however the laboratory says its not meant for men and may not be accurate.
    A couple of months ago i used the lowest possible dose of anastrazole and during a 6 week period i used 3mg, closer injections have reduced the need of anastrazole.

    However trying a new way of taking anastrazole, i put one pill in a syringe and then draw up alcohol for a total volume of 2ml so i can take smaller doses several times a week, i have noticed i tend to get more pain in my body especially lower back when i take 0.25mg doses so hoping more steady levels of estradiol will make me feel better, i just started so dont know yet how good it works.
     
  20. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    But we want it to.
     

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