The Utilization and Impact of Aromatase Inhibitor Therapy in Men With Elevated Estradiol Levels on Testosterone Therapy

Anastrozole can be used as a comprehensive treatment in conjunction with testosterone replacement therapy to help prevent this unwanted symptom. By blocking the aromatization of testosterone, it prevents an excess of estrogen and therefore gynecomastia. In conclusion, there are many unsolved questions and gaps in our knowledge on human brain aromatase that remain to be explored by future research.

• In healthy male volunteers, anastrozole has been shown to increase adiposity, particularly in the intraabdominal compartment (13).
• Neoadjuvant antihormonal therapy with an AI is a particularly attractive option for postmenopausal women who wish to attempt breast conservation and have strongly ER- and PgR-positive tumours that are ≥ 3 cm and have low proliferation rates.
• Estrogen, although typically considered a female hormone, plays crucial roles in the male body.
• Regular blood tests every 4-6 weeks are recommended when starting TRT or adjusting your protocol.

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However, no beneficial effects were seen on muscle strength, body composition or quality-of-life scores. A similar increase of testosterone levels in the absence of effects on body composition and strength was reported in a study, in which elderly men with borderline low levels of serum testosterone were treated with anastrozole during 1 year 38. There is a number of possible explanations for the lack of a clear treatment effect.

How often should I check my estrogen levels on TRT?

Finally, for women completing 5 years of tamoxifen, extended adjuvant antihormonal therapy with letrozole has shown a reduced recurrence rate, particularly for node-positive patients. American Society of Clinical Oncology guidelines recommend that an AI be included in a woman’s adjuvant regimen if she has ER-positive and/or PgR-positive breast cancer. The decision to use AI as initial endocrine therapy, as opposed to switching to an AI after 2–3 years of tamoxifen therapy, is likely to be guided by the tumour characteristics. Patients who have ER-positive tumours with unfavourable characteristics, such as HER-2 positivity, PgR negativity or nodal positivity, are likely to be selected for immediate AI therapy. However, patients with ER-positive tumours without unfavourable characteristics are likely to be selected for tamoxifen treatment for 2–3 years before taking an AI for 2–3 years.

Consequently, men with high estrogen may experience numerous symptoms, one of which is gynecomastia, aka “man boobs.” Over the counter estrogen blockers are available as well in the form of nutritional supplements. They are not as effective as prescription drugs but can work well in some men and worth trying before a prescription aromatase inhibitor. The best way to ensure your protocol is working is by testing your estradiol levels every 4-6 weeks until your TRT is dialed in.

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Changes in gonadal steroid hormone levels, lower extremity strength, body composition (fat and muscle), lipid levels, prostate-specific antigen levels, and symptoms of urinary obstruction were all recorded at baseline and every 3 Post cycle therapy buy months thereafter. Aromatase inhibition could be an alternative to testosterone administration to mitigate declining androgen production in hypogonadal older men. Unlike testosterone replacement, aromatase inhibition lowers circulating estradiol levels, which potentially prevents adverse effects of testosterone supplementation.

Estrogens are likely to exert hemodynamic effects at both a central and peripheral level, potentially in a gender-specific manner, demanding a further detailed assessment of the consequences of aromatase inhibition. In a randomized, double-blind, placebo-controlled, cross-over study, we have shown that aromatase inhibition with anastrozole impairs insulin-stimulated peripheral glucose disposal, without affecting hepatic glucose production or lipolysis. An effect on the primary end point for the study was achieved despite recruiting 17 of a target 20 participants. Anastrozole was detected in plasma from all participants at the end of the active phase, ranging from 18.4 to 197.5 ng/mL (mean 59.9 ± 3.6 ng/mL) and not detected at the end of the placebo phase. However, this was a proof-of-concept trial that was designed to answer mechanistic questions and the sample size of this trial is larger than some other mechanistic studies (Pitteloud et al., 2005; Yialamas et al., 2007). Indeed, the findings of this trial will provide impetus for a larger trial with AI in older men.

The primary source of estrogen prior to menopause are the ovaries (not the peripheral conversion of androgens to estrogen by aromatase as in postmenopausal women). The present findings suggest that in men with hypogonadism, aromatase activity could be an important determinant of musculoskeletal health. Men with high aromatase activity are able to maintain a higher BMD despite low circulating testosterone, but they have lower lean and higher truncal fat mass as compared to those with lower aromatase activity.

Fulvestrant is also approved for postmenopausal women with HR-positive, HER2-negative locally advanced or metastatic breast cancer who have not previously been treated with hormone therapy (11). In addition, it may be used in premenopausal women who have had ovarian ablation. In general, natural and synthetic aromatase inhibitors are used to treat low testosterone levels, estrogen dominance, and gynecomastia. In postmenopausal women, these compounds are also used in the treatment and prevention of breast cancer.

It’s typically taken the day of or the day after their TRT dose if they’re on twice-weekly injections—one of the most common TRT regimens. Anastrozole, which comes in a pill form, allows your doctor to tweak your estrogen without touching your newly-optimized T levels. James R. Staheli, D.O., is the Medical Director for Broad Health, Hone Health’s affiliated medical practice, and a family medicine doctor, with a specialization in men’s hormone health.