The anastrozole debate — are 70% of TRT doctors prescribing a harmful drug?
So I’ve been on TRT for about 6 months now (150mg/week) and my doc immediately put me on anastrozole 0.5mg twice a week to “control estrogen.” I’ve been feeling pretty off lately – achy joints, low libido (ironic right?), and just generally blah. Started doing some research and holy crap, apparently like 70% of TRT doctors are prescribing AIs when most guys don’t even need them? I got my estradiol tested and it’s at 18 pg/mL which from what I’m reading is actually TOO LOW for a guy. Apparently estrogen is actually important for men – bone health, libido, cardiovascular function, the whole nine yards. Now I’m reading all these stories about guys who stopped their AI and felt way better within weeks. My doctor seems to be from the old school of thought that any E2 over 30 is dangerous, but newer research suggests that’s complete BS. Has anyone else dealt with this? Did your doc put you on an AI automatically? I’m thinking about stopping it but obviously want to hear other experiences first.
Dude YES. I went through the exact same thing. My first TRT doc had me on arimidex from day one and I felt like absolute garbage for months. Joints hurt, couldn’t sleep, dick didn’t work despite having “optimal” testosterone levels. Finally switched doctors and the new guy was like “why are you even taking this?” Stopped the AI and within 3 weeks I felt like a new person. My E2 went up to 45 and I feel amazing. The old guard definitely overprescribes this stuff because they’re terrified of estrogen.
The issue is that a lot of docs still use really outdated reference ranges for estradiol in men. They’re literally using the same ranges they’d use for post-menopausal women which makes zero sense. Recent studies show that E2 in the 20-40 range is actually on the lower end for men on TRT, and some guys feel best in the 40-60 range. That said, SOME guys do aromatize heavily and genuinely need a small dose of AI. But yeah, prescribing it prophylactically without even checking labs first is terrible practice imo. Mike’s experience above is super common unfortunately.
I’m gonna offer a different perspective here – I actually DO need my anastrozole. I’m 38M and I aromatize like crazy, even on just 120mg/week my E2 shot up to 78 and I had legit symptoms (water retention, emotional, nipple sensitivity). With 0.25mg twice weekly I sit around 35-40 and feel great. So I think the real answer is it depends on the individual. The problem isn’t the drug itself, it’s doctors prescribing it without testing first and then never retesting to see if it’s actually needed. Def talk to your doc about stopping it temporarily and retesting in 4-6 weeks to see where you land naturally.