Should I take an estrogen blocker with testosterone?
Testosterone replacement therapy aims to raise testosterone levels in men back to normal, healthy ranges when levels have dropped due to age or other factors. However, increases in testosterone can cause a corresponding increase in estrogen levels due to an enzyme called aromatase that converts testosterone to estrogen. This can lead to side effects like gynecomastia, fluid retention, and mood problems.
Many men taking testosterone therapy also take an estrogen blocker or aromatase inhibitor to prevent these high estrogen side effects. Some key points about combining testosterone and an estrogen blocker:
- Estrogen blockers prevent testosterone from being converted to estrogen. Popular options are aromatase inhibitors like anastrozole and exemestane.
- Taking an estrogen blocker can help minimize side effects like gynecomastia and fluid retention that higher estrogen levels cause.
- Bloodwork is important to dial in your doses - check testosterone, estrogen, red blood cell counts, and other hormones to ensure levels are optimal.
- Some men do well on testosterone therapy alone, while others need the addition of an estrogen blocker to feel their best. Pay attention to symptoms and get labwork done to determine if you need extra estrogen suppression or not.
- Potential side effects of estrogen blockers include joint pain, headaches, loss of libido, and reduced bone mineral density with long term use. Rotate time on/off these medications with your doctor’s guidance.
- CYP3A4 inhibitors like ketoconazole and ritonavir can slow the breakdown of steroids and cause high estrogen symptoms - avoid combining these drugs. Grapefruit juice should also be avoided.
- Dose adjustments are often needed - start low, get follow up bloodwork done, and slowly increase doses of testosterone and/or the estrogen blocker to reach ideal hormone levels.
- Once dialed in, recheck hormone levels at least twice a year while on this combination of medications. As we age, dose requirements can change.
Key Considerations
There are a few important factors to weigh when deciding whether to add an estrogen blocker to your testosterone replacement:
- Your current symptoms - are you experiencing side effects like spicy nipples, itchy breasts, fluid retention, or emotional issues that may be signs of high estrogen? These would warrant trying an estrogen blocker.
- Blood test results - what is your current total and free testosterone, estradiol, and other hormone levels? Hard labwork evidence is key for determining if estrogen suppression is needed.
- Your risk tolerance for side effects - do potential side effects like joint ache or reduced bone density concern you? Weigh pros and cons.
- Convenience factors - the need for additional medication and more frequent lab monitoring may influence your decision.
- Cost - estrogen blockers often have high out-of-pocket costs, especially newer ones like anastrozole and exemestane. Check your coverage.
- Your doctor’s guidance - your physician’s input is invaluable; have an open discussion about whether adding an estrogen blocker aligns with your health goals on TRT.
Who Should Consider an Estrogen Blocker?
You may benefit from adding an estrogen blocker like aromasin, arimidex, or AIs if:
- You have high estradiol levels on your labwork.
- You develop gynecomastia - male breast tissue growth.
- You retain fluid, get puffy nipples/breasts, have erectile issues, or other high estrogen signs while on TRT.
- Your doctor recommends it to help optimize your hormone profile.
- You wish to maximize muscle growth with higher testosterone levels.
First get follow up bloodwork done 4-8 weeks after starting testosterone therapy. If estrogen is elevated, try reducing your T dose first before adding another med.
Example Regimens
- 100-150 mg/week testosterone cypionate or enanthate injections 0.25 mg anastrozole twice weekly.
- 180-200 mg/week testosterone cypionate or enanthate 0.5 mg/twice weekly exemestane.
- 6 mg testosterone gel daily 1 mg anastrozole once daily
- Testosterone pellet implants every 4 months arimidex during weeks 5-12 post-implant.
Again, bloodwork is critical for first dialing in and then continually monitoring this stack of medications. Adjust AI dosing up or down to keep estradiol optimal on labwork.
