How to Raise Testosterone with Arimidex Awhile back, I discussed how I decided to raise my testosterone level and how I did it. Basically, my doctor prescribed me anastrozole (trade name Arimidex), an aromatase inhibitor which lowers estradiol, a form of estrogen. Estrogen feeds back negatively on luteinizing hormone (LH), the main stimulant of testosterone production. By lowering estradiol, feedback inhibition is decreased, LH goes up, and more testosterone is produced. The synthesis of androgens, the class of male sex steroids that includes testosterone, goes like this:
By inhibiting aromatase, less testosterone is converted to estrogens, including estradiol. It s important to get your hormone levels checked relatively regularly, since driving estradiol down too far with an aromatase inhibitor is undesirable, even in men. So I got it rechecked as part of my annual doctor visit. Following are my test results: Results were good, right about where they should be. According to this study, men with an average age of 55 had an average testosterone level of 520, and at age 63, T was 420, quite a drop. My level of 985 is probably in the upper range of normal even for a young man. Of interest, doctors are supposed to see a patient at least annually when
they re prescribing just about any drug at all. But my doctor told me that anastrozole falls under the radar of regulators they don t care much. He told me that if he had prescribed me testosterone itself, for testosterone replacement therapy (TRT), then regulators would definitely be watching. Ironic, because women regularly get all the female hormones they need whenever necessary. A defense of putting testosterone supplementation on a list of scheduled (highly regulated) drugs is that it can change behavior, and allegedly has a possibility of being abused. Yet female hormones change behavior too and they are not scheduled. The lesson I draw from that is that society has a low opinion of male behavior, but no problem with female behavior. As further evidence of that idea, boys in school regularly get drugged with other scheduled drugs like Ritalin or amphetamines. I don t know how many doctors would prescribe anastrozole, possibly not many, but getting a doc to prescribe it may be easier and cheaper than getting one to prescribe TRT. That s especially if your T level is not obviously low. Mine was 575 before I started, which is well within the normal range. Age may make a difference to getting a scrip too. A man with a T level of 575 who was a lot younger than me would likely have a worse chance of getting a doctor to prescribe a testosterone-boosting drug. Furthermore, older men tend to have higher estradiol levels; if your estradiol level is already within the normal range, then there s no possibility of lowering it further in order to boost testosterone. Obese men often have higher estradiol, as fat tissue seems to lead to more aromatase activity and more testosterone is converted to female hormones. So, an overweight or obese man interested in this line of testosterone-boosting could have his estradiol checked and, if high, could see a doctor about getting anastrozole or another aromatase inhibitor. To get TRT, one often has to visit an expensive male hormone clinic or antiaging clinic, and then you have to pay for the medications. Anastrozole costs me $4.00 a month. However, I do pay out-of-pocket for my doctor visits and tests, since he doesn t take insurance. Insurance companies are not only an administrative pain-in-the-neck for doctors, they limit what the doctor can do for his patients by limiting what they will pay for. I ve had some good body composition changes lately. I had been eating more than enough in an attempt to increase muscle mass, but it looked as if the only thing that was doing was increasing my fat mass. Over about two months, I dropped 10 pounds, from 170 to 160, all of it fat, using intermittent fasting. (I know it was all fat because I continued lifting throughout my weight loss, and the weights of my lifts actually increased. I continue to fast regularly.) But, how much of that may be due to higher testosterone, I don t know. Hopefully the good changes will continue.
PS: Check out my Supplements Buying Guide for Men. Aromatase inhibitors, doctors, & me Anastrozole (trade name Arimidex), best aromatase inhibitor for men? Testosterone Replacement Therapy Here s the story of what I think is the best aromatase inhibitor and my experience with it. Awhile back, I read a post at Danger and Play on testosterone replacement therapy (TRT). While I wasn t terribly interested in injecting myself with
testosterone once a week or even more often, the take-home message I got from that post is this: why would you let anyone else s opinion on TRT influence your course of action? Sure, if there are health risks to TRT and someone knows better than me, I m always ready to listen, but most of the objections to TRT that I ve seen are moralistic, to the effect that you shouldn t take T because it isn t natural or something like that. Apparently you should just be satisfied with getting older, losing your muscle or your sex drive, becoming weak, in general just fading away, all because someone somewhere doesn t like the idea of boosting testosterone. But I decided that that was all hogwash. The reasons that I wasn t terribly interested in TRT as far as injections went were two. One, while I m nearly 60 years old, my T levels were not so bad, having been measured at 575 a couple years back. I can probably credit that to a decent diet (low-carb paleo) and my weightlifting habit. The second reason is the expense: unless one is willing to go the illegal or semi-legal routes, you ve got to pay for a doctor (unless insurance covers that, more on this below), as well as the T itself. The doctor is by far the biggest expense; if you re paying cash out of pocket, and going to a doc you ve never seen before, then you re talking hundreds of dollars just to get going, besides all the hassle of appointments and so on. Nevertheless, I thought boosting my T levels might be a good thing to do. I already had a doctor of longstanding who helped me with chronic fatigue syndrome. He s a cash only doctor, doesn t take insurance, but I saw and paid him willingly for years because the other doctors I d seen for my fatigue were not much use. Even though I ve recovered from my chronic fatigue, I still occasionally see him, and so I emailed him and asked whether, at a T level of 575, he considered me a candidate for TRT. Most doctors would not, I think, even consider TRT for a man with a T level that high. Testosterone is listed as a Schedule 3 drug, which means it s considered to have a potential for abuse, and is therefore tightly controlled. Doctors can come in for extra scrutiny when they prescribe too many controlled drugs, and I think this accounts for the reluctance of many doctors to do so. An aromatase inhibitor My own doctor shot back with a suggestion: an aromatase inhibitor. Aromatase inhibitors work to boost T by decreasing the production of estrogens, especially estradiol, the most potent estrogen. Since estradiol feeds back on natural T production, inhibiting it, lowering estradiol levels results in an increase in T. My estradiol level at the last reading had been 70, higher than the upper limit of normal for men. Why that was I don t know, but estradiol levels increase with age in men, so maybe that was all there was to it. So my doctor prescribed me anastrozole, the most commonly used aromatase inhibitor. Anastrozole, also known by the trade name of Arimidex, is generic and cheap: I pay about twelve dollars for a three month supply. The dosage is
one-half milligram twice a week, which is quite low. Estradiol is necessary even in men, with things like bone composition depending on it, so you don t want to drive it too low or abolish it altogether. I noticed a difference shortly after starting to take it. For one thing, my exercise recovery appears a lot better. I used to need a solid three days off between weight sessions in order to recover fully; now I need only two. I haven t gained any weight, but I d say my body composition is better: a bit leaner, a bit more muscle. (I can t seem to gain weight to save my life at this point.) And, yes, my sex drive increased noticeably. Last time my T level was measured, it had increased to 700, a modest increase of about 20%. In some studies, using higher doses of anastrozole and in low T men, T levels have increased as much as 50%, and free T levels even more. Probably my modest but noticeable results came about because I use a low dose and wasn t low T to begin with. However, my estradiol level decreased to 40, well within the normal range of a young man. This may also account for what I consider a successful result of the treatment. Doctors and the best aromatase inhibitor Reinforcing what I wrote above about doctors, I recently went to see a new doc, insurance-paid, for the first time, and told him I was taking an aromatase inhibitor, which I coyly said was to lower my estradiol levels. He said that he d never heard of it being used for that, and told me that I needed to see an endocrinologist, as he wasn t going to prescribe it for me. Hell with that, I thought. I went back to my old, cash-only doc, who had no problem renewing my prescription for anastrozole. I intend to keep taking it for some time to come. Who should consider taking an aromatase inhibitor? There s been a generational, secular decline in testosterone levels, which may be caused by environmental pollutants, endocrine disruptors, or obesity, or all of them together. Many men, even young men, have low T levels, and if this is caused by estrogens in the environment, an aromatase inhibitor might be just the thing. If you can t seem to get rid of that belly fat, or your exercise recovery doesn t seem right, this might be something to consider. As for older men, an aromatase inhibitor could help them too. The possible downsides seem low, anastrozole is cheap, and it may not be difficult to find a doc willing to prescribe it. PS: For more on raing T and building muscle, see my book, Muscle Up.
PPS: Check out my Supplements Buying Guide for Men. The FDA is coming after testosterone The U.S. Food and Drug Administration is currently reviewing whether to limit testosterone replacement therapy (TRT) to certain narrowly defined conditions. See: Will the FDA Tighten the Use of Testosterone Replacement Therapy? Knowing how the FDA works on these things, it s a good bet that restriction of TRT will be the order of the day. Ironic or hypocritical it is that estrogen-related hormones are handed out to women like candy. But men face high scrutiny when asking for TRT. Let s call it the War on Men. But that s neither here nor there, since there s nothing we can do about it. If you need TRT, whether due to age or some other reason, count on facing extra scrutiny from your doctor. Although the FDA ruling may only affect drug companies ability to advertize testosterone, and not your doctor s ability to prescribe it, you can bet that doctors will be extra wary about it with the possibility of the FDA or state boards breathing down their necks. I would say that this gives extra impetus to the use of aromatase inhibitors, which I discussed both here and in my book. Aromatase inhibitors, such as anastrozole, can increase testosterone levels by 50 to 100%, and doctors will be more likely to prescribe them. Another aromatase inhibitor is diindolylmethane (DIM), an OTC supplement. However, I m not aware of any studies that showed an increase in T with DIM. (If any reader is aware of one, I d appreciate leaving a link in comments.)
Resveratrol is also an aromatase inhibitor, and in rats, it doubled sperm counts and T levels. Increasing testosterone by inhibiting aromatase Kindke has an interesting post on an easy way to increase testosterone, through inhibiting the enzyme aromatase. This enzyme is responsible for converting testosterone (T) into estradiol. In the study Kindke linked, T increased as much as 60% in healthy young men with normal T levels. That s pretty good. See charts below.
I looked for some other studies. Just so we can see whether the same effects hold in older men with low T, look at this one: Effects of Aromatase Inhibition in Elderly Men with Low or Borderline-Low Serum Testosterone Levels. As men age, serum testosterone levels decrease, a factor that may contribute to some aspects of age-related physiological deterioration. Although androgen replacement has been shown to have beneficial effects in frankly hypogonadal men, its use in elderly men with borderline hypogonadism is controversial. Furthermore, current testosterone replacement methods have important limitations. We investigated the ability of the orally administered aromatase inhibitor, anastrozole, to increase endogenous testosterone production in 37 elderly men (aged 62 74 yr) with screening serum testosterone levels less than 350 ng/dl. Subjects were randomized in a double-blind fashion to the following 12-wk oral regimens: group 1: anastrozole 1 mg daily (n = 12); group 2: anastrozole 1 mg twice weekly (n = 11); and group 3: placebo daily (n = 14). Hormone levels, quality of life (MOS Short-Form Health Survey), sexual function (International Index of Erectile Function), benign prostate hyperplasia severity (American Urological Association Symptom Index Score), prostate-specific antigen, and measures of safety were compared among groups. Mean ± SD bioavailable testosterone increased from 99 ± 31 to 207 ± 65 ng/dl in group 1 and from 115 ± 37 to 178 ± 55 ng/dl in group 2 (P < 0.001 vs. placebo for both groups and P = 0.054 group 1 vs.
group 2). Total testosterone levels increased from 343 ± 61 to 572 ± 139 ng/dl in group 1 and from 397 ± 106 to 520 ± 91 ng/dl in group 2 (P < 0.001 vs. placebo for both groups and P = 0.012 group 1 vs. group 2). Serum estradiol levels decreased from 26 ± 8 to 17 ± 6 pg/ml in group 1 and from 27 ± 8 to 17 ± 5 pg/ml in group 2 (P < 0.001 vs. placebo for both groups and P = NS group 1 vs. group 2). Serum LH levels increased from 5.1 ± 4.8 to 7.9 ± 6.5 U/liter and from 4.1 ± 1.6 to 7.2 ± 2.8 U/liter in groups 1 and 2, respectively (P = 0.007 group 1 vs. placebo, P = 0.003 group 2 vs. placebo, and P = NS group 1 vs. group 2). Scores for hematocrit, MOS Short-Form Health Survey, International Index of Erectile Function, and American Urological Association Symptom Index Score did not change. Serum prostate-specific antigen levels increased in group 2 only (1.7 ± 1.0 to 2.2 ± 1.5 ng/ml, P = 0.031, compared with placebo). These data demonstrate that aromatase inhibition increases serum bioavailable and total testosterone levels to the youthful normal range in older men with mild hypogonadism. Serum estradiol levels decrease modestly but remain within the normal male range. The physiological consequences of these changes remain to be determined. The older men in this study had a huge increase in T, more than double the level of free T in one group. These are very worthwhile results, comparable (I believe) to actual T supplementation. So, aromatase inhibitors work in both young, normal T level, and older, abnormal T level, men. Notable is that the aromatase inhibitor mentioned above, anastrozole, is now generic and fairly cheap. Don t know if it can be had from overseas pharmacies. Also, I posted the other day that resveratrol increases sperm counts and T levels in rats. The mechanism might very well be aromatase inhibition: The red wine polyphenol resveratrol displays bilevel inhibition on aromatase in breast cancer cells. Don t know what if any downside aromatase inhibitors have. It seems a whole lot easier to take them than to use injectable T or any other kind.