During cycle, does an AI/SERM help facilitate recovery?

[Michael Scally MD]

A bit of a sidestep. Did someone ask about the use of AI during the cycle to help decrease HPTA negative feedback?

I would like to hear some thoughts before chiming in. Thanks.

 

[ApeShitFuckJacked]

I asked about AI during pct. Would it be a worthwhile addition considering it is just another mechanism that lowers negative feedback of e2?

 

[Mike Oxbig]

I don't see much value in worrying about the estrogen negative feedback loop when you're already being suppressed by androgens. It doesn't seem to become relevant until you start PCT.

 

[Michael Scally MD]

I asked about AI during pct. Would it be a worthwhile addition considering it is just another mechanism that lowers negative feedback of e2?

An AI could absolutely be part of PCT. i have some theoretical considerations for not including an AI, but the data would be the key.

 

[Michael Scally MD]

I don't see much value in worrying about the estrogen negative feedback loop when you're already being suppressed by androgens. It doesn't seem to become relevant until you start PCT.

My thoughts exactly, but since E2 is stated to be on a molar basis 200X more effective at negative feedback would it be of use to facilitate PCT.

I do not think that one could observe gonadotropin changes in a typical AAS cycle, but that does not preclude a diminished negative feedback. The question is if this translates into an "easier" PCT. One could conceivably have a trial but that would be difficult, but possible. I do have a single TRT trial that I posted months ago that I need to retrieve.

 

[tacohuman]

An AI could absolutely be part of PCT. i have some theoretical considerations for not including an AI, but the data would be the key.

What dosage/AI would you recommend when including an AI in pct? I might try it for my second, that way I have labs from the first to make a comparison.

 

[Michael Scally MD]

I need to pull up the paper and upload any figures/tables. I would like to see confirmation in one way or another by someone else. While this is on TRT, it does show an effect. On a cycle, there should theoretically be an effect but not observable with these endpoints.

Mechlin CW, Frankel J, McCullough A. Coadministration of Anastrozole Sustains Therapeutic Testosterone Levels in Hypogonadal Men Undergoing Testosterone Pellet Insertion. The Journal of Sexual Medicine. Coadministration of Anastrozole Sustains Therapeutic Testosterone Levels in Hypogonadal Men Undergoing Testosterone Pellet Insertion - Mechlin - 2013 - The Journal of Sexual Medicine - Wiley Online Library

Introduction - Current U.S. Food and Drug Administration–approved therapies for hypogonadism involve testosterone (T) replacement. Testosterone pellets (TP) require a minor office procedure every 3 to 4 months. The need for repeated insertions increases the likelihood of a complication. Anastrozole (AZ) is an aromatase inhibitor that has been used off-label for the treatment of male hypogonadism. AZ increases T levels by lowering serum estradiol (E2) levels and increasing gonadotropin (GTP) levels.

Aim - We hypothesized that the concomitant use of AZ with TP insertions would sustain therapeutic T levels and increase the interval between TP insertions.

Methods - Men treated with TP for hypogonadism at an academic center were offered AZ (1?mg/day) at the time of TP reinsertion as a way of potentially decreasing the frequency of TP insertions. Total T (TT), free T (FT), sex hormone binding globulin, E2, luteinizing hormone (LH), and follicle-stimulating hormone FSH levels were obtained prior to T replacement and at 6 and 15 weeks from TP insertion. Men were re-implanted at 16 weeks if their TT levels were less than 350?ng/dL and their symptoms recurred. We retrospectively reviewed our records of men who underwent TP, TP, and AZ from 2011 to 2012. Demographics, TT, FT, LH, FSH, and E2 levels were recorded. Data were analyzed with anova and a Tukey's test.

Main Outcome Measure - TT level at 6, 15, or >15 weeks from TP insertion.

Results - Thirty-eight men with 65 insertions were analyzed. The TP AZ group had significantly higher TT and FT levels than the TP group at >120 days (P?<?0.05). The TP group had significantly higher E2 levels at all time points (P?<?0.01). GTP levels remained stable in the TP AZ group. Average time to reinsertion in TP AZ was 198 days vs. 128 days in the TP group.

Conclusion - Men on TP AZ maintain therapeutic T levels longer than men on TP alone and have significantly less GTP suppression.

 

[Michael Scally MD]

LH levels were significantly lower in the TP than the TP AZ group (P < 0.01) (A).
FSH levels were significantly higher with anastrozole compared with TP alone (P < 0.01) (B).
Estradiol levels were significantly higher in the TP group than TP AZ treatment at all time points (P < 0.05) (C).

 

[Burrr]

I was expecting to see an increase of Test in the users with adex at the 180 day mark, but was surprised that it showed increase during days 1-60. That would mean that the added test was endogenous, right? Interesting that when you would expect hpta to be shut down from the test pellets, that the adex lead to higher LH and FSH production. Pretty strong argument for using an AI during cycle, and during PCT

 

[ApeShitFuckJacked]

I was expecting to see an increase of Test in the users with adex at the 180 day mark, but was surprised that it showed increase during days 1-60. That would mean that the added test was endogenous, right? Interesting that when you would expect hpta to be shut down from the test pellets, that the adex lead to higher LH and FSH production. Pretty strong argument for using an AI during cycle, and during PCT

Unfortunately I do not believe an AI will have anywhere near this effect on LH levels during an AAS cycle.

If you notice the TT levels were barely in TRT range, 500ng/dl. If TT levels would have been 5000ng/dl I highly doubt less negative e2 feedback would be enough to combat the extreme extent of negative androgen feedback.

This is a good study for use of an AI during TRT treatment and PCT.

Not necessarily applicable to an AAS cycle used by body builders or strength athletes IMO. That is not to say I don't believe you should control e2 for other reasons.

What do you think Dr.?