Aromatase inhibitors while on T?

[youngbuck]

After a couple rounds of recent blood work, my doctor has raised the possibility of putting me on an aromatase inhibitor because of persistently high estrogen levels. I've been experiencing some off and on spotting over the past several months, and while my testosterone is still solidly in the male range and everything else checks out, my estradiol has skyrocketed for no apparent reason. It's all quite frustrating since I've been on T for about 4.5 years with no issues until now, but it seems very likely I need blockers to resolve this problem. Does anyone here have any experience with using them, particularly while already on testosterone? (If it helps to be more specific, my doctor recommended arimidex.) I'm fine with doing what's necessary for my health and my sanity, but would appreciate some input because I don't know what, if anything, I should expect. Thanks, guys.

[FTMax]

You may want to edit the title. Estrogen blockers are not the same thing as aromatase inhibitors. Estrogen blockers are used during puberty to suppress the production of sex hormones until someone can get on hormones. Aromatase inhibitors suppress the the process of aromatization wherein excess testosterone is converted to estrogen in fat cells. Generally you wouldn't take an estrogen blocker at the same time as T, though some people do take them concurrently when they first start hormones. I have also never heard of an FTM needing to use an aromatase inhibitor.

The thing with T levels is that while the reference range is fairly broad, nobody can say for sure what the threshold is where your body will start converting T to E. For some people it's really high, for some people it's really low. Personally I would consider reducing my T dose for a month and getting labs done to see how things look before I would add another medication.

You've been on T for 4.5 years, so it seems strange that your dose would suddenly not be right if your T and E levels had been right previously. Is anything different about you now? Have you gained weight? Have you had a hysterectomy with ovaries removed?

[youngbuck]

You may want to edit the title. Estrogen blockers are not the same thing as aromatase inhibitors. Estrogen blockers are used during puberty to suppress the production of sex hormones until someone can get on hormones. Aromatase inhibitors suppress the the process of aromatization wherein excess testosterone is converted to estrogen in fat cells. Generally you wouldn't take an estrogen blocker at the same time as T, though some people do take them concurrently when they first start hormones. I have also never heard of an FTM needing to use an aromatase inhibitor.

The thing with T levels is that while the reference range is fairly broad, nobody can say for sure what the threshold is where your body will start converting T to E. For some people it's really high, for some people it's really low. Personally I would consider reducing my T dose for a month and getting labs done to see how things look before I would add another medication.

You've been on T for 4.5 years, so it seems strange that your dose would suddenly not be right if your T and E levels had been right previously. Is anything different about you now? Have you gained weight? Have you had a hysterectomy with ovaries removed?

Thanks for the suggestion; edited the title to be more clear.

I'm actually currently on a trial run of a lower dose to see if that resolves the problem on its own, but I have my doubts. My doctor lowered my dose last summer and it resulted in my T levels crashing for a few months, so I've been sort of working my way back to my previous baseline ever since. That's the only reason I can think of that my E levels would be so elevated, because nothing else has changed -- no surgeries, weight gain, etc. It's also why I worry that lowering my dose won't help, since that's kind of what got me in this position in the first place. I'm pretty sure I need to remain within a certain dosage range to keep my T levels up, but why that's not suppressing the estrogen by itself anymore is anyone's guess.

My doctor did say that many trans men don't get their E levels checked often or at all, and he believes more guys may need inhibitors than they realize to be transitioning safely and effectively. (I also wouldn't be the first patient of his to use them.) I thought it was an interesting point of view.