Before you guys read the full discussion, check this study out (which is what the conversation is based off of):
http://jcem.endojournals.org/cgi/conten ... ct/86/1/53
Here's the first e-mail thread -- the Doctor's replies are in bold:
Dear Dr. Hayes,
Your article "Differential Regulation of Gonadotropin Secretion by
Testosterone in the Human Male: Absence of a Negative Feedback Effect of
Testosterone on Follicle-Stimulating Hormone Secretion" was very interesting, especially with respect to my situation.
I am a 21 year old man, who has been on finasteride (Propecia/Proscar) 1 mg/day for 3+ years (since I was 18) to combat male pattern baldness. After three full years on the drug, I decided to get my blood work done at your clinic as I was experiencing sexual problems. While my testosterone was in the upper end of the range (799 ng/dL -- range: 241-827), my estrogen was far above (212 pg/mL -- range: 40-115). The diagnosis was that the extra testosterone not converted into DHT by the finasteride was aromatizing into estrogen.
The internist here suggested that (since I wanted to keep the finasteride in
my regiment) to go on Arimidex (as in your study) at very low dosages. He suggested 0.50-1.0 mg/week (half that dosage taken twice a week) to bring my estrogen levels back into the normal range. However, he would not write a prescription for me, and so I purchased the Arimidex from an online pharmacy in Canada.
I understand that it is a very potent anti-cancer drug for post-menopausal
women. I do not want to baseline my estrogen levels, nor do I want to
continue with higher than normal levels.
1. My question to you, in light if your research, is 1 mg/week too much or
too little to return my estrogen levels within normal range? The best way to answer that question is to remeasure your estrogen levels on Arimidex. Also can you clarify if it was total estrogen, estradiol, or estrone that was found to be elevated in the past. Do you have any symptoms of estrogen excess such as breast enalrgement or tenderness? Were you evaluated for other potential casues of
high estrogen leels?
2. Also, Should I take it twice a week or every other day? Or a low dose
every day? I understand the plasma life is 30-60 hours, however, I do not
know what this means to effectiveness in the body. The recommendation for anastrozole isthat it be taken daily.
3. I have purchased a pill-cutter, but realize that some medications are not
dispersed evenly throughout the pill. Is this a known problem with Arimidex if I split the pill? Will the other half (that sits in the pill cutter until
I use it) lose its effect? No
4. With respect to your article, I understand that Arimidex's effect on FSH
should not interfere with finasteride's effect of retaining hair. Is this a
correct assumption? Yes
And the next e-mail thread is:
Dear Dr. Hayes,
Thank you very much for your quick response.
Here are my answers to your questions and some more inquiries if you do not mind:
>>Also can you clarify if it was total estrogen, estradiol, or estrone that
>>was found to be elevated in the past.
The number of 212 pg/mL was total estrogens. I do not have a breakdown of the number by different derivatives of estrogen. Do you recommend that I get this done? The total estrogen assay is unreliable and rarely done now. I would suggest getting measurement of estradiol instead.
>>Do you have any symptoms of estrogen excess such as breast >>enlargement or tenderness? Were you evaluated for other potential >>causes of high estrogen levels?
No, I do not have any real concrete side effect such as gyno. However, I
have noticed that my libido is down and sexual activity is not as
pleasureful as before. This is a primary concern of mine with the elevated
levels of estrogen, and I hope Arimidex can help in this regard. I was not
evaluated for other potential causes -- are there any in particular that I
should watch out for? The decrease in libido may be related to the reduction in DHT as opposed to an increase in estrogen so may or may not improve witrh Arimidex.
You mention that Arimidex should be taken daily. Since it is a rather
expensive drug, what dosage would be adequate to bring the total estrogen level down to the recommended range (40-115 pg/mL)? A number suggested by a doctor was between 0.50 mg and 1.0 mg per week. You recommend that I take the drug daily -- since the pill is quite small, how shall I cut the pill in such small doses? And what should those dosages be? As you are aware, it is not FDA approved for use in men. The dose that has been used in research studies has ranged from 1 to 10 mg/d. My feeling is that when you get your estradiol level measured it will not be elevated and Rx with Arimidex will not be indicated. Estrogen is important for maintaining bone mass in emn so that it is important to bear this in mind when taking drugs designed to suppress estrogen levels.
D.
http://jcem.endojournals.org/cgi/conten ... ct/86/1/53
Here's the first e-mail thread -- the Doctor's replies are in bold:
Dear Dr. Hayes,
Your article "Differential Regulation of Gonadotropin Secretion by
Testosterone in the Human Male: Absence of a Negative Feedback Effect of
Testosterone on Follicle-Stimulating Hormone Secretion" was very interesting, especially with respect to my situation.
I am a 21 year old man, who has been on finasteride (Propecia/Proscar) 1 mg/day for 3+ years (since I was 18) to combat male pattern baldness. After three full years on the drug, I decided to get my blood work done at your clinic as I was experiencing sexual problems. While my testosterone was in the upper end of the range (799 ng/dL -- range: 241-827), my estrogen was far above (212 pg/mL -- range: 40-115). The diagnosis was that the extra testosterone not converted into DHT by the finasteride was aromatizing into estrogen.
The internist here suggested that (since I wanted to keep the finasteride in
my regiment) to go on Arimidex (as in your study) at very low dosages. He suggested 0.50-1.0 mg/week (half that dosage taken twice a week) to bring my estrogen levels back into the normal range. However, he would not write a prescription for me, and so I purchased the Arimidex from an online pharmacy in Canada.
I understand that it is a very potent anti-cancer drug for post-menopausal
women. I do not want to baseline my estrogen levels, nor do I want to
continue with higher than normal levels.
1. My question to you, in light if your research, is 1 mg/week too much or
too little to return my estrogen levels within normal range? The best way to answer that question is to remeasure your estrogen levels on Arimidex. Also can you clarify if it was total estrogen, estradiol, or estrone that was found to be elevated in the past. Do you have any symptoms of estrogen excess such as breast enalrgement or tenderness? Were you evaluated for other potential casues of
high estrogen leels?
2. Also, Should I take it twice a week or every other day? Or a low dose
every day? I understand the plasma life is 30-60 hours, however, I do not
know what this means to effectiveness in the body. The recommendation for anastrozole isthat it be taken daily.
3. I have purchased a pill-cutter, but realize that some medications are not
dispersed evenly throughout the pill. Is this a known problem with Arimidex if I split the pill? Will the other half (that sits in the pill cutter until
I use it) lose its effect? No
4. With respect to your article, I understand that Arimidex's effect on FSH
should not interfere with finasteride's effect of retaining hair. Is this a
correct assumption? Yes
And the next e-mail thread is:
Dear Dr. Hayes,
Thank you very much for your quick response.
Here are my answers to your questions and some more inquiries if you do not mind:
>>Also can you clarify if it was total estrogen, estradiol, or estrone that
>>was found to be elevated in the past.
The number of 212 pg/mL was total estrogens. I do not have a breakdown of the number by different derivatives of estrogen. Do you recommend that I get this done? The total estrogen assay is unreliable and rarely done now. I would suggest getting measurement of estradiol instead.
>>Do you have any symptoms of estrogen excess such as breast >>enlargement or tenderness? Were you evaluated for other potential >>causes of high estrogen levels?
No, I do not have any real concrete side effect such as gyno. However, I
have noticed that my libido is down and sexual activity is not as
pleasureful as before. This is a primary concern of mine with the elevated
levels of estrogen, and I hope Arimidex can help in this regard. I was not
evaluated for other potential causes -- are there any in particular that I
should watch out for? The decrease in libido may be related to the reduction in DHT as opposed to an increase in estrogen so may or may not improve witrh Arimidex.
You mention that Arimidex should be taken daily. Since it is a rather
expensive drug, what dosage would be adequate to bring the total estrogen level down to the recommended range (40-115 pg/mL)? A number suggested by a doctor was between 0.50 mg and 1.0 mg per week. You recommend that I take the drug daily -- since the pill is quite small, how shall I cut the pill in such small doses? And what should those dosages be? As you are aware, it is not FDA approved for use in men. The dose that has been used in research studies has ranged from 1 to 10 mg/d. My feeling is that when you get your estradiol level measured it will not be elevated and Rx with Arimidex will not be indicated. Estrogen is important for maintaining bone mass in emn so that it is important to bear this in mind when taking drugs designed to suppress estrogen levels.
D.
