Anastrozole with BAT question

[cigafred]

As I experiment with BAT (to the horror of some), one of my doctors has strongly told me to limit Anastrozole to 0.5 mg once every two months or, at most, 0.5 mg at the time of injection and 0.5 mg one week later, saying

“anastrozole only stops the conversion to estradiol. 2-OHE1 and 16a-OHE1 are more deleterious than estradiol.”

1. Anyone have any guidelines for an appropriate dosage of anastrozole? I have started searching the BAT clinical trials, but it is a tedious process and I have not come up with any specifics yet. Of course one can measure estradiol for guidance. I think there has been general agreement that we want estradiol to be about 20 pg/mL, less than 30 and certainly more that 12. My most recent measurements, away from BAT, were 20, 13, and 15. During BAT, however, estradiol levels after injection, despite taking anastrozole, have been 58 and 108. Not sure if these temporary surges are significant or not.

2. As for 2-OHE1 and 16a-OHE1, Patrick has covered this well, including

“DIM: There was an "increase of 47% in the 2-OHE1/16alpha-OHE1 ratio from 1.46 to 2.14 ..."

“Results of experiments in multiple laboratories over the last 20 years have shown that a large part of the cancer-inducing effect of estrogen involves the formation of agonistic metabolites of estrogen, especially 16-alpha-hydroxyestrone. Other metabolites, such as 2-hydroxyestrone and 2-hydroxyestradiol, offer protection against the estrogen-agonist effects of 16-alpha-hydroxyestrone."

“There are two major hydroxylation metabolic pathways for its elimination: the "2" path (2-Hydroxylation) & the "16alpha" path (16a-Hydroxylation). The latter produces metabolites that are thought to be carcinogenic. The "2" path produces benign, & perhaps even protective, metabolites.”

So I guess the problem is that by using anastrozole to limit estradiol there is greater usage of the 16alpha-OHE1 hydroxylation pathway.

Any thoughts are appreciated.

[Tall_Allen]

I wouldn't be taking anastrozole at all. Men need some estrogen.

[cigafred]

Thanks smurtaw. The explanation the doctor gave is in the introductory quotation in my post. I am experimenting with BAT, as I said, but with T-cyp injections at greater intervals, three or four months depending on how long it takes my PSA to go back under 0.05 or so.

Looking at the hormonal flow chart you included, if one starts with an increase in testosterone then the only pathway to E1 is via E2, so if T to E2 is reduced, it seems that should reduce any resulting increase in E1, and thus the metabolites of E1. That doesn’t square with my (very limited) understanding of the process.

I am not concerned with average levels of E2, only with the surge which results from the injection, and with whether or not that surge needs to be suppressed.

I greatly appreciate your thoughtful response.

[cigafred]

That would be five times what I am being told is the maximum for me. I am just trying to get 1.5 times, so I will keep on with the discussion with the doc.

[Medline]

Anastrozole, not Exemestane or Letrozole, is an ER-alpha Agonist.

pubmed.ncbi.nlm.nih.gov/320...

While Anastrozole is Estrogenic, Exemestane may be Androgenic!

pubmed.ncbi.nlm.nih.gov/179...

[cigafred]

I have looked at these two studies, but I am not smart enough to translate them into dosage considerations for anastrozole during hight T?

[cigafred]

It will take more time, but I think I am beginning to understand.

[cigafred]

Letrozole sounds like it might be a good solution, but I will have to do a lot of research first. Thanks for the idea.