Are you wondering if Anastrozole (an AI) is necessary when your Testosterone treatment falls below 200mg? In this video, we discuss what it looks like going towards 200mg or above, and why it might be better to stay below that threshold for most men.

Anastrozole is a medication used to treat breast cancer, prostate cancer, and prevent the body from shifting Testosterone into Estrogen. However it's also another medication you need to take when on TRT if you're someone to sensitive to aromatizing. Some men find it preferable to avoid this by staying below a certain treatment threshold, or find benefit by having an acceptable amount of additional estrogen.

Transcript

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Brian Mckinley: Is that it'll start recording from this point forward and I just clean it up later. I'll try not to talk while you're talking because the way that Google meets recorded records, it is. As soon as someone talks, it switches the picture back to them. So after I do my prompt, I'll kind of let you finish up the rest of it and go from there. See if you like that type thing.

Trace Owens: Okay.

Brian Mckinley:  Yeah, so sorry. So Hey, welcome back. It's Brian with Alpha MD. I am here today with one of our providers who's kind of decided to join us and our YouTube adventures and speak to some things that, you know, we're not as as knowledgeable on personally or that they specialize in and today that is going to be a trace Trace Owens. And so, I'm gonna pass A question over to him but I'm kind of introduce himself, say hi. And yeah, the main thing that I want to ask Trace today is

Brian Mckinley:  How much testosterone is is too much testosterone when it comes to treating men, kind of side effects. And what kind of benefits do you have by going higher staying lower? You know, I think you usually have a more balanced approach when it comes to treatment from everything that I've seen. So would you mind kind of talk about that for people who don't really know how much is too much or how that might affect them?

Trace Owens: Yeah, absolutely. Appreciate it. And thanks for inviting me. I'm Trace Owens. And I'm one of the providers here with FMD and that's actually a really good question. I get this on occasion. Most people think always, more is better and with this in particular more doesn't equal better, all right, can and rare occasions but for the vast majority, no. So typically we will start out and what we call a therapeutic range. That is optimally somewhere around, 200 or less milligrams a week mostly because

Trace Owens:  While we're getting the testosterone levels up, it takes a little bit more than what you're naturally producing in order to kind of fill that tank if you will. So we all have a fuel tank. We don't really know exactly what the size is. So there's these parameters, and these lab values that were created and those are rough estimate ranges. They were mostly created about the lab companies. There wasn't a whole lot of input from providers or Experts on what those ranges should be. They just kept saying, Hey, we're drawing these labs, We need to put a range in and this is kind of what we've seen and so there's no specific number. It's a very subjective number. That's kind of one of the tough points about testosterone is

Trace Owens:  You can't compare a number to another person mostly because that fuel tank. Again, we don't know what your fuel tank is specifically. We weren't tracking your testosterone after puberty and for the last five or ten years every year, every six months. So we don't really know what your normal range would have been. And now it's starting to decline or you're starting to exhibit symptoms. So we want to get those symptoms resolved and we want to get that number up.

Trace Owens:  I tell people, I don't draw hard lines. So I, I definitely think that if people are having symptoms that warrants testing out and seeing if their number is low, and if it is, then we can start therapy. Starting therapy is going to be mild and should start to see some sort of improvement when we do follow up. That's really The biggest question. I ask is, How are you feeling? Because that's the most subjective part of it. Oh man. My labs came back. I'm feeling amazing. I have better mental clarity, better stamina, better energy. I feel like I want to go exercise more. You know, all of, that's perfect. That's great. That's what I want to know. I want to see how your numbers are only because I want two things to happen. I want it to go up from where it was And then I want to make sure it's in a safe.

Trace Owens:  And when I say safe range, I don't necessarily mean under a specific number. I that again, is kind of a hard concept for some people, because a lot of the guidelines have always been referencing x number to X number. And I don't feel that that's a firm representation of somebody subjective, interpretation of how they feel. So, it's hard to objectify that with a number. But we can tell based on their symptoms and if they are feeling great perfect that's safe range. Again I want to make sure it is within some sort of normal relevancy, right. Under a thousand somewhere like that under 1500. It also depends on their age and if they have ever done testosterone therapy before and a half previous numbers kind of knowing where their fuel tank would have been before

Trace Owens: The other thing I look at is some of the blood values. So this medication can affect certain things like the sticky components of blood. Like matter, it hemoglobin, red blood cells. And if we get those too high, and this is where too much is, never a good thing or can be not better if we elevate those sticky components, we then start to jeopardize, or put someone in a position for something potential and that could be either a heart attack or stroke and that is the last thing in the world. We want to do because we're trying to make people feel better. I don't want to cause harm. I don't want to put somebody into a danger situation or inadvertently, cause them to have an issue. So, We look at that, that's the safe range. That's kind of where I go with that. I always think…

Brian Mckinley: Yeah, we've done a lot of videos where we've talked about how testosterone in and of itself is usually heart protective and there's a lot of studies on that. So when you say, You know, you know, more is sometimes not better. And they know sometimes that can cause, you know, a heart attack or something like that or some type of event. Would you mind explaining how that actually happens and how like the excess of high levels of testosterone may cause that? But, you know, we, we usually say and talk about how it's, it's heart protective. So how does that transition from? Oh testosteroneous heart protective to too much. You know all the sudden you might have a heart attack just so someone you know at home understands why?

Trace Owens: Oh, absolutely. Yes, so it is it is very much cardio protective. There are a lot of great properties. When doing testosterone serial therapy in that safe, therapeutic range. That is very beneficial to our cardio metabolical, absolutely. But there is a point where it can go a little too far. So, like I was saying with the red blood cells and thematica in the hemoglobin, when those numbers get too high, those are the sticky components of the blood and when those numbers and when that sticky stuff gets together and it can form a clot that kind of structure occlude a coronary vessel, or a cerebral or a brain vessel. And that's where we can get clots in our brain stroke. Or we can get a clot in our heart, which is a heart attack. And that's where we have to say, Okay, we want to stay in this certain range and not get too high and that's based off the blood values when our testosterone levels are too high. That's what we're putting into compromise is elevating those

Trace Owens: Add values to where we could potentially cause some harm. If we keep that number low enough or in a therapeutic range and usually People will notice people won't feel better when they're really high in those and…

Brian Mckinley: Yeah.

Trace Owens: those regards. And oftentimes, they even tell me like, I really don't feel great. And that's when I say, Okay, let's take a look at these numbers because you might actually be too high. Contrary to what we think and a lot of what we've read or been told

Trace Owens: That number oftentimes is just elevated and then by just and usually it's not even a huge dramatic reduction. Usually it's like going from 200 down to 150 and then all of a sudden they're like holy crap, I feel great. So amazing, everything started clearing up. I start feeling you know I've been getting more energy again and it's because that blood isn't so s*** like the viscosity isn't that thick. So it's now loose, it's moving freely, it's getting all the stuff to the receptors that it needs to get to and…

Brian Mckinley: Gotcha.

Trace Owens: everything's working fine. And so that's where we try to get down. So That 200 mark on the Testosterone Levels, The 200 milligrams a week, that's kind of where I try to stay at or below and below is almost always better.

Trace Owens:  There are a few times where I think it's warranted to go over and those instances. And these are, these are kind of outliers. I have a patient who had testicular cancer when they were very young. So they have not had any kind of major testosterone producing factories for the most of their adult life. So, they Need a lot of additional testosterone, they are, they're triathlete. So they're extremely physically active and they demand a lot more of that hormone. And so therefore with that person in particular we do go a little over but it's not much It's very, very I think it's 220. A week is where we go with that person.

Trace Owens:  So yeah that's kind of one of the the rare instances where I see people going over. There are people who do initially want to try to push a boundary and I respect that in some instances. They may have had a past history of having a requiring elevated testosterone from prior treatment and and they're fine in that world. And that's great. We can always justify that and continue it. But again, I just don't want to cause harm that's kind of my greatest fear. Is that I put somebody in jeopardy or cause them an issue and that's the opposite direction. We're going.

Brian Mckinley: Gotcha. Yeah, thank you because, you know, you talked a lot about how there's a maximum range for effectiveness in the past and how there were some side effects as you do, go higher what What stops something? What stops more testosterone from from being better? Like I know there's more side effects but you say people don't feel, you know, stronger, you know better or anything like that. Or is there some reason that the human body can't handle more testosterone or that it wouldn't be effective to just add more and just deal with the side effects is there some kind of like natural limiter or something like that?

Trace Owens: There is yep. Yeah, it's actually really good question. So our bodies everyone on this planet. We produce testosterone and we produce estrogen. Those are two very big hormones and they are on a seesaw so they're always trying to balance each other out. So as one of these levels goes up or down the other one will try to match it and that process is called aromatate or aromatizing where if our testosterone gets too high. So we have a limited number of receptors in our body that can accept testosterone. And as those get flooded and full, let's just say for arguments sake, that we're on 200 a week. And and this is common at 200 and this is why usually getting just a smidge lower like 175, 150 is usually like a really great range. So we maximize all those receptors at 200 a week.

Trace Owens:  There will be a amount floating around freely throughout the body. Just waiting to get gobbled up free testosterone when that free testosterone is just hanging out for a while. Our body says, Hey, we have all this extra stuff. Let's converted over to actually into balance out that level now. So now we're going to elevate our estrogen levels. So typically we like to keep that in a certain range as well, and as estrogen starts raising and this is where people start to feel horrible, we will get what we call emotional lability. So liability, in our emotions might be mood swings where, which will mad, and then we feel sad and then we feel angry all within two or three minutes. And that another thing that can happen from elevated estrogen,

Trace Owens:  Is a sensitive nipples. So sensitive nipples is one of those side effects that can be extremely uncomfortable when you're trying to work out. Nothing sucks worse. And you're trying to lift weights, or you're on a bike and things are rubbing, and you're just like, this is so uncomfortable. So, we oftentimes will notice and see the early signs of that, with the sense of the middle's and with the emotional ability, and we'll go Ah, Okay. Sounds like you're absence getting a little high and sometimes it's luxurious, we can draw a lab and go. Oh yeah. Your estrogen is very elevate. It's like 40 50. So oftentimes that will warrant an estrogen blocker or an aromatase inhibitor. I'm asking all the real common one but again

Trace Owens: Earlier just consists of doing it, testosterone every week, and then you don't need anything additional. So those are the most common things that I'll hear.

Brian Mckinley: Gotcha. Yeah, thank you. That makes a lot of sense. Hope that has helped a lot of viewers at home as well.