Should I Take an Aromatase Inhibitor on TRT? (TRT Q&As)
Timeline
Timestamp
Topic
00:00
Should I take an aromatase inhibitor and gonadorelin along with my testosterone?
A 33-year-old man describes a TRT protocol that includes anastrozole and gonadorelin and asks for guidance. Dr. O’Connor favors individualized, low-dose testosterone rather than routinely adding an aromatase inhibitor, and questions the purpose of gonadorelin unless there is a specific fertility-related plan.
A 33-year-old man describes a TRT protocol that includes anastrozole and gonadorelin and asks for guidance. Dr. O’Connor favors individualized, low-dose testosterone rather than routinely adding an aromatase inhibitor, and questions the purpose of gonadorelin unless there is a specific fertility-related plan.
02:08
Can my sex drive recover after very high-dose Trenbolone use caused persistent libido and erection problems?
A 28-year-old man reports severe sexual dysfunction after a bodybuilding prep involving very high doses of testosterone and Trenbolone. Dr. O’Connor says Tren can have profound effects on sexual function and the brain, advises never using it again, and says improvement may occur gradually over time while maintaining a more sustainable TRT regimen.
A 28-year-old man reports severe sexual dysfunction after a bodybuilding prep involving very high doses of testosterone and Trenbolone. Dr. O’Connor says Tren can have profound effects on sexual function and the brain, advises never using it again, and says improvement may occur gradually over time while maintaining a more sustainable TRT regimen.
05:06
Should I be concerned that my PSA increased slightly after starting TRT?
A 53-year-old man reports his PSA rising from 0.77 to 0.86 after beginning TRT. Dr. O’Connor considers this small increase reassuring in context, explains that some PSA increase can occur after testosterone is started, and recommends continued monitoring and appropriate urologic evaluation.
A 53-year-old man reports his PSA rising from 0.77 to 0.86 after beginning TRT. Dr. O’Connor considers this small increase reassuring in context, explains that some PSA increase can occur after testosterone is started, and recommends continued monitoring and appropriate urologic evaluation.
07:15
Is there a way to lower my PSA while staying on testosterone if biopsies and MRI have found no prostate cancer?
A 59-year-old man with PSA levels around 6 to 7 asks whether he can lower the number without reducing testosterone. Dr. O’Connor discusses BPH, continued urologic surveillance, and DHT-blocking drugs such as finasteride and dutasteride, while warning that lowering PSA pharmacologically can complicate interpretation of future PSA results.
A 59-year-old man with PSA levels around 6 to 7 asks whether he can lower the number without reducing testosterone. Dr. O’Connor discusses BPH, continued urologic surveillance, and DHT-blocking drugs such as finasteride and dutasteride, while warning that lowering PSA pharmacologically can complicate interpretation of future PSA results.
10:30
Could my very high hemoglobin from testosterone and occasional Anavar be contributing to my anxiety and other symptoms?
The member reports hemoglobin around 19 along with severe anxiety and unusual burning and pins-and-needles sensations that improved after stopping testosterone and donating blood. Dr. O’Connor considers the hemoglobin concerning and discusses lowering testosterone exposure, checking CBC and complete iron studies, evaluating sleep apnea and cardiovascular health, and carefully managing any need for phlebotomy.
The member reports hemoglobin around 19 along with severe anxiety and unusual burning and pins-and-needles sensations that improved after stopping testosterone and donating blood. Dr. O’Connor considers the hemoglobin concerning and discusses lowering testosterone exposure, checking CBC and complete iron studies, evaluating sleep apnea and cardiovascular health, and carefully managing any need for phlebotomy.
14:03
How can I manage low libido and temporary high blood pressure when I restart TRT?
A 29-year-old fire medic reports low energy and mediocre libido on TRT and says his blood pressure rises when treatment begins. Dr. O’Connor emphasizes lower, more frequent testosterone dosing, individualized ester selection, diet and sodium control, exercise, and blood pressure monitoring, with medication such as telmisartan considered when appropriate.
A 29-year-old fire medic reports low energy and mediocre libido on TRT and says his blood pressure rises when treatment begins. Dr. O’Connor emphasizes lower, more frequent testosterone dosing, individualized ester selection, diet and sodium control, exercise, and blood pressure monitoring, with medication such as telmisartan considered when appropriate.
Video Summary
This mailbag discussion focuses on questions about symptom plateaus reported during testosterone therapy. It explains that perceived stalls can occur despite stable dosing and appropriate labs. Plateaus are framed as common phases rather than signs of treatment failure.
A central portion discusses how lifestyle factors, sleep, stress, and expectations influence perceived progress. The episode emphasizes reassessing context before assuming therapy limitations. Perspective is highlighted to guide interpretation.
The closing segment reinforces testosterone therapy as long-term care requiring patience. Ongoing monitoring, proportional interpretation, and expectation alignment are emphasized. Hormone therapy is positioned as benefiting from steady evaluation rather than frequent change.
Drug Callouts
Drug
Description
Testosterone
Testosterone is an androgen hormone used therapeutically to treat confirmed testosterone deficiency and related symptoms. In this mailbag episode, testosterone therapy is discussed in relation to symptom plateaus.
Condition Callouts
Condition
Description
Testosterone deficiency
Testosterone deficiency is a clinical condition characterized by low circulating testosterone levels with associated symptoms. It is referenced as the indication for therapy while emphasizing plateau interpretation.
Key Takeaways
- Symptom plateaus are common during therapy.
- Stable labs do not guarantee noticeable change.
- Lifestyle factors influence perceived progress.
- Monitoring often precedes adjustment.
- Patience supports long-term success.