From the Research
Anastrozole should typically be started in men when estradiol levels exceed 40 pg/mL, particularly if they are experiencing symptoms of elevated estrogen or are on testosterone replacement therapy, as evidenced by a study published in 2021 1. The goal of treatment is to maintain estradiol within the normal male reference range of approximately 20-30 pg/mL, not to suppress it completely, to avoid adverse effects like bone mineral density loss, joint pain, and mood changes. Some key points to consider when initiating anastrozole therapy include:
- Monitoring estradiol levels 4-6 weeks after starting treatment and periodically thereafter to adjust the dosage as needed
- Starting with a standard dose of 0.5 mg twice weekly or 0.25 mg every other day, which can be adjusted based on follow-up estradiol levels
- Being aware of potential side effects, such as joint pain, decreased bone density, fatigue, and mood changes, and adjusting the dosage if these occur
- Considering the use of anastrozole in men with elevated estradiol levels on testosterone therapy, as it has been shown to effectively reduce estradiol levels and improve symptoms 1
- Keeping in mind that anastrozole is a potent aromatase inhibitor with rapid absorption and slow elimination kinetics, as demonstrated in a pharmacokinetic and pharmacodynamic study in adolescent males 2.