E2 sitting at 60 and I feel fine, do I really need an AI?

[Beantown Rick]

Got bloodwork back, E2 at 60 pg/mL while running 500mg test e. Feel completely fine, libido is strong, no water retention, no moodiness, gym performance is the best it has been in years. Doc is pushing me to take anastrozole but every time I have used an AI in the past I feel flat and my joints ache. Is there a real reason to chase a lower number when everything feels good? At what point is high E2 actually a problem vs just a lab value?

[Dutchman]

This is actually a well-documented debate. The historical target of 20-30 pg/mL was based on TRT studies using older assay methods that often overestimated E2 in men. More recent research using liquid chromatography mass spectrometry assays suggests many men feel and perform optimally at values that would look alarming on older reference ranges. If you have no symptoms at 60 and your haematocrit, lipids and cardiovascular markers are acceptable, there is a reasonable argument to leave it alone. Long-term elevated E2 in supraphysiologic conditions is associated with some cardiovascular risk, but this is not a short-term concern you need to act on today. Monitor lipids and BP closely, that is where the real signal will be.

[Davo]

Go by feel, not numbers. Crashed E2 is far worse than high E2 in my experience. Tanked mine with adex years ago, took 6 weeks to recover, joints were shot, zero libido, depressed. If you feel good at 60 then leave it. Get lipids checked and keep BP in check, that matters more.

[Marc NL]

Makes sense to go by symptoms. Out of curiosity what does your BP look like? That and hematocrit are the two things I would watch when E2 is that elevated on a blast. Do you notice any difference in recovery between sessions at 60 vs when you have run with E2 lower?