How much arimidex should I take?

How much Arimidex should I take on TRT?

The best gage I have found to control your Estradiol levels is to gage your night time and morning wood. At good levels or what I call the sweet spot you get your night time and morning wood back so strong it will wake you up and you can hang a coat on it.

Most men do good taking .25 mgs or 1/4 of a 1mg. pill, I use a pill cutter to cut the small pill in half then I stand it on the cut end and use a single edge razor to cut this in half. A good way to take arimidex is by how high your levels are. I tested over 90 pg/ml so we tried doing .5 mgs every other day after 8 weeks my next set of labs showed it did not move below 90, test said >90. So we did .5 mgs. every day in about 2 weeks I got some strong night time and morning wood back after not having them for many yrs.

I kept doing this dose and in 8 weeks my next set of labs said <20 back in the day labs were like this they did not have to good labs we have today they could not read lower the 20. My Dr. told me this looks to low to stop taking the Arimidex. The one thing I noticed was my wood stopped and stopping the Arimidex my wood came back in about 7 weeks my next test at 8 weeks was 24 pg/ml. So we went back on the Arimidex but the Dr. told me to take .5 mgs every 3 days I was on this dose not a week and lost wood. This is when I figured out going to low you lose wood. And the longer your too low the longer it takes to get levels back up.

I stopped the arimidex right away and got my wood back in 4 days. I then after playing with the dose for a time found the best dose is .25mgs every 2 to 3 days.

So lets say your labs are less the 50 pg/ml if your take .5 mgs you can go down so dam fast your miss the sweet spot of your wood and go to low. It’s best with lower levels 50 and under to do less Arimidex .25mgs every 2 days if later your lose wood when it comes back go to every 3 days.

I have found estradiol is the hardest hormone to control, it goes up or down from month to month some times I need .25mgs every 2 days other times I need .25mgs everyday most of the time I do well on every 3 days.

So between wood and labs I do great and so do most of the men I have told this to. I keep a log on how much I am taking and how I feel. Doing this and reading back in my log I was able to tell when I was going to high or to low my Dr. lets me dose my arimidex by how I feel.

Over the yrs. I have posted this story until I am blue in the face. ”

Update 6/14/2017 – I now recommend split injections over Arimidex when possible. Please see my post Here

Tags: arimidex, TRT

Bodybuilders Bulk Up Using … Cancer Drugs?

This article is a collaboration between MedPage Today and:

Noah Thomas’ tattooed biceps are almost 18 inches around, to hear him tell it. His YouTube channel is full of advice for other weight lifters on how to build muscle. In at least one video, he demonstrates how he injects testosterone.

In another, Thomas talks about a side effect of having too much testosterone: high estrogen levels. Too much of this “female” hormone could lead to a host of well-known problems among bodybuilders — gynecomastia, low sex drive.

But Thomas — whom we couldn’t reach for comment — has a plan for fixing that.

“I heard Arimidex is useful,” he says in the video. “I don’t think I’m going to get any support from my endocrinologist. … I do think my psychiatrist might be willing to get that for me.”

Arimidex, also known by its chemical name anastrozole, is an aromatase inhibitor — a breast cancer drug. While steroids and growth hormone make headlines when athletes abuse them, breast cancer drugs are a lesser-known staple of doping regimens, for athletes and “weekend warriors” alike. Star therapies of the breast oncology world — like tamoxifen (Nolvadex) and exemestane (Aromasin) — provide an easy, non-injectable means of cutting estrogen’s unwanted side effects.

And bodybuilders are packing other little-known pharmaceuticals into their routines — some of which, like ghrelin mimetics and selective androgen receptor modulators (SARMs), are still under investigation in clinical trials and are not available on any regulated market.

Demand for Breast Cancer Drugs

Weightlifters don’t seem to have a preference for either class of anti-estrogens. There are the selective estrogen receptor modulators (SERMs) like tamoxifen, or the aromatase inhibitors like anastrozole. Both classes mitigate the effects of estrogen, which is metabolized from testosterone. When testosterone levels are high, estrogen levels also tend to increase as a natural byproduct.

“All they do is block estrogen,” Fred Rowlett, president of the North American Natural Bodybuilding Federation, said of the nonchalant attitude weight lifters have about taking cancer drugs. “When you don’t have estrogen, you gain nothing but muscle.”

Rowlett’s organization champions drug-free bodybuilding, and prescription anti-estrogens are on the group’s list of banned substances, modeled on that of the International Olympic Committee. These breast cancer drugs are also on the prohibited performance-enhancing drugs lists from the U.S. Anti-Doping Agency and the World Anti-Doping Agency.

Abuse of breast cancer drugs isn’t limited to top athletes. “Weekend warriors” and enthusiastic gym-goers are driving demand, as scores of YouTube videos attest. There are no data on how widely used anti-estrogens are in this community, but Rowlett says it’s common practice.

Given that they’re prescription drugs, the obvious question is how bodybuilders are getting their hands on them.

Rowlett says family practice physicians tend to write the scripts directly to those who are working out. There is also the potential for doctor shopping if one clinician refuses, as Thomas pointed out in his video.

And, of course, there’s an underground market that anyone with Internet access can peruse. On its homepage, HardcorePeptides.com boasts tamoxifen and exemestane for under $40. Anti-Estrogens.com is a bit pricier, at $79 for a 30-pack of tamoxifen tablets.

It’s unclear if the products are diverted, or if they’re synthesized in a homegrown lab, à la Breaking Bad. Some may simply be scams to obtain credit card information, a common problem that many of the sites denounce and attempt to reassure potential buyers with customer service hot lines and other security measures.

A spokesperson for AstraZeneca, which makes Nolvadex and Arimidex, told MedPage Today that diversion and counterfeiting of its products for this purpose “isn’t something we’re aware of.” Pfizer, maker of Aromasin, didn’t comment on whether they were aware of the diversion or counterfeiting of the drug.

Then there are the specialized supplements — which don’t require a prescription — that claim to target estrogen and aromatase, readily up for sale on Amazon.com and other sites. But like the rest of the unregulated supplement industry, there’s no guarantee that these bottles contain what’s on their labels.

Hungry for the Hunger Hormone

Researchers have been interested in ghrelin, called the hunger hormone for its ability to spark appetite, as a potential target for obesity treatment, but it’s had more practical application in wasting disease. Ghrelin mimetics, such as GHRP6 and GHRP2, are still only in clinical trials, and none are commercially available on any market anywhere in the world.

They’re readily for sale, however, on a vast amount of websites, along with other growth-hormone-releasing peptides such as ipamorelin and hexarelin. Ghrelin mimetics’ potent stimulation of growth hormone secretion is the reason it’s valued in muscle-building circles.

The hormones are all blatantly listed on sites like peptideboys.com and deboralabs.com, side-by-side with anabolic steroids and other performance-enhancing drugs. Some purport to be selling their peptides to scientists, but at the same time they tout “discreet shipping.”

Jose Garcia, MD, PhD, of Baylor College of Medicine, who has been involved in studies of ghrelin mimetics, told MedPage Today that scientists would never acquire their active drugs that way.

“You would never go to a site like this because there is no quality control so you never know if these products are contaminated or if they contain what they’re supposed to,” Garcia said. “Not even for animal experiments.”

It’s likely that these drugs are being made in underground labs, he added.

The same goes for nonsteroidal selective androgen receptor modulators (SARMs), which are also still under investigation for wasting disease. A Google search of where to buy one of the most popular ones, enobosarm (Ostarine is the proposed trade name), returns plenty of results. As with ghrelin mimetics, most of the sites claim their products are for research purposes only and aren’t intended for human consumption.

What’s Regulated?

Since steroids make the Drug Enforcement Agency’s list of controlled substances, inventive entrepreneurs have tried to get around legal issues by making supplements, prohormones, and designer steroids. There’s much overlap between these categories, with prohormones being hormone precursors that can amplify the effect of existing hormones, while designer steroids are typically anabolic drugs that were never marketed for medicinal purposes.

Companies that produce these agents have been linked to top athletes, like Barry Bonds and BALCO, and, more recently, Biogenesis and several top baseball players including Alex Rodriguez and Ryan Braun.

Every now and then the FDA also cracks down on these agents — typically after adverse event reports, as was the case with last month’s consumer warning on the Mass Destruction supplement. A 28-year-old in North Carolina developed liver failure after weeks of using the product, which the FDA said contained at least one synthetic anabolic steroid.

Federal prosecutors have also gone after distributors of these supplements, with Bodybuilding.com — the “largest Internet retailer of supplements in the world,” according to a Department of Justice press release — paying a $7 million fine in 2012 for selling drugs that were misbranded as supplements.

The feds had behind them the Designer Steroid Control Act, which updated the earlier Anabolic Steroid Control Act in order to bring these supplements under the umbrella of illegal steroids.

But anti-estrogens, ghrelin mimetics, and SARMs aren’t included in any of that regulation, and they’re not on the controlled substances list.

Joseph Moses, a spokesperson for the DEA, told MedPage Today that even though these drugs aren’t controlled substances, they could be used in prosecution.

“If we seized them when we seized steroids that are controlled, we could bring them into court as evidence that the individual intended to use those substances or, if it’s on a bulk level, to distribute them,” Moses said.

Doctors who help weightlifters to obtain steroids via prescription can get in trouble with the law for illegal distribution, as was the case for a Pittsburgh Steelers doctor who falsely claimed his patients had hormonal disorders so they could get their drugs. He was also charged with healthcare fraud — which covered the drugs prescribed to combat the side effects of steroid use.

Guidelines from both the American Association of Clinical Endocrinologists and The Endocrine Society state that testosterone therapy should be limited to men with testosterone deficiency. The American Academy of Family Physicians also has a policy statement against helping patients obtain performance-enhancing drugs.

“Our policy is very clear,” Reid Blackwelder, MD, president of the AAFP, told MedPage Today. “We don’t think anything should be prescribed for enhancing athletic performance,” including prescription drugs that work against estrogen, he said.

“All of these medicines,” he said, “should only be used for their intended medical purposes.”

Comment

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Your blood pressure is the force of your blood against the walls of your arteries as your heart pumps. Every time your heart beats (this is the heart contracting), it pumps blood into the arteries. Your blood pressure is highest when your heart beats and lowest when the heart rests between beats. Blood pressure readings use two numbers, read one over the other. The top number (systolic pressure) measures blood pressure when the heart beats. The bottom number (diastolic pressure) measures blood pressure in between heartbeats. A normal blood pressure reading is 120/80 or slightly lower. If you have a blood pressure reading of 140/90 or higher, you’re considered to have high blood pressure (also known as hypertension).

High blood pressure usually doesn’t have any symptoms, so you may not realize you have it.

Several breast cancer treatments can cause high blood pressure:

  • hormonal therapy:
    • Arimidex (chemical name: anastrozole)
    • Aromasin (chemical name: exemestane)
    • Evista (chemical name: raloxifene)
    • Fareston (chemical name: toremifene)
    • Faslodex (chemical name: fulvestrant)
    • Femara (chemical name: letrozole)
    • tamoxifen
  • targeted therapy:
    • Avastin (chemical name: bevacizumab)
    • Herceptin (chemical name: trastuzumab)

Some pain medicines you may be taking during breast cancer treatment also can cause high blood pressure.

Managing high blood pressure

High blood pressure increases your risk of heart problems, stroke, and kidney problems. If you have chest pains, a severe headache, nausea, dizziness, or lose your sight, call your doctor immediately.

If you have a history of high blood pressure, talk to your doctor about the best ways to control it. You may be able to take medication. You also can try these tips to keep your blood pressure in a healthy range:

  • Exercise regularly. This keeps your heart fit and helps you maintain a healthy weight.
  • Reduce stress. Try relaxation techniques such as guided imagery or mediation.
  • Don’t smoke. Smoking can raise your blood pressure.
  • Eat a healthy diet. Fill your plate with foods low in saturated fat and sodium, and try to eat plenty of fruits and vegetables.
  • Maintain a healthy weight. Regular exercise and a healthy diet can help.
  • Avoid alcohol and caffeine because they can raise your blood pressure.

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Arimidex

SIDE EFFECTS

Serious adverse reactions with ARIMIDEX occurring in less than 1 in 10,000 patients, are: 1) skin reactions such as lesions, ulcers, or blisters; 2) allergic reactions with swelling of the face, lips, tongue, and/or throat. This may cause difficulty in swallowing and/or breathing; and 3) changes in blood tests of the liver function, including inflammation of the liver with symptoms that may include a general feeling of not being well, with or without jaundice, liver pain or liver swelling.

Common adverse reactions (occurring with an incidence of ≥ 10%) in women taking ARIMIDEX included: hot flashes, asthenia, arthritis, pain, arthralgia, hypertension, depression, nausea and vomiting, rash, osteoporosis, fractures, back pain, insomnia, headache, bone pain, peripheral edema, increased cough, dyspnea, pharyngitis and lymphedema.

In the ATAC trial, the most common reported adverse reaction ( > 0.1%) leading to discontinuation of therapy for both treatment groups was hot flashes, although there were fewer patients who discontinued therapy as a result of hot flashes in the ARIMIDEX group.

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Clinical Trials Experience

Adjuvant Therapy

Adverse reaction data for adjuvant therapy are based on the ATAC trial . The median duration of adjuvant treatment for safety evaluation was 59.8 months and 59.6 months for patients receiving ARIMIDEX 1 mg and tamoxifen 20 mg, respectively.

Adverse reactions occurring with an incidence of at least 5% in either treatment group during treatment or within 14 days of the end of treatment are presented in Table 1.

Table 1 :Adverse reactions occurring with an incidence of at least 5% in either treatment group during treatment, or within 14 days of the end of treatment in the ATAC trial*

Certain adverse reactions and combinations of adverse reactions were prospectively specified for analysis, based on the known pharmacologic properties and side effect profiles of the two drugs (see Table 2).

Table 2 : Number of Patients with Pre-specified Adverse Reactions in ATAC Trial*

Ischemic Cardiovascular Events

Between treatment arms in the overall population of 6186 patients, there was no statistical difference in ischemic cardiovascular events (4% ARIMIDEX vs. 3% tamoxifen).

In women with pre-existing ischemic heart disease 465/6186 (7.5%), the incidence of ischemic cardiovascular events was 17% in patients on ARIMIDEX and 10% in patients on tamoxifen. In this patient population, angina pectoris was reported in 25/216 (11.6%) patients receiving ARIMIDEX and 13/249 (5.2%) patients receiving tamoxifen; myocardial infarction was reported in 2/216 (0.9%) patients receiving ARIMIDEX and 8/249 (3.2%) patients receiving tamoxifen.

Bone Mineral Density Findings

Results from the ATAC trial bone substudy at 12 and 24 months demonstrated that patients receiving ARIMIDEX had a mean decrease in both lumbar spine and total hip bone mineral density (BMD) compared to baseline. Patients receiving tamoxifen had a mean increase in both lumbar spine and total hip BMD compared to baseline.

Because ARIMIDEX lowers circulating estrogen levels it may cause a reduction in bone mineral density.

A post-marketing trial assessed the combined effects of ARIMIDEX and the bisphosphonate risedronate on changes from baseline in BMD and markers of bone resorption and formation in postmenopausal women with hormone receptor-positive early breast cancer. All patients received calcium and vitamin D supplementation. At 12 months, small reductions in lumbar spine bone mineral density were noted in patients not receiving bisphosphonates. Bisphosphonate treatment preserved bone density in most patients at risk of fracture.

Postmenopausal women with early breast cancer scheduled to be treated with ARIMIDEX should have their bone status managed according to treatment guidelines already available for postmenopausal women at similar risk of fragility fracture.

Cholesterol

During the ATAC trial, more patients receiving ARIMIDEX were reported to have an elevated serum cholesterol compared to patients receiving tamoxifen (9% versus 3.5%, respectively).

A post-marketing trial also evaluated any potential effects of ARIMIDEX on lipid profile. In the primary analysis population for lipids (ARIMIDEX alone), there was no clinically significant change in LDL-C from baseline to 12 months and HDL-C from baseline to 12 months.

In secondary population for lipids (ARIMIDEX+risedronate), there also was no clinically significant change in LDL-C and HDL-C from baseline to 12 months.

In both populations for lipids, there was no clinically significant difference in total cholesterol (TC) or serum triglycerides (TG) at 12 months compared with baseline.

In this trial, treatment for 12 months with ARIMIDEX alone had a neutral effect on lipid profile. Combination treatment with ARIMIDEX and risedronate also had a neutral effect on lipid profile.

The trial provides evidence that postmenopausal women with early breast cancer scheduled to be treated with ARIMIDEX should be managed using the current National Cholesterol Education Program guidelines for cardiovascular risk-based management of individual patients with LDL elevations.

Other Adverse Reactions

Patients receiving ARIMIDEX had an increase in joint disorders (including arthritis, arthrosis and arthralgia) compared with patients receiving tamoxifen. Patients receiving ARIMIDEX had an increase in the incidence of all fractures (specifically fractures of spine, hip and wrist) compared with patients receiving tamoxifen .

Vaginal bleeding occurred more frequently in the tamoxifen-treated patients versus the ARIMIDEX-treated patients 317 (10%) versus 167 (5%), respectively.

Patients receiving ARIMIDEX had a lower incidence of hot flashes, vaginal bleeding, vaginal discharge, endometrial cancer, venous thromboembolic events and ischemic cerebrovascular events compared with patients receiving tamoxifen.

10-Year Median Follow-Up Safety Results From The ATAC Trial

Results are consistent with the previous analyses.

Serious adverse reactions were similar between ARIMIDEX (50%) and tamoxifen (51%).

  • Cardiovascular events were consistent with the known safety profiles of ARIMIDEX and tamoxifen.
  • The cumulative incidences of all first fractures (both serious and non-serious, occurring either during or after treatment) was higher in the ARIMIDEX group (15%) compared to the tamoxifen group (11%). This increased first fracture rate during treatment did not continue in the post-treatment follow-up period.
  • The cumulative incidence of new primary cancers was similar in the ARIMIDEX group (13.7%) compared to the tamoxifen group (13.9%). Consistent with the previous analyses, endometrial cancer was higher in the tamoxifen group (0.8%) compared to the ARIMIDEX group (0.2%).
  • The overall number of deaths (during or off-trial treatment) was similar between the treatment groups. There were more deaths related to breast cancer in the tamoxifen than in the ARIMIDEX treatment group.
First-Line Therapy

Adverse reactions occurring with an incidence of at least 5% in either treatment group of trials 0030 and 0027 during or within 2 weeks of the end of treatment are shown in Table 3.

Table 3 : Adverse Reactions Occurring with an Incidence of at Least 5% in Trials 0030 and 0027

Less frequent adverse experiences reported in patients receiving ARIMIDEX l mg in either Trial 0030 or Trial 0027 were similar to those reported for second-line therapy.

Based on results from second-line therapy and the established safety profile of tamoxifen, the incidences of 9 pre-specified adverse event categories potentially causally related to one or both of the therapies because of their pharmacology were statistically analyzed. No significant differences were seen between treatment groups.

Table 4 : Number of Patients with Pre-specified Adverse Reactions in Trials 0030 and 0027

Second-Line Therapy

ARIMIDEX was tolerated in two controlled clinical trials (i.e., Trials 0004 and 0005), with less than 3.3% of the ARIMIDEX-treated patients and 4.0% of the megestrol acetate-treated patients withdrawing due to an adverse reaction.

The principal adverse reaction more common with ARIMIDEX than megestrol acetate was diarrhea. Adverse reactions reported in greater than 5% of the patients in any of the treatment groups in these two controlled clinical trials, regardless of causality, are presented below:

Table 5 :Number (N) and Percentage of Patients with Adverse Reactions in Trials 0004 and 0005

Body as a Whole: Flu syndrome; fever; neck pain; malaise; accidental injury; infection

Cardiovascular: Hypertension; thrombophlebitis

Hepatic: Gamma GT increased; SGOT increased; SGPT increased Hematologic: Anemia; leukopenia

Metabolic and Nutritional: Alkaline phosphatase increased; weight loss

Mean serum total cholesterol levels increased by 0.5 mmol/L among patients receiving ARIMIDEX. Increases in LDL cholesterol have been shown to contribute to these changes.

Musculoskeletal: Myalgia; arthralgia; pathological fracture

Nervous: Somnolence; confusion; insomnia; anxiety; nervousness

Respiratory: Sinusitis; bronchitis; rhinitis

Skin and Appendages: Hair thinning (alopecia); pruritus

Urogenital: Urinary tract infection; breast pain

The incidences of the following adverse reaction groups potentially causally related to one or both of the therapies because of their pharmacology, were statistically analyzed: weight gain, edema, thromboembolic disease, gastrointestinal disturbance, hot flushes, and vaginal dryness. These six groups, and the adverse reactions captured in the groups, were prospectively defined. The results are shown in the table below.

Table 6 : Number (n) and Percentage of Patients with Pre-specified Adverse Reactions in Trials 0004 and 0005

Post-Marketing Experience

These adverse reactions are reported voluntarily from a population of uncertain size. Therefore, it is not always possible to estimate reliably their frequency or establish a causal relationship to drug exposure. The following have been reported in post-approval use of Arimidex:

  • Hepatobiliary events including increases in alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, gamma-GT, and bilirubin; hepatitis
  • Rash including cases of mucocutaneous disorders such as erythema multiforme and Stevens-Johnson syndrome
  • Cases of allergic reactions including angioedema, urticaria and anaphylaxis
  • Myalgia, trigger finger and hypercalcemia (with or without an increase in parathyroid hormone)

Read the entire FDA prescribing information for Arimidex (Anastrozole)

Cardiologists are not telling women with breast cancer to decline treatment — far from it. But in its first-ever statement on the most common female cancer, the American Heart Association warned on Thursday that breast cancer survivors, especially those treated with common chemotherapies, are at increased risk for heart failure and other cardiovascular diseases. And it called on cancer doctors to weigh the benefits of those treatments against the heart risks they pose.

It has been known for years that some breast cancer drugs (including some also used for other cancers) can weaken the heart muscle, causing heart failure. But the group of heart doctors is concerned that if heart symptoms arise years after cancer treatment, the link to chemo may be missed.

An older class of drugs called anthracyclines, which includes doxorubicin, can kill cardiomyocytes, which make up the heart muscle, especially in older women or those with pre-existing heart disease. Taxanes, such as paclitaxel, can cause an abnormally slow heart rhythm, while hormone drugs such as tamoxifen can cause potentially fatal thromboembolisms, or blood clots. The aromatase inhibitor anastrozole has been linked to heart attacks and other cardiovascular events. Trastuzumab (Herceptin) can cause heart failure, especially in women over 50 and those with underlying heart disease or hypertension.

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In most cases, however, the absolute risk is fairly low, said Dr. Laxmi Mehta, director of the Women’s Cardiovascular Health Program at Ohio State University and lead author of the AHA’s statement, which was published in the journal Circulation. Herceptin studies have found a heart failure incidence of up to 4 percent, for instance.

The greatest risk is from doxorubicin, and it increases with the number of treatment cycles. Eight treatments at the typical intravenous dose brings a 5 percent risk of heart failure, but a 26 percent risk after 11 such treatments and a 48 percent risk after 14.

“The intent of the paper is certainly not to say don’t treat breast cancer,” Mehta said. “We want patients to undergo the best treatments available. But we also want patients and their doctors to be aware” that breast cancer drugs can damage the heart.

That’s especially important many years after treatment. Insurers usually won’t pay for cancer survivors to keep seeing an oncologist, so primary care physicians need to be aware that women who were treated for breast cancer are at higher risk of heart disease, said Dr. Otis Brawley, chief medical officer of the American Cancer Association. And if a woman goes to an emergency rooom with symptoms of heart failure, he said, triage nurses need to factor in past breast cancer treatment when making the initial determination of whether she has heart failure.

Knowing a woman’s history of breast cancer treatment can be crucial when treating her heart. Dr. Susan Gilchrist, a cardiologist at MD Anderson Cancer Center who runs the only U.S. program for women’s heart health after cancer, said she would treat hypertension, obesity, and other risk factors even more aggressively in a patient who had received doxorubicin, for instance. And awareness of how chemo affects the heart can in some cases limit the risk: giving IV therapy slowly seems to cause less risk of eventual heart failure than giving it all at once.

The AHA statement might help explain two puzzles about cancer treatment. One is why patient survival is higher at comprehensive cancer centers than in community practices, meaning those not affiliated with an academic institution. Doctors at the former are generally more experienced, and having cardiologists under the same roof can mean better management of the cardiovascular harms from cancer treatment.

“I think the general oncologist absolutely knows the side effects of cardiotoxic drugs such as anthracyclines and Her2 targeted therapies,” said Dr. Neelima Denduluri, a breast oncologist in Virginia who was not involved in the AHA statement. But primary care physicians might not be as knowledgeable, and it’s useful to “remind the busy general practitioner and the medical oncologist that they need to pull the cardiologist in.”

Another puzzle is why screening mammography, meant to detect breast cancer when it is supposedly more treatable, doesn’t seem to reduce the risk of premature death from all causes, rather than breast cancer only. In one of the world’s longest-running mammography studies, researchers in Canada found that among women aged 40 to 59 who were randomly assigned to regular mammograms, mortality after 5, 10, and 15 years was indistinguishable from women not getting regular mammograms. But beginning at 20 years, deaths from all causes were slightly higher in the mammogram group.

It may be that lives saved from breast cancer are being lost to heart disease. “Treatment-related mortality is not reliably captured in breast-cancer mortality,” said Dr. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice.

Cardiovascular disease kills more women than breast cancer. Among older women, it even kills more who have been diagnosed with localized (not advanced) breast cancer: The long-running Women’s Health Initiative reported last year that among women in their 70s with localized breast cancer, over a 10-year period 17 percent died from breast cancer and 22 percent from cardiovascular disease.

Anti-Estrogens, Synthol, and Johnny Law

T NATION addresses the current state of steroid science, this time addressing anti-estrogens, avoiding the long arm of the law, Synthol protocols, and the Proviron comeback.

T Nation: I keep reading about the different anti-estrogens (Nolvadex, Arimidex, Clomid) and have no idea when to use what drug. What’s the deal with these ancillary meds and what’s the best way to use them?

Estrogen has some nasty side effects that any bodybuilder (heck, any man) would want to avoid. These sides include water retention, fat gain, and the development of breast tissue (i.e. gynecomastia). As much as these side effects suck, they’re exponentially worse for a physique competitor, so bodybuilders have long sought out the best means to keep estrogen at manageable levels.

There are essentially two ways to control estrogen. The first is with a SERM (Selective Estrogen Receptor Modulator) such as Nolvadex (tamoxifen) or Clomid (clomephine), and the second is with an AI (aromatase inhibitor) such as Arimidex (anastrozole), Aromasin (exemestane), and Femara (letrozole).

A SERM deals with estrogen once it’s causing problems, while an AI blocks estrogen at the source. In other words, a bodybuilder would use an AI to prevent estrogen issues from occurring, but a SERM might be a better choice if already dealing with estrogen-based side effects like sore nipples.

Anti-estrogens play a larger role pre-contest, when a physique competitor wants to eliminate as much estrogen as possible to present a hard, granite-looking physique. It’s not uncommon for guys (and gals) to increase their doses as high as 1 mg Arimidex or 2.5 mg. letrozole every day for the final few weeks.

In the offseason, these doses usually aren’t warranted – you don’t want to totally quash estrogen as a little bit helps with sex drive and growth. Something like 1 mg. Arimidex every other day (or even every third or fourth day) is ample in the offseason to keep estrogen sides at bay while growing.

One thing to note is that many of these ancillaries (especially Femara/letrozole) are very harsh on blood lipids; they can drop HDL levels down to dangerous levels very quickly. However, the aromatase inhibitor Aromasin (exemestane) has shown to not have these effects, so it may be a wiser choice for the long run.

Aromasin doses are usually around 25 mg. every day pre-contest, and about half that in the offseason.

T Nation: I’ve noticed that Proviron seems to be making a comeback, at least in some circles. I thought this drug was outdated?

Those of you who’ve been around the block a while will recall bodybuilders using the drug Proviron (Schering’s brand name for mesterolone) as a pre-contest anti-estrogen before it was replaced by superior means for estrogen control (see question above).

However, don’t close the book on Proviron just yet. Mesterolone has a few other very cool properties that make it a desirable addition to virtually any cycle, both offseason or pre-contest; so much so, that quite a few guys just use it year round. These properties include:

• Increased libido

• Reduced SHBG (steroid-hormone binding globulin), thereby increasing the effectiveness of a steroid cycle

• Increased muscular “hardness” by way of its androgenic properties

It’s even easy on the wallet – usually about a dollar a day – so you can see with all these synergistic benefits it would be an attractive addition to a cycle.

Nowadays, it’s fairly easy to get mesterolone powder from China, so many UGLs (underground labs) are capping and selling their own versions of Proviron, and for very attractive prices.

The original Schering Proviron came in 25 mg. caps, but many UGLs now make 50 mg. and even 100 mg. capsules. A good daily dose would be 50 mg. to 100 mg. a day and always used in conjunction with other steroids – Proviron is not a good stand-alone drug.

Pre-contest dosing is often ramped up to 200 mg. or more in the final weeks before a show for a maximum “hardening” effect.

T Nation: Do guys on the sauce need to eat more protein than someone that’s natural? What other dietary changes do they need to make?

Anabolic steroids do increase the body’s ability to synthesize protein, but that doesn’t necessarily mean that an enhanced lifter needs to consume more dietary protein – they just use what they eat with better efficiency.

All too often guys starting a cycle will begin by doubling or even tripling their caloric intake, resulting in a look that can be best described as ten pounds of cottage cheese stuffed into a Ziploc bag.

Unless you’re looking to play the Stay-Puft Marshmallow Man in an upcoming Ghostbusters remake, it’s a much better idea to approach your diet changes gradually, something that applies whether you’re “on” or “off.”

Since everyone’s metabolism is different and can change from day to day (even hour to hour and minute to minute), it’s hard for me to give a cookie cutter answer for approaching nutrition. Simply, your best bet is to monitor your progress on a regular basis and modify as needed to keep yourself progressing towards your goals. You may find that you can indeed handle more calories while on than off, but make changes in small realistic amounts, not drastic overhauls.

One final note – human growth hormone is definitely one substance that DOES increase food “utilization,” for lack of a better word. Many bodybuilders have reported that they can consume far more calories once they add GH to their stack and still stay very lean. It’s almost like the more food they eat, the more they grow – and no, not the expanding waistline kind of growth.

If you’re an experienced lifter that has made significant gains with basic AAS stacks (Testosterone, Deca-Durabolin, Equipoise, etc.), then GH might just be what you need to take it to the next level.

T Nation: I’m an amateur competitive bodybuilder considering using a site enhancement oil like Synthol. What would be the best way to use this without making myself look like a complete idiot? I just need to bring up my arms a bit – they’re 19 inches but at 5’8 they need to be a bit bigger to be competitive.

There are a number of different protocols floating around on the Internet and most will work just fine, ifyou stick to the recommendations. Some guys just plain get greedy, and those are the ones that end up looking like they have a watermelon attached to their arm.

A safe and reasonable Synthol schedule for biceps and triceps would look something like this:

Weeks 1/2/3: Loading Phase

• For triceps, shoot only in the long head (the biggest head) and start off with 2 to 3 cc, three times a week (every other day).

• For biceps, shoot into both heads (that’s why it’s “biceps” and not “uniceps”) and start off with 2 to 3 cc per head, two times per week (something like Monday and Friday).

Weeks 4 and beyond: Maintenance

• Triceps (long head): 2 to 3 cc, twice a week (Monday and Friday)

• Biceps (both heads): 2 to 3 cc, once a week (any day)

Make sure to use a needle that’s at least 1″ long (1.5″ would be better for most), allowing you to get the oil deep into the muscle.

Doing the shots before training that particular muscle group (earlier that day) seems to help minimize soreness a bit, with some users also reporting a better “mind-muscle” connection when shooting before training.

Like any injection, keep things as hygienic as possible. Getting an abscess in your arm is not the kind of swelling you’re looking for.

T Nation: How big should I allow myself to get before starting a pre-contest diet? I’ve always started my diet with as much mass as possible, though I keep hearing about guys staying leaner year round.

Do you mean how fat should you let yourself get? Nine times out of ten, the guys who think they’re “smooth” or “bulky” are just plain fat, by anyone’s standard.

True, you can’t grow without a caloric surplus, and since it’s difficult to pinpoint the exact amount needed to be in an “optimal surplus,” many will overshoot things a bit and end up getting smoother in the process.

It makes sense in theory, as gaining a little fat is better than the alternative – not eating enough to support muscle gains. The problem is that way too many lifters develop blinders as to what’s really happening to their bodies and confuse weight gain (i.e. fat gain) with muscle growth. The result is often a 40-inch waist and an ass the size of Rhode Island.

As for “how big” one should allow themselves to get, it depends on a number of factors including:

Individual metabolism – guys with faster metabolisms can get away with pushing the calories a little higher, while guys with slower metabolisms need to reign things in a bit.

The timeline – how far out is the competition? Four months from now, or 18 months? Obviously, a shorter time line would require the athlete not get too out of shape.

Enhanced or not – natural guys should stay a bit leaner, not only because they don’t have access to the pharmaceutical fat loss arsenal that enhanced guys do (GH, T3, clenbuterol, etc.), but also because they don’t have the hormonal support from Testosterone and other anabolics to minimize the catabolic effects of a long, severe diet.

The fact is, setting a fat-limit is very individual, and depends a bit on personal preference. Some vain bastards just don’t like to get too big and bloated in the offseason, while others with an affinity for sweatshirts and baggy sweats think it’s the greatest thing in the world. Find your own sweet spot that allows you to make consistent gains, but also stay sane and healthy in the process.

T Nation: It seems like every week I hear of a new steroid bust. What sort of precautions would you recommend for staying out of the big house?

Take a lesson from Baretta and don’t do the crime if you can’t do the time. While many might disagree with the drug laws in the U.S. as they pertain to anabolic steroids, they do exist and you’re always taking a risk when you engage in illegal activity. Many lives (and families) have been shattered by AAS, so ask yourself first if it’s really worth it in the first place.

With that public safety message out of the way, let’s get into some of the nitty-gritty that may save you from an extended stay in the crowbar hotel.

For the seller:

• Never deal locally. You expose yourself way too much this way. All transactions should be anonymous, i.e. through email and other “nonphysical” means.

• Anonymous, anonymous, anonymous. Never use your real name for anything. Get fake IDs if you need to, get multiple post office boxes, multiple addresses, etc., and never use the same address for ordering gear or powder that you use for manufacturing or storing. Pay bums to do your Western Union transactions for you. Ship out of different locations.

• Use a laptop with a WiFi connection in a public place, like a coffee shop or hospital. This prevents the authorities from being able to track your IP address.

• Don’t get greedy. Get in, make your money (smartly and safely), then get out. The longer in the game, the more risk of getting caught. Don’t make it a lifelong career.

For the buyer:

• Similar to the seller, make sure you remain anonymous at all times. Never use your real name to order, and make sure you don’t keep your “stash” in the same place you have your stuff sent to (in the event that a controlled delivery is executed, and your place is searched).

• Again, use a laptop with a Wifi connection in a public place.

• Keep orders relatively small. You don’t want to do a million small orders (that would increase your exposure), but a big order that gets snagged looks much more like a dealer than just a recreational user. You never want to look like a dealer… trust me.

Truth is, you can never be too cautious. There’s no guarantee that you’ll never get caught even if you dot all the I’s and cross all the T’s, but you can certainly minimize your exposure to law enforcement, and hopefully keep your freedom in the process.

So, are columns like this about steroid use and bodybuilding passé, or do you still like reading about this illicit world even though you have no intention of ever using growth-promoting drugs? Let us know.

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