Anastrozole is a prescription medication that works by blocking the aromatase enzyme. This enzyme converts testosterone into estradiol, the primary form of estrogen. Although anastrozole is not FDA-approved specifically for low testosterone treatment, it is commonly prescribed “off-label” by physicians for this purpose. Off-label prescribing means using a medication for a condition other than the one it was originally approved to treat. This practice is common and accounts for approximately 20% of all prescriptions. At Nimbus, we only use off-label medications when there is strong evidence supporting their safety and effectiveness.
Your Nimbus hormone test indicated elevated estradiol levels likely due to increased aromatase activity. Aromatase activity and consequently estradiol levels tend to increase with age and higher body fat percentage.
Anastrozole impacts testosterone levels in two main ways. First, by lowering estrogen levels, it stimulates an increase in luteinizing hormone, which signals the testes to produce more testosterone.
The second effect is by directly reducing the conversion of testosterone to estrogen, decreasing the estradiol-to-testosterone ratio by about 77%, thus making more testosterone available to your body’s cells.
Side effects typically result from excessive estrogen suppression. Estrogen plays important roles in men, including maintaining bone density, sexual function, prostate health, and metabolism.³ At Nimbus, we carefully monitor estradiol levels throughout treatment and adjust anastrozole dosing if estrogen becomes too low. Other reported side effects include stomach upset, bone pain, mood changes, and fluid retention.
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Pregnyl, or HCG (Human Chorionic Gonadotropin), is a prescription medication used to treat low testosterone levels. Pregnyl mimics the natural hormone LH (Luteinizing Hormone), which signals the testes to produce testosterone. Although Pregnyl is not FDA approved specifically for increasing testosterone, it is prescribed off-label for this purpose. Off-label prescribing means using a medication for a condition other than that originally approved. This practice is common, with about 20% of prescriptions being off label. At Nimbus, we only use off label medications when supported by strong evidence for safety and effectiveness.
Pregnyl was selected based on your age and hormone testing results. It can help restore normal testosterone levels in men who produce sufficient LH but whose testes do not adequately respond to it. Pregnyl is also used to help maintain fertility in men undergoing testosterone therapy.
Pregnyl has been shown to effectively restore normal testosterone levels in men with testosterone deficiency while preserving fertility. Studies demonstrate similar improvements in metabolic health, blood sugar regulation, and lean muscle mass compared to testosterone therapy.² Additionally, Pregnyl is associated with fewer adverse effects compared to testosterone treatment.³
Pregnyl is generally well tolerated, though some side effects have been reported in clinical trials, including headache, restlessness, fatigue, swelling of the ankles or feet, mood changes, and breast tenderness.⁴
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Clomiphene is a prescription medication that increases testosterone levels by encouraging the brain to release more FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone). It works by blocking estrogen’s ability to suppress the signals that trigger the release of these hormones. FSH and LH are essential for normal testicle function, including testosterone production and sperm development.¹ Clomiphene is not FDA-approved specifically to treat low testosterone but is commonly prescribed “off-label” by physicians. Off-label prescribing means a medication is used for a purpose other than what it was originally approved for, which is common and done when there is strong evidence for safety and effectiveness.
Your Nimbus testing showed that clomiphene is an effective option for restoring normal testosterone levels because of low or borderline LH levels. Clomiphene is particularly effective for men younger than 55 who have secondary hypogonadism, a condition where the problem lies in the brain or pituitary gland rather than the testes. Unlike direct testosterone therapy, clomiphene stimulates your body’s own production of testosterone by increasing LH and FSH, which also helps preserve fertility and sperm production. It works best in men without diabetes, heart disease, or hypertension.
A retrospective study of 400 men with low testosterone found that clomiphene restored normal levels in 88% of participants, with 77% reporting symptom improvement.³ Another study comparing testosterone injections to clomiphene found both treatments had similar improvements in symptoms and patient satisfaction.⁴ Clomiphene is widely recognized as a viable alternative to testosterone replacement therapies.
About 8-11% of men in clinical trials reported mild side effects, including fluid retention, breast tenderness, nausea, dizziness, fatigue, visual disturbances, and mood changes. These adverse effects are generally minor and manageable.³⁻⁵
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Dehydroepiandrosterone (DHEA) is a hormone made by the adrenal glands, ovaries, testes, and brain cells. DHEAS levels peak around age 20 and then decline as we age. The sulfated form (DHEA-S), which makes up 98% of circulating DHEA, is the most abundant steroid hormone in the body. DHEAS is a more stable measure of this hormone as it has a slower clearance from circulation and does not experience day-to-day fluctuations.¹ ²
DHEA is a precursor to other sex hormones, including testosterone. Low levels of DHEA are associated with heart disease, endothelial dysfunction, atherosclerosis (the root cause behind strokes and heart attacks), bone loss, inflammatory diseases, and sexual dysfunction.³ DHEA also modulates the immune system. In older adults, use has been associated with increased muscle strength, bone density, and reduced body fat.⁴ Low levels of DHEA-S have also been associated with increased all-cause mortality in elderly men.⁵ A 2020 meta-analysis of randomized controlled trials found that DHEA did not significantly change blood pressure or body weight, but it did increase lean mass and decrease fat mass.⁶
Your laboratory tests indicate that your testosterone, DHEA-S, or both are outside of the optimal range, and your questionnaire indicated that the symptoms you are experiencing could benefit from supplementation. DHEA supplementation has been shown to increase testosterone levels in men.⁷
A 1-year double-blind, placebo-controlled RCT of DHEA 100 mg per day found that supplementation increased levels from baseline by threefold in men.⁸ Another 1-year RCT of 50 mg per day of DHEA in men aged 60 to 79 years found that serum DHEA-S levels returned to young adult values after 6 months of supplementation.⁹ Other trials have found similar results: DHEA supplementation effectively increases blood levels.⁴
Oral DHEA and DHEA-S supplementation is usually well tolerated. Reported adverse effects include hirsutism, abdominal pain, acne, nausea, urinary urgency, testicular wasting, aggression, and breast tenderness or enlargement (gynecomastia).⁴
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