Anastrozole

Mechanism: Non-steroidal, reversible aromatase inhibitor. Blocks the aromatase enzyme from converting androgens to estrogens. Effect is dose-dependent and reversible -- estrogen rebounds when discontinued.

Dosage:

• On-cycle (symptom-based): 0.25-0.5 mg EOD, only when E2 symptoms are present
• High aromatisers: 0.5 mg EOD (rarely need more)
• Never use prophylactically without symptoms

Administration:

• Oral tablet, can be taken with or without food
• Tablet can be split for micro-dosing (0.25mg)

Key Notes:

• Second-line E2 management -- SERMs (Tamoxifen) are preferred first-line for gyno
• Worsens lipid profile (estrogen is cardioprotective -- lowering it increases cardiovascular risk)
• Over-use causes crashed E2: joint pain, lethargy, low libido, mood issues, bone density loss
• Reversible inhibitor: estrogen can "rebound" when stopped suddenly after prolonged use
• Symptoms warranting use: gyno onset (puffy/sensitive nipples), excessive water retention, high BP from fluid, ED/mood issues
• Does NOT need to be used on every cycle -- many users never need an AI