Positives

• Men with elevated estradiol on TRT reported normalized E2 and reduced gynecomastia/water retention with low-dose anastrozole PMC.
  
  
• Aromatase inhibition raised endogenous testosterone modestly in older hypogonadal men, useful when LC has suppressed the HPG axis PMC.
  
  

Negatives

• Crashed estradiol led patients to report worse sexual function, joint pain and rising fat mass despite higher testosterone PMC.
  
  
• A patient on anastrozole developed drug-induced liver injury after a mild SARS-CoV-2 infection, suggesting LC patients may face added hepatotoxicity risk Wiley.
  
  

Hurdles & Side Effects

• Anastrozole is not FDA-approved for men, so prescriptions are off-label and rarely covered by insurance PMC.
  
  
• Long pharmacologic half-life makes over-suppression of estradiol common and slow to reverse PMC.