Can anastrozole improve testosterone in men?

Testosterone levels naturally decline as men age. Low testosterone (low T) can lead to a host of health problems like low sex drive, fatigue, erectile dysfunction (ED), and muscle weakness. 

Testosterone replacement therapy (TRT) is the go-to treatment for low T, but it comes with side effects: it can lead to male infertility by lowering the sperm count. That’s why some healthcare providers offer other treatments to treat low T like clomiphene (brand name Clomid). You might have also heard of a drug called anastrozole used to supplement low T levels, however, it’s not routinely recommended.

Testosterone support

Created by doctors, backed by science.

Start now

Anastrozole (brand name Arimidex) is occasionally used to supplement low testosterone. This drug works by decreasing the amount of estrogen the body makes. 

It was originally developed to treat what’s called hormone receptor-positive breast cancer in postmenopausal women. Hormone receptor-positive means that the cancer cells grow in response to the hormone estrogen, which explains why anastrozole can treat these kinds of breast cancers. 

Currently, anastrozole is only FDA-approved for use in women. But like clomiphene, some providers prescribe anastrozole off-label to treat low testosterone in men. However, there isn’t enough evidence to recommend it as a standard treatment for low T. 

There is limited evidence for anastrozole’s effectiveness in men.

In one small study, anastrozole increased testosterone in older men with mild hypogonadism (low T) (Leder, 2004). In another study looking at men with low testosterone and infertility, taking anastrozole led to increased testosterone and increased sperm count in some (Shoshany, 2017). 

Although anastrozole may increase testosterone levels, a recent analysis suggests that it doesn’t lead to improvements in sexual function like better erections or higher libido (sex drive). It also doesn’t improve semen quality. Currently, there isn’t sufficient evidence to recommend anastrozole as a routine treatment for low T in clinical practice (Awouter, 2020).

When compared to clomiphene, another off-label treatment for low T, men had significantly higher increases in testosterone than on anastrozole (Helo, 2015). 

In some cases, a healthcare professional might consider prescribing low-dose anastrozole for men who receive TRT. The reason is that testosterone injections can increase estrogen levels, sometimes leading to unwanted breast growth (gynecomastia) in men. Arimidex and other aromatase inhibitors may reduce estrogen hormone levels in men and potentially treat gynecomastia (Rhoden, 2004).

We often think of testosterone and estrogen as exclusively male (androgen) and female (estrogen) hormones. However, men and women naturally produce both hormones, and a balance between the two is vital for good health in both sexes. 

In men, having too little testosterone or too much estrogen can lead to problems like low sex drive, breast tenderness or enlargement, and erectile dysfunction. The primary sex hormone for men is testosterone, which is made in what are called Leydig cells in the testicles. Men also make a small amount of estradiol, a potent estrogen (de Ronde, 2011). 

Estradiol is made directly by the testicles, but the majority comes from the conversion of testosterone into estradiol by the aromatase enzyme. Anastrozole blocks the action of aromatase (called aromatization), which slows down the conversion of testosterone to estradiol. This boosts overall testosterone levels and lowers estradiol (de Ronde, 2011). 

Most of what we know about the side effects of anastrozole comes from research in women who took it as a cancer treatment. Side effects reported included hot flashes, back pain, arthritis, depression, and bone fractures (FDA, 2011). 

One possible side effect of anastrozole in men is decreased bone health, which is another reason why the drug is not recommended as a routine treatment for low T. In older men with low testosterone, a study showed that anastrozole treatment improved T levels, but also decreased spinal bone density (Burnett-Bowie, 2009). 

Low T (hypogonadism) affects an estimated 40% of men over 45. Having low testosterone can contribute to bothersome symptoms like erectile dysfunction, low libido, decreased muscle strength, and loss of bone mass (osteoporosis) (Sizar, 2021). 

Age is the most common cause of low T. However, other factors that play a role include obesity, sleep apnea, certain medications, and viral infections (Sizar, 2021).

If you think you have a testosterone deficiency, a healthcare provider can perform a blood test to find out for sure. Typically, they’ll order tests to check your total testosterone and free testosterone levels, preferably in the morning (Sizar, 2021). 

As we mentioned, a common low T treatment is testosterone replacement therapy. TRT comes in several forms including injections, gels, and patches. TRT works by giving your body exogenous testosterone to raise your baseline hormone levels; when taken as directed, testosterone therapy is safe and effective (Rivas, 2014).

The downside is there are side effects of testosterone therapy, the major one being its negative impact on male fertility. Over time, TRT shuts down your body’s natural sperm and testosterone production, which can eventually lead to infertility (Patel, 2019). 

What if you want to give your body a natural testosterone boost?  Some studies suggest that high-intensity exercise, like sprinting, may be linked to higher T levels (Sato, 2016). 

The same goes for high-intensity interval training (HIIT). During HIIT classes, you engage in periods of intense cardio alternated with periods of lower-intensity activity (Riachy, 2020; Hayes, 2019). But even lighter aerobic exercise, such as jogging or walking, may lead to increases in testosterone (Kumagai, 2016). 

It also makes sense to cut down on alcohol. The occasional drink most likely won’t affect you, but chronic and heavy alcohol consumption seem to be associated with lower testosterone and decreased sperm quality (Muthusami, 2005). 

---

How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Editorial Guidelines | Medical Review Process

Current version

February 02, 2022

Written by

Cale Li, MD

Fact checked by

Felix Gussone, MD

---

About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.