What is the most appropriate medication adjustment for a trans man receiving testosterone therapy with rising estradiol levels?

The most appropriate medication adjustment for a trans man receiving testosterone therapy with rising estradiol levels is to add anastrozole 1 mg orally weekly. Anastrozole is an aromatase inhibitor that decreases the conversion of androgens to estrogens, effectively addressing elevated estradiol levels. In individuals undergoing testosterone therapy, it is not uncommon for some testosterone to convert to estradiol, which can lead to unwanted side effects, including feminizing effects or symptoms of estrogen dominance.

Adding anastrozole can help to manage these estradiol levels without reducing the overall testosterone therapy that is crucial for masculinization and other benefits that testosterone provides. This adjustment helps maintain the desired effects of testosterone therapy while minimizing the risks associated with increased estradiol levels.

Increasing testosterone dosages or lowering them may not effectively address the rising estradiol levels and could possibly lead to further complications or insufficient hormonal balance. Similarly, while DHEA can have benefits related to hormonal levels, it would not specifically target the issue of rising estradiol in this context, making anastrozole the most suitable and effective option.