Hi Dr. Tyler Vincent, I started TRT about 8 weeks ago. My latest blood work shows a total testosterone of around 1,450 ng/dL. My combined estrogen (E1 + E2) is approximately 152 pg/mL (Estrone 86 pg/mL + Estradiol ~66 pg/mL), so I'm above the range of 50–100 pg/mL that I've often seen discussed. I brought this up with my TRT doctor. He told me that this isn't necessarily a problem because estrogen is expected to increase proportionally with testosterone. He said that if I want to lower my estrogen, I should simply reduce my testosterone dose. He also said that if I decide to use anastrozole, it would be at my own risk, and he would not recommend it because lowering estrogen could disrupt the testosterone-to-estrogen balance and potentially lead to side effects such as reduced libido, depression, and other symptoms. My question is: Do you agree with this approach? In someone with a testosterone level of around 1,450 ng/dL, do you think estrogen should simply be accepted as long as it rises proportionally, or do you believe there is an upper level (for E2 or combined E1 + E2) where using a low-dose aromatase inhibitor becomes beneficial, even if testosterone remains high?