This is a conversation I end up having with a lot of men.

If you’re on hormone therapy and your provider suggests adding an aromatase inhibitor—often called an AI—it’s worth slowing down and really understanding what that means before moving forward.

Most commonly, this medication is anastrozole. It’s used to lower estrogen levels, and in certain situations, it can be helpful. But it’s not something that should be added automatically or without a clear reason—especially in men.

Before you say yes to it, you should know what it can affect and what to watch for.

Estrogen Isn’t the Enemy

One of the biggest misconceptions I see is the idea that estrogen is “bad” for men.

It’s not.

Men need estrogen for bone strength, joint health, cardiovascular function, mood, and cognitive health. When estrogen is suppressed too aggressively—whether with anastrozole or another AI—men often start to feel worse, not better.

That’s why lowering estrogen shouldn’t be a knee-jerk reaction.

Bone Health Deserves More Attention

This is one of the most important things to understand.

Estrogen plays a major role in maintaining bone density in men. When estrogen drops too low, bones can gradually become weaker and more fragile. Over time, that increases the risk of fractures and osteoporosis.

Some studies have shown that bone mineral density can decline within a year of using aromatase inhibitors. If you already have risk factors—age, prior bone loss, family history—this matters even more.

If an AI is being recommended, bone health should absolutely be part of the discussion.

What About Heart Health?

Aromatase inhibitors can also affect cardiovascular risk.

They’ve been associated with changes in cholesterol, including lowering HDL (the “good” cholesterol). For men who already have high blood pressure, insulin resistance, or carry extra weight around the middle, this is something to take seriously.

This doesn’t mean an AI is always wrong—but it does mean heart health shouldn’t be ignored when one is prescribed.

Vision Changes Aren’t Common—but They’re Real

This is something almost no one talks about.

There have been reports of vision changes with aromatase inhibitors, including blurred vision and increased eye pressure. These side effects are rare, but they’re real—and they shouldn’t be brushed off.

If you notice changes in your vision after starting an AI, that’s something to address right away.

Mood, Memory, and Brain Fog

Estrogen also affects the brain.

Some men on anastrozole notice increased anxiety, low mood, irritability, or a sense of brain fog. Others report memory issues or difficulty concentrating. These symptoms often show up when estrogen is pushed too low.

If your mental clarity or mood changes after starting an AI, that’s important feedback—not something to ignore.

Joint and Muscle Pain Is One of the Most Common Complaints

This is probably the side effect I hear about the most.

Joint stiffness, muscle aches, and overall discomfort are common with aromatase inhibitors. For some men, it’s mild. For others, it interferes with workouts, daily movement, or sleep.

Pain shouldn’t be the price of hormone therapy.

Questions Worth Asking Before Starting an AI

Aromatase inhibitors aren’t always wrong—but they’re not one-size-fits-all either.

If an AI like anastrozole is being recommended, it’s reasonable to ask:

  • Why is this needed in my case?
  • Are there other ways to address this issue?
  • What symptoms should I watch for?
  • How will we reassess if I don’t feel better?

You deserve to understand the why behind every medication.

Thoughtful Hormone Care Matters

Hormone therapy works best when it’s individualized, not when medications are layered on automatically.

At Mason City Wellness in Mason City, Iowa, the focus is always on how you feel, how your body responds, and whether a treatment is truly improving your quality of life.

If something doesn’t feel right—or if you feel worse after a change—that’s worth talking through. You should never feel stuck on a medication just because it’s “standard.”

Good care means staying informed, asking questions, and adjusting when needed.

Samantha Smith ARNP, NP-C