Estradiol Cypionate
Long-acting estradiol injection for menopause and perimenopause symptoms and for gender-affirming hormone therapy, given every one to two weeks. Prescribed and dosed by a licensed physician.
Injection
from $139/mo
Taken by mouth · Twice a week
Estrogen controlAromatase inhibitor
Exemestane Tablets
Exemestane (Aromasin, commercial brand): aromatase inhibitor, similar to anastrozole, for reducing estrogen when elevated during testosterone therapy. Twice weekly or as lab-directed.
- Blocks aromatase to reduce estrogen conversion
- Commercial brand with consistent potency
- Used like anastrozole when estradiol is high
- Monthly$89/mo
- Every 3 months$207 billed up front$69/mo
- Every 6 monthsBest value$354 billed up front$59/mo
- Free, discreet shipping
- Licensed U.S. pharmacy
- Board-certified physicians
Disclaimer: Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Products are compounded by a licensed pharmacy. The FDA has not reviewed or approved compounded products for any use for safety, efficacy, or quality. Compounded medications are not FDA-approved brand-name products.
- How
- Taken by mouth
- How often
- Twice a week
- Each shipment
- 9 tablets
- Strength
- 25 mg
What is exemestane?
(ex-EM-uh-stane)
Exemestane is an aromatase inhibitor (AI), similar in mechanism to anastrozole, that blocks the conversion of testosterone to estrogen. It is a commercial brand (Aromasin) with pharmaceutical-grade potency. Typical dose: 12.5–25 mg twice per week or as needed based on estradiol levels. Like anastrozole, it is only used when recent labs show elevated estradiol during testosterone therapy.
What's in it
- ExemestaneLowers estrogen made from testosterone
Commercial brand
pharmaceutical-grade aromatase inhibitor
Exemestane is regulated as a branded medication (Aromasin). It carries the same need for estradiol testing before use and regular monitoring. Over-suppression of estrogen carries cardiovascular and bone density risks.
Is it right for you?
Who it's for
Men who did not tolerate anastrozole.
What sets it apart
It disables the enzyme that makes estrogen permanently, instead of blocking it for a few hours.
Worth knowing before you start
Take it after a meal: it is absorbed much better with food.
What to expect
Lab-guided dosing
estradiol levels drive decisions, not symptoms alone
Reduced breast symptoms
tenderness and swelling typically improve in 2–4 weeks
Stable mood and energy
when estrogen is in range, mood and water retention often normalize
Bone and heart monitoring
avoiding over-suppression protects long-term health
How estrogen control works
Day 1
A US-licensed physician reviews your symptoms on testosterone (breast tenderness, mood changes, water retention). Estradiol lab is ordered; results guide decisions on aromatase inhibitors or tamoxifen.
1Week 1
Estradiol lab comes back. If high, your physician prescribes anastrozole 1 mg twice weekly or tamoxifen 10–20 mg daily, depending on the issue (high conversion vs. breast tissue sensitivity).
2Weeks 2–4
Symptoms from high estrogen (breast tenderness, mood swings, bloating) begin to improve. Some people feel better within days; others take 3–4 weeks.
3Week 6
Follow-up estradiol lab. If it is now in range, your physician adjusts or stops the AI/SERM. If still high, dose is increased or agent is switched.
4Beyond
Estradiol is monitored every 6–12 weeks. Your physician aims to keep estrogen in a healthy range, not suppressed, not elevated, to preserve bone and cardiovascular health.
5
Individual results vary. Benefits reflect what Zepym Health members commonly report to their physician at check-ins; they are not the results of a clinical trial.
How you use it
This is the starting dose the pharmacy prints on the label. Your physician sets yours and adjusts it with you.
- How
- Taken by mouth
- Dose
- 1 tablet (25 mg)
- How often
- Twice a week
- Each shipment
- 9 tablets
- Pharmacy label
- Take 1 tablet (25 mg) by mouth twice weekly for 30 days.
A sample week
- M
- T
- W
- T
- F
- S
- S
Twice a week
The science of estrogen control
Exemestane is an irreversible aromatase inhibitor, meaning it permanently disables the aromatase enzyme for the life of that enzyme molecule. This differs slightly from anastrozole (reversible), but clinical effect is similar.
In testosterone therapy, exemestane reduces estrogen when labs show elevation. Standard dosing is adjusted based on follow-up estradiol levels. Your physician may switch between anastrozole and exemestane based on response.
Learn moreImportant safety information and common side effects
Aromatase inhibitors (anastrozole, exemestane) and selective estrogen receptor modulators (tamoxifen) are prescribed off-label to manage estrogen during testosterone therapy. Estradiol must be tested before starting: over-suppression can reduce bone density and harm cardiovascular health. Common side effects: mild joint aches, hot flushes, mood changes. Tamoxifen carries a small risk of blood clots and endometrial changes with long-term use (>1 year). Tell your physician about bone health, prior thrombosis, or family history of clots. Stop and seek care for leg pain/swelling, chest pain, or signs of stroke.
Every plan includes
- Personalized, physician-guided plan
- Monthly, 3-month and 6-month plans
- Dispensed by a US-licensed compounding pharmacy
- Unlimited protocol adjustments and messaging
- Ongoing support and check-ins
- Pause or cancel anytime
- Reviewed by our in-house physicians
How it works
1.Connect with a physician
Answer a few questions online and a US-licensed physician reviews your health, history and goals to make sure treatment is right for you. 100% online. No in-person visit required.
2.Get your discreet shipment
If approved, your treatment is compounded by a US-licensed, LegitScript-certified pharmacy, inspected for quality, and shipped discreetly to your door.
3.Receive continuous support
Start with one goal, then keep building over time. Unlimited physician messaging, easy refills and dose adjustments, all from the Zepym Health app.
Exemestane educational content reviewed by our physician
Scott Nass, MDDoctor of Medicine, board-certified in Family Medicine
Charles R. Drew University and David Geffen School of Medicine at UCLA. Family Medicine residency at Ventura County Medical Center.
Frequently asked questions
How do I take Exemestane Tablets?
Taken by mouth, twice a week. The starting prescription is 1 tablet (25 mg) each time. Your physician sets your own dose and it is printed on your label.
How much arrives in each shipment?
9 tablets at the starting strength, shipped to your door from a licensed US pharmacy.
What is the difference between exemestane and anastrozole?
Both block aromatase, but exemestane is irreversible (disables the enzyme permanently) and anastrozole is reversible (blocks temporarily). Clinically, the effect is similar. Exemestane is a commercial pharmaceutical brand; anastrozole is often compounded. Your physician chooses based on availability, response, and preference.
Do I always need an aromatase inhibitor on testosterone?
No. Many men convert testosterone to estrogen at a normal rate and do not need an AI. Your physician orders an estradiol lab; if it is normal, no AI is needed. Only if estradiol is high and causing symptoms does your physician prescribe one.
Can I use tamoxifen and aromatase inhibitors together?
Not typically. They work differently (tamoxifen blocks estrogen in breast tissue; AIs lower overall estrogen). Your physician chooses the right tool for your issue: high overall estrogen calls for an AI; breast tissue sensitivity calls for tamoxifen.
What if I need an AI long-term?
Long-term aromatase inhibitor use can reduce bone density over time. Your physician may recommend bone density screening (DEXA scan) and calcium/vitamin D supplementation if AI use extends beyond 1–2 years.
How often do I check estradiol levels?
Initial check: before starting any AI or SERM. After starting or adjusting dose: 6 weeks. Then: every 3–6 months once stable, or when symptoms change. Annual bone health screening is recommended with long-term AI use.
Testosterone without unwanted estrogen effects.
Gonadorelin
A copy of the brain's own GnRH signal that keeps the testes producing testosterone and sperm, used alongside testosterone therapy and in fertility care. Prescribed and dosed by a licensed physician.
Injection
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7-Keto DHEA Capsules
7-Keto DHEA, a metabolite of DHEA that does not convert to testosterone or estrogen. Supports energy and metabolism without hormonal side effects.
Capsule
from $79/mo
Anastrozole - Men
A low-dose aromatase inhibitor for men on testosterone therapy whose blood work shows high estradiol, easing breast tenderness and water retention. Slow-release capsule, prescribed and dosed by a licensed physician.
Capsule
from $54/mo
The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Individual results vary.
Sources
- 1
Endocrine Society Clinical Practice Guidelines for testosterone therapy: managing estrogen with aromatase inhibitors.
J Clin Endocrinol Metab, 2018 - 2
Tamoxifen for gynecomastia in testosterone replacement therapy: a review of evidence.
J Clin Med, 2021
Exemestane Tabletsfrom $59/mo