Injection
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.
Starting at $159/mo
Estrogen controlAromatase inhibitor
Exemestane Tablets
RxPrescription onlyTaken by mouth · Twice a week · 25 mg · Estrogen control · Aromatase inhibitor
Starting at $69/mo
Exemestane (Aromasin, commercial brand): aromatase inhibitor, similar to anastrozole, for reducing estrogen when elevated during testosterone therapy. Twice weekly or as lab-directed.
How many tablets per month?
MonthlyEvery 3 months
9 tabletsper month
You'll receive 9 tablets per month. $89 billed monthly. Cancel anytime.
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- Blocks aromatase to reduce estrogen conversion
- Commercial brand with consistent potency
- Used like anastrozole when estradiol is high
Every plan includes
- Personalized, physician-guided plan
- 9 tablets per month, monthly and 3-month
- 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
- Physician-guided care
- Ongoing, expert support
- 100% online
- Free, discreet shipping
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.
- How it is taken
- Taken by mouth
- How often
- Twice a week
- Dose range
- 25 mg
- Form
- Estrogen control · Aromatase inhibitor
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.
How it works,
week by week.
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.
Week 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).
Weeks 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.
Week 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.
Beyond
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.
What you may notice,
and when.
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
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.
Safety first:
what to know before you start.
Important 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.
The research behind
exemestane.
Exemestane is a steroidal aromatase inhibitor approved for breast cancer in women. In men its use to control estradiol is off-label, and the human evidence is one early small study.
- Estradiol38% lower
In an early study in men, exemestane at 25 mg daily lowered estradiol by about 38%, and at 50 mg by about 32%, while testosterone rose by about 60% and 56%. Lipids and IGF-we did not change. The authors called it a potent aromatase inhibitor in men.
Early pharmacology study, men, 2003 - Long-term safetynot studied
The same authors said that long-term efficacy and safety need further study. We found no controlled trial of exemestane in men with hypogonadism on testosterone therapy.
Early pharmacology study, men, 2003 - Male use reviewlimited evidence
A 2021 review of aromatase inhibitors in male infertility, useful for grading the evidence. It does not establish an exemestane-specific benefit.
Yang et al., Hum Reprod Update 2021
What the studies found
- Lowers estradiol in men: about 38% lower at 25 mg and about 32% lower at 50 mg in an early study (Early pharmacology study in men, 2003).
- Raises testosterone in the same study, by about 60% and 56% at those doses (Early pharmacology study in men, 2003).
- Otherwise unproven in men with hypogonadism: the only human data are that early study, and it did not test clinical outcomes.
The early result is a short study, not a trial of men on testosterone therapy. Exemestane is not a brand product in this line, and any use is off-label and needs estradiol monitoring.
What this does not say
- Estradiol that is too low can harm bone, lipids and mood.
- The available male data are small and early.
- Results from breast-cancer use in women do not transfer directly to men.
The research
behind it.
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.
Testosterone beyond the gym:
what the trials show across body systemsSex drive, blood counts, bone, blood sugar and thinking: what the Testosterone Trials and T4DM found, and where the evidence stops.Read the researchTestosterone and the heart:
what TRAVERSE foundThe safety question most men ask first: heart events, fractures, prostate and blood counts, in the largest placebo-controlled trial of testosterone.Read the research
what the trials show across body systemsSex drive, blood counts, bone, blood sugar and thinking: what the Testosterone Trials and T4DM found, and where the evidence stops.Read the researchTestosterone and the heart:
what TRAVERSE foundThe safety question most men ask first: heart events, fractures, prostate and blood counts, in the largest placebo-controlled trial of testosterone.Read the research
Getting started
takes a few minutes.
- 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.
Frequently asked questions
Contact supportHow 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.
Exemestane educational content reviewed by our physician
Scott Nass, MD Doctor 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.
More options
in this area.
Capsule
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.
9 capsules per month
Starting at $63/mo
Capsule
Anastrozole Capsules
Anastrozole, an aromatase inhibitor used in men to control estrogen levels during testosterone therapy. Prescribed and dosed by a licensed physician.
9 capsules per month
Starting at $63/mo
Tablet
Anastrozole Tablets
FDA-approved anastrozole tablets, an aromatase inhibitor used at low doses in men on testosterone therapy whose estradiol runs high. Prescribed by a licensed physician only after blood work.
5 tablets per month
Starting at $63/mo
References
- 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
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.