Contraindications: Exemestane is contraindicated in pre-menopausal women, individuals with known hypersensitivity to steroidal AI compounds, and anyone with active hepatic impairment. Do not use alongside oestrogen-containing therapies, as pharmacological antagonism renders both agents ineffective.
Side Effects: At mild-cycle mini-PCT doses of 12.5 mg, side effects are typically limited. Potential effects include transient joint discomfort from reduced synovial lubrication, fatigue, and mood variability tied to estrogen flux. At no point should Exemestane be used to drive estradiol below the physiological floor, as this produces libido impairment, cognitive effects, and lipid profile deterioration.
Monitoring: Serum estradiol should be measured via LC-MS/MS or high-sensitivity immunoassay — not standard immunoassay — for accurate male reference-range interpretation. Total testosterone, LH, and FSH monitoring at PCT end confirms HPT axis recovery. Lipid panel (HDL in particular) should be evaluated if Exemestane use extends beyond four weeks.
PCT: Exemestane is an AI, not a SERM, and does not directly stimulate gonadotropin release. For mild cycles where HPT suppression is moderate, Exemestane alone may be adequate; for deeper suppression profiles, include gonadotropin-stimulating support. Discontinue Exemestane once bloodwork confirms recovery — continuing past this point risks iatrogenic estrogen deficiency.