It should be noted that in theory if one was to consistently suppress your natural estrogen levels for a long period of time, this would negatively impact your health, including your cholesterol. Due to the ability of Letrozole- to inhibit estrogen so much, this should definitely be a concern to most users. However the research that has focused on the relationship between use of letrozole and cholesterol levels is rather inconsistent in it's findings. Many studies have concluded that the compound is detrimental to both a user's HDL and LDL cholesterol levels, while other research has found no link. Obviously individuals are best served to monitor their cholesterol while using any compound via blood tests however barring that, letrozole should simply not be run for extended periods of time if at all possible. Doing so could cause serious medical complications.
Along with the issues related to blood lipids is the fact that many users complain that their libido is dramatically reduced when using the compound. This is related to the fact that estrogen is partly responsible for the regulation of an individual's sex drive. Since Letrozole- is so potent it can often drive estrogen levels too low and this inhibits a user's libido. To avoid this users can lower dosages, but some anecdotally report that even extremely low doses of the drug can cause problems. If this is the case a less potent compound such as exemestane or anastrozole may be a more appropriate option.
While interesting and somewhat counterintuitive to conventional thinking, the results from this analysis should not be overinterpreted. The issue of temporality is a major concern. The exposure in this situation, training protocol, is likely to be adjusted either temporarily or permanently post-acute injury, and the wording of the questionnaire did not capture this nuance. Furthermore, the respondents gave fairly broad answers to their definition of an acute injury from a strained muscle to severe ligament and orthopedic injuries. Nonetheless, the primary outcome of interest from this analysis was the significant differential in predicted acute injury probability by sex across all training age levels, as seen in Figure 2.
It all comes back to the tanning analogy for me. Who is going to be darker: the guy who spends fifteen minutes a week tanning or the guy who spends thirty minutes a week tanning? Assuming all else is equal, the athlete who puts in more work will better. Drugs, in the end, do allow you to do more work and you should take advantage of that fact. Most don’t.
Everyone has a different tolerance for volume. I’m not suggesting you immediately jump into a high volume routine. What I am suggesting is, just like a tan, over time, you have to continually expose yourself for longer and longer times in order to keep making gains. Your natural limit will eventually be defined by what you can realistically recover from. Drugs push that line a lot further down the road.
With that said, I don’t think there is any real difference in how natural and enhanced lifters should train . If you’re autoregulating the volume and intensity for both groups, the issue takes care of itself. Over time, after years of training, you’d notice that the enhanced lifters would, on average, being doing much more volume. That said, there will still be some individuals who do significantly less volume because that is simply what works best for the body.
Regardless, in a majority of cases, the best athletes will be the ones who best tolerate the largest amount of volume. Whether you’re natural or enhanced, your goal should be, eventually, to work up to the highest level of volume you can personally handle. Just like with a tan that is the only way to keep getting darker.
In the end, in my opinion, the only real difference is that enhanced lifters will be able to push themselves much farther than they otherwise would while making better progress in the process. However, the process remains the same for both groups: gradually add volume over time until you simply can’t anymore.
If you’d like to learn more about performance enhancing drugs , again, I won’t hesitate to recommend Llewelyn’s Anabolics which contains more than 800 medical references on the subject. Don’t get broscienced; inform yourself with actual science.