Controversies with Testosterone Therapy - Management of Erythrocytosis and Elevated Estradiol

madman · Oct 12, 2025

* No universally accepted cutoff: 30, 40, or 50 pg/mL?

Controversies with Estradiol

madman · Oct 12, 2025

Clinical Approach to Elevated Estradiol & TRT

madman · Oct 12, 2025

Future Directions

madman · Oct 12, 2025

Conclusions

madman · Oct 12, 2025

Thread 'Estrogen-It's what makes a real man'

Sep 24, 2022

Study: Low estrogen can cause problems for men

Study: Low estrogen can cause problems for men (2013)

Dr. Joel Finkelstein, an endocrinologist at Harvard Medical School and the lead author of a new study, talks about the effects of declining estrogen in men.

Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men (2013)

Joel S. Finkelstein, M.D., Hang Lee, Ph.D., Sherri-Ann M. Burnett-Bowie, M.D., M.P.H., J. Carl Pallais, M.D., M.P.H., Elaine W. Yu, M.D., Lawrence F. Borges, M.D., Brent F. Jones, M.D., Christopher V...

madman · Oct 12, 2025

Thread 'Testosterone Therapy and Erythrocytosis - the most common dose-limiting effect of testosterone therapy'

Apr 21, 2024

Testosterone Therapy and Erythrocytosis • The Blood Project

Introduction Androgens play a crucial role in the development and maintenance of: Male reproductive and sexual functions Body composition Erythropoiesis

www.thebloodproject.com

Introduction

Androgens play a crucial role in the development and maintenance of:

Male reproductive and sexual functions

Body composition

Erythropoiesis

Muscle and bone health

Cognitive function
Testosterone falls progressively with age and a significant percentage of men over the age of 60 years have serum testosterone levels that are below the lower limits of young...

Nelson Vergel · Oct 13, 2025

Great graphics. Unfortunately, not a great job on showing more data on estradiol benefits. At least he mentions some of the risks of overtreating estradiol. Also, never addressed what “ treat based on symptoms” means. Most symptoms blamed on high estradiol have nothing to do with E2.

Seagal · Oct 13, 2025

Nelson Vergel said:
Great graphics. Unfortunately, not a great job on showing more data on estradiol benefits. At least he mentions some of the risks of overtreating estradiol. Also, never addressed what “ treat based on symptoms” means. Most symptoms blamed on high estradiol have nothing to do with E2.

It's about Erythrocytosis. Maybe treat based on symptoms vs treat based on numbers. I recall an earlier study which linked E2 to Erythrocytosis, and it employed AI to manage it when E2 was high on modest TT levels.

Seagal · Oct 13, 2025

madman said:
Example of some of the data looking at the rates of erythrocytosis
View attachment 53312

Why the difference between TU and TE/TC? What dose and injection intervall?
When topical is mentioned it probably means Androgel. Not the same as twice daily high percentage Testo cream. Etcetera

You provided a much clearer correlation, i.e. accumulated free T.

Oral TU is outstanding. Why? That's intriguing.

madman · Oct 13, 2025

Nelson Vergel said:
Great graphics. Unfortunately, not a great job on showing more data on estradiol benefits. At least he mentions some of the risks of overtreating estradiol. Also, never addressed what “ treat based on symptoms” means. Most symptoms blamed on high estradiol have nothing to do with E2.

You would need to listen to the full presentation which includes a Q&A at the end to catch the gist here.

I will be post the link after I am done posting some of the other presentations.

Unfortunately he did not spend enough time on the benefits (bone health, libido & erectile function, metabolic regulation) as the presenters were only given 20-30 minutes and he was the last one on the panel so he only had 15 minutes!

Dr Khera was the moderator.

Dr. Lipshultz was there too!

Mastodont · Oct 15, 2025

Seagal said:
Why the difference between TU and TE/TC? What dose and injection intervall?
When topical is mentioned it probably means Androgel. Not the same as twice daily high percentage Testo cream. Etcetera

You provided a much clearer correlation, i.e. accumulated free T.

Oral TU is outstanding. Why? That's intriguing.

I can tell you why, that data is based on manufacturers data, on frequency of 10-12 weeks for the 1000mg injection, so people are spending most of that time in physiological levels and even low levels for the last weeks.

Seagal · Oct 15, 2025

Mastodont said:
I can tell you why, that data is based on manufacturers data, on frequency of 10-12 weeks for the 1000mg injection, so people are spending most of that time in physiological levels and even low levels for the last weeks.

The nebido protocol.

For oral TU the data is then probably based on once daily protocol, resulting in less accumulated fT over the day and enough time to clear E2.

madman · Nov 16, 2025

madman said:
Clinical Approach to TRT & Erythrocytosis
View attachment 53321

Thread 'TESTOSTERONE: A SAFETY UPDATE 2025'

Nov 16, 2025

Professor Michael Zitzmann

We also know hematocrit can be increased by testosterone preparations. It depends on the preparation, and we think that there is data that shows that the threshold of 52-54% should not be surpassed, and men should be controlled for the hematocrit especially in the first year of treatment every 3 months

Hematocrit & Thromboembolic Risk

* TTh increase Hematocrit - clinically relevant at >52-54%

* Recommended: Control Hematocrit every 3 months in the 1st year

...

madman · Nov 29, 2025

Thread 'EAU Guidelines on Male Sexual and Reproductive Health: 2025 Update on Male Hypogonadism, ED, Premature Ejaculation'

Nov 29, 2025

* Elevated haematocrit is common with TTh, typically occurring within 3–12 mo. Levels up to 54% appear safe, but higher values may increase CV risk [15].

* Treatment adjustments are required for haematocrit >54% (requiring withdrawal and phlebotomy in high-risk cases)

Fig. 1 – Diagnostic evaluation of late-onset hypogonadism. cFT = calculated free testosterone; LH = luteinising hormone; MRI = magnetic resonance imaging; PRL = prolactin; SHBG = sex hormone–binding globulin; T =...