Seems like a very intelligent guy. Wish he was still in the forefront of progressing TRT forward. He seems to have a perfectly balanced and rationale stance on E2. He says that estrogen is the most important hormone for MEN, more so than even testosterone. Then he goes on to say that E2 still needs to be managed and balanced, because if not, high E2 symptoms can occur. Sounds like views that are the perfect balance of what we see on this forum, and the views of Dr. Nichols, Jay, and the other docs on the round table. Thanks for posting this.
lowe2sucks
Member
I would even say testosterone is not as important as metabolites of testosterone DHT and Estradiol.. testosterone is just a pre cursor to those 2 extremely important hormones.. and evidence for this is if you block one of them or both by using 5ar inhibitor or aromatase inhibitor you get baaad side effects
lowe2sucks
Member
indeed!
Dr. John Crisler
Physician
I just got my old pal Dr. Shippen an invite to speak at the April 2019 AMMG conference in Miami. He is going to speak on HCG monotherapy and estrogen management. So we will have new lecture material to post from him.
Dr. John Crisler
Physician
The variable is everyone is so different.
Exactly. What I said is still true, but you’re absolutely right, everyone has their own individual range(s) that their hormones need to fall into for his/ her body to consider itself “balanced”.
Some of us might have similar ranges where we feel balanced, but at the end of the day, it’s all very individualistic when it comes to hormones. That’s why it blows my mind when Dr. Nichols is recommending a range for total E2 of 50-70, I believe. He’s not only recommending a range, but a range for TOTAL E2, not free E2 which would make more sense. This is 2008 thinking, not 2018. In 2018 we should know by now that people are so different, and one guy’s ideal E2 can be around 20, and another guy possibly 90. And why we are not going by free E2 yet is beyond me. Unless I’m missing something, that’s like a doctor only going by total testosterone. We would look at him like he has an IQ of 80, max. So why are we still going by total E2? I must be missing something, because it makes zero sense to me.
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Cannot wait to hear his updated views on these topics.
Dr. John Crisler
Physician
We do have androgen receptors, literally, all over the body. They are important, and many body mechanisms rely of their action. But it's very clear many of the benefits of TRT actually come because when you administer testosterone, you subsequently raise estrogen. When T is too low, so is E.
This movement toward an appreciation for estrogen in men's health is a very good thing.
This movement toward an appreciation for estrogen in men's health is a very good thing.
Dr. John Crisler
Physician
I've had a slide in my lecture set for years which states: "If the patient has no symptoms of elevated estrogen, I do not add an AI".
If the patient feels good with a total E2 at 50-70, he probably is good. At least he hasn't been driven too low with inappropriately high AI dosing.
Having said that, I am concerned because there are no studies which show inducing high levels (as verified by proper LC/MS testing--not the invalid immunoassay technique; those studies are often misapplied to this dialogue) of estrogen is safe for men. It's one thing to acknowledge driving estrogen too low is always bad (which is what every single study purporting to show any AI use as dangerous did), something entirely different to claim estrogen should be as high as possible. We certainly can all agree "more is not better" with respect to testosterone dosing--is it different for estrogen?
I monitor SHBG levels (which can trend up or down) in order to get an idea for Free E2, just as we can do for T. Free E2 is, at this time, a very expensive test.
Vince Carter
Banned
Free E is key to the low SHBG guy, i always have to add that caveat of it's affordable for the guy. Too knowing it's a trough/low point number and not static in that range. Great to see you mentioning it @Dr. John Crisler
Thanks for the response, and agree completely. Really wish there were studies done, ON MEN, that looked at the potential consequences of high E2, and more importantly, determined where the upper cutoff is to where the side effects outweighed the benefits. Because we obviously already know there is negative consequences to any hormone being in excess, so we don’t need a study to tell us that E2 at too high of a level is going to cause issues. We just need to know what issues it can cause, and the upper range that they found where the side effects began to outweigh all the benefits of E2, in most of the test subjects.
But we all pretty much know that we shouldn’t be holding our breath for any studies like this, unfortunately. So in the meantime, I think we all just need to be getting our free E2 done, and reporting our results in regards to mood, libido, erection quality, etc. Yes, this isn’t as good as a study, where they can hopefully tell us objective things like where does E2 stop being cardiovascular protective, and start potentially increasing your cardiovascular risk, but it’s all we can do while we wait for studies on high E2 in men to be done.
And yes, cost is a huge factor, I understand, but I still hope more guys start testing for it. Even if they do it once every 3rd or 4th time they get labs done. And hopefully the cost of the test comes down in the future.
Wow very good point! I didn’t even think of this being an option. I feel so stupid lol. If there is a formula for free T, you’re right, there probably is a way to figure out someone’s calculated free E2.
Vince Carter
Banned
Ive not found a similar formula, Id like it if there was one though, as said the test can be cost prohibitive.
So just checked discountedlabs, and it turns out the free E2 is not as expensive as I thought. Sensitive E2 is $52, and free sensitive E2 is $108. So it’s not too bad if you’re only get one or the other. But most guys are still going to want their total tested, even if they get their free E2 done. So then the cost would be $160 for both, opposed to $52 if you just get the sensitive done by itself. So I get why guy’s aren’t getting both done.
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