Dr. Eugene Shippen on estradiol, aromatization...

[DragonBits]

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.

So what do we do with the Free E2 information? Does any doctor know what to do with it? Does anyone here know what their free E results were?

Defy will want you to get the E2 sensitive test done if they are requiring any labs, so you don't really have a choice about that. Any care from a doctor or clinic will want an E2 test done, some will require the sensitive test, some will be OK with the immunoassay technique, BUT no one will accept the free E2 test in place of the E2 test.

In the end, it appears you are then doing the free E2 test for your own use. I can see it might be useful if you have odd symptoms that aren't apparent with the normal labs. I don't know if it will be easy or hard (or necessary) to convince a doctor that they should consider your freeE2 result.

EDIT: I would assume that those with average SHBG inside of the range won't need to bother with freeE2? Taking a swag at what it should be seems good enough to me unless your shbg is very low or very high.

 

[jhperez81]

We mostly ignore total T, total T4, total T3 when managing hormones so why don’t we ignore Total E2? After all it’s the free active hormone that really matters right?

 

[Vince Carter]

Using Free E is just like the change that took place from immunoassay to LC/MS/MS, better things come along but the acceptance of it takes some time.
As tyo what to do with it, there's a lab range, obviously, which is just numbers. But out Dr's have enough trouble knowing what's right and whats wrong with the numbers that LC/MS/MS produces, too. I mean what's too high and what's too low; symptoms.

 

[Vince Carter]

We mostly ignore total T, total T4, total T3 when managing hormones so why don’t we ignore Total E2? After all it’s the free active hormone that really matters right?

I think you're right...for instance I no longer run Total Test, only Free T. I don't see any path that tells me I need to know how much is bound up and unsable in my body. Such is with the LC/MS/MS test...I see that just the same way. It might not be the same but I see it as such.

 

[DragonBits]

I think you're right...for instance I no longer run Total Test, only Free T. I don't see any path that tells me I need to know how much is bound up and unsable in my body. Such is with the LC/MS/MS test...I see that just the same way. It might not be the same but I see it as such.

Before Excel male, I used to research which test I should get, and often read that free T was not a very reliable test.

Why not, then, just test free testosterone and avoid the whole SHBG issue? Unfortunately, lab tests for free testosterone are also unreliable—even more so than tests for total testosterone. "If you run the same person's blood on the same test three times, you get different answers," Dr. Kormos says. In fact, a study by the Endocrine Society found that measurements of free testosterone in the same blood sample can vary by a factor of five.

Testing your testosterone: It's tricky - Harvard Health

I assume you are taking about free AND bioavailable. I agree with you IF you can trust the results. On the other hand, as long as your TT is under 1500 ng/dl, discount labs list the price for Total T and FreeT combined is $30.45, so I am not sure why you shouldn't get that test.

 

[Vince Carter]

I didn't say anything about the accuracy of the test, and in saying it's unreliable what you mean to say and what you qouted meant to say is that it is a calculation and not a direct measurement.

So long as it's only $30 write me a check and I'll get the tests you think I should have. Deal?

 

[Gman86]

Before Excel male, I used to research which test I should get, and often read that free T was not a very reliable test.

Why not, then, just test free testosterone and avoid the whole SHBG issue? Unfortunately, lab tests for free testosterone are also unreliable—even more so than tests for total testosterone. "If you run the same person's blood on the same test three times, you get different answers," Dr. Kormos says. In fact, a study by the Endocrine Society found that measurements of free testosterone in the same blood sample can vary by a factor of five.

Testing your testosterone: It's tricky - Harvard Health

I assume you are taking about free AND bioavailable. I agree with you IF you can trust the results. On the other hand, as long as your TT is under 1500 ng/dl, discount labs list the price for Total T and FreeT combined is $30.45, so I am not sure why you shouldn't get that test.

Even if the free test is somewhat unreliable, it's reliable enough to give us the information we need. I've had so many labs done over the years, and my free T is usually around where I would think it should be, taking into account my total T, SHBG and Albumin levels. So overall, it's accurate enough for me to trust it without even having my total T done. But the test I use for quest has total, free and bioavailable all in one. Plus my labs are covered 100% by insurance, so for me personally, there's no reason to not get total run anyways. But I don't really need it, due to the free testosterone test being accurate enough to base protocol changes on, in my opinion.

 

[Gman86]

Dragonbits, you have a decent point. For now, doctors are still going to most likely require a serum E2 test. But with most HRT doctors nowadays, the free E2 will be beneficial to have. For instance, I'm with Defy, and they require a serum E2 test, but when I have the free E2 test done, they absolutely take it into account. Me and Nurse Jill have gone over my free E2 results every time I've had a consultation with her, and she takes my free E2 into account more so than my total E2. So yes, it's not going to matter with every doctor, but if you're with one that knows what they're doing, it's absolutely beneficial to have. It would actually be a decent Litmus test to see if your doctor knows what they're doing, now that I think about it lol.

And Vince Carter nailed it. Things take time to be accepted. Yes we all know now that free T is what matters, and if a doctor only tested total T we would think they were from the stone age of TRT. But this wasn't always the case. 10 years ago the top TRT doctors were probably all basing their protocols off of total T. I think in time we will look back on testing only total E2 as stone age TRT thinking, but it just takes time for things to shift.

And Vince Carter is also right, even if we do all test free E2, it is going to take time for doctors, as well as us patients, to come to a consensus on where we should be keeping our free E2 levels. But it is going to be much much easier to all come to a common consensus of this, than an ideal total E2 range, in my opinion. It excludes variables like SHBG, Albumin, and just overall how each guy metabolically processes E2. I just foresee it being much easier to dial in E2 for everyone when we can focus on free E2, instead of total E2. And the sooner we get started on this shift, the sooner we can all understand where optimal free E2 levels should be. That's why it makes me laugh seeing Dr. Nichols and Jay talk about ideal total E2 ranges so sternly. I already look at them now like they are two guys from the stone age of TRT, due to them focusing so much on total E2, and I'm pretty sure even they are going to look back on podcasts like that in a couple years and cringe. It's just how progression works though. It happens so quickly, that we can all look back on our thinking, whether it be a year ago, month ago, or even a week ago, and cringe at the way our thought process was in regards to certain topics. We are all just human, and we are all not perfect. So no judgment on my end. Just my observations/ opinions, that's all.

 

[DragonBits]

Even if the free test is somewhat unreliable, it's reliable enough to give us the information we need. I've had so many labs done over the years, and my free T is usually around where I would think it should be, taking into account my total T, SHBG and Albumin levels. So overall, it's accurate enough for me to trust it without even having my total T done. But the test I use for quest has total, free and bioavailable all in one. Plus my labs are covered 100% by insurance, so for me personally, there's no reason to not get total run anyways. But I don't really need it, due to the free testosterone test being accurate enough to base protocol changes on, in my opinion.

Good to know, in actual practice I think some on the forum get a little to anal about how exact these labs really are. Get a good estimate is likely enough.

Gman, since you do test your free E2, how different is it from what you would expect? Has it changed how you manage your protocol?

 

[Gman86]

Good questions Dragonbits, what I'll do is post all my E2 labs, total and free, and you guys can make your own conclusions on how different the free E2 values are compared to what you would think they would be, based off the total values and SHBG. And it has definitely changed how I manage my protocol. I take into consideration greatly where my free E2 sits. I do still take into account where my total sens E2 is though. Mostly because not enough talk has been done on ideal free E2 ranges. So to find my ideal range for E2, I personally factor in both total and free E2, at the moment.

E2 NOT Sensitive - 71
E2 Free - 1.88 (0.2-1.5)
SHBG 44 (10-50)

E2 Sensitive - 8
E2 NOT Sensitive - 13
E2 Free - 0.28 (0.2-1.5)
SHBG 51 (10-50)

E2 Sensitive - 9
E2 NOT Sensitive - 13
E2 Free - 0.28 (0.2-1.5)
SHBG 36 (10-50)

E2 Sensitive - 46
E2 NOT Sensitive - 27
E2 Free - 0.58 (0.2-1.5)
SHBG 47 (10-50)

E2 Sensitive - 57
E2 NOT Sensitive - 56
E2 Free - 1.35 (0.2-1.5)
SHBG 41 (10-50)

E2 Sensitive - 58
E2 NOT Sensitive - 68
E2 Free - 1.48 (0.2-1.5)
SHBG 44 (10-50)

E2 Sensitive - 10
E2 NOT Sensitive - 15
E2 Free - 0.33 (0.2-1.5)
SHBG 45 (10-50)

After analyzing all the data, I personally feel like it would be ideal to keep my total E2 around 30-50. I feel like my free E2 would be in a nice place with my total E2 falling somewhere in that range.

 

[at15]

the one thing i cannot understand with keith nichols is the fact that he says young men have raging estradiol levels. I have seen young men's blood tests and this is not the case. As well as for myself at age 25. What is your experience Doctor Crisler seeing men with healthy testosterone in their teens and twenties, is estradiol also elevated or usually normal?

 

[Blackhawk]

Excerpt from Normal Estradiol Levels in Men

"Just what are normal, youthful and healthy levels of estradiol in a male? Check out this data:

To answer these questions, we can go back to a 2000 Clinical Endocrinology study where they summarized a variety of hormone levels by age, including estradiol:

• 20-29: 102.9 pmol/l
• 30-39: 94.17 pmol/l
• 40-49: 90.76 pmol/l
• 50-59: 81.02 pmol/l
• 60-69: 78.82 pmol/l
• 70-80: 80.37 pmol/l

The above are in international units and not the standard pg/ml, so let me do that conversion for everyone reading this in the U.S. (The appropriate conversion factor is 3.671.)

• 20-29: 28.0 pg/ml
• 30-39: 25.7 pg/ml
• 40-49: 24.7 pg/ml
• 50-59: 22.1 pg/ml
• 60-69: 21.5 pg/ml
• 70-80: 21.9 pg/ml

Many of us would guess that estradiol levels would rise as we put on weight with aging, right? However, the data above shows that that is decidedly not the case and estradiol levels to tend to fall as the decades roll by. This is part of the reason that so many men end up with osteoporosis. And making the matter worse is that our SHBG levels climb, leaving us with less free estradiol as we age as well. (SHBG binds to estradiol as well as testosterone.)

Most importantly, notice that youthful estradiol levels are 28 pg/ml for men in the 20's and about 26 pg/ml for men in their 30's according to this study. This is a powerful argument that youthful estradiol levels fall right in the 20-30 range recommended by my old clinic."



REFERENCES:

1) Clin Endocrinol (Oxf), 2000 Dec, 53(6):689-95, "Age-related changes of serum sex hormones, insulin-like growth factor-1 and sex-hormone binding globulin levels in men: cross-sectional data from a healthy male cohort"

2) Weak Erections with Nebido and Arimidex?

3) Clinical Chemistry, 2014, 60:3, "Performance of Direct Estradiol Immunoassays with Human Male Serum Samples"

4) Osteoporos Int, 2015 Oct 28, "Serum total estradiol, but not testosterone is associated with reduced bone mineral density (BMD) in HIV-infected men: a cross-sectional, observational study"

 

[at15]

good stuff blackhawk.

what do you have to say about this keith ??

i thought we need 60-80 pg/ml for maximum protection against heart disease and cancer ?

 

[Gman86]

Thanks for posting that Blackhawk, really good excerpt. My natural E2 levels fall somewhat in line with the figures in the excerpt. Here are the only three labs I ever had done while on nothing. The first two were pre-TRT when I was 29, and the last bloodwork was right before I turned 30 when I had to come off everything to get into a new TRT clinic.

8-5-15 Labcorp
Total T - 584 (348-1197 ng/dL)
Free T - 7.3 (9.3-26.5)
SHBG - 57.1 ( 16.5 - 55.9)
E2 NOT sensitive - 14.6 (7.6-42.6)

11-2-15 Quest
Total T - 691 (250-1100 ng/dL)
Free T - 73.9 (46.0-224.0)
SHBG - 45 (10-50)
E2 Sensitive- 25

8-31-16 Quest
Total T - 601 (250-1100 ng/dL)
Free T - 54.3 (46.0-224.0)
SHBG - 53 (10-50)
E2 NOT Sensitive - 23

 

[Gman86]

good stuff blackhawk.

what do you have to say about this keith ??

i thought we need 60-80 pg/ml for maximum protection against heart disease and cancer ?

I just don’t see how his logic makes sense. He’s basing his range off of the fact that studies show that the optimal level of E2 in women starts around 60-80, and therefore this range carries over to men. He thinks that Mother Nature got it wrong and she should of been keeping young males E2 much higher in the prime of their lives. But I just don’t think studies in women can carry over to men like that. The other factor that he is not taking into account is that most of his men are on testosterone cream applied to the scrotum, which either decreases aromitization, or allows for higher levels of E2 without many side effects. I’m honestly not sure which one. I know it’s at least one of the two.

 

[Gman86]

I just feel like we should trust Mother Nature a little more. Whatever E2 levels that young men have in the prime of their lives, is most likely the ideal range for overall health. Possibly going a little above this might yield some positive benefits in regards to the cardiovascular system and bone health, for example, but I just don’t think I can get on board with raising E2 levels to that of which we see in healthy women. Something just tells me the E2 figures and positive benefits they found in those studies don’t simply just carry over to men. It just doesn’t seem logical.

 

[JimBob]

These questions should be taken to the TOT Roundtable tomorrow evening for Doc Nichols to address.

 

[JimBob]

These questions should be taken to the TOT Roundtable tomorrow evening for Doc Nichols to address.

He could claim that since testosterone levels have been falling for decades now, these estradiol numbers are all sub-optimum.

 

[DragonBits]

Women get a lot more autoimmune diseases than men, estrogen is thought to be the cause these immune diseases.

You can google autoimmune and estrogen. Also estrogen dominance.

Not sure if estrogen is the reason women get alzheimer's more often than men, at age of 65, women have a 1 in 6 chance of developing Alzheimer’s, compared to a 1 in 11 chance for men.

It's natural that estrogen would decline with age in men because estrogen in men is derived from testosterone. While estrogen declines a little with age, testosterone declines a lot more.

 

[lowe2sucks]

Women get a lot more autoimmune diseases than men, estrogen is thought to be the cause these immune diseases.

You can google autoimmune and estrogen. Also estrogen dominance.

Not sure if estrogen is the reason women get alzheimer's more often than men, at age of 65, women have a 1 in 6 chance of developing Alzheimer’s, compared to a 1 in 11 chance for men.

It's natural that estrogen would decline with age in men because estrogen in men is derived from testosterone. While estrogen declines a little with age, testosterone declines a lot more.

estradiol protects against alzeimhers stop this estrogen dominance bullshit please
low estrogen is risk factor for alzeimers
estradiol alzeimers - Google Search
AIs induce memory and cognitive problems and what AIs do? block aromatase thus lower testosterone > estradiol conversion