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Expert Interviews
Estradiol in Men: Interview with Urology Professor Dr Ranjith Ramasamy
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<blockquote data-quote="Dr Justin Saya MD" data-source="post: 70853" data-attributes="member: 12687"><p>LONGTERM is the key question...and it is truly a question as we don't have good data, for safety or risk, longterm. I like to allow symptoms to dictate, but I still struggle with the unknowns of safety especially > 45-50pg/mL. SHBG adds another layer of complexity, as I've noted to many members here recently. Just quoting a total E2 level, whatever that level may be, is shortsighted and doesn't factor in the importance of SHBG and FREE levels of the hormones. In other words, a total E2 of 35pg/mL is a COMPLETELY different scenario for a low SHBG guy as opposed to a high SHBG guy. I think many (even practitioners) don't appreciate this nuance. </p><p></p><p>There are no valid studies of safety/risks of elevated E2 levels for men ON TRT with upper physiologic range T levels, so we do the best with the info we have. There are a few studies (not men on TRT mind you) that did suggest a possible trend in increased carotid atherosclerosis (increased IMT as an indicator for increased cardiovascular disease) with increases in FREE estradiol levels. </p><p></p><p><a href="https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2006-0932" target="_blank">https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2006-0932</a></p><p></p><p><a href="http://circ.ahajournals.org/content/109/17/2074.long#sec-7" target="_blank">http://circ.ahajournals.org/content/109/17/2074.long#sec-7</a></p></blockquote><p></p>
[QUOTE="Dr Justin Saya MD, post: 70853, member: 12687"] LONGTERM is the key question...and it is truly a question as we don't have good data, for safety or risk, longterm. I like to allow symptoms to dictate, but I still struggle with the unknowns of safety especially > 45-50pg/mL. SHBG adds another layer of complexity, as I've noted to many members here recently. Just quoting a total E2 level, whatever that level may be, is shortsighted and doesn't factor in the importance of SHBG and FREE levels of the hormones. In other words, a total E2 of 35pg/mL is a COMPLETELY different scenario for a low SHBG guy as opposed to a high SHBG guy. I think many (even practitioners) don't appreciate this nuance. There are no valid studies of safety/risks of elevated E2 levels for men ON TRT with upper physiologic range T levels, so we do the best with the info we have. There are a few studies (not men on TRT mind you) that did suggest a possible trend in increased carotid atherosclerosis (increased IMT as an indicator for increased cardiovascular disease) with increases in FREE estradiol levels. [url]https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2006-0932[/url] [url]http://circ.ahajournals.org/content/109/17/2074.long#sec-7[/url] [/QUOTE]
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Expert Interviews
Estradiol in Men: Interview with Urology Professor Dr Ranjith Ramasamy
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