High Estradiol in Men Not Associated with ED

Nelson Vergel · Jan 12, 2016

Testosterone replacement improves quality of life and is aromatized in men in adipose tissues to estrogen. Hyperestrogenism is believed to be harmful to male sexuality. This is a description of our experience of screening 34,016 men in the Low T Centers, of which approximately 50% were converted to treatment. Men were treated with injectable testosterone, and we have available data from 2009 to 2014.

The data were extracted from our electronic health record (AdvancedMD) of 35 Low T Centers across the United States. In all, 7,215 (20.2%) out of the 34,016 patients had high estradiol levels defined as >/=42.6 pg/ml. Estradiol was measured using electro-chemiluminescence immunoassay.

Of the patients who had high estradiol levels, the age distribution was as follows: 132/989 (13.3%) were older than 65 years, 3,753/16,955 (22.1%) were between 45 and 65 years; 2,968/15,857 (18.7%) were between 25 and 44 years, 7/215 (3.3%) were younger than 25 years. The difference between extreme age groups (<25 and >/=65) was statistically significant using a chi-square test (p = .013). The correlation coefficient of serum estradiol to age was .53, SD = 8.21.

It was observed that practitioners used aromatase inhibitor and selective estrogen receptor modulator to treat symptoms of hyperestrogenism, irrespective of blood estradiol levels. Gynecomastia was rarely documented as a reason for the prescription.

OUR FINDING WAS THAT HIGH ESTRADIOL LEVELS WERE NOT ASSOCIATED WITH HIGHER RATES OF LOW LIBIDO BUT ESTABLISHED HIGHER RATES OF DOCUMENTED LOW LIBIDO WITH THOSE WITH NORMAL OR LOWER ESTRADIOL LEVELS. The difference was statistically significant (p < .05).

Tan RS, Cook KR, Reilly WG. High estrogen in men after injectable testosterone therapy: the low T experience. Am J Mens Health 2015;9(3):229-34. http://jmh.sagepub.com/content/9/3/229.abstract

maxadvance · Jan 12, 2016

boom .....

Re-Ride · Jan 13, 2016

[Estradiol was measured using electro-chemiluminescence immunoassay.]

Not the LS MS/MS "ultra sensitive" methodology

Vince Carter · Jan 13, 2016

My experience with Low T Center would I think, for me, invalidate all of that. Maybe it's just observations and not scientific but they were terrbile at treating my Estrogen. Take a .5mg today. Don't take any next week. Take a .25 mg 2x week. Don't take any next week. They were all over the map with me for four months, let alone low SHBG isn totally incompatible with their once per week injections.

Vince · Jan 13, 2016

I like this post, my estrogen have never been high. Since starting TRT, my libido has been very strong.

lcvl · Jan 13, 2016

Libido or ED? Two different things.

Re-Ride · Jan 13, 2016

Vince said:
I like this post, my estrogen have never been high. Since starting TRT, my libido has been very strong.

Vince, isn't it true that the most commonly discussed concern on here regarding "high" estradiol is ED or 'lack of morning wood" rather than low libdo?

It appears that the conclusion questions treatment of hyperestrogenism with SERMS or A.I.'s in the absence of gyno. The authors also claims that (some percentage) of practitioners prescribe based on "symptoms irrespective of E2 serum levels".

I'm glad that you like the study and are not among those who do have TRT related hyperestrogenism. I wish I could share your enthusiasm. The methodology is flawed.

The incidence and degree of ED and low libido are difficult things for researchers to measure since they are not direct observations. Unless the cost comes down on the LC- MS/MS assay ( which the authors failed to use ) for serum E2 we will not likely see any meaningful large studies useful to the practitioner as guidelines for treating hyperestrogenism. It is likely that state of the art involves consideration of E2 in conjunction with symptoms on a case by case basis.