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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Side Effect Management
Is Testosterone to Estradiol Ratio Important in Men?
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<blockquote data-quote="Nelson Vergel" data-source="post: 22389" data-attributes="member: 3"><p>Vince</p><p></p><p>I will try to find the paper that looked at ratios for fertility purposes. It is not a ratio that is well researched but more and more clinicians are talking about.</p><p></p><p style="margin-left: 20px">Very little data on T/E2 ratios (that actually use LC/MS for both parameters).</p> <p style="margin-left: 20px"></p> <p style="margin-left: 20px">My hypothesis is that, like all hormones, there is an inverted U-shaped curve (for benefits vs T/E2 ratio). Some studies hint at T/E2 above 14, but we have no data on the upper range since very high T/E2 may be indicative of low estradiol.</p> <p style="margin-left: 20px"></p> <p style="margin-left: 20px">Post #12: <a href="https://www.excelmale.com/forum/threads/is-testosterone-to-estradiol-ratio-important-in-men.4921/" target="_blank">Is Testosterone to Estradiol Ratio Important in Men?</a></p> <p style="margin-left: 20px"></p> <p style="margin-left: 20px">Since 0.3-0.4 percent of TT is normally aromatized into E2 in healthy men, then it makes sense that</p> <p style="margin-left: 20px"></p> <p style="margin-left: 20px">1/0.03= 33 should be used as a benchmark</p> <p style="margin-left: 20px"></p> <p style="margin-left: 20px">Estradiol tends to plateau as T dose increases (probably also due to increased DHT that acts as an estradiol blocker). Aromatization was shown to be higher for older men here:</p> <p style="margin-left: 20px"></p> <p style="margin-left: 20px"><a href="https://www.excelmale.com/effect-of-testosterone-injections-on-estradiol-and-dht-in-young-and-older-men/" target="_blank">Effect of Testosterone Injections on Estradiol and DHT in Young and Older Men - ExcelMale</a></p> <p style="margin-left: 20px"></p> <p style="margin-left: 20px">I think 0.25 mg per week of anastrozole makes sense for men whose conversion is above 0.3 percent (I think we should monitor estradiol like we do free T. Free T percent should be 2% of TT or above). DHT should be 10% of TT or above.</p> <p style="margin-left: 20px"></p> <p style="margin-left: 20px">I have been trying to get a hold of this doctor since he did not mention what T/E2 ratios were best:</p><p>AUA 2017:<strong> Calculated Free T and T:E Ratio but not Total Testosterone and Estradiol Predict Low Libido</strong></p><p></p><p>Boston, MA (UroToday.com) Libido is thought to be influenced by hormonal milieu, particularly testosterone. The knowledge about the role of estradiol in male sexual function has been found to be more important than originally thought. The estradiol cut-off point of 5 ng/dL in hypogonadal men is thought to directly affect libido. Dr. Gupta presented a study assessing the impact of sex hormones on libido specifically in a cardiac patient population.</p><p></p><p>The study focused on 200 men in a cardiology practice who completed the IIEF-15, ADAM, and previous ED treatment questionnaires. Additionally all patients had serum total testosterone (T), estradiol (E), and sex hormone binding globulin (SHBG) levels measured via morning lab draws. Their free testosterone (CFT) was calculated using an online ISSM calculator. Patients that were diagnosed for hypogonadism in the past or who were currently on medications possibly affecting T levels were excluded. Hormonal levels were correlated to responses to the IIEF questions 11 and 12 (IIEF11, IIEF12), focusing on libido.</p><p></p><p>Results demonstrated the mean total T level to be 310 ng/dL with CFT of 5.4 ng/dL. Mean E levels were 4.4 ng/dL and mean T:E ratio was 8.2. Importantly, 55% of patients had T levels less than 300 ng/dL and 74% of patients had a CFT < 6.5 ng/dL. Negative correlation was found between estradiol and IIEF11 and IIEF12, but was not statistically significant. However, a positive correlation was found between IIEF11 and IIEF12 and CFT and T:E ratio (p=0.007, p=0.009, respectively). At a cutoff of E=5ng/dL, no difference was found for either hypogonadal or eugonadal men on the IIEF11 or IIEF12.</p><p></p><p>In summary, CFT and T:E ratio were predictive of positive libido response on IIEF11 & 12 questions in the IIEF questionnaire. Estradiol, even at a cutoff of 5 ng/dL, was not independently associated with improved libido. Surprisingly, no correlation was found between total testosterone and IIEF11 (desire frequency). The effect of testosterone and estradiol on libido requires further research with prospective studies.</p><p></p><p>Presented By: Nikhil Gupta, Springfield, IL</p><p></p><p>Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre</p><p></p><p>at the 2017 AUA Annual Meeting - May 12 - 16, 2017; Boston, Massachusetts, USA</p><p style="margin-left: 20px"></p></blockquote><p></p>
[QUOTE="Nelson Vergel, post: 22389, member: 3"] Vince I will try to find the paper that looked at ratios for fertility purposes. It is not a ratio that is well researched but more and more clinicians are talking about. [INDENT]Very little data on T/E2 ratios (that actually use LC/MS for both parameters).[/INDENT] [INDENT][/INDENT] [INDENT]My hypothesis is that, like all hormones, there is an inverted U-shaped curve (for benefits vs T/E2 ratio). Some studies hint at T/E2 above 14, but we have no data on the upper range since very high T/E2 may be indicative of low estradiol.[/INDENT] [INDENT][/INDENT] [INDENT]Post #12: [URL='https://www.excelmale.com/forum/threads/is-testosterone-to-estradiol-ratio-important-in-men.4921/']Is Testosterone to Estradiol Ratio Important in Men?[/URL][/INDENT] [INDENT][/INDENT] [INDENT]Since 0.3-0.4 percent of TT is normally aromatized into E2 in healthy men, then it makes sense that[/INDENT] [INDENT][/INDENT] [INDENT]1/0.03= 33 should be used as a benchmark[/INDENT] [INDENT][/INDENT] [INDENT]Estradiol tends to plateau as T dose increases (probably also due to increased DHT that acts as an estradiol blocker). Aromatization was shown to be higher for older men here:[/INDENT] [INDENT][/INDENT] [INDENT][URL='https://www.excelmale.com/effect-of-testosterone-injections-on-estradiol-and-dht-in-young-and-older-men/']Effect of Testosterone Injections on Estradiol and DHT in Young and Older Men - ExcelMale[/URL][/INDENT] [INDENT][/INDENT] [INDENT]I think 0.25 mg per week of anastrozole makes sense for men whose conversion is above 0.3 percent (I think we should monitor estradiol like we do free T. Free T percent should be 2% of TT or above). DHT should be 10% of TT or above.[/INDENT] [INDENT][/INDENT] [INDENT]I have been trying to get a hold of this doctor since he did not mention what T/E2 ratios were best:[/INDENT] AUA 2017:[B] Calculated Free T and T:E Ratio but not Total Testosterone and Estradiol Predict Low Libido[/B] Boston, MA (UroToday.com) Libido is thought to be influenced by hormonal milieu, particularly testosterone. The knowledge about the role of estradiol in male sexual function has been found to be more important than originally thought. The estradiol cut-off point of 5 ng/dL in hypogonadal men is thought to directly affect libido. Dr. Gupta presented a study assessing the impact of sex hormones on libido specifically in a cardiac patient population. The study focused on 200 men in a cardiology practice who completed the IIEF-15, ADAM, and previous ED treatment questionnaires. Additionally all patients had serum total testosterone (T), estradiol (E), and sex hormone binding globulin (SHBG) levels measured via morning lab draws. Their free testosterone (CFT) was calculated using an online ISSM calculator. Patients that were diagnosed for hypogonadism in the past or who were currently on medications possibly affecting T levels were excluded. Hormonal levels were correlated to responses to the IIEF questions 11 and 12 (IIEF11, IIEF12), focusing on libido. Results demonstrated the mean total T level to be 310 ng/dL with CFT of 5.4 ng/dL. Mean E levels were 4.4 ng/dL and mean T:E ratio was 8.2. Importantly, 55% of patients had T levels less than 300 ng/dL and 74% of patients had a CFT < 6.5 ng/dL. Negative correlation was found between estradiol and IIEF11 and IIEF12, but was not statistically significant. However, a positive correlation was found between IIEF11 and IIEF12 and CFT and T:E ratio (p=0.007, p=0.009, respectively). At a cutoff of E=5ng/dL, no difference was found for either hypogonadal or eugonadal men on the IIEF11 or IIEF12. In summary, CFT and T:E ratio were predictive of positive libido response on IIEF11 & 12 questions in the IIEF questionnaire. Estradiol, even at a cutoff of 5 ng/dL, was not independently associated with improved libido. Surprisingly, no correlation was found between total testosterone and IIEF11 (desire frequency). The effect of testosterone and estradiol on libido requires further research with prospective studies. Presented By: Nikhil Gupta, Springfield, IL Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre at the 2017 AUA Annual Meeting - May 12 - 16, 2017; Boston, Massachusetts, USA [INDENT][/INDENT] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Side Effect Management
Is Testosterone to Estradiol Ratio Important in Men?
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