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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Side Effect Management
Should We Be Managing Estradiol and Hematocrit in Men on Testosterone Replacement?
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<blockquote data-quote="Dr Justin Saya MD" data-source="post: 71240" data-attributes="member: 12687"><p>Well said Dr Nichols and this could perhaps summarize the entire estradiol discussion. I will say, however, from my experience of treating over 10 thousand patients I have seen my fair share who unfortunately do have symptoms and respond favorably to CONSERVATIVE aromatase inhibition. Many of these can even be somewhat predicted, albeit not with 100% accuracy (most notably obese patients, those with very high baseline E:T ratios, and those with baseline low SHBG). You did note that you treat (or would treat) when symptoms are present, which I feel puts you on the right side of the fence on that one for sure.</p><p></p><p>On the topic of possible longterm risks of elevated E2 in males, as we all know there is not strong data one way or the other. I'll post below a couple study links that I mentioned on the forum a few days ago on a different thread regarding E2 and Carotid IMT. What I found interesting about the first study was that they did NOT administer oral estradiol (which you rightly pointed out previously would provide useless comparisons as ORAL estrogens, synthetic or bioidentical, can increase coagulability independent of actual E2 levels)...they administered parenteral estradiol which means that the data should hold true for actual serum E2 levels as opposed to the route of delivery. Your input and alternative views are welcome and appreciated as they contribute to scholarly discussion. Curious if you are a follower or mentee of Dr Neal Rouzier? Your position on some of these topics are very similar. The copy/paste from the other thread is below. All the best.</p><p></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>https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2006-0932</p><p></p><p>http://circ.ahajournals.org/content/109/17/2074.long#sec-7</p><p></p><p>Just noticed the link for the parenteral estradiol study was broken, so I've included citation below.</p><p></p><p>Parenteral estrogen versus combined androgen deprivation in the treatment of metastatic prostatic cancer: part 2. Final evaluation of the Scandinavian Prostatic Cancer Group (SPCG) Study No. 5.</p><p>Randomized controlled trial</p><p>Hedlund PO, et al. Scand J Urol Nephrol. 2008.</p></blockquote><p></p>
[QUOTE="Dr Justin Saya MD, post: 71240, member: 12687"] Well said Dr Nichols and this could perhaps summarize the entire estradiol discussion. I will say, however, from my experience of treating over 10 thousand patients I have seen my fair share who unfortunately do have symptoms and respond favorably to CONSERVATIVE aromatase inhibition. Many of these can even be somewhat predicted, albeit not with 100% accuracy (most notably obese patients, those with very high baseline E:T ratios, and those with baseline low SHBG). You did note that you treat (or would treat) when symptoms are present, which I feel puts you on the right side of the fence on that one for sure. On the topic of possible longterm risks of elevated E2 in males, as we all know there is not strong data one way or the other. I'll post below a couple study links that I mentioned on the forum a few days ago on a different thread regarding E2 and Carotid IMT. What I found interesting about the first study was that they did NOT administer oral estradiol (which you rightly pointed out previously would provide useless comparisons as ORAL estrogens, synthetic or bioidentical, can increase coagulability independent of actual E2 levels)...they administered parenteral estradiol which means that the data should hold true for actual serum E2 levels as opposed to the route of delivery. Your input and alternative views are welcome and appreciated as they contribute to scholarly discussion. Curious if you are a follower or mentee of Dr Neal Rouzier? Your position on some of these topics are very similar. The copy/paste from the other thread is below. All the best. "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. " https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2006-0932 http://circ.ahajournals.org/content/109/17/2074.long#sec-7 Just noticed the link for the parenteral estradiol study was broken, so I've included citation below. Parenteral estrogen versus combined androgen deprivation in the treatment of metastatic prostatic cancer: part 2. Final evaluation of the Scandinavian Prostatic Cancer Group (SPCG) Study No. 5. Randomized controlled trial Hedlund PO, et al. Scand J Urol Nephrol. 2008. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Side Effect Management
Should We Be Managing Estradiol and Hematocrit in Men on Testosterone Replacement?
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