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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Side Effect Management
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<blockquote data-quote="Dr Justin Saya MD" data-source="post: 31084" data-attributes="member: 12687"><p>Nice articles, Nelson. Nothing very new, although the rat study about androgen receptors is interesting, albeit we certainly can't necessarily extrapolate to humans. The most accurate statement made in my opinion: </p><p></p><p>"It is irrational to think that there would not be hazards when concentrations are artificially suppressed well below the lowest extreme of the physiologic range, just as occurs when estrogen is elevated past the upper limit of normal."</p><p></p><p>THIS is what it all boils down to...BALANCE. The problem is we do not have a concrete reference of what ELEVATED E2 levels are for most males (complicated further by the fact that we are all unique and what is elevated for one, may not be elevated for another). We do know we don't want E2 levels typically much below 20pg/mL, thus we have a lower reference cut-off, but are still lacking an upper level cut-off. </p><p></p><p>I share the well-intentioned concern for overly aggressive AI use, especially after hearing from one of my patients recently that his PHYSICIAN told him estradiol levels in males should be ZERO! Okay, that's completely insane, especially for a medical professional. I also have some concern with the notion that males should not have a healthy concern for E2 levels >45-50pg/mL longterm. We simply don't have any data on the possible affect of sustained/longterm levels in these ranges on the male body. We don't know! When it comes to E2, I'm a proponent of balance and moderation. With typical goal levels for *most* males in the 20-45pg/ml range (on sensitive assay). When E2 symptoms present, I find they most often vanish when E2 levels are maintained 20-35pg/ml. </p><p></p><p>Yes, T:E ratio plays SOME role here, but from my experience it is mostly limited to playing a role in the patient's ability to tolerate higher E2 levels without overt E2 symptoms, but still doesn't offer any insight into whatever else may be going on behind the scenes from higher E2 levels, including possible longterm consequences that we have no data on currently.</p><p></p><p>I may have a unique perspective here, not shared by others, as I treat both male and female patients for HRT/TRT. I see most young, healthy, fertile females (20yo, 25yo, 30yo) presenting with natural E2 levels typically in the range of 50-100pg/mL. Now they will fluctuate throughout different phases of the menstrual cycle, but very often fall in this range. Further, for menopausal females that I have on TREATMENT to elevate their E2 (due to low levels from menopause) we often aim for levels in that range. Thus, estradiol levels >50pg/mL are often the NORMAL levels for young, healthy, fertile females. I have a tough time convincing myself that any levels in a similar range would be normal or healthy for males for any EXTENDED duration of time (although I have seen folks on the forums touting the T:E ratio theory as a justification for just that, even purporting and claiming to guys that E levels in the 40-50 pg/mL range may still be LOW for a male when using the T:E ratio theory). I would opine that E2 levels >35pg/mL are NEVER low for a male, regardless of the concurrent T levels. </p><p></p><p>We should start a "Stop The Estradiol Madness" forum, lol!</p></blockquote><p></p>
[QUOTE="Dr Justin Saya MD, post: 31084, member: 12687"] Nice articles, Nelson. Nothing very new, although the rat study about androgen receptors is interesting, albeit we certainly can't necessarily extrapolate to humans. The most accurate statement made in my opinion: "It is irrational to think that there would not be hazards when concentrations are artificially suppressed well below the lowest extreme of the physiologic range, just as occurs when estrogen is elevated past the upper limit of normal." THIS is what it all boils down to...BALANCE. The problem is we do not have a concrete reference of what ELEVATED E2 levels are for most males (complicated further by the fact that we are all unique and what is elevated for one, may not be elevated for another). We do know we don't want E2 levels typically much below 20pg/mL, thus we have a lower reference cut-off, but are still lacking an upper level cut-off. I share the well-intentioned concern for overly aggressive AI use, especially after hearing from one of my patients recently that his PHYSICIAN told him estradiol levels in males should be ZERO! Okay, that's completely insane, especially for a medical professional. I also have some concern with the notion that males should not have a healthy concern for E2 levels >45-50pg/mL longterm. We simply don't have any data on the possible affect of sustained/longterm levels in these ranges on the male body. We don't know! When it comes to E2, I'm a proponent of balance and moderation. With typical goal levels for *most* males in the 20-45pg/ml range (on sensitive assay). When E2 symptoms present, I find they most often vanish when E2 levels are maintained 20-35pg/ml. Yes, T:E ratio plays SOME role here, but from my experience it is mostly limited to playing a role in the patient's ability to tolerate higher E2 levels without overt E2 symptoms, but still doesn't offer any insight into whatever else may be going on behind the scenes from higher E2 levels, including possible longterm consequences that we have no data on currently. I may have a unique perspective here, not shared by others, as I treat both male and female patients for HRT/TRT. I see most young, healthy, fertile females (20yo, 25yo, 30yo) presenting with natural E2 levels typically in the range of 50-100pg/mL. Now they will fluctuate throughout different phases of the menstrual cycle, but very often fall in this range. Further, for menopausal females that I have on TREATMENT to elevate their E2 (due to low levels from menopause) we often aim for levels in that range. Thus, estradiol levels >50pg/mL are often the NORMAL levels for young, healthy, fertile females. I have a tough time convincing myself that any levels in a similar range would be normal or healthy for males for any EXTENDED duration of time (although I have seen folks on the forums touting the T:E ratio theory as a justification for just that, even purporting and claiming to guys that E levels in the 40-50 pg/mL range may still be LOW for a male when using the T:E ratio theory). I would opine that E2 levels >35pg/mL are NEVER low for a male, regardless of the concurrent T levels. We should start a "Stop The Estradiol Madness" forum, lol! [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
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