High Estradiol Boosts Libido in Men on Testosterone Therapy

[Nelson Vergel]

I have been warning men and clinics not to be so aggressive treating estradiol in men with the overuse of anastrozole. Here is a recent study done in Houston.



Elevated serum estradiol is associated with increased libido in men receiving testosterone replacement therapy (TRT), according to researchers.

In a study of 423 men on TRT, Ranjith Ramasamy, MD, working with Larry Lipshultz, MD, at the Baylor College of Medicine in Houston, measured subjects' testosterone and estradiol levels and asked the men to rate the quality of their libido using a five-point Likert scale (1= terrible, 5 = excellent). The researchers categorized the men as having low or high testosterone (below or above 300 ng/dL, respectively) and low or high estradiol (below 5 and above 5 ng/dL (50 pg/mL), respectively).

Men with high serum testosterone levels reported significantly greater libido than men with low level and those with high serum estradiol levels had significantly greater libido than subjects with low levels. In all, 60.4% of men with both high testosterone and estradiol levels reported very good or excellent libido (score as 4 or 5) compared with 31.3% of participants with both low testosterone and estradiol levels, the researchers reported in European Urology (published online ahead of print). These results are expected to be presented at the American Urological Association annual meeting in Orlando this May.

http://www.renalandurologynews.com/...n-men-on-testosterone-therapy/article/335894/

 

[paco]

This is an interesting study. I would be interested in knowing more about the type of assay used to measure estradiol. I am a patient of Dr. Lipshultz, and he does most hormone testing either at his own lab or at a Baylor College of Medicine lab. (I'm not sure which, but the results say "LABORATORY FOR MALE REPRODUCTIVE RESEARCH & TESTING, CLIA# 45D660126".)

The range for my recent estradiol test was .5 - 5.0 ng/dl. I'm presuming they were using the same assay in this study.

 

[ratbag]

This study looks flawed. Because they are comparing High T w/high E2 vs Low T w/Low E2. and claiming that those with high E2 have better libido? Yet those with high E2 have high T. We know that Low T is synonymous with Low E2. So all this study is saying is that patients with T above 300 have better libido than those with T less than 300. If all patients had total testosterone level of say 600 ng/dL then they could have compared E2 levels vs libido. This study is ambiguous. Now everyone will be saying high E2 is better?

"In all, 60.4% of men with both high testosterone and estradiol levels reported very good or excellent libido (score as 4 or 5) compared with 31.3% of participants with both low testosterone and estradiol levels"

 

[Nelson Vergel]

I am reading the full paper now.

 

[JWSimpkins]

This study looks flawed. Because they are comparing High T w/high E2 vs Low T w/Low E2. and claiming that those with high E2 have better libido? Yet those with high E2 have high T. We know that Low T is synonymous with Low E2. So all this study is saying is that patients with T above 300 have better libido than those with T less than 300. If all patients had total testosterone level of say 600 ng/dL then they could have compared E2 levels vs libido. This study is ambiguous. Now everyone will be saying high E2 is better?

"In all, 60.4% of men with both high testosterone and estradiol levels reported very good or excellent libido (score as 4 or 5) compared with 31.3% of participants with both low testosterone and estradiol levels"

Yeah, I'm thinking it has more to do with the T to E ratio rather than just an increase in E2 alone.

 

[Nelson Vergel]

From the paper:

Elevated Serum Estradiol Is Associated with Higher Libido in Men on Testosterone Supplementation Therapy

Testosterone has always been considered to be a male hormone, whereas oestrogen has typically been discussed in the context of being a female hormone. Conventionally, the goal of testosterone supplementation therapy (TST) in men was to raise serum testosterone levels and lower oestrogen levels. A recent study by Finkelstein et al. high- lighted an important role for oestrogen in regulation of sexual function in men on TST [1]. In that study, dramatic declines in libido were observed in conjunction with decreased levels of serum oestrogen. Although oestrogen is associated with male sexual behaviour [2], the distinct roles of testosterone and oestrogen on sexual function in men on TST are controversial. We thus sought to elucidate the associations between serum testosterone, estradiol, and libido in men undergoing TST for symptomatic hypogonadism (total testosterone <300 ng/dl and three or more symptoms on the Androgen Decline in Aging Male [ADAM] questionnaire).

Men on TST (injections or gels; n = 423) presenting to a large-volume, tertiary referral andrology clinic were asked to rate the quality of their libido using 5-point Likert scales (1 = terrible, 5 = excellent) as part of the validated, quanti- tative ADAM questionnaire [3]. Men were categorised as having low (0.5&#8211;5.0 ng/dl) or high (>5.0 ng/dl) estradiol

Univariate analysis noted associations between libido and age, and FSH, LH (analysed as continuous variables), estradiol, and testosterone levels (analysed as categorical variables, and which remained significant even when analysed as continuous variables) (Table 1). Interestingly, on multivariate analysis, only estradiol at serum levels >5 ng/dl (50 pg/mL) (2.13; p = 0.04) was associated with greater libido.

While this study highlights the importance of oestrogen in men on TST, the limitations include a lack of control group and no score comparisons before and after com- mencement of TST. Furthermore, a larger sample size may have unmasked a confounding relationship between testosterone and libido.

 

[pmgamer18]

I don't buy this study and most of the study's coming out lately none are approved study's all I can go by is to tell what I leaned from being on TRT over 33 yrs is high E2 is very bad there is a sweet spot for E2 levels and when your in this sweet spot you will get your Rem Sleep Wood back every night so strong it will wake you up it is so good you can hand a coat on it.

I was on TRT starting at age 27 after 20 years my sex life plain old stopped and I had Panic Attacks, BPH with one bladder infection after the other and felt very hot and would sweat bad all day and night. My Anxity was very bad when I found out about high E2 in men many yrs. ago it was very hard to get my Dr. to even test this. When he did my levels were over the top of the range. I had bad ED and could not reach an orgasm needed to use a penis pump and ring to have sex with my wife.

Even then I could not get my Dr. to give me Arimidex he tired all kinds of things until I got mad and asked him way he would not give me arimidex. He said BCBS would call him asking why I am using a cancer med for women on you and they will not pay for it.

I told him give me it I will pay for it will he did and BCBS payed for it no problem still it took a very long time to get this down taking .5 mgs EOD after 12 weeks of this my E2 came down to the top of the range so we did the Arimidex .5 mgs everyday and in 4 weeks I woke up with some Rem Sleep Wood so now I did not need the pump.

But still I would lose the wood to have sex because I would worry about it working and this would kill it so my Dr. gave me Cialis it just came out he told me to take 20 mgs E3D and tihs fixed my problem and after 10 yrs of not being able to have normal sex my sex life was back.

And later my BPH went away and the panic attacks stoped and I was not feeling hot all the time and sweating. Today I gage my E2 levels by my Rem Sleep Wood if I don't think I had it the night before I would check it before I got out of bed If I could get it up but it was not good enough for sex. This tells me I am to high and I would just take an extra .25 mgs of arimidex. If I could not get it up even a little this told me I am to low and I would just stop the Arimidex unitl my RSW came back.

This works for me and a lot of other men I have told about it as for libido this takes time to come back and for some it never does they just don't work hard enough at keeping the E2 in the sweet spot.

One other thing I found out is if your on pain meds this will slow down how E2 meds work and you will need more of it today I need Aromasin 3 pills / day to keep in the sweet spot for my E2 and I am 70 yrs old.

 

[ratbag]

Still, drawing conclusions from this study isn't helping anyone on or off TRT. This is so common. We see so much junk and flawed studies. A lot of MD's go by these headline news articles -"High Estradiol Boosts Libido in Men on Testosterone Therapy" and this poses a problem for the average guy on TRT who's MD is only mediocre (and most MD's fall into this category) Just another disservice to our efforts to make people and MD's aware of what proper and successful TRT protocol is. For every step fwd we take 3 backwards.... end of rant!

 

[Eli1947]

Each time an over simplification of verycomplicated issue deemed to give variety of wrong answers.

 

[Nelson Vergel]

Estradiol in Men

Estradiol is important and not a single study (I have read them all) have come up with what the highest level is before being considered to have excess estradiol. I have gone through gynecomastia data in teenagers and many do not of these kids do not have high estradiol. What they have is low testosterone to estradiol ratios (under 10 if you divide TT in ng/dL by estradiol in pg/mL). It seems that T/E ratios of over 14 tend to minimize issues related to gynecomastia and decreased fertility.

As testosterone goes up, so does estradiol. Testosterone is estradiol's prohormone for a good reason. Like testosterone, estradiol regulates sex drive and cognitive function. There are two estradiol receptors (alpha and beta) that have different functions. Depending on medications, liver issues, genetic predisposition, etc some men tend to produce T and E2 in lower T/E2 ratios than others. Low T/E2 ratios may be linked to gynecomastia, low fertility, low sex drive, etc

You will find that ExcelMale is the only forum where estradiol data is being closely followed. I am pretty obsessed with this since I believe a lot of guys are tanking their estradiol. These guys will eventually have low bone density, low sex drive, and low cognitive function as they age.

One more thing: many men are getting their estradiol measured with the regular test instead of the ultrasensitive. I did not believe there was much of a difference (the ultrasensitive E2 test is also more expensive). A few of us got our estradiol tested by both methods from the same blood sample and found out that the ultrasensitive tests E2 value were at most half of E2 measured by the regular test. This can also imply that many guys are being over treated with anastrozole based on inflated E2 values.

I am attaching a paper that discusses estradiol in men for those of you who like to read. I would suggest you do so before you attack my views.

I have written about this issue and posted it here:

Role of Estradiol (Estrogen) in Men and Its Management

Check your estradiol (sensitive) blood levels cheaply: DiscountedLabs.com REGISTERED MEMBERS: DOWNLOAD ATTACHED ESTRADIOL LECTURE HANDOUT AT THE BOTTOM OF THIS POST Click here for a comprehensive article about the 18 things you should know about estradiol in men By Nelson Vergel, BsChE...

www.excelmale.com

Why All Men Should be Tested with the Sensitive Estradiol Test

 

[ratbag]

Nelson that link is dead....

 

[pmgamer18]

Nelson,

I don't know many men that keep there E2 levels to low and as for that Ultra Sensitive Estradiol test by Quest levels <29 from day one Quest labs as had problems with this test telling men they are to low when in fact going by how they were feeling they felt to high. My Dr. called a friend at the lab and he told my Dr. on the QT that they are having big problems with this test. Even Dr. John stopped using the Ultra test he went to LabCorp then they came out with a Sensitive and the same dam thing telling men not even on E2 meds or TRT that there levels were <3 it is odd so many men had a level for <3 E2 labs have a long way to go to get it right.

My Dr. dose both the Ultra Sensitive and the older E2 test #4021 the Ultra is most of the time saying I am very low like <5 when the #4021 test says I in the mid 30's but I don't take my E2 meds the morning of my labs and so they should be high. I have a huge problem with high E2 levels. Every once and a wile the Ultra test will be about the same as the 4021 test.

Still I don't go by labs I go by how I feel you do labs get them back in 2 weeks and every thing has changed by then it is very hard to dose E2 meds by labs.

 

[Nelson Vergel]

Still, drawing conclusions from this study isn't helping anyone on or off TRT. This is so common. We see so much junk and flawed studies. A lot of MD's go by these headline news articles -"High Estradiol Boosts Libido in Men on Testosterone Therapy" and this poses a problem for the average guy on TRT who's MD is only mediocre (and most MD's fall into this category) Just another disservice to our efforts to make people and MD's aware of what proper and successful TRT protocol is. For every step fwd we take 3 backwards.... end of rant!

Ratbad

This study was done by Dr Lipshultz' team. He is my urologist and probably the most open minded and progressive TRT researcher out there. He has 7 fellows who do studies every year. I will be meeting his team next week. My goal is to reanalyze the data to look at T/E2 ratios.

He also did this study with HCG :

Concomitant Intramuscular Human Chorionic Gonadotropin Preserves Spermatogenesis in Men Undergoing Testosterone Replacement Therapy



Purpose: Testosterone replacement therapy results in decreased serum gonadotropins and intratesticular testosterone, and impairs spermatogenesis, leading to azoospermia in 40% of patients. However, intratesticular testosterone can be maintained during testosterone replacement therapy with co-administration of low dose human chorionic gonadotropin, which may support continued spermatogenesis in patients on testosterone replacement therapy.

Materials and Methods: We retrospectively reviewed the records of hypogonadal men treated with testosterone replacement therapy and concomitant low dose human chorionic gonadotropin. Testosterone replacement consisted of daily topical gel or weekly intramuscular injection with intramuscular human chorionic gonadotropin (500 IU) every other day. Serum and free testosterone, estradiol, semen parameters and pregnancy rates were evaluated before and during therapy.

Results: A total of 26 men with a mean age of 35.9 years were included in the study. Mean follow up was 6.2 months. Of the men 19 were treated with injectable testosterone and 7 were treated with transdermal gel. Mean serum hormone levels before vs during treatment were testosterone 207.2 vs 1,055.5 ng/dl (p <0.0001), free testosterone 8.1 vs 20.4 pg/ml (p = 0.02) and estradiol 2.2 vs 3.7 pg/ml (p = 0.11). Pretreatment semen parameters were volume 2.9 ml, density 35.2 million per ml, motility 49.0% and forward progression 2.3. No differences in semen parameters were observed during greater than 1 year of followup. No impact on semen parameters was observed as a function of testosterone formulation. No patient became azoospermic during concomitant testosterone replacement and human chorionic gonadotropin therapy. Nine of 26 men contributed to pregnancy with the partner during followup.

Conclusions: Low dose human chorionic gonadotropin appears to maintain semen parameters in hypogonadal men on testosterone replacement therapy. Concurrent testosterone replacement and human chorionic gonadotropin use may preserve fertility in hypogonadal males who desire fertility preservation while on testosterone replacement therapy.

 

[Nelson Vergel]

I was able to find the right estradiol blood test based on mass spectrometry/liquid chromatography:

Affordable ultrasensitive estradiol test

 

[Nelson Vergel]

Estradiol in Men: Libido and Brain Function

Role of estradiol in the brain The effect of estradiol on libido is seen at various levels of regulation, starting with direct effects in the brain (Figure 1). Areas of the brain that control sexual behavior in mammals are thought to do so via pheromones that induce specific sexual effects on...

www.excelmale.com

 

[Nelson Vergel]

Effect of Estradiol on Men's Libido

Descriptions of the roles of estradiol in men and its management in men on testosterone therapy.

www.discountedlabs.com

 

[Nelson Vergel]

New data Relation of Testosterone, Dihydrotestosterone and Estradiol with Changes in Outcomes Measures in the Testosterone Trials - PubMed

 

[Nelson Vergel]

The role of estradiol in males: Implications for libido and testosterone replacement therapy.

Historically, when we think of sex hormones in men and women, we identify testosterone as the core regulator of orderly male growth and sexual function. In a similar fashion, we identify estrogens central to regulating sexual and reproductive function along with a host of non-reproductive...

www.excelmale.com