E Levels Stable for Transgender Men on Testosterone

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Beyond Testosterone Book by Nelson Vergel
Transgender men (F to M) are treated with guidelines suggesting a possible need for estrogen-lowering strategies over the course of their post-transitional life. A small study at Boston University sought to determine e2 levels in transgender men receiving exogenous testosterone, and whether an AI was required.


  • Estradiol levels were extracted from the electronic medical records of 34 anonymized transgender men treated with testosterone therapy at the Endocrinology Clinic at Boston Medical Center. Data were sufficient to observe 6 years of follow up.
  • With increased testosterone levels in transgender men, a significant decrease in estradiol levels was noted.
  • There was a significant negative correlation between testosterone levels and body mass index, which may serve to explain part of the mechanism for the fall in estradiol levels.
  • Even though the fall in estradiol levels was significant statistically, the actual levels remained within the normal male range, even with 6 years of follow-up.

These data suggest that when exogenous testosterone is used to achieve normal serum male testosterone levels for transgender men, it is converted to normal male levels of estradiol, with some decline in those estradiol levels that might be attributable to a fall in fat mass. There appears to be no role for aromatase conversion inhibitors or other estrogen-reducing strategies in transgender men.




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