J. Keith Nichols MD
New Member
720 is a misleading number while on injectable T. There is a significant difference in the T level from day 1 after the injection to days 7-10, so I am unsure what day your level was drawn after your previous injection. Nonetheless, that's the problem I see with injectable T. The values go supraphysiologic right after the injection to what I would consider low (720) at day 7-10 ( a roller coaster effect). The free T is the number you should be focusing on, but at 720 total it would not be that great. I only use a compounded cream applied 2x per day at a 200mg/gm concentration which is the strongest concentration you can make due to it crystallizing at any higher concentration ( 10x the concentration of androgen) Dosage is adjusted based on symptom improvement, but I can tell you most men in our clinic feel best around 1500 with a free T between 40-50. The cream maintains a constant level around 1500 without the rolller coaster effect seen with injections and without the high spikes in E2. . Injections also cause a adverse effect on your lipid profile that the transdermal cream does not.
Now with E2, you do not want to block it. We don't even measure it in our male patients any longer as all studies where E2 is blocked it is harmful to men. If you develop mastalgia or then we give a AI for a few weeks until symptoms resolve and then it is discontinued. Have not had to do this in hundreds of patients. E2 is just as important o men as it is for women, we just don't need as much. It is vital for cognition, protection of Alzheimer's disease, sexual function, Bome strength, decreased visceral body fat, cardiovascular protection, and very importantly it is apoptotic to prostate cancer cells. It helps protect the prostate. If fact, it used to be used for the treatment of prostate cancer before casodex and lupron. In studies that show cardiovascular harm with high estradiol level they are baseline studies. The men died of heart attacks secondary to their obesity and other risk factors for MIs. Their E2 was high from the obesity but the E2 got blamed but it was a passive bystander. Now look at the interventional studies where men are actually give T (>E2) and don't block E2 and there is only beneficial effects. The increase in E2 from obesity is quiet different from raising E2 with TRT.
Lastly, a lot of the confusion comes from the bodybuilding community where T is abused in extremely high doses. This is not medical TRT. The T abuse will result in E2 levels that a premenstal women would have and the subsequent symptoms which would require a AI. Medical TRT and performance enhancement T abuse are apples and oranges. If you are on medical TRT based on evidence based medicine by a well trained physician, then quit worrying about your E2 levels. The higher the better for the reasons mentioned abone. If you are one of the few that develop mastalgia then take a AI for a short time until symptoms resolve. My E2 was 75 when I checked it last just to make sure it was in that range and not in the lower range. When you were 20-25 your E2 was anywhere form 50-75 or so and you were probably doing great.
Bottom line....don't block your estrogen
Now with E2, you do not want to block it. We don't even measure it in our male patients any longer as all studies where E2 is blocked it is harmful to men. If you develop mastalgia or then we give a AI for a few weeks until symptoms resolve and then it is discontinued. Have not had to do this in hundreds of patients. E2 is just as important o men as it is for women, we just don't need as much. It is vital for cognition, protection of Alzheimer's disease, sexual function, Bome strength, decreased visceral body fat, cardiovascular protection, and very importantly it is apoptotic to prostate cancer cells. It helps protect the prostate. If fact, it used to be used for the treatment of prostate cancer before casodex and lupron. In studies that show cardiovascular harm with high estradiol level they are baseline studies. The men died of heart attacks secondary to their obesity and other risk factors for MIs. Their E2 was high from the obesity but the E2 got blamed but it was a passive bystander. Now look at the interventional studies where men are actually give T (>E2) and don't block E2 and there is only beneficial effects. The increase in E2 from obesity is quiet different from raising E2 with TRT.
Lastly, a lot of the confusion comes from the bodybuilding community where T is abused in extremely high doses. This is not medical TRT. The T abuse will result in E2 levels that a premenstal women would have and the subsequent symptoms which would require a AI. Medical TRT and performance enhancement T abuse are apples and oranges. If you are on medical TRT based on evidence based medicine by a well trained physician, then quit worrying about your E2 levels. The higher the better for the reasons mentioned abone. If you are one of the few that develop mastalgia then take a AI for a short time until symptoms resolve. My E2 was 75 when I checked it last just to make sure it was in that range and not in the lower range. When you were 20-25 your E2 was anywhere form 50-75 or so and you were probably doing great.
Bottom line....don't block your estrogen
Last edited:
