Treatment of estrogen (estradiol) levels in men on TRT: An anonymous doctor survey

[Nelson Vergel]

Urology. 2020 Feb 8. pii: S0090-4295(20)30123-0. doi: 10.1016/j.urology.2020.01.032. [Epub ahead of print]

Treatment of estrogen levels in the management of hypogonadism: An anonymous survey of ISSM members.

Butaney M1, Thirumavalavan N2, Balasubramanian A3, McBride JA2, Gondokusumo J2, Pastuszak AW4, Lipshultz LI2.

Baylor College of Medicine

Abstract
OBJECTIVE:
To assess the variability in management of estrogen levels in men treated with testosterone therapy (TTh). With the significant increase in the last two decades in the treatment of hypogonadism and the use of TTh, detailed guidelines for the management of estrogen levels are necessary. (1) MATERIALS AND METHODS: An anonymous survey was electronically distributed to the membership of the International Society for Sexual Medicine including questions on demographics, symptoms, and their approach to management of estrogen in patients on TTh. Chi-square test was used to determine associations.

RESULTS:
The response rate was 22.5% (489/2168). 62.4% indicated that they check serum estrogen at initial evaluation, but only 54.7% monitor levels in patients on TTh (p=0.02). Fellowship-trained and North American respondents were more likely to monitor patients(p<0.05). 69.4%, 47.7%, and 14.4% of respondents prescribe anti-estrogenic medications in symptomatic patients with elevated estrogen levels, for asymptomatic elevated estrogen levels, and prophylactically respectively. Academic respondents were more likely to prescribe an anti-estrogen medication to symptomatic patients and prophylactically(p<0.05). Anastrozole was the most common medication prescribed for symptomatic hyperestrogenemia (62.3%), but starting doses varied significantly, from 1mg weekly to 1mg daily.

CONCLUSIONS:
Approximately 50% of practitioners treating men with TTh monitor estrogen levels. Symptoms play a role in prescribing patterns and significant variability in aromatase inhibitors regimens exists. Increased monitoring of estrogen levels in men on TTh will facilitate an understanding of the symptoms, effects of high and low estrogen levels, and aid in standardization of research and therapy.

 

[Nelson Vergel]

Before You Post About Estradiol or Anastrozole- READ THIS FIRST

 

[Westin]

My Dr. at Mayo Clinic refuses to test E2 levels, even after I sent him all the research showing TC can raise E2. He said " Checking for E2 in adult males is not our standard of care". He would not even discuss it. Thankfully I found another doc that checks E2, and all the other TRT tests that can play into dialing in. Now if I had a major medical issue I would use Mayo for that. For primary care I would stay away. They are very rigid and will not budge regardless of hard data.

 

[Nelson Vergel]

My Dr. at Mayo Clinic refuses to test E2 levels, even after I sent him all the research showing TC can raise E2. He said " Checking for E2 in adult males is not our standard of care". He would not even discuss it. Thankfully I found another doc that checks E2, and all the other TRT tests that can play into dialing in. Now if I had a major medical issue I would use Mayo for that. For primary care I would stay away. They are very rigid and will not budge regardless of hard data.

If I was a doctor, I would not check estradiol at baseline and would only check it afterward if real gynecomastia (not nipple sensitivity) is starting. Most men on proper TRT do not have gynecomastia and water retention should not be assumed to be related to high estradiol. Please read all I have written in the second post since this topic really has tired me out after I have shown enough data in the last 10 years.