Estradiol in Men: Interview with Urology Professor Dr Ranjith Ramasamy

[johndoesmith]

That was one of the first instances wherein we thought estrogen is probably very important because, as everyone knows, clomiphene actually blocks the action of estrogen on the brain. And once you block the action of estrogen on the brain the estrogen receptors in the brain do not get activated and therefore these men complain of impaired libido.

This is something I've always suspected with clomid myself! I often noticed the similarities in mental symptoms from guys on clomid, and guys with low E2.

Physically, the symptoms resemble high E2.

Being fat sometimes ... I've never found this association to be true, people always say all fat people have more estrogen - not true.

I always believed this myself! I've talked to guys who were the same body type as me, height, weight, and all. They were high aromatizers while I was a very very low aromatizer.

http://onlinelibrary.wiley.com/doi/10.2164/jandrol.108.006296/pdf

It's 17 beta-estradiol, which is being checked, even though they tell you estrogen, because the other components do not exist in the blood with long enough half-life that can be measured

That is the one part I had an issue with, estrone and estriol do not have half lives that are too short to measure.

Estrone is just much weaker than estradiol, and estriol doesn't exist in levels high enough to consider, outside of a pregnant woman.

I assume he's just simplifying it a bit, but to say that estradiol is estrogen and estrogen is estradiol, is oversimplifying to the point of lost meaning.

Good job on the interview Nelson.

It seemed a point of emphasis (by way of being mentioned about a dozen times) are the risks of dropping estradiol to "undetectable levels" of which I hope EVERYONE agrees...there's nothing good to be found down there!

It seemed a point of emphasis (by way of being mentioned about a dozen times) are the risks of dropping estradiol to "undetectable levels" of which I hope EVERYONE agrees...there's nothing good to be found down there!

Absolutely agree. I lived with near undetectable estradiol for long enough to know that it should be regarded as an 8th amendment violation.

 

[sportsfan8724]

Greatly appreciate that answer Dr Saya!

 

[Vince]

Excellent video, should be a requirement for all TRT doctors to watch.

 

[Vince Carter]

LONGTERM is the key question...and it is truly a question as we don't have good data, for safety or risk, longterm. I like to allow symptoms to dictate, but I still struggle with the unknowns of safety especially > 45-50pg/mL. SHBG adds another layer of complexity, as I've noted to many members here recently. Just quoting a total E2 level, whatever that level may be, is shortsighted and doesn't factor in the importance of SHBG and FREE levels of the hormones. In other words, a total E2 of 35pg/mL is a COMPLETELY different scenario for a low SHBG guy as opposed to a high SHBG guy. I think many (even practitioners) don't appreciate this nuance.

There are no valid studies of safety/risks of elevated E2 levels for men ON TRT with upper physiologic range T levels, so we do the best with the info we have. There are a few studies (not men on TRT mind you) that did suggest a possible trend in increased carotid atherosclerosis (increased IMT as an indicator for increased cardiovascular disease) with increases in FREE estradiol levels.

https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2006-0932

http://circ.ahajournals.org/content/109/17/2074.long#sec-7

I'll be testing Free E in the coming weeks, this aspect of E management is what is on my mind recently and I'm glad you're providing the insight.

 

[franksepe]

Where is this poster that you talked about in the video?

 

[Brian7624]

Question: The Doc mentioned that gyro can take place in the absence of high estradiol. He said in the interview he would treat this with tamoxifen 20mg twice daily. He mentions this could be a result if elevated IGF-1.

I have some pain (sensation) and a small hard lump in one of my nipples, about the size of a large bb. I did let me E2 drift up into the high 40's and that's when it was worse. Last two E2 sensitive test where 15 and 25, still have some sensation in the nipple lump is still there. Previous blood work showed my IGF-1 was above range. Any thoughts or experience would be appreciated. Prolactin was in normal range as well. Thanks

 

[Dr Justin Saya MD]

Question: The Doc mentioned that gyro can take place in the absence of high estradiol. He said in the interview he would treat this with tamoxifen 20mg twice daily. He mentions this could be a result if elevated IGF-1.

I have some pain (sensation) and a small hard lump in one of my nipples, about the size of a large bb. I did let me E2 drift up into the high 40's and that's when it was worse. Last two E2 sensitive test where 15 and 25, still have some sensation in the nipple lump is still there. Previous blood work showed my IGF-1 was above range. Any thoughts or experience would be appreciated. Prolactin was in normal range as well. Thanks

Higher IGF-1 can make you more susceptible to gynecomastia, especially in the presence of high estradiol. However, the details you describe including the small size do not sound very worrisome, particularly if you keep your estradiol within physiologic range moving forward.

 

[Brian7624]

Higher IGF-1 can make you more susceptible to gynecomastia, especially in the presence of high estradiol. However, the details you describe including the small size do not sound very worrisome, particularly if you keep your estradiol within physiologic range moving forward.

Thanks Dr.! I appreciate your time and input.