T:E Ratio: How Do I Calculate It?

[killerhair]

Can someone give me specifics on the Total T / E2 formula? For example my Quest labs represent Total T in ng/dl and my E2 in pg/ml.

Based on numbers other users are posting I assume the formula is:

Ratio = (Total T ng/dl / E2 pg/ml ).

Sorry if this has already been posted. I have looked but I couldn't find what units where being used for each.

Thanks.

 

[johndoesmith]

Can someone give me specifics on the Total T / E2 formula? For example my Quest labs represent Total T in ng/dl and my E2 in pg/ml.

Based on numbers other users are posting I assume the formula is:

Ratio = (Total T ng/dl / E2 pg/ml ).

Sorry if this has already been posted. I have looked but I couldn't find what units where being used for each.

Thanks.

Generally when it's calculated, units aren't changed. Most of the time testosterone is in ng/dl and E2 is in pg/ml.

Sometimes E2 will be in pmol/l which generally 40 pmol/l = 10 pg/ml. All pmol/l tests are standard assays, because they're almost always from non united states labs. I believe I've seen one sensitive assay from Australia but that's the only other country I know of that has it.

T/E2 ratio is a guide, not a perfect tool that applies in all situations. My T/E2 ratio on TRT is about 30, where generally 14-20 is stated to be the target range. My pre TRT ratio was 50 or so, in this case a higher number = less aromatization. TRT will cause more aromatization because of the AUC(area under the curve) increasing. There aren't large diurnal variations like with a natty guy's testosterone that drops off during the day.

That's something to keep in mind. When a guy's initial labs show 300 total test and E2 at 30, he's going to have E2 issues on TRT, even without accounting for the higher aromatization on TRT. Basic math indicates that at 900 he'd have an E2 of 90, this isn't always the case but he's certainly going to have a rather high E2 level on TRT, and thus starting TRT with a low dose of AI would be a good idea.

 

[Vince]

Can someone give me specifics on the Total T / E2 formula? For example my Quest labs represent Total T in ng/dl and my E2 in pg/ml.

Based on numbers other users are posting I assume the formula is:

Ratio = (Total T ng/dl / E2 pg/ml ).

Sorry if this has already been posted. I have looked but I couldn't find what units where being used for each.

Thanks.

There is a good thread on testosterone and estradiol ratio, you may be interested in Reading.

Is Testosterone to Estradiol Ratio Important in Men?

 

[Nelson Vergel]

Very little data on T/E2 ratios (that actually use LC/MS for both parameters).​

​

My hypothesis is that, like all hormones, there is an inverted U-shaped curve (for benefits vs T/E2 ratio). Some studies hint at T/E2 above 14, but we have no data on the upper range since very high T/E2 may be indicative of low estradiol.​

​

Post #12: Is Testosterone to Estradiol Ratio Important in Men?​

​

Since 0.3 percent of TT is normally aromatized into E2 in healthy men, then it makes sense that​

​

1/0.03= 33 (both in ng/dL)​

​

Estradiol tends to plateau as T dose increases (probably also due to increased DHT that acts as an estradiol blocker). Aromatization was shown to be higher for older men here:​

​

Effect of Testosterone Injections on Estradiol and DHT in Young and Older Men - ExcelMale​

​

I think 0.25 mg per week of anastrozole makes sense for men whose conversion is above 0.3 percent (I think we should monitor estradiol like we do free T. Free T percent should be 2% of TT or above). DHT should be 10% of TT or above.​

 

[Cataceous]

...​

Estradiol tends to plateau as T dose increases (probably also due to increased DHT that acts as an estradiol blocker). ...​

I wonder if that's due to the aromatase saturation effect described here? Otherwise wouldn't DHT raise estradiol a little by displacing it from receptors? You can see this effect in a free estradiol calculator, where fE2 does go up a little as you raise DHT.

 

[Nelson Vergel]

Another interesting study.

Elevated T/E2 Ratio Is Associated with an Increased Risk of Cerebrovascular Disease in Elderly Men

Abstract
Objective
To investigate the relationship between sex hormones and the risk of vascular disease in elderly men and to evaluate the advantages and disadvantages of testosterone replacement.

Methods
A total of 337 men, aged 60 to 91 years, were enrolled in this single-center, cross-sectional study, and their sex hormone levels were assessed. Linear and logistic regression analyses were utilized to compare the sex hormone levels between patients with and without vascular disease. The nonparametric K-sample test was used for inter-group comparisons.

Results
Aging and abnormal metabolism were both significantly associated with an increased risk of vascular diseases and changes in sex hormone levels. Primary linear and logistic regression analyses showed no significant differences in sex hormone concentrations between patients with and without vascular diseases after adjusting for age. Logistic regression with abnormal metabolism as categorical variable showed that free testosterone (FT) and free estradiol (FE2) had significant relationships with CEVD risk (P<0.05). In further regression with all metabolic continuous variables included, the testosterone/estradiol (T/E2) ratio replaced FT and FE2 (P<0.05). Trend line analyses showed that T/E2 actually had a binomial linear correlation with the risk of cerebrovascular disease; its best protective effect occurred at values of 0.13–0.15, with an OR value extremely close to those of FT and FE2 (0.23 vs. 0.24–0.25).

Conclusion

Sex hormone levels were tightly correlated with the incidence of cerebrovascular disease in elderly men. Elevated FT levels and a higher T/E2 ratio might increase the risk of cerebrovascular disease, while higher FE2 decreased this risk. Elevated T/E2 was the key parameter in the relationship between sex hormones and the risk of cerebrovascular disease. The balance between T and E2 may be more important than their absolute quantities. Extremely low or high T/E2 values will harm the brain blood vessels. Careful consideration should be given before beginning testosterone replacement treatment, and supplementation with estrogen seems a good way to protect the blood vessels of the brain in elderly men.

Full paper for those who want to discuss it instead of giving personal opinions. Keep in mind that they used ECLIA to measure hormones, not LC/MS as we do now (hormone values may be skewed to higher values than they actually are)

Elevated T/E2 Ratio Is Associated with an Increased Risk of Cerebrovascular Disease in Elderly Men

 

[Nelson Vergel]

I wonder if that's due to the aromatase saturation effect described here? Otherwise wouldn't DHT raise estradiol a little by displacing it from receptors? You can see this effect in a free estradiol calculator, where fE2 does go up a little as you raise DHT.

Not sure if I have seen data that shows that as DHT increases along with T there is actually an increase of E2 just solely because of the effect of DHT on estrogen receptors. This is hard to prove since as T increases, so does E2 along with DHT.

T, DHT, and estradiol all bind to SHBG. SHBG decreases with increased T dose. So, free DHT, free T, and free E2 may raise. But free E2 may actually be protective in older men at least when it comes to cerebrovascular disease, as shown above.

I would love for someone here to review that paper. I am short of time but would welcome actual analysis instead of opinions.

 

[YBWV]

Very little data on T/E2 ratios (that actually use LC/MS for both parameters).​

​

My hypothesis is that, like all hormones, there is an inverted U-shaped curve (for benefits vs T/E2 ratio). Some studies hint at T/E2 above 14, but we have no data on the upper range since very high T/E2 may be indicative of low estradiol.​

​

Post #12: Is Testosterone to Estradiol Ratio Important in Men?​

​

Since 0.3 percent of TT is normally aromatized into E2 in healthy men, then it makes sense that​

​

1/0.03= 33 should be used as a benchmark​

​

Estradiol tends to plateau as T dose increases (probably also due to increased DHT that acts as an estradiol blocker). Aromatization was shown to be higher for older men here:​

​

Effect of Testosterone Injections on Estradiol and DHT in Young and Older Men - ExcelMale​

​

I think 0.25 mg per week of anastrozole makes sense for men whose conversion is above 0.3 percent (I think we should monitor estradiol like we do free T. Free T percent should be 2% of TT or above). DHT should be 10% of TT or above.​

I believe that your suggesting a number for DHT - 10% (or above) of TT - will be helpful to the many guys struggling to acheive relief of symptoms whilst on TRT.
We know 10% is the broad average for healthy eugonadal men.

There are a number of posts here on the Forum from (often younger) guys who are struggling. They post their Labs (sometimes 4 pages) and frequently there's no numbers for DHT.
While I get that DHT in Serum might only provide a "hint" of levels in peripheral tissue, surely it's a hint that's worth taking particularly when guys are reporting unresolved symptoms like anxiety, low mood state and sexual dysfunction.

I noticed the announcement that the DHT Serum test with DiscountedLabs has been reduced to $50 and guys that don't know their number would do well to take the test.

Having adequate levels of FT and a sufficiency and balance of E2 to DHT, will help those guys find relief of their symptoms.

 

[Nelson Vergel]

YBWV

I agree 100%. DHT should be checked in men whose libido does not increase even after achieving total testosterone above 700 ng/dl and free T of 2% (free T is another good predictor of libido). For men who have good insurance or more funds, including prolactin would also be a good idea. Thyroid hormone exploration is also good especially if low libido is present along with fatigue.

ED Blood Test Panel

 

[CoastWatcher]

YBWV

I agree 100%. DHT should be checked in men whose libido does not increase even after achieving total testosterone above 700 ng/dl and free T of 2% (free T is another good predictor of libido). For men who have good insurance or more funds, including prolactin would also be a good idea. Thyroid hormone exploration is also good especially if low libido is present along with fatigue.

ED Blood Test Panel

Prolactin, despite the costs associated with measuring it, should be a baseline value captured when a potential TRT patient has his initial workup, I believe. In the event it is elevated, it will have to be addressed if a successful journey on the hormone highway is to be undertaken. Note it at the front end.

 

[JRos895]

Very little data on T/E2 ratios (that actually use LC/MS for both parameters).​

​

My hypothesis is that, like all hormones, there is an inverted U-shaped curve (for benefits vs T/E2 ratio). Some studies hint at T/E2 above 14, but we have no data on the upper range since very high T/E2 may be indicative of low estradiol.​

​

Post #12: Is Testosterone to Estradiol Ratio Important in Men?​

​

Since 0.3 percent of TT is normally aromatized into E2 in healthy men, then it makes sense that​

​

1/0.03= 33 should be used as a benchmark​

​

Estradiol tends to plateau as T dose increases (probably also due to increased DHT that acts as an estradiol blocker). Aromatization was shown to be higher for older men here:​

​

Effect of Testosterone Injections on Estradiol and DHT in Young and Older Men - ExcelMale​

​

I think 0.25 mg per week of anastrozole makes sense for men whose conversion is above 0.3 percent (I think we should monitor estradiol like we do free T. Free T percent should be 2% of TT or above). DHT should be 10% of TT or above.​

@Nelson Vergel do you still believe this?
This seems a little bit on the aggressive side for AI use, no? This would suggest that one with a T/E ratio of 20-25 should be using an AI (though .25mg is certainly not a hefty dose).

 

[Nelson Vergel]

Role of T:E ratio in predicting the efficacy of recombinant HCG and T treatment in male hypogonadism

ABSTRACT Objective: We aimed to investigate the role of testosterone to estradiol ratio in predicting the effectiveness of human chorionic gonadotropin and testosterone treatments in male hypogonadism. Materials and methods: Thirty-six male patients with hypogonadotropic hypogonadism were...

www.excelmale.com

 

[JRos895]

Role of T:E ratio in predicting the efficacy of recombinant HCG and T treatment in male hypogonadism

ABSTRACT Objective: We aimed to investigate the role of testosterone to estradiol ratio in predicting the effectiveness of human chorionic gonadotropin and testosterone treatments in male hypogonadism. Materials and methods: Thirty-six male patients with hypogonadotropic hypogonadism were...

www.excelmale.com

I don’t understand how this study answers my question. It says to keep the T/E ratio around 12. Your statement above suggests that if one had a ratio of 15-30, that they should take an AI.

 

[Nelson Vergel]

Your statement above suggests that if one had a ratio of 15-30, that they should take an AI.

Where did I say that?

T/E ratios are calculated dividing T (ng/dL) by E2 (in pg (not ng)/mL (not dL).
Example:

Total T: 1,200 ng/dL
Sensitive estradiol: 45 pg/mL (or ng/L)

T/E2= 1200/45= 27

Expected E2= 0.3 percent of total T= 0.003 x 1,200 ng/dL= 3.6 ng/dL= 36 pg/mL


Paper:

CLINICAL UROLOGY: Original Articles

EVIDENCE OF A TREATABLE ENDOCRINOPATHY IN INFERTILE MEN
The Journal of Urology
Volume 165, Issue 3, March 2001, Pages 837–841

Purpose
We establish whether a subset of infertile men have decreased serum testosterone-to-estradiol ratios and whether this condition can be corrected with an oral aromatase inhibitor.

Materials and Methods

The serum testosterone-to-estradiol ratios of 63 men with severe male factor infertility or hypergonadotropic hypogonadism (mean follicle-stimulating hormone 21.2 ± 1.8) were compared with those of an age matched, fertile, control reference group. Of the 63 men 43 were azoospermic with biopsy proved severe male infertility and 20 were oligospermic. The men with the lowest ratios (less than 20th percentile) were treated with 50 to 100 mg. of the aromatase inhibitor testolactone orally twice daily. Testosterone-to-estradiol ratios and semen analyses were evaluated during testolactone therapy.

Results
Men with severe male infertility had significantly lower testosterone (328 versus 543 ng./dl., p <0.01) and higher estradiol (58.4 versus 43.5 ng./l. OR pg/mL, p = 0.01) than fertile control reference subjects, resulting in a decreased testosterone-to-estradiol ratio (×10] = 6.9 ± 0.6 versus 14.5 ± 1.2, respectively, p <0.01). Of the 45 men treated with testolactone a correction of these abnormalities was seen and ratios increased into the normal range (5.0 ± 0.3 to 12.7 ± 1.2, p <0.01). Semen analyses were considered evaluable only in men with sperm in the ejaculate before aromatase inhibitor treatment. Semen analyses before and during testolactone treatment revealed significant increases in sperm concentration (16.1 to 28.9 million sperm per ml., p = 0.03) and motility (27.1% to 45.3%, p <0.01) in 12 oligospermic men.

Conclusions

We identified an endocrinopathy in men with severe male factor infertility that is characterized by a decreased serum testosterone-to-estradiol ratio. This ratio can be corrected by aromatase inhibition, resulting in a significant improvement in semen parameters in oligospermic patients.

 

[JRos895]

Where did I say that?

T/E ratios are calculated dividing T (ng/dL) by E2 (in pg (not ng)/mL (not dL).
Example:

Total T: 1,200 ng/dL
Sensitive estradiol: 45 pg/mL (or ng/L)

T/E2= 1200/45= 27

Expected E2= 0.3 percent of total T= 0.003 x 1,200 ng/dL= 3.6 ng/dL= 36 pg/mL


Paper:

CLINICAL UROLOGY: Original Articles

EVIDENCE OF A TREATABLE ENDOCRINOPATHY IN INFERTILE MEN
The Journal of Urology
Volume 165, Issue 3, March 2001, Pages 837–841

Purpose
We establish whether a subset of infertile men have decreased serum testosterone-to-estradiol ratios and whether this condition can be corrected with an oral aromatase inhibitor.

Materials and Methods

The serum testosterone-to-estradiol ratios of 63 men with severe male factor infertility or hypergonadotropic hypogonadism (mean follicle-stimulating hormone 21.2 ± 1.8) were compared with those of an age matched, fertile, control reference group. Of the 63 men 43 were azoospermic with biopsy proved severe male infertility and 20 were oligospermic. The men with the lowest ratios (less than 20th percentile) were treated with 50 to 100 mg. of the aromatase inhibitor testolactone orally twice daily. Testosterone-to-estradiol ratios and semen analyses were evaluated during testolactone therapy.

Results
Men with severe male infertility had significantly lower testosterone (328 versus 543 ng./dl., p <0.01) and higher estradiol (58.4 versus 43.5 ng./l. OR pg/mL, p = 0.01) than fertile control reference subjects, resulting in a decreased testosterone-to-estradiol ratio (×10] = 6.9 ± 0.6 versus 14.5 ± 1.2, respectively, p <0.01). Of the 45 men treated with testolactone a correction of these abnormalities was seen and ratios increased into the normal range (5.0 ± 0.3 to 12.7 ± 1.2, p <0.01). Semen analyses were considered evaluable only in men with sperm in the ejaculate before aromatase inhibitor treatment. Semen analyses before and during testolactone treatment revealed significant increases in sperm concentration (16.1 to 28.9 million sperm per ml., p = 0.03) and motility (27.1% to 45.3%, p <0.01) in 12 oligospermic men.

Conclusions

We identified an endocrinopathy in men with severe male factor infertility that is characterized by a decreased serum testosterone-to-estradiol ratio. This ratio can be corrected by aromatase inhibition, resulting in a significant improvement in semen parameters in oligospermic patients.

View attachment 17270

You said “I think 0.25 mg per week of anastrozole makes sense for men whose conversion is above 0.3 percent (I think we should monitor estradiol like we do free T. Free T percent should be 2% of TT or above). DHT should be 10% of TT or above.”

An estradiol of 45 pg/ml relative to a TT of 1200 is about a conversion of .38 percent and is a T/E ratio of about 26. Since .38>.3, your statement above suggests that one with that TT/E2 profile should take .25mg of the AI.

A T/E ratio of 30 is a conversion rate of .33 percent (which is above .3 percent) so your statement also suggests that one with a T/E ratio of 30 should take an AI.

 

[Nelson Vergel]

Ok, I missed by 0.08 percent. That was wrong of me!. It is just a suggestion, not a recommendation anyways. And not one that anyone cares to follow anyway. I wish it was that simple.

If you read all the years of estradiol information I have posted, you would understand how trivial this math is as nothing is exact in endocrinology. I believe that most men do not need anastrozole. My saying that a tiny dose of 0.25 mg per week may be needed for those with low T/E2 ratios is done to pacify those who think all their water retention, mood and other non-E2 side effects are caused by this "evil" metabolite.

How to Predict Estradiol and DHT at Different Testosterone Doses

I was able to come up with a table using the predictive model equation derived from data in this study: The Effects of Injected Testosterone Dose and Age on the Conversion of Testosterone to Estradiol and Dihydrotestosterone in Young and Older Men Summary This video discusses a research paper...

www.excelmale.com

 

[JRos895]

Not trying to bust your balls or anything. I was just wondering what you thought was a proper guideline range for T/E ratios. 15-20? 15-35?

Or in E/T terms, .03-.06? .04-.07?

Having read your articles, the .3 benchmark you suggested above seemed out of line with your general views on AI use.

 

[Nelson Vergel]

I repeat:

1. There are no guidelines for managing T/E ratios.
2. There is no information on optimum T/E ratios.
3. The tiny amount of data shows that ratios below around 14? are detrimental to fertility.
4. The latest study (posted above) showed more erections at T/E of 13? but they did not assess optimum.
5. I made a mistake to even mention an anastrozole dose based on no evidence. I believe that anastrozole should not be used by men on TRT.

What else do you need me to say?

 

[JRos895]

This is a slightly different point but I figured this was a good thread to post it in.

Isn’t it interesting that men and clinics always say they want high normal T levels but never say they want high normal E levels (usually wanting low or medium)?

This is even among the men and clinics that acknowledge “oh hey E is important and has health benefits, we shouldn’t crash it to 0”, but still push AIs to push levels into the low or medium range.

This widespread practice phenomenon and practice basically assumes that E, although not evil, is still not as “good” or “healthy” as T.

Is there really any evidence to suggest that high normal E levels are any less healthy as high normal T levels?

 

[Nelson Vergel]

Is there really any evidence to suggest that high normal E levels are any less healthy as high normal T levels?

NO evidence for men with HIGH T levels.

The only evidence of "high E2 is bad" is in men with low T levels (hence, low T/E2 ratios)