What is the correct Test to Estradiol ratio? (Dr. Crisler)

[thomastobird]

I've seen a lot of people mention that it's not so much the Testosterone levels, but more the test-estradiol ration. What's my goal? My total test is near the top now, estradiol is 175 (<206), free test is around mid range. What should I be aiming for? I'm pretty damn puffy now.lol

Also can too much DHT cause any problems other then baldness? When my free test was at the very bottom of the range my DHT was at the top of the range. If I add a lot more free test I assume my DHT is going to be sky high. Can this cause problems like ED or anything?

Thanks for any help.

 

[thomastobird]

Only those who do no truly understand the nature of hormones, and their interaction with our physiology, would place weight upon a T/E, or any other, ratio, as a treatment goal.

Doing so completely ignores the absolute effects of the individual hormones.

This thinking is most often used by those who simply want to excuse very high serum testosterone levels. It's just like, a six years ago when (it seems) all the self-appointed Internet steroid gurus were claiming it didn't matter how high your estrogen is, as long as T is (some undefined) proportion higher. I argued it out, getting through to some, not others. It was silly then, and just as silly now.

Thanks Dr, John.

 

[thomastobird]

Only those who do no truly understand the nature of hormones, and their interaction with our physiology, would place weight upon a T/E, or any other, ratio, as a treatment goal.

Doing so completely ignores the absolute effects of the individual hormones.

This thinking is most often used by those who simply want to excuse very high serum testosterone levels. It's just like, a six years ago when (it seems) all the self-appointed Internet steroid gurus were claiming it didn't matter how high your estrogen is, as long as T is (some undefined) proportion higher. I argued it out, getting through to some, not others. It was silly then, and just as silly now.

Dropping E2 will still be a good idea though, no? Since I'm really puffy, and my free T is mid/low range while Total T is near the top? Would this mean my Free T is converting into E2 instead, so if I block that enzyme I should be less puffy, and have more free T floating around?

 

[KSman]

Dropping E2 will still be a good idea though, no? Since I'm really puffy, and my free T is mid/low range while Total T is near the top? Would this mean my Free T is converting into E2 instead, so if I block that enzyme I should be less puffy, and have more free T floating around?

The concept of a T:E ratio is valid. Who is going to be manipulating a T:E ratio without first getting T restored to useful ranges. With T restored, if E is too high, many things go wrong and one can lower E while TRT dose is steady and have amazing positive results. On the other hand, one can have high-normal T and with E too high [still in normal range] and feel like crap.

The basic point is to understand that once T levels are in a good range, if E is out of balance, you will be too. So call it balance or ratio, either way you can get the job done.

If your E is too high and you lower it, the following probably will happen:

E goes down.
Less FT is converted to E, so FT may increase.
The lower E should lead to lower SHBG.
Lower SHBG may not change TT much but will allow for more FT to exist.

Higher E levels can cause some water retention for some, some get fatter and are then prone to more belly and butt fat. in some cases lowering E will allow for reapportionment of fat. Not lowering E in some cases where it is near or above upper normal range can make fat loss difficult or impossible.

 

[KSman]

I've seen a lot of people mention that it's not so much the Testosterone levels, but more the test-estradiol ration. What's my goal? My total test is near the top now, estradiol is 175 (<206), free test is around mid range. What should I be aiming for? I'm pretty damn puffy now.lol

Also can too much DHT cause any problems other then baldness? When my free test was at the very bottom of the range my DHT was at the top of the range. If I add a lot more free test I assume my DHT is going to be sky high. Can this cause problems like ED or anything?

Thanks for any help.

What is your T dose? Injected or transdermal?

I am not familar with that reference range, but by scaling to the 0-53 range that I am familiar with, I would expect that you would be better off in the 78-110 range. Your are too close to the upper end of the range. Some will get brain fog, ED, low libido, low energy, depression/mood problems while having high T levels. A good T level is not enough, there needs to be a balance with or of E as well. Some guys have not found the right Doctors and do not get any treatment for E problems.

 

[thomastobird]

The concept of a T:E ratio is valid. Who is going to be manipulating a T:E ratio without first getting T restored to useful ranges. With T restored, if E is too high, many things go wrong and one can lower E while TRT dose is steady and have amazing positive results. On the other hand, one can have high-normal T and with E too high [still in normal range] and feel like crap.

The basic point is to understand that once T levels are in a good range, if E is out of balance, you will be too. So call it balance or ratio, either way you can get the job done.

If your E is too high and you lower it, the following probably will happen:

E goes down.
Less FT is converted to E, so FT may increase.
The lower E should lead to lower SHBG.
Lower SHBG may not change TT much but will allow for more FT to exist.

Higher E levels can cause some water retention for some, some get fatter and are then prone to more belly and butt fat. in some cases lowering E will allow for reapportionment of fat. Not lowering E in some cases where it is near or above upper normal range can make fat loss difficult or impossible.

Thats good to hear. I have all those symptoms but it's kind of hard identifying everything. Pretty sure I just need to get that FT up to the top of the range. My SHBG looks good, so hopefully some arimidex or something will help with what you said.

What is your T dose? Injected or transdermal?

I am not familar with that reference range, but by scaling to the 0-53 range that I am familiar with, I would expect that you would be better off in the 78-110 range. Your are too close to the upper end of the range. Some will get brain fog, ED, low libido, low energy, depression/mood problems while having high T levels. A good T level is not enough, there needs to be a balance with or of E as well. Some guys have not found the right Doctors and do not get any treatment for E problems.

Well my TT was mid range and FT was at the very bottom. I started taking HCG and TT is at the top, with E2 at 175. My doc just gave me 100mg Test E a week about a week ago which I frontloaded at 200mg. So I don't know what the results will be on that but I'm getting even more puffy then when my E2 was at 175 with just HCG. Look like the friggin michelin man lol.

I Yeah I have all those symptoms still. I'm hoping it's just a Test/ Estradiol problem and not HGH because my IGF-1 came back lowish. I'll talk to my doc about getting my E2 levels down there next appt in 7 weeks.


Thanks

 

[JanSz]

The concept of a T:E ratio is valid. Who is going to be manipulating a T:E ratio without first getting T restored to useful ranges. With T restored, if E is too high, many things go wrong and one can lower E while TRT dose is steady and have amazing positive results. On the other hand, one can have high-normal T and with E too high [still in normal range] and feel like crap.

The basic point is to understand that once T levels are in a good range, if E is out of balance, you will be too. So call it balance or ratio, either way you can get the job done.

If your E is too high and you lower it, the following probably will happen:

E goes down.
Less FT is converted to E, so FT may increase.
The lower E should lead to lower SHBG.
Lower SHBG may not change TT much but will allow for more FT to exist.

Higher E levels can cause some water retention for some, some get fatter and are then prone to more belly and butt fat. in some cases lowering E will allow for reapportionment of fat. Not lowering E in some cases where it is near or above upper normal range can make fat loss difficult or impossible.

In an effort to avoid discussion about T, E levels and T:E ratio, my current theory is to do the following tests and adjust as need. Proper levels of T & E are individual and depend mostly on SHBG level.

Testosterone, Free, Bio/Total (LC/MS/MS)
Estradiol, Bioavailable
Estradiol, Free

I think all four (Free & BAT) should be in upper range.

Previously when only less specific tests were available, phisicians had to resort to certain rules of thumb (T:E ratio) and shortcuts.


http://www.nicholsinstitute.com/PDF/Interpret.pdf

http://www.questdiagnostics.com/hcp/intguide/EndoMetab/EndoManual_3rdEd_2004.pdf

There are other estrogens that needs to be watched.

 

[JanSz]

The concept of a T:E ratio is valid. Who is going to be manipulating a T:E ratio without first getting T restored to useful ranges. With T restored, if E is too high, many things go wrong and one can lower E while TRT dose is steady and have amazing positive results. On the other hand, one can have high-normal T and with E too high [still in normal range] and feel like crap.

The basic point is to understand that once T levels are in a good range, if E is out of balance, you will be too. So call it balance or ratio, either way you can get the job done.

If your E is too high and you lower it, the following probably will happen:

E goes down.
Less FT is converted to E, so FT may increase.
The lower E should lead to lower SHBG.
Lower SHBG may not change TT much but will allow for more FT to exist.

Higher E levels can cause some water retention for some, some get fatter and are then prone to more belly and butt fat. in some cases lowering E will allow for reapportionment of fat. Not lowering E in some cases where it is near or above upper normal range can make fat loss difficult or impossible.

In an effort to avoid discussion about T, E levels and T:E ratio, my current theory is to do the following tests and adjust as need. Proper levels of T & E are individual and depend mostly on SHBG level.

Testosterone, Free, Bio/Total (LC/MS/MS)
Estradiol, Bioavailable
Estradiol, Free, LC/MS/MS 36169X
http://www.nicholsinstitute.com/TestDetail.aspx?TestIDpass=36169XEstradiol, Free, LC/MS/MS

http://www.nicholsinstitute.com/TestDetail.aspx?TestIDpass=14966XTestosterone, Free, Bioavailable, and Total, LC/MS/MS


I think all four (Free & BAT, T & E) should be in upper range.

Previously when only less specific tests were available, phisicians had to resort to certain rules of thumb (T:E ratio).

There are other estrogens that need to be addressed.
Estrogens, Fractionated, LC/MS/MS 36742X

Includes: Estrone, LC/MS/MS; Estradiol, Ultrasensitive, LC/MS/MS; Estriol
http://www.nicholsinstitute.com/TestDetail.aspx?TestIDpass=36742XEstrogens, Fractionated, LC/MS/MS

Nichols Institute - Endocrinology

Nichols Institute - Endocrinology

 

[thomastobird]

Think about what you are saying: all is true, (except your second to last paragraph is somewhat convoluted) but has absolutely nothing to do with T/E ratio.

Again, this invalid concept is used to excuse high T; or to say E can be high as long as T is much higher.

If you think T/E, or any other ratio, is a treatment goal, then you are then concluding that hormones do not have their own intrinsic properties and effects.

Also, the effects of SHBG are very different as it moves through (even) its normal range. That fact alone totally destroys any concept of ratio.

Keep going in your education. You will see my point.

I understand kind of I think that a T to E ratio isn't what you're looking for as it can be adjusted for low Test, or High test and not necissarily be correct. ex. 10 E2 with 400TT, 25 E2 with 1000 TT, and 50E2 with 2000TT arn't the same thing.

So if my TT is at the top of the range at 900, free test is mid range, and E2 is near the top of the range, and I'm puffy and still feel like crap is there anything I should be aiming for with E2 to kick my Free Test up a bit?

 

[thomastobird]

How about you lower your E a bit then?

Why are you so blinded by trying to elevate Free T?

Because I still feel like crap, and I hear that Free T should be brought up to the top of the range. Wouldn't lowering Estrogen with arimidex bring up free t anyways?

 

[thomastobird]

We lower E in order to lower E. Why? because we do not want its ill effects at higher concentrations.

Forget about Free T for a while.

This'll cook your noodle: many of the Free T assays aren't valid anyway. And do you want to base your treatment on a number? And how about one that is only 2%?!

Alright, thanks you very much. I'll focus on the E2 for now.

Is there an Ideal target? KSman mentioned 78-110. Just want to verify that would be a good target area.

 

[JanSz]

Alright, thanks you very much. I'll focus on the E2 for now.

Is there an Ideal target? KSman mentioned 78-110. Just want to verify that would be a good target area.

It depends on the SHBG concentration.

Short and sweet.

SHBG (and Albumin) binds testosterone and estrogen.


Proper testosterone levels are obtained when watching (and adjusting)

FreeT
and
BAT

Proper estrogen (or only estradiol ???) levels are obtained by watching (and adjusting)

FreeE
BioAvailable Estrodial
====================================
That is the reason for these tests

Testosterone, Free, Bio/Total (LC/MS/MS)
Estradiol, Bioavailable
Estradiol, Free, LC/MS/MS 36169X
.
.
============================================================
===================================
In above (the correct) test for freeT and BAT and (I guess) FreeE and BAE the resulting numbers are calculated using tested values of SHBG, Albumin, TotalT (and TotalE or TotalE2) plus formula.

Those numbers (free & bio) are not assayed, this unfotunately happen and then we deal with incorrect tests.

I would like to get my hands of the formula used by Quest Diagnostics, please post link if you find it.

The formula I was using previously is not giving good results.

I bet that formula is posted someplace at their web site, I just cant find it.
Nichols Institute - Home
.
.

 

[thomastobird]

Thank you very much guys.

 

[pmgamer18]

After reading Dr. Shippen's book I tried the do the ratio thing when it was at about I believe he said 20/1 I felt like crap. What I read in LEF on the web is the best that works for me they say to keep your to start Total and Free T levels up into the upper 1/3 of your labs range for a young man. And to keep your Estradiol "E2" down between 10 to 30 best at 20. Now adding in what Dr. John says if your SHBG is lower you can keep your E2 lower. I don't follow any range anymore I use my morning wood as a gauge to how good my E2 levels are if I have good strong wood in my rem sleep my levels are good. I call it the wood gauge.:thumbsup:

 

[hardasnails1973]

It depends on the SHBG concentration.

Dr john or whom ever does shbg flucstuate as frequently as e2does

 

[hardasnails1973]

EXCELLENT question!


I do not believe it varies throughout the day as other sex hormones do, more "averaging" concentrations.

I mean does it takes complete cell turn over 3-4 months to see the cellular changes. I know e2 can change in matter of hours in serum, Because no matter what I do my shbg does not drop even driving e2 into the ground which makes me think that it may take longer cellular or in serum for it to change and ruling out all other variable thyroid, adrenal, dhea some thing going to have to make it give eventually .. Low inuslin levels could be a possible factor ..given low cholesterol and low trigyceriedes, ldl

 

[JanSz]

EXCELLENT question!


I do not believe it varies throughout the day as other sex hormones do, more "averaging" concentrations.

http://www.andrologyjournal.org/cgi/reprint/10/5/366.pdf

Page 2 of 6 contains chart of daily (24 hrs) variations of:
Testosterone
SHBG
non-SHBG bound Testosterone
Total Protein
============================================
I think each chart have two lines because:
two groups of men were studied


Ten healthy young men, mean age 27.3 years, and 10
healthy older men, mean age 70.7 years were studied.
.==============================================

Note
Total T level difference in two groups
rather similar SHBG curves
circardian rhytm of BioAvailable T in young men, flat curve in old
not sure what to say about TotaProtein.

-------------------------------------------------------------
When on suplemental Testosterone we are raising the BAT level but we are not able to reproduce daily circadian thytm.
.
.

 

[JanSz]

Thank you. I had already seen this study. IMPO, it's sample size is too small to have the "power" such a study requires. quires. Also, I do not believe RIA is a reliable assay methodology for SHBG--it has shown to be very unreliable at many laboratories. Further, in my clinical experience, SHBG does not vary in this manner. However, please refer to the passage I have bolded: does this add wieght to th ecoming notion that TD's are better than IM or pellets?
----------------------------
demonstrate a circadian pattern in young men and this
circadian rhythmicity becomes blunted with normal
aging.

People with low testosterone have all kind of other problems.
Some/many do not absorb transdermals. If anything, transdermals absorbtion is additional variable in already complicated situation.

The goal is to induce some daily variability in non-SHBG bound testosterone.
How about short acting testosterone (short half life) injected ED or E2D or E3D?
Trip to
The Roid Calculator

half-lifes
Testosterone propionate 2days
Testosterone phenylpropionate 3days
Testosterone isocaproate 4days
Testosterone decanoate 7days
Testosterone cypionate 6days
Testosterone entantate 5days

 

[KSman]

A busy thread indeed!

Dr J; I keep thinking about this T:R ratio thing that you do not like. Yes, I do not ignore the implications of absolute levels of T or E. I am an Engineer, that provides some instincts for better or worse. I know about drugs that have competitive actions on receptors. With anastrozole, the levels of that need to be increased with the amount of gear for body builders as increased T would otherwise overwhelm what would would be an effective dose. That smells like a ratio effect to me. I have read many times, and seemed to have experienced, that E can compete with T at T receptors, and that seems just like the competitive nature or anastrozole, again something that also seems to be driven by the ratio of two competing influences. So while I agree that absolute amounts of T&E cannot be ignored, we cannot also ignore the competitive nature of TvsE molecules on T receptors, and at a stretch, looking for symmetry, there might be an effect of T interfering with the effect of E on E receptors as well.

For me, the concept of ratio is alive and well. Perjaps it can be called a balance, but to me its the same thing. I did not invent this T:R ratio concept, but for me it seems to have a ring of truth.

 

[KSman]

There's no truth to it whatsoever. It is purely an invention of the mind which means nothing. You yourself have not yet provided one shred of evidence to back up what you believe to be true. Nor has anyone else, for that matter.

Why do bodybuilders who have HUGE T, with subsequent elevated E--within this mythical ratio people like to cling to--suffer gyno, water retention, ERECTILE DYSFUNCTION, etc? Or, at the other end of the range, I can show you many patients who came in with T at bottom of normal range, E at bottom of normal range, who still feel like crap. Agsin, in the ratio.

The simple fact is the absolute concentration of each hormone is what counts. And each patient has their own "ratio". This is the concept all who believe this misguided concept are missing. Which is why "ratio" may be useful to explain clinical symptoms, but is not a treatment goal in any way. Therefore, no standardization possible.

Either this "ratio" works, or it doesn't. And it clearly does not.

I still think that the competitive actions of T&E at the receptors is going to be a ratio driven response, as with the model of anastrozole and T with aromatase. If you add more T, as with body builders, you need more anastrozole to keep the aromatization in check [to maintain a given level of serum E2].

I also anchored my arguments earlier within the context of TRT where the T levels will be within a beneficial range.

I am not saying that a T:E ratio would be a therapeutic target, but it does seem to explain things in the same fashion that LEF talks about estrogen dominance in syndrome-X as well as some cases of PMS [for the gals]. Again, a balance of the effects. There are many expressions of getting ones hormones balanced.

 

[JanSz]

See above bolded.

Quote
by Dr John:
Yes, it CAN explain, for instance, explain why low T is so bad, because E, for some reason, tends to rise. But that is the only environment T/E ratio is of use. Of note, haven;t you just changed your mind, that T/E is not a treatment goal! Good!
=============================================
For me, I have already forgot T:E ratio.

We are stiil on a quest to find the right T & E levels.

Additionally we (I) would like it to be less of an art and more as science or mathematics/chemistry.

Currently I think that good T&E levels I should achieve by getting in the top range te following:

Free T & Free E
and
BAT & BAE

but possibly we may want to revisit the ratios, just on different level:

FreeT:FreeE

BAT:BAE

any takers?

 

[KSman]

See above bolded.
Of note, haven;t you just changed your mind, that T/E is not a treatment goal! Good!

I never stated that I thought that is should be a treatment goal, but that it is a valid concept.

 

[JanSz]

So we should start guys out on a system we already know to be inferior? Not me: I give them a shot at the best. If, and only if, that doesn't work, for whatever reason or reasons, then we can always switch to IM.

Would you go to a doctor, and place your faith in, who chooses second place for you--for his/her own convenience?

Hmm, I was thinkig to introduce short term variations in T levels by using
Testosterone propionate because it have short half life 2 days,
and schedule E3D

instead of currently used Testosterone cypionate half life 6 days

And that was already tried and proved inferior.
Would like to see the study described somewhere.
===========================================

Now the hope is that using Androgel daily, but skipping one day should work better, why?


circadian rhythm = non shbg bound T levels low/high=1.5/2.5=0.6
circadian rhythm ----> 60% variations/24 hr

E3D or E2D variations over 2 or 3 days

skipping Androgel once/week -----> once a week dips

 

[plymouth city]

Hmm, I was thinkig to introduce short term variations in T levels by using
Testosterone propionate because it have short half life 2 days,
and schedule E3D

instead of currently used Testosterone cypionate half life 6 days

And that was already tried and proved inferior.
Would like to see the study described somewhere.
===========================================

Now the hope is that using Androgel daily, but skipping one day should work better, why?


circadian rhythm = non shbg bound T levels low/high=1.5/2.5=0.6
circadian rhythm ----> 60% variations/24 hr

E3D or E2D variations over 2 or 3 days

skipping Androgel once/week -----> once a week dips

I have never heard of anyone using the gel to skip a day a week.

Who's protocol is this and why is it beneficial?