Archive for 'E2'

This lab was my first check of Estradiol and occurred just before I started the aromatase inhibitor Arimidex to control this strongest estrogen in men. I had just started Testim 5g/day with no HCG. Estradiol is also known as E2 and is blamed often for libido and erection issues. There is a great deal of talk about Estradiol needing to be at a certain “sweet spot” often reported as around 25 pg/mL. In this lab my value is 82 pg/ml, which is high given the lab range reported for men as less than or equal to 29 pg/mL.

Note the really important lesson here is twofold. First, the “sweep spot” theory is just that – a theory, and a bunk one at that. While it may be true in some men, and at the time of this test I thought I found the cause of my own libido issues, later when my levels were steady at a number greater than 82pg/mL functioning and sexual appetite were more than just fine. My sweet spot seems to be a range that is not too high (what that number is I do not know) or too low. Second, the real metric of interest is a stable level that is not bouncing around all over the place.

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Types of Testosterone Replacement

There are four main types of testosterone replacement that are available.

Transdermal testosterone includes patches (which will not be covered due to their low absorption rates) and gels such as Testim and Androgel, which are both 1% concentrations, and creams from a compounding pharmacy which range from concentrations of 1% to 10% with higher concentration rates equating to lower skin surface area for application. A study indicated Testim absorption to be better than Androgel, however my personal experience is that both are good absorbers. The smell of Testim turns most men off to its use, but I found that women particularly like the odor. However, my insurance does not cover Testim. Androgel efficacy is improved in my case by rubbing it on the flanks as well as the arms. Remember, the more surface area the higher the DHT, which can lead to unwanted side effects such as acne, accelerated hair loss in those prone to male pattern baldness, and hair growth in unwanted areas. However, the boost in libido and improvement in erections is noticeable for me. Shots, mentioned next, worked fine in my case for about 1 month. Two months into the treatment I had profound lack of libido and total erectile dysfunction unresponsive to PDE5 inhibitors such as Viagra and Levitra.

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Testosterone Facts and Education

So just how does the male body produce testosterone? While the number of systems that can impact testosterone production is large in number, the basics are rather simple. Let’s start at the hypothalamus and work our way down.

  • The hypothalamus produces gonadotropin-releasing hormone (GnRH)
  • This hormone triggers the anterior pituitary gland to produce two other hormones
  • These two hormones are luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
  • LH stimulates the Leydig cells in the testicles to produce testosterone while FSH regulates the development, growth, pubertal maturation, and reproductive processes of the body and acts synergistically with LH in male reproductive health.

Simple enough, but what happens is one or more of these systems is compromised in some manner? Defects in the hypothalamus or pituitary gland that compromise the release of GnRH (and subsequently FSH and LH) or adversely affect the release of FSH or LH from the anterior pituitary lead to what is known as secondary hypogonadism. A defect in the testicles that causes a reduction or cessation of gonadal response to LH is characterized as primary hypogonadism. There are many causes of both primary and secondary hypogonadism. The link lists only some of the causes. Also check out this link. Hypogonadism that is present absent any of these conditions or any other known conditions that affect male testosterone production comes under the heading idiopathic hypogonadism. This later label correctly describes my own condition.

Typically a doctor will order a test that measures the total serum testosterone. This is a simple blood test that provides a number, usually in the units of nanograms per deciliter (ng/dl). Normal values vary by the lab performing the test on the blood sample, but typically values are from around 300ng/dL to 1000ng/dl. However, caution should be used in using this raw value as an stark indicator of hypogonadism. For some men presenting with low normal values or even normal values symptoms of low testosterone are often seen. Therefore the entire clinical picture is needed to ensure treatment is provided even in the face of so-called normal results. Also, an entire workup of the thyroid function as well as adrenal function is necessary. Any issue with either of these glands can often lead to hypogonadism or mimic they symptoms of hypogonadism. Also, an understanding of any issues with these glands will guide the treating physician in the selected treatment. As an example, long-standing hypothyroidism will impair the absorption of transdermal testosterone due to build-up of mucin in the skin of people. Mucin causes the skin to thicken impairing absorption of transdermal testosterone.

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