Also just food for thought. Every 12 weeks I lower my patients dose for 4 weeks to allow their system to come out of homeostasis and allow receptor sites to become more sensitive.
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sorry for off topic, but could you maybe help me out in my thread? Im on clomidtherapy
I am not saying that E1 and E3 do not matter. From a practical point of view these are not easily directly modified and then you have to deal with why you bother testing if you cannot manage and do not have a good idea of what the therapeutic targets should be. You have to pick the low hanging fruits. Most guys do not have any adverse issues with E1 and E2.
In a TRT context the main or most significant source of E2 is T–>E2 then E2–>E3 in the liver. There is an other cascade E1–>E3 and both E3 cascades are significantly in the liver. There is also an issue for some with adverse gut flora making estrogen metabolites available as estrogens that can be reabsorbed. What is the criteria for ordering these labs based on symptoms? Urine metabolite analysis exceeds what can be attempted in a forum.
By controlling E2, E2–>E3 is limited.
Meanwhile, 80:20 rule is vastly in favor of what I am doing VS the inadequate male hormone care that drives guys to this forum.
How are you selecting guys for deeper analysis that includes urine metabolites? Known liver problems or symptoms on TRT?
T:E ratios? Absolute estrogen levels do matter when it comes to limiting gene expression mediated with estrogens. In any case, if T levels are bounded to therapeutic levels in TRT then target E2 levels and T:E ratios are very interrelated and it does not really matter how you want to view the situation.
I do state that most guys seem to have optimal energy, mood, initiation, libido and socialization with E2 near E2=22pg/ml with high normal TT and FT. Yes, there are some exceptions and no one can fully qualify everything suggested in ever post and thread. I can’t post the content of all of the stickies in very post. Guys need to work some things out on their own.
How would you mange these issues in this forum? How do you propose that the few guys needing deeper work could be identified and directed to more comprehensive care. And yes, most guys are not able to access doctors who understand any basics at all.
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You both have a great points, and lucky for me by applying parts of both positions I, and others, may be able to get perfectly dialed in.
Right now my T:E ratio is ~7%, and I feel far from ideal. Getting my E2 down to 22 would put me at an ideal 4% ratio. What I’m experiencing, and I believe others are too, is that I can’t control the ratio by increasing T. When I increase T my E2 seems to escalate at a higher rate leaving me feeling worse and losing all the potential benefits of increased T.
Thanks to both of you for providing so much great info. Because of guys like you, guys like me have found a lot of hope. Keep it up, your contributions are beyond appreciated.
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Where are you located?
Try 3 injections a week. What’s your body fat and digestion look like?
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Columbus Ohio
Ratio of what exactly?
If E2:FT, we have Quest with a range that is hugely higher than Labcorp. If we can’t agree about what FT is, how can we talk about a E2:FT ratio without qualifying about what lab company is involved. I do no know if Quest has a wacky Bio-T range.
SHBG+E[123] is bio-available. SHBG+T is not. A ratio based on TT is a problem because SHBG can be so variable. A ratio based on Bio-T would be more to the point. Bio-T is a great thing, but seems to be rarely tested.
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lol what you’ve written here is spot on - let me know if I can help clarify anything specific!
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Thanks man haha. I feel like I’m alone blowing in the breeze trying to explain this to people. @Shadow_Pro
Unfortunately I’m sitting at 24% body fat. That’s down from 30% back in January, but been a painstakingly slow process. I will definitely try 3 shots…do you prefer IM or SQ? As far as I know digestion is good. At least I’ve never had an apparent issue come up that’s made me feel the need to address it.
Thanks again for your contribution! Everyone here benefits from you sharing your knowledge and life experience.
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You make a great point. Without exact comparisons, same labs etc, there will always be issues and variables that will be extremely difficult to solve for. Heck, I just got a new thermometer, actually bought a 2nd to verify, and it now appears I have hypo thyroid issues on top of low T.
I’m beginning to realize How incredibly lucky I am to have this forum as an invaluable resource, an open minded dr that I enjoy working with, and the hope that the combo will give me a shot at a new healthy and positive life.
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Well the more accurate information in these forums the better.
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Yea I agree - that being said, the amount of misinformation is astounding
If you want to know more than parking spots:
We are been led to believe that higher doses of T can’t be doing anything for body builders? How many parking spots do body builder have?
When you increase T you can be increasing T–>E2 and serum E2 levels and that E2 does find receptors. Increased T mediated gene expression will make a lot of changes in cellular functions.
“Explain to me why binding affinity is increased for estradiol when there is also increased testosterone since the amount of receptor sites don’t dramatically increase”
-why do we need to care? We do not need to get to that level to manage the issues critical to outcome.
Where do you find evidence that this has any basis in fact?
If true; should young normal virile guys lower their T levels every 12 weeks to improve their quality of life?
Sorry man but quoting wiki doesn’t make you revolutionary or novel in your understanding. I have done my best to bring real and practical knowledge to this forum and honestly I’m rather tired of it. I do wish all the best for all of you guys and remember - go by how YOU feel.
Also - young men and those not on TRT have hormones that oscillate. They never are released at a steady state nor amount. They change daily. So the body acts to modulate it on its own.
Thanks for all the info. Quick question, what’s been you most successful treatment protocol? Sounds like 3 injections is helpful in TE ratio and control. Do you normally use hcg and in what case do you prescribe an AI if ever? Finally, from your experience have you seen any benefits of IM vs SQ injections, which do you prefer. Thanks again for your contributions!
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Hey man - yea I usually use a 3x a week injection schedule with my patients. I honestly haven’t seen a huge benefit to sub q when the injection schedule is kept at 3x a week. Again I almost never use AI with patients unless all attempts to fix liver function and digestion have failed. If I consistently see readings way out of range I will consider using extremely low dose aromasin. I have previously said that I use daily tamoxifen with my patients - not hcg. It does the job just fine 
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