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According to the National Institute of Health, gynecomastia can affect more than 50% of adolescent boys during puberty. At the same time, gynecomastia can also affect up to 65% of men between 27 and 92 years, depending on their lifestyle, habits, drug intake, and other factors. But what is gynecomastia and why so many men get it? Is it dangerous? And what can you do to treat it effectively and safely? Keep reading this article to find out everything you need to know about gynecomastia, its types, causes, and treatment options. Table of Contents What is Gynecomastia? What Kinds of Gynecomastia Are There? Physiological Gynecomastia Neonatal Gynecomastia Pubertal Gynecomastia Aging Gynecomastia What Hormone Inbalances Can Cause Gynecomastia? Pharmacological Gynecomastia Caused by Medications How to Treat Gynecomastia Gynecomastia FAQ What is Gynecomastia? In simplest terms, gynecomastia is commonly known as “man boobs.” It’s a health issue characterized by an increase of the breast tissue in adolescent boys as well as adult males. Although this type of condition doesn’t usually pose serious health risks, it can have profound psychological consequences. Men simply don’t like having breasts which look like those of women. The prevalence of gynecomastia in seniors over 50 years of age is approximately 70%. In rare cases, untreated gynecomastia can lead to different types of diseases, including breast cancer, so that’s why it’s essential to accurately diagnose and treat them. Gynecomastia can also be referred to as male breast enlargement, and it splits into three main categories - physiological, pathological, and pharmacological. Let’s take a closer look at each one.   What Kinds of Gynecomastia Are There? Physiological Gynecomastia This type of gynecomastia is usually caused by an imbalance in the testosterone and estrogen ratio in the body. As you probably know, these two are the essential sex hormones, and they need to be present in specific quantities in the bloodstream in both males and females. For example, men have 40 times more testosterone than females, but they also have small amounts of estrogen. This estrogen helps with libido, bone density, and other critical bodily functions. Women have higher quantities of estrogen, but small amounts of testosterone for libido, muscle mass, mood, etc. Men who have relatively more estrogen than necessary to balance testosterone tend to develop gynecomastia. This can be caused by various factors. Neonatal Gynecomastia It usually happens at birth when the ratio of estrogen to testosterone is imbalanced. It should resolve itself after a few weeks. Parents must seek a doctor's help if the gynecomastia persists after one year. Pubertal Gynecomastia This type of gynecomastia usually happens among teenagers who reach puberty. The balance of estrogen to testosterone goes out of whack, and the breasts of adolescent boys grow more than usual. The issue should get resolved automatically in less than two years. If it doesn’t more investigations are required to determine the cause of this type of gynecomastia. Aging Gynecomastia Adult males who get old will also experience mild gynecomastia, which is caused by advanced age. This process happens as a result of an increase in aromatase activity. In other words, the brain, fat tissue, liver and testicles convert a larger portion of testosterone into estrogen. The resulting higher estrogen to testosterone ratio causes aging gynecomastia.   What Hormone Inbalances Can Cause Gynecomastia?   This type of gynecomastia is usually caused by an increase in estrogen hormones, a decrease in androgen hormones or a combination of both. Here are a few hormone inbalances that can cause gynecomastia: 1. Androgen deficiency Gynecomastia can be caused by a testosterone deficiency in males of all ages. When testosterone levels drop, estrogens become more prevalent and might dictate a breast enlargement in men. In such cases, gynecomastia acts as a symptom of testosterone deficiency and it helps individuals become aware of this health issue. Testosterone deficiency is usually associated with a higher aromatization rate (which converts more testosterone to estrogen) and a decrease in the production of luteinizing hormone (LH). The Klinefelter Syndrome is usually associated with hypogonadism in those patients. Unfortunately, this health issue can increase the likelihood of developing breast cancer; that’s why it’s crucial to test the testosterone levels as soon as possible if gynecomastia is observed in patients. Breast enlargement caused by androgen deficiency can be treated with testosterone replacement therapy (TRT). In these cases, testosterone is administered in an exogenous manner by using injections, creams, pills, gels, etc. 2. Hyperprolactinemia Hyperprolactinemia is a health condition in which a male has higher levels of the hormone prolactin in his bloodstream. Prolactin is a hormone present in all mammals which allows them to produce milk. Hyperprolactinemia might be caused by a type of growth on the pituitary gland, a condition known as a prolactinoma. This growth triggers an increase in the production of prolactin, which causes hyperprolactinemia. Certain medications can cause increased prolactin. One side effect of this condition is gynecomastia. 3. Estrogen Excess Different types of estrogens cause an increase in breast development in both males and females. However, males tend to have a much smaller amount of estrogen in their bodies, so the breast enlargement stops after a while. In some cases, an excessive amount of estrogen can be produced, which leads to gynecomastia. Tumors tend to cause excess estrogen production, which in turn leads to gynecomastia. The administration of exogenous estrogens can also trigger gynecomastia in males of all ages. Patients who develop tumors also experience other symptoms such as Cushing's syndrome, weight loss, and an accumulation of fat in the abdominal area. In some cases, gynecomastia can also be a symptom of more severe disease such as testicular cancer. People who have gynecomastia should also receive a thorough investigation of the testicles to see if more serious health issues are present. 4. Thyroid Problems The thyroid gland is a vital contributor to the healthy development of a male. Conditions such as hypothyroidism or hyperthyroidism can lead to abnormal secretion of testosterone, decreasing the levels of this hormone in the bloodstream. As a result, estrogens become more prevalent, and they cause gynecomastia in most patients. If patients are assessed, and their gynecomastia is caused by thyroid issues, receiving thyroid treatment is the most appropriate solution. After the thyroid hormonal balance is restored, gynecomastia usually goes away on its own. 5. Obesity People who are obese usually have gynecomastia as well. This happens because the aromatization of testosterone into estrogen occurs in the adipose tissue. As a result, having more fat around the body allows more testosterone to be converted into estrogen, which results in breast enlargement. 6. Growth Hormone Excess Another cause of gynecomastia might be represented by an excessive amount of growth hormone and IGF-1 in the bloodstream. These hormones are responsible for growing muscle mass and bones. Studies show a correlation between gynecomastia in pubertal boys and a high amount of growth hormone and IGF-1 in the blood. Men using growth hormone or growth hormone releasing hormones should be aware of this issue. 7. Other Causes Gynecomastia might also be caused by different other health conditions. For example, chronic liver disease can significantly decrease testosterone production, which leads to breast enlargement and gynecomastia. Resuming a healthy diet after a long period of starvation can also cause gynecomastia. That's because, during periods of food scarcity, the production of testosterone is reduced. Testicular damage might also trigger enlargement of breasts in men.   Pharmacological Gynecomastia Caused by Medications   It has been discovered as a result of numerous studies that gynecomastia can also be caused by various drugs. For example, some medications can reduce testosterone production; others might cause an increase in estrogen hormones or disrupt the sensitivity of androgen receptors. Opioids can also cause gynecomastia. 1. Performance-Enhancing Drugs (PEDs) in Athletes It is a well-known fact that various performance-enhancing drugs are taken by athletes and non-athletes to increase their sports performance. Anabolic-androgenic steroids (AAS) are usually used to increase muscle mass, reduce recovery time, and improve sports performance. One side effect of abusing such drugs is the development of gynecomastia since most anabolic steroids shut down the body’s own testosterone production, which increases the estrogen to testosterone ratio. Abusing PEDs cause breast enlargement in men because it increases the aromatization process. This converts more testosterone into estrogen and gynecomastia appears as a result.  After a prolonged period of abuse, other health complications can arise, such as erectile dysfunction and infertility. 2. Getting Exogenous Estrogen The estrogen hormone can be absorbed into the bloodstream in various ways and usually accidentally. For example, animals who are treated with estrogen-rich food or drugs are eaten by men who absorb some of these hormones. Similarly, some creams which are used to treat baldness can cause an increase in estrogen production, which leads to gynecomastia. Similarly, soy-based products tend to contain estrogens (known as phytoestrogens), which can get into the bloodstream. Lavender and tea tree oil also contain phytoestrogens and are commonly found in food and cosmetics. 3. Using Recreational Drugs Different types of drugs, such as marijuana can also cause gynecomastia if abused. The experts are not yet aware of why this process happens, but there is a health condition known as marijuana-induced gynecomastia. It is believed that this drug can reduce the production of testicular testosterone, which leads to hypogonadism and gynecomastia.   How to Treat Gynecomastia As you probably have figured it out, there's no one-size-fits-all treatment for gynecomastia in men. This condition can be a problem by itself, or it can be a symptom of a more severe health issue which needs to be investigated immediately. As a general rule of thumb, gynecomastia can be caused by an increased aromatization of testosterone to estrogen, increased IGF-1, decrease thyroid function with or without a decrease in testosterone production. These two conditions can be triggered by drug abuse, organ damage, genetics, or other factors. Once the first physical symptoms are observed, the patient needs to visit his healthcare provider immediately to do more investigations. Gynecomastia is characterized by an increase of the hard to the touch breast tissue, especially under the nipple area. Therefore, it shouldn’t be confused with fat mass. The doctor can perform various investigations such as doing a blood test for testosterone and/or for estrogen levels. Depending on these results, the doctor might recommend other tests to discover why the testosterone to estrogen ratios are unbalanced. If testosterone blood levels are low, doctors prescribe testosterone replacement therapy.  If estrogen is high while testosterone is normal, doctors usually prescribe tamoxifen.  However, certain more advanced gynecomastia cases require surgery to extract breast gland tissue. In some cases, gynecomastia is caused by other underlying issues. For example, if it's caused by thyroid problems, the thyroid gland must be treated with appropriate medication. If gynecomastia is caused by liver damage, addressing the liver might help to fix gynecomastia for good. Those who are obese should consider losing weight to alleviate their gynecomastia symptoms. Entering a weight loss program and eating healthier foods can facilitate the process of losing weight.   Gynecomastia FAQ Here are a few answers to some of the questions you might have about gynecomastia. 1. Is Gynecomastia Painful? Some patients might experience mild pain in their chest area as well as tenderness, especially when gynecomastia gets into an advanced state. However, the pain is not sharp or intense, and it usually goes away once proper treatment for gynecomastia is administered. 2. Does the Breast Tissue Subside Once Gynecomastia Is Treated? One of the main concerns of patients with gynecomastia is whether the breast tissue will continue to "hang" after the condition is treated. Unfortunately, the tissue will not subside on its own in most cases, but there are solutions to this problem. Once the underlying cause of gynecomastia is treated, patients can perform small surgeries to remove the excess breast tissue and achieve a more "manly" chest. 3. Does Scarring Occur After Removing the Breast Tissue? Luckily, the scarring is minimal around the nipple area and almost invisible. Patients can go to the beach and not worry that someone will see that they had gynecomastia surgery because the scarring is virtually non-existent. 4. Are There Any Other Drugs or Substances Which Cause Gynecomastia? Certain drugs or substances might cause gynecomastia such as marijuana, steroids, or other performance-enhancing drugs. However, men might develop breast tissue enlargement as a result of consuming high amounts of alcohol too. Alcohol can damage the liver, which in turn decreases the production of testosterone. At the same time, certain drugs such as spironolactone, ketoconazole, and others can also trigger the development of gynecomastia. Cimetidine, which is a drug used to treat ulcer, is also associated with this type of health issue. Conclusions Treating gynecomastia can be done with relative ease these days, as long as you are aware of its existence. For a complete and thorough test which helps you diagnose this condition quickly, check out the Gynecomastia Test Panel. This lab test panel provided by Discounted Labs can be done using a blood sample, and you get the results in just a few business days. The results can help your doctor decide what therapies are best for you to eliminate your gynecomastia.   Reference: Sansone A, et al. Gynecomastia and hormones. Endocrine. DOI 10.1007/s12020-016-0975-9

What are the common symptoms of gynecomastia? Common symptoms of gynecomastia include breast swelling and tenderness, nipple discharge, and breast enlargement. It is important to note that gynecomastia may occur on one or both sides of the chest and can affect males of all ages, from infants to older adults. What is Gynecomastia and How to Diagnose it   Gynecomastia is a benign enlargement of the male breast resulting from a growth of the glandular tissue of the breast, known as male breast tissue. It is defined clinically by the presence of a rubbery or firm mass extending concentrically from the nipples. At least 30% of males, including older men, will be affected during their life. Since it causes anxiety, psychosocial discomfort, and fear of breast cancer, early diagnostic evaluation of male breast tissue enlargement is important, and patients usually seek medical attention. Evaluation of gynecomastia must include a detailed medical history, clinical examination, specific blood tests, imaging, and tissue sampling. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery. Men who start experiencing this problem complain of pain and tenderness around the nipple area. Gynecomastia was reported to cause an imbalance between estrogen and androgen action or an increased estrogen to androgen ratio, due to increased estrogen production, decreased androgen production or both, which can lead to a decrease in the level of testosterone compared with the level of estrogen. As men get older, they produce less testosterone. Older men also tend to have more body fat, and this can cause more oestrogen to be produced. These changes in hormone levels can lead to excess breast tissue growth. Androgens include testosterone and DHT. High estradiol in the presence of low testosterone and DHT, growth hormone (IGF-1 is a metabolite), and a genetic predisposition to gynecomastia can increase the size of breast tissue in men. Additionally, the lowered testosterone can cause the breast glands to enlarge and the weight gain means fatty tissue accumulates under the breast, leaving the man with a larger quantity of glandular tissue and more fat in the breast. As fat cells are estrogenic, this additional fat can further disrupt the balance between testosterone and estrogen. Gynecomastia Causes Physiological gynecomastia, also known as physiologic gynecomastia, is common in pubertal boys and appears to be associated with increased hormone levels of insulin-like growth factor-1 (IGF-1) and pubertal growth, but not with a shift in the balance between estrogen and testosterone, a new study suggests. Study authors noted that IGF-1 together with estrogen is essential for the growth of breast tissue, and it appears that the effect of growth hormone on breast growth is mediated through IGF-1. "The stimulatory effect of IGF-1 on breast formation was synergized by estradiol, which was also elevated in boys with physiologic gynecomastia in our study. However, serum testosterone was similarly elevated, leaving the estradiol/testosterone ratio unaltered." Prolactin, another anterior pituitary hormone integral to breast development, is not only secreted by the pituitary gland but may also be produced by normal mammary tissue epithelial cells and breast tumors (14, 15). Testosterone converts into estradiol, DHT, and other metabolites. Men with higher amounts of the enzyme aromatase usually have this problem even at lower doses of testosterone. The growth of this glandular tissue is also influenced by a higher fat percentage, older age, excessive alcohol intake, and the use of certain medications. Gynecomastia rarely occurs in men using testosterone replacement since testosterone to estradiol ratios are improved. Estrogen levels that are too high or are out of balance with testosterone levels can cause liver disease and gynecomastia. In several studies on testosterone replacement, only a very small percentage of people receiving testosterone experience growth of breast tissue. In one HIV-specific study conducted by Dr. Judith Rabkin in New York, she reported that out of 150 men enrolled in the study, two men experienced this adverse reaction. Dihydrotestosterone (DHT) is a natural metabolite of testosterone that has antiestrogen activity and cannot be converted into estradiol at the tissue level. Systemic or locally administered DHT has been successfully prescribed for the treatment of patients with idiopathic and estrogen-induced gynecomastia. Gynecomastia is also seen in men with androgen resistance with low testosterone production and DHT, where unfettered estrogen can stimulate subsequent breast development. However, in men with normal androgen receptor activity, estradiol is unable to stimulate breast development. This is thought to be due to an imbalance between the inhibitory and stimulatory effect of these hormones. Gynecomastia may be caused by abnormal hormone changes, any condition that leads to an increase in the ratio of estrogens/androgens such as liver disease, kidney failure, thyroid disease, and some non-breast tumors. Certain health conditions, like hypogonadism, can either cause or be linked with gynecomastia. Click: Buy gynecomastia blood test panel   Gynecomastia Symptoms Gynecomastia is a condition that causes the breast tissue in males to swell and become larger than usual. The primary symptom of gynecomastia is noticeable breast enlargement in men, which can be unilateral or bilateral. Other symptoms include tenderness or pain around the nipple area, swelling or lumps in the breast tissue, and changes in breast shape or texture. In some cases, one of the gynecomastia symptoms may also be the discharge from the nipples. If you experience any of these symptoms, it's essential to consult with a doctor to determine the underlying cause and explore treatment options. Medications and Products That Can Cause Gynecomastia Some medications have been reported in the medical literature to cause gynecomastia due to decreases in testosterone, increases in estradiol, or both. These include: · Antiandrogens.  · HIV medications.  · Anti-anxiety medications. · Tricyclic antidepressants.  · Glucocorticoid steroids. · Antibiotics. · Ulcer medication such as cimetidine . · Cancer treatment (chemotherapy). · Heart medications such as digitalis and calcium channel blockers. · Anabolic steroids · Soy and flaxseed · Exposure to pesticides and byproducts of plastic processing has also been linked to increased estrogen and decreased sperm count in men. If the cases of gynecomastia are drug-induced, gynecomastia symptoms like decreased tenderness and softening of the glandular tissue will usually be apparent within one month after discontinuation of the drug. However, if the cases of gynecomastia have been present for more than one year, it is unlikely to regress substantially, either spontaneously or with medical therapy, because of the presence of fibrosis. In such circumstances, surgical subcutaneous mastectomy, ultrasound-assisted liposuction, and suction-assisted lipectomy, including gynecomastia surgery options like liposuction, are the best options for cosmetic improvement, as described in several case series. If symptoms persist after two years or past 17 years of age, further evaluation is indicated. During the rapid, proliferative phase, manifested clinically as breast pain and tenderness, medical therapy may be attempted. Most studies of drugs -- including testosterone (in patients without hypogonadism), have been uncontrolled and thus difficult to interpret because gynecomastia may resolve spontaneously. The few randomized, double-blind, placebo-controlled trials generally have been limited by small samples and do not disclose the potential side effects. Gynecomastia Treatments: Although not approved for the treatment of gynecomastia, the selective estrogen-receptor modulator tamoxifen, administered orally at a dose of 20 mg daily for up to 3 months, has been shown to be effective in randomized and nonrandomized trials, resulting in partial regression of gynecomastia symptoms in approximately 80% of patients and complete regression in about 60%. Patients in whom tamoxifen is effective usually experience a decrease in pain and tenderness within one month. In a retrospective analysis of a series of patients with idiopathic gynecomastia, 78% of patients treated with tamoxifen had complete resolution of gynecomastia, as compared with only 40% of patients receiving danazol. In case series describing the use of tamoxifen for this condition in more than 225 patients, adverse events were uncommon but can include body aches, low sex drive, and fatigue. In a double-blind study of 282 men randomized to receive 20 mg of tamoxifen once per day with bicalutamide or bicalutamide alone found that after six months, gynecomastia and breast pain were significantly reduced in men who received tamoxifen (88 versus 96 percent in the control group). The aromatase inhibitor anastrozole was not shown to be more effective than placebo in a randomized, double-blind, placebo-controlled trial in boys with pubertal gynecomastia. Although in an uncontrolled study of 10 patients with pubertal gynecomastia, the selective estrogen-receptor modulator raloxifene was shown to result in more than a 50% decrease in the size of the gynecomastia in the majority of the boys, there are insufficient data to recommend its use at this time. Lowering the testosterone dose had not proven helpful for the two patients in Dr. Rabkin's study. The use of antiestrogens, such as tamoxifen 10 mg twice daily, with lower doses of testosterone have been effective. Some physicians prescribe low dose aromatase inhibitors for men with early-onset gynecomastia. Gynecomastia can become permanent if the condition lasts very long although it may reduce in size when the androgen use is discontinued. In rare cases, surgical correction may be necessary in severe cases. For men who experience enlarged breast size, doctors usually check estradiol levels to determine whether too much testosterone is being converted into estrogen. However, physicians usually forget that other hormone metabolites like DHT and IGF-1 may be involved in the development of gynecomastia, so they do not include these tests in the diagnostics panel. In order to properly diagnose gynecomastia, your healthcare provider will take your past health and medicine history and give you a physical exam. A blood test may also be recommended to check hormone levels. In some cases, a biopsy may be performed to examine the breast tissue for cancer cells, especially if there are any breast abnormalities detected during a mammogram. Warning: Bringing estrogen down to very low levels could cause health problems in men in the long run. Hair/skin quality and health, brain function, bone density, lipids, sexual function, and other important factors may be greatly influenced by estrogen. More information about estradiol and gynecomastia. Bibliography: Braunstein, G. D., M.D. (2007). Gynecomastia. The New England Journal of Medicine, 357(12), 1229-123712 Schulster M, Bernie AM, Ramasamy R. The role of estradiol in male reproductive function. Asian J Androl 2016;18:435-4034

Estrogen in Men: Myths and Realities of High Estradiol In men, the liver, fat cells, and other cells aromatize testosterone to produce estradiol, which is a hormone that is more prevalent in women than in men. Estradiol is responsible for healthy bone density and cholesterol, but its role in men’s sex drive, body composition, and other variables is a source of great debate. It is crucial to understand that estrogen plays a significant role in male reproductive health, particularly in the processes of sperm production and maturation within the testes. Many men on testosterone replacement therapy (TRT) initially fear high estradiol levels since they fear it causes water retention and gynecomastia. However, it is important to note that fat cells play a significant role in the production of aromatase, which can lead to higher levels of estradiol in the body. Below, we will discuss why most men on TRT do not have to be overly concerned about the estradiol lab ranges that are ill-fitted for men on TRT, as the ranges of LabCorp and Quest were not derived from a dataset of men on TRT who usually have higher total testosterone blood levels. What is Estradiol and Why is it Important for Men's Health? Estradiol is a type of estrogen hormone that plays a crucial role in men’s health. Often referred to as a 'female sex hormone,' estradiol also plays a crucial role in male health. It helps regulate bone density, cognitive function, libido, and mood. However, high levels of estradiol in men can lead to negative effects like decreased muscle mass, increased body fat, and hormonal imbalances. Men’s liver, fat, and other cells aromatize testosterone to produce estradiol, a hormone that is more prevalent in women than in men. Estradiol is responsible for healthy bone density and cholesterol, but its role in men’s sex drive, body composition, and other variables is a source of great debate. Many men on testosterone replacement therapy (TRT) initially fear high levels of estradiol since they fear it causes water retention and gynecomastia. We will talk about why most men on TRT do not need to worry too much about the estradiol lab ranges that do not work well for them because LabCorp and Quest did not get their ranges from a group of men on TRT who usually have higher total testosterone blood levels. High levels of estradiol in men are associated with abdominal obesity and an increased risk of cardiovascular disease. What is High Estradiol?: Predicted Blood Levels in Young and Older Men on TRT Transcript of video below: There needs to be more clarity on the subject since LabCorp and Quest have very narrow, sensitive estradiol test ranges. Those estradiol test ranges were primarily derived from men not on testosterone replacement therapy. Men on TRT tend to have higher testosterone levels than men not on testosterone replacement. So, believe it or not, a paper published many years ago predicts estradiol and DHT levels in men given different doses of testosterone. This study examined what happens to blood levels of testosterone, estradiol, and DHT when injecting different testosterone doses in young and older men. This study was very nicely done at the Boston University School of Medicine by well-known testosterone researchers. Dr. Basin is one of them and has done excellent work for the last 30 years. Video: How to Predict High Estradiol in Men Testosterone is the precursor hormone for estradiol. The aromatization of testosterone in the liver, fat, and other cells, including the testes, results in estradiol, a hormone that is more prevalent in women than men. Nature created it for a reason. It is responsible for healthy bone density and cholesterol, but its role in men's sex drive, body composition, and other variables is a source of great debate. Many anti-aging or men's health clinics prescribe aromatase inhibitors (AIs) to men who start testosterone replacement therapy (TRT). Higher estradiol blood levels in the presence of low testosterone can cause breast tissue growth (gynecomastia) in some men and possibly other issues. Some people speculate that high estradiol levels can also lead to difficulty achieving or maintaining an erection, but no scientific papers have been published on this subject. Since higher testosterone blood levels can result in higher estradiol levels in men, the belief is that using an AI will prevent breast tissue growth and erectile dysfunction by lowering any potential increase in estradiol. However, we have no data on how high is too high when it comes to this hormone in men using testosterone therapy. Emerging data show that low testosterone-to-estradiol ratios may correlate more closely to infertility, gynecomastia, and erectile problems than high estradiol levels alone. The truth about these speculations is starting to emerge, but we still need more data to say what the upper value of the optimal range of estradiol in men is. We have a lot of evidence about the lower side of the optimal range since it has been found that estradiol blood levels below 10–20 pg/mL can increase bone loss in men. A recently published study also nicely demonstrated that low estradiol could be associated with higher fat mass and lower sexual function in men. So, be careful when a clinic wants to put you on an aromatase inhibitor without first justifying its use. Increased Aromatase Activity and the Role of Aromatase Inhibitors in Men Aromatase is an enzyme that converts testosterone to estradiol, a form of estrogen. Germ cells, along with Leydig cells, are significant sources of estrogen production in the testes. In men, aromatase activity is typically low, but certain conditions can increase it, a process known as aromatase overexpression. This can lead to higher levels of estradiol in the body, which can have negative effects like decreased libido and muscle mass in the adult male. However, some studies suggest that moderate increases in estradiol may have cardiovascular benefits. One condition that can increase aromatase activity and therefore estradiol levels is aromatase excess syndrome, a genetic condition that affects both males and females. It’s important for men to maintain healthy levels of both testosterone and estradiol, and understanding the role of the aromatase enzyme, especially in conditions like aromatase excess syndrome, is crucial in managing estradiol levels. Estradiol in Men After Different Testosterone Doses: Study Details This study's findings were published in the Journal of Clinical Endocrinology and Metabolism in 2010. The fantastic thing is that nobody has reviewed it, even though it's probably the most important paper on what happens to estradiol and DHT in men on TRT. The study enrolled 51 young men aged 19 to 35 and 52 older men aged 59 to 75. These men were given a gonadotropin-releasing hormone agonist to shut down their gonadotropins, LH and FSH, testosterone, estradiol, and DHT. So, these were courageous volunteers who were willing to have their hormones wholly shut down. So, why did they do this? They did it because the researcher wanted to start from zero regarding hormones. So, those men were given injections of different doses of testosterone enanthate, 25, 50, 125, 300, and up to 600 milligrams a week for five months. And the researchers measured the testosterone, estradiol, and DHT blood levels. Unfortunately, they used the old estradiol test based on immunoassay. This estradiol test may not be the best for accurate estradiol testing. The use of an ultra-sensitive estradiol test is more accurate since it has no interference from CRP or inflammatory markers Usually, the sensitive estradiol is 20% lower than the estradiol levels measured by the old test. Let's assume that most of these men did not have inflammation. Here are their baseline characteristics. Interestingly, they were even exposed to such high doses of testosterone. So, after a four-week controlled period, they were given a testosterone blocker, the gonadotropin-releasing hormone agonist that shuts down gonadotropins. This drug is used to treat prostate cancer. They were randomized to receive weekly injections of testosterone enanthate for 20 weeks. The researchers found an issue with the higher testosterone dose in older men, with a few more side effects. They stopped a few men from continuing with the 600 milligrams of testosterone weekly. And then the randomization was limited to 25, 50, 125, and 300 milligrams of testosterone injections weekly. I've warned people not to use high testosterone doses, especially older people with comorbidities and heart problems. Increased blood pressure and tachycardia are some of the side effects listed in the study paper. So, what you see here are serum estradiol E2:T ratios. We talk about ratios on ExcelMale.com. Here are the opposite DHT and T ratios from what I typically talk about when dividing T by E2. And the black bars are younger men, and the white bars are older men. So, this is total estradiol, free estradiol, total DHT, and free DHT. And when we talk about free, what does that mean? It is the unbound estradiol and unbound DHT that aren't bound by sex hormone-binding globulin. And those two free estradiol and free DHT tests are rarely tested in clinics. DiscountedLabs.com does provide a free estradiol test for those who are interested. But since there are no studies about free estradiol blood levels in men, it's hard to say what a good free estradiol level is. High Estradiol in Men on TRT Most men on TRT initially fear high estradiol since they fear it causes water retention and gynecomastia. While high estradiol levels in men can cause gynecomastia, in women, similar hormonal imbalances are linked to an increased risk of breast cancer. They feel puffy; they may have more sensitive nipples. I will discuss this in another video because those symptoms are usually not connected to high estradiol per se when men have moderate to high testosterone levels. The most common cause of edema, or the problem of holding onto water weight, is a slowdown in sodium metabolism in the kidneys brought on by testosterone and androgens. Sodium (salt) retention happens in the first few weeks, especially with higher TRT doses in older men. The stimulating effects of testosterone may be to blame for the sensitive nipple issue, which typically does not cause gynecomastia. However, it is important to note that symptoms of high estrogen in men can also include swelling or enlargement of breast tissue, erectile dysfunction, infertility, depression, and delayed puberty. So, as you can tell, total E2, free E estradiol, and DHT increase with increasing testosterone doses, and this increase is much more pronounced in older men. It’s good to mention that these volunteers were not fat men. The increased fat mass has been linked to increased estradiol levels, which are often measured through body mass index (BMI). These are men with a BMI of around 26, which is not a high number. But anyway, we do see an increase. And older men, in white, tend to have a higher estradiol increase. DHT is the same thing. Although the differences were not as noted between young and old, you can tell here the free DHT. When you divide estradiol into testosterone, that’s when you see a decrease. Estradiol increases to a higher degree than testosterone, so the ratio of E2 divided by T decreases. The total DHT to T ratio is the same; it decreases as we increase the testosterone dose, but not as fast as the estradiol. It is essential to mention that 0.3% to 0.4% of testosterone is aromatized into estradiol. That’s a very tiny amount; that’s 0.4%. The conversion of testosterone to DHT by 5 alpha-reductase is around 10%. That’s why you see the scales a little more prominent on the DHT side. What to Know About Estrogen in Men Estrogen is commonly associated with women, but men also have this hormone in their bodies. The testes and adrenal glands are primarily responsible for producing estrogen in a male body. Estradiol is a type of estrogen that plays an important role in maintaining bone health, regulating cholesterol levels, and supporting brain function. Low levels of estradiol in men can contribute to a variety of health issues, such as decreased libido, erectile dysfunction, and osteoporosis. It's important for men to understand their hormonal balance, including their levels of estradiol, and work with a healthcare provider to address any imbalances or concerns related to erectile function and hormone balance. Buy an affordable, ultrasensitive estradiol test:   Understanding Androgens and Estrogens Estradiol is a type of estrogen that is found in both men and women. While it is often associated with female reproductive health, estradiol plays an important role in male health as well. Estrogens influence male reproductive function by maintaining a hormonal balance between estrogens and androgens, which is crucial for male fertility. In fact, it is responsible for regulating bone density, cholesterol levels, and even mood. When there is high estradiol in men, it can lead to a variety of health problems. Understanding the balance between androgens (male hormones) and estrogens (female hormones) is crucial for sexual development and maintaining optimal health for both men and women, especially in relation to the menstrual cycle. Risk Factors of Having High Estradiol in Men Estrogen is often associated with females, but it also plays a crucial role in men's health. High or low levels of estrogen in males can have negative impacts on their overall health. Men who have higher than normal levels of estrogen, also known as estrogen, may experience breast enlargement, erectile dysfunction, infertility, and other issues. On the other hand, men with lower than normal levels of estrogen may experience decreased bone density, muscle mass, and sex drive. It is important for men to maintain balanced estrogen levels through proper diet, exercise, and medical treatment if necessary. However, it is important to note that too much estrogen, also known as high levels of estrogen, can also be harmful to men's health, and it is important for individuals to monitor their estrogen levels and consult with a doctor if they have any concerns. How Men Can Keep Their Estrogen Levels Balanced Estrogen is typically associated with women, but men also have this hormone in their bodies. Estradiol is the most potent form of estrogen in men and plays a crucial role in maintaining bone density, sperm production, and sexual function. However, too much or too little estradiol can cause various health problems. Men can keep their estrogen levels balanced by maintaining a healthy weight, avoiding exposure to environmental toxins, managing stress levels, and getting enough sleep. A balanced diet rich in fiber and phytoestrogens, along with proper monitoring and control through hormone replacement therapy, may also help regulate estrogen levels in men, ensuring healthy sperm production. Normal Estrogen Levels in Men Estrogen is often thought of as a female hormone. However, it's also present in men, just at lower levels. One type of estrogen found in men is estradiol. Normal levels of estradiol in men vary depending on age and other factors. In general, levels range from 10 to 60 pg/mL. If levels are too high or too low, it can lead to health issues such as osteoporosis, sexual dysfunction, and mood changes. Men should discuss their estrogen levels with their healthcare provider to ensure they are within a healthy range for their age and overall health status. This includes monitoring the amount of estrogen in their body, as there are two main types of estrogen in men: estrone and estradiol, and an imbalance of these hormones can have negative effects on their health. Gynecomastia and High Estradiol in Men Gynecomastia is a condition that causes men to develop breast tissue. Studies on male mice, such as αERKO and ArKO models, highlight the effects of estrogen deficiencies on sexual behavior and fertility. One of the underlying causes of gynecomastia is an imbalance of hormones, including estradiol. Estradiol is a form of estrogen that is typically found at higher levels in women. However, men also have small amounts of estradiol in their bodies. When the balance between estradiol and testosterone is disrupted, it can lead to the development of breast tissue in men. Treatment for gynecomastia may involve addressing the hormonal imbalance through medication or surgery, depending on the severity of the condition. You can buy a gynecomastia lab test panel on Discounted Labs. Low Estradiol Can Cause Loss of Libido and Erectile Dysfunction One of the significant impacts of estradiol deficiency in men is the loss of libido. Low levels of estradiol can lead to decreased sex drive, which can cause problems in relationships and affect overall quality of life. However, it's essential to note that there are other factors that can impact libido as well, such as stress, depression, low testosterone levels, and a lack of sexual activity. If you're experiencing a loss of libido, it's important to talk to your doctor to determine the underlying cause and discuss possible treatment options. A Study Helps to Predict Normal Estradiol and DHT Test Levels in Men on TRT Most men on TRT don't have to be so concerned about the LabCorp or Quest estradiol ranges that usually scare people because they're always high. And there is statistical significance in the baseline values of young and older men. DHT increases were higher in older men. In younger men, usually, that's also connected to total testosterone and is also related to higher libido. Older men had lower DHT, which was also linked to their lower testosterone. Sex hormone-binding globulin (SHBG) is also higher in older men. The researchers in this study came up with a model with factors to predict the estradiol and DHT response curves. They provided two equations for young men (estradiol and DHT) and two for older men. Using those equations, you can roughly estimate the predicted estradiol and DHT levels for different testosterone blood levels. These equations enable us to see what is considered a “normal” estradiol level instead of using estradiol lab ranges that are ill-fitted for men on TRT. As previously mentioned, the estradiol ranges of LabCorp and Quest were not derived from a dataset of men on TRT who usually have total testosterone blood levels over 600 ng/dL (many men on TRT have T levels of 1000 ng/dL or more!). The Importance of Preserving Proper Levels of Estradiol in Men Our bodies transform 0.4% of testosterone into estradiol to balance the potentially negative effects of testosterone alone on lipids and other variables. If you have “high” testosterone, your estradiol should be “high.” Treating that estradiol with an aromatase inhibitor may not be needed and can potentially crash your estradiol level. Estradiol has essential roles in men, including the regulation of hormone levels. Estradiol comes in to protect us from higher testosterone and helps improve lipids, HDL, and endothelial function. Women tend to live longer than men because they have more estrogen to protect them against the cardiovascular risks we are all exposed to. So, don't freak out when you see the 60s, even in the 70s, depending on how high your testosterone is. And the only problem we're having in this field is that we still need to do a study that goes after symptomology depending on estradiol blood levels when we control testosterone. We know that estradiol levels under 15 picograms per milliliter cause problems with bone density and even fat gain. Many members of ExcelMale.com say that their penile sensitivity decreases when they have low estradiol. We do not know what high estradiol in men means in relation to estradiol blood levels in relation to testosterone. Can high estradiol in men on TRT with relatively high testosterone blood levels cause issues? Is there a proper and healthy testosterone-to-estradiol ratio?. If somebody is, let's say, at 1,275 ng/dL of testosterone and 64 pg/mL of estradiol, is there any consequence to that? We don't know. And the problem I'm seeing is that most of you guys are assuming too much; you're assuming that because you're holding water or you have sensitive nipples, you have high estradiol. And you start treating with an AI without even testing your blood levels of estradiol, especially using the sensitive assay. That concerns me because once you start treating with an AI, you can crash your estradiol. “Crashed estradiol” has become one of the most significant traffic source keywords for ExcelMale because people are experiencing that more and more. I hope you enjoyed the presentation. Please remember to subscribe to the ExcelMale forum and the ExcelMale YouTube channel, and make sure that you click on that little bell that will tell you when I upload new videos. Thanks a lot, and stay safe. Estrogen Dominance and Hormonal Imbalance Estrogen dominance occurs when there is an imbalance between estrogen and testosterone levels in the body. This hormonal imbalance can lead to a range of symptoms, including weight gain, mood swings, and decreased libido. Men experiencing estrogen dominance may notice an increase in body fat, particularly around the abdomen, and may struggle with emotional changes such as irritability or depression. Additionally, estrogen dominance can negatively impact overall health by contributing to conditions like insulin resistance and cardiovascular issues. Maintaining a proper balance between estrogen and testosterone is crucial for optimal health and well-being. Exposure to Endocrine Disruptors and Environmental Toxins Endocrine disruptors and environmental toxins can significantly impact estrogen levels and overall health. These substances, found in everyday items like plastics, pesticides, and personal care products, can mimic the effects of estrogen in the body, leading to hormonal imbalances. When these toxins enter the body, they can bind to estrogen receptors, disrupting the natural hormonal balance and potentially causing a range of health problems. It’s essential to be aware of these environmental toxins and take steps to minimize exposure, such as choosing organic foods, using natural personal care products, and avoiding plastic containers. Other Non-Reproductive Effects of High Estrogen High estrogen levels can have a range of non-reproductive effects on the body, impacting various aspects of health and well-being. Some of the common non-reproductive effects include: Weight gain and obesity: Elevated estrogen levels can lead to increased body fat, particularly around the abdomen, contributing to obesity. Mood swings and emotional changes: High estrogen can cause mood swings, irritability, and even depression. Fatigue and low energy: Men with high estrogen levels may experience chronic fatigue and a general lack of energy. Insomnia and sleep disturbances: Hormonal imbalances can disrupt sleep patterns, leading to insomnia and poor sleep quality. Skin problems: High estrogen levels can cause skin issues such as acne and rosacea, affecting overall skin health. Maintaining balanced estrogen levels is essential for overall health and well-being, and addressing any hormonal imbalances can help alleviate these symptoms. Foods that Lower Estrogen: Cruciferous Vegetables and Sulforaphane Cruciferous vegetables, such as broccoli, cauliflower, and Brussels sprouts, are known for their ability to help lower estrogen levels in the body. These vegetables contain a compound called sulforaphane, which has been shown to support the detoxification of excess estrogen. Incorporating cruciferous vegetables into your diet can help maintain healthy estrogen levels and support overall hormonal balance. Additionally, these vegetables are rich in fiber and other essential nutrients, making them a valuable addition to a healthy diet. By including more cruciferous vegetables in your meals, you can naturally help regulate estrogen levels and promote better health. Buy an affordable, ultrasensitive estradiol test:   I hope you enjoyed the presentation. Please remember to subscribe to the ExcelMale forum and the ExcelMale YouTube channel, and make sure that you click on that little bell that will tell you when I upload new videos. Thanks a lot, and stay safe. More information about high estradiol in men Citations Understanding Blood Test Results: Estradiol (Male) Aromatase Inhibitors in Men: Mechanisms and Benefits Aromatase Inhibitors: No More, No Less Estrogen in Men: Understanding Its Role and Effects The Role of Estradiol in Male Reproductive Health Effects of Estrogen on Men's Health Estrogen in Men: What You Need to Know Estrogen's Impact on Men's Health: A Scientific Study When to Take Anastrozole with Testosterone Estrogen and Male Health: Research Findings The Role of Estrogen in Men's Health When to Use Aromatase Inhibitor with TRT What Causes High Estradiol Levels in Males?  

Introduction Most men would not believe that estradiol is a male hormone, as they are unaware of the role that estradiol (E2) plays in the maintenance of men's health. E2 is important for many things, including the quality and quantity of sperm [1,] controlling the GH-IGF-1 axis [3,] bone growth and keeping bones healthy [4,] body composition and glucose metabolism [5,] vasomotor stability [6,] and brain function [8]. Estradiol is a hormone more abundant in women than men that is produced by the aromatization of testosterone in the liver, fat, and other cells [1]. It has been shown to be responsible for healthy bone density [2], but its role in men's sex drive, body composition, and other variables is debated [3]. High estradiol blood levels can cause gynecomastia in the presence of low testosterone [4]. Anastrozole, a blocker of estradiol production, is prescribed to men who start testosterone replacement therapy (TRT) [5]. However, there is no data on how high is too high when it comes to estradiol in men [6].   Table of Contents Introduction The Essential Role of Aromatase in the Production of E2 E2 and the Function of the Male Reproductive System The Effect of E2 on the Growth Hormone-IGF-1 Axis The Effects of E2 on the Development and Health of Bones and Skeletons The Influence of E2 on the Composition of the Body as well as Glucose Metabolism Regulation of Vasomotor Stability by E2 and Its Effects The Role of Nitric Oxide in Vasodilation The Effects of Estrogen on NO Production and Vasodilation The Need for Further Research Potential Side Effects of Testosterone Therapy and the Role of Aromatase Inhibitors A Critical Review of Current Evidence Potential Risks of Overuse of Aromatase Inhibitors The Case for Individualized Treatment Approach Estradiol: Overview and Effects Impact of High Estradiol Levels Low Estradiol: Risks and Treatment Testosterone and Estradiol: A Complex Relationship Estradiol's Role in Physiology Estradiol in Hypogonadism Studies and Findings Estradiol and Chronic Heart Failure Estradiol's Impact on Bone Density Estrogen in Men: Studies Conclusion References: The Essential Role of Aromatase in the Production of E2 Aromatase is an enzyme that converts androstenedione and testosterone into E2 in males [3]. According to the research that has been done, the hormone E2 is critically important in the control of a variety of different elements of male health [6]. E2 and the Function of the Male Reproductive System The modulation of spermatogenesis is one of the key functions that E2 performs in the male reproductive system. Working as a paracrine factor, it does its job in the Sertoli cells of the testis, where it helps germ cells mature and divide [1]. It also changes the hypothalamic-pituitary-gonadal axis, which controls the production of testosterone and the making of sperm [1, 7]. The Effect of E2 on the Growth Hormone-IGF-1 Axis It has been proven that E2 plays a significant role in the regulation of the GH-IGF-1 axis in men [3]. In healthy men, there is a positive correlation between the levels of E2 and the levels of serum IGF-1. It is possible that E2 uses negative feedback to limit GH secretion. The Effects of E2 on the Development and Health of Bones and Skeletons E2 is a crucial hormone for the growth and upkeep of men's bones, as well as their overall skeletal health. It does so by promoting osteoblast differentiation and activity and suppressing osteoclast differentiation and activity [4] [11]. In this way, it exerts an indirect influence on these features. The Influence of E2 on the Composition of the Body as well as Glucose Metabolism E2 has an effect on both the makeup of a man's physique as well as his glucose metabolism. It appears to selectively accelerate the accumulation of body fat in subcutaneous regions while at the same time limiting the accumulation in visceral regions [5]. Additionally, it has been demonstrated that E2 can improve glucose metabolism in hypogonadal men [5]. Regulation of Vasomotor Stability by E2 and Its Effects Additionally, E2 contributes to the regulation of vasomotor stability in males. People think that the production of nitric oxide (NO) plays a role in how ethyl ester affects blood vessels. The Role of Nitric Oxide in Vasodilation Nitric oxide, often known as NO, is an important physiological mediator that plays a role in a wide variety of biological activities, some of which are associated with the cardiovascular system. In the setting of the vascular system, NO plays an important function in vasodilation, controlling blood pressure, preventing blood clots, and stimulating angiogenesis [1, 2, 5]. The Effects of Estrogen on NO Production and Vasodilation It has been demonstrated that estrogens, in general, can have an effect on the generation of NO and, as a result, can mediate vasodilation. They can use both direct and indirect processes to achieve the desired vasodilatory effects. There are direct mechanisms that involve attaching to estrogen receptors on endothelial cells and making more NO. This, in turn, causes the blood vessels to become more dilated. One of the indirect ways that could be at work is by changing the production and release of other vasoactive chemicals, like prostaglandins, which could have an effect on NO production. The Need for Further Research Please be aware that despite the fact that the idea that NO synthesis mediates the vasodilation effects of E2 is reasonable based on the known actions of estrogens and NO, further research is required to determine the particular role that E2 plays in this process. Because of this, to get a better understanding, it would be important to look at the original research papers or more recent studies that focus on the part that E2 plays in changing NO production and vasodilation. Potential Side Effects of Testosterone Therapy and the Role of Aromatase Inhibitors When men undertake testosterone therapy (TTh), their estrogen levels may increase, and this may, in some instances, result in the development of nipple or breast soreness or even gynecomastia (the formation of male breast tissue in males). This can be a clear indicator that aromatase inhibitors should be used to reduce the amount of estrogen in the body. A Critical Review of Current Evidence Even so, there is not enough proof to support the regular use of aromatase inhibitors along with TTH when there are not any signs of estrogen overload. Although testosterone levels returned to normal after therapy with an aromatase inhibitor, the symptoms of low testosterone did not improve, according to the findings of one randomized controlled trial. Potential Risks of Overuse of Aromatase Inhibitors In addition, decreasing estrogen levels below a key threshold may raise the likelihood of developing osteoporotic changes and decrease insulin sensitivity, particularly in people who are receiving TTH. These risks may be increased in people who are already at higher risk for developing osteoporosis. The Case for Individualized Treatment Approach The study did not find any evidence to support the claim that taking TTH with aromatase inhibitors or other medicines would lead to lower levels of estrogen that would be better than taking TTH by itself. On the other hand, it was shown that certain TTH-treated men who had elevated estrogen levels but did not experience any clinical improvements from TTH did respond to actions taken to lower estrogen levels. These efforts included either a reduction in the amount of testosterone or the use of aromatase inhibitors. When this occurs, DXA monitoring is an option that should be examined. Estradiol: Overview and Effects Estradiol is a hormone more abundant in women than men that is produced by the aromatization of testosterone in liver, fat and other cells [1]. It has been shown to be responsible for healthy bone density [2], but its role in men's sex drive, body composition, and other variables is debated [3]. Impact of High Estradiol Levels High estradiol blood levels can cause gynecomastia in the presence of low testosterone [4]. Anastrozole, a blocker of estradiol production, is prescribed to men who start testosterone replacement therapy (TRT) [5]. However, there is no data on how high is too high when it comes to estradiol in men [6]. Low Estradiol: Risks and Treatment Low estradiol can be associated with higher fat mass and lower sexual function in men [7], so it is important to be careful when a clinic wants to put you on this drug without first justifying its use [8]. The most important details are that many clinics may be using the wrong estradiol test [9], and that most men on testosterone replacement therapy (TRT) do not develop gynecomastia even without using anastrozole [10]. Testosterone and Estradiol: A Complex Relationship Some physicians monitor estradiol blood levels after 6-8 weeks of TRT initiation using the sensitive estradiol test to determine if anastrozole use is warranted [11]. After 4-6 weeks on anastrozole, its dose can be adjusted to ensure that estradiol is not under 20 pg/ml [12]. The body of evidence suggests that after aromatase P450 inhibitors biotransform testosterone in the tissues, the ERs (estrogen receptors) in men mediate its effects [13]. Estradiol's Role in Physiology Some of the things that estrogen does are control LH feedback, skeletal homeostasis, lipid metabolism, cardiovascular physiology, brain development, and spermatogenesis [14]. Estradiol in Hypogonadism Estradiol serum concentration in adult males is around 20-30 pg/ml, with a production rate of 45 g/d [15]. Low levels of estradiol are associated with increased fat and decrease in sexual desire and erectile function compared to higher levels [16]. Studies and Findings This study found that estradiol levels of 21.80 pg/ml and > 30.11 pg/ml resulted in greater mortality in men with hypogonadism, suggesting that estrogen deficiency is largely responsible for some of the key consequences of male hypogonadism [17]. Estrogens have a fundamental role in the regulation of body fat and sexual function, and this suggests that measuring estradiol might be helpful in assessing the risk of sexual dysfunction, bone loss, or fat accumulation in men with hypogonadism [18]. Estradiol and Chronic Heart Failure A study examined the relationship between serum concentration of estradiol and mortality in men with chronic heart failure and reduced left ventricular ejection fraction (LVEF) [19]. Results showed that men in the lowest and highest estradiol quintiles had increased mortality, while those in the highest quintile had increased survival rates [19]. Estradiol's Impact on Bone Density Estradiol below 11 pg/ml was associated with increased bone loss [20]. Estrogen deficiency is common in men with chronic HF and is associated with increased morbidity and mortality [21]. Estrogen appears to play an important role in determining bone mineral density in men, but it is unclear if it also affects bone   Estrogen in Men: Studies Estradiol is a hormone more abundant in women than men that is produced by the aromatization of testosterone in liver, fat and other cells [1]. It has been shown to be responsible for healthy bone density [2], but its role in men's sex drive, body composition and other variables is debated [3]. High estradiol blood levels can cause gynecomastia in the presence of low testosterone [4]. Anastrozole, a blocker of estradiol production, is prescribed to men who start testosterone replacement (TRT) [5]. However, there is no data on how high is too high when it comes to estradiol in men [6]. Low estradiol can be associated with higher fat mass and lower sexual function in men [7], so it is important to be careful when a clinic wants to put you on this drug without first justifying its use [8]. The most important details are that many clinics may be using the wrong estradiol test [9], and that most men on testosterone replacement therapy (TRT) do not develop gynecomastia even without using anastrozole [10]. Some physicians monitor estradiol blood levels after 6-8 weeks of TRT initiation using the sensitive estradiol test to determine if anastrozole use is warranted [11]. After 4-6 weeks on anastrozole, its dose can be adjusted to ensure that estradiol is not under 20 pg/ml [12]. The body of evidence suggests that testosterone in men is mediated by the ERs (estrogen receptors) after its biotransformation by the aromatase P450 inhibitors in the tissues [13]. These estrogen-mediated actions include feedback regulation of LH, regulation of skeletal homeostasis, lipid metabolism, cardiovascular physiology, and brain and spermatogenesis [14]. Estradiol serum concentration in adult males is around 20-30 pg/ml, with a production rate of 45 g/d [15]. Low levels of estradiol are associated with increased fat and decrease in sexual desire and erectile function compared to higher levels [16]. This study found that estradiol levels of 21.80 pg/ml and > 30.11 pg/ml resulted in greater mortality in men with hypogonadism, suggesting that estrogen deficiency is largely responsible for some of the key consequences of male hypogonadism [17]. Estrogens have a fundamental role in the regulation of body fat and sexual function, and this suggests that measuring estradiol might be helpful in assessing the risk of sexual dysfunction, bone loss, or fat accumulation in men with hypogonadism [18]. A study examined the relationship between serum concentration of estradiol and mortality in men with chronic heart failure and reduced left ventricular ejection fraction (LVEF) [19]. Results showed that men in the lowest and highest estradiol quintiles had increased mortality, while those in the highest quintile had increased survival rates [19]. Estradiol below 11 pg/ml was associated with increased bone loss [20]. Estrogen deficiency is common in men with chronic HF and is associated with increased morbidity and mortality [21]. Estrogen appears to play an important role in determining bone mineral density in men, but it is unclear if it also affects bone loss in elderly men [22]. Another study assessed longitudinal rates of change in bone mineral density in young and elderly men and related these to circulating total and bioavailable estrogen and testosterone levels [23]. The rate of increase in bone mineral density at the forearm sites in the young men was significantly correlated to serum total and bioavailable estradiol and estrone levels, but not with total or bioavailable testosterone levels [23].  Elderly men with bioavailable estradiol levels below the median had significantly higher rates of bone loss and levels of bone resorption markers than men with bioavailable estradiol levels above 40 pmol/liter [23]. Ranjith Ramasamy and Larry Lipshultz conducted a study of 423 men on TRT and found that those with high testosterone and estradiol levels had significantly greater libido than those with low levels [24]. The results are expected to be presented at the American Urological Association annual meeting in Orlando [24]. Hyperestrogenism is believed to be harmful to male sexuality [25]. A study screening 34,016 men in Low T Centers revealed that 7,215 (20.2%) had high estradiol levels [26]. The age distribution of those with high estradiol levels was as follows: 132/989 (13.3%) were older than 65 years, 3,753/16,955 (22.1%) were between 45 and 65 years, 2,968/15,857 (18.7%) were between 25 and 44 years, 7/215 (3.3%) were younger than 25 years [26]. The correlation coefficient of serum estradiol to age was .53 [26]. Low blood levels of estradiol (E2) are associated with brittle bones in old men, according to a new study [27]. Age-adjusted models showed that E2 and free E2 but not testosterone (T) associated significantly inversely with cortical porosity [28]. Free E2 also associated significantly with trabecular bone volume fraction, but this association did not remain significant after further adjustment [28]. Low serum E2 may reduce cortical bone strength and increase fracture risk in older men [29]. Conclusion The hormone estradiol, also known as E2, has emerged as a key player in a myriad of biological functions in males. It is involved in the regulation of sperm health, the growth hormone-insulin-like growth factor-1 axis, bone health, body composition, glucose metabolism, vasomotor stability, and brain function. The key enzyme aromatase, which facilitates the conversion of androstenedione and testosterone to E2, is integral to these processes. Understanding the role of E2 in male physiology helps shape our approach to health issues like low testosterone and the potential side effects of testosterone therapy. While the use of aromatase inhibitors can sometimes be beneficial in managing the effects of elevated estrogen levels, more evidence is needed before they can be recommended for routine use alongside testosterone therapy. It is also crucial to consider the balance between testosterone and E2 in the male body, as overly suppressing estrogen levels might lead to unintended consequences such as osteoporotic changes and decreased insulin sensitivity. As we deepen our understanding of E2's role in the body, it becomes clear that a nuanced, individualized approach to treatment is needed to balance the benefits and risks. Finally, there are still many open questions about the specific mechanisms through which E2 influences different aspects of male health. For example, the relationship between E2 and nitric oxide in mediating vasodilation remains to be fully elucidated. Therefore, more research is required to continue building a comprehensive understanding of E2's role in men's health. As we continue to learn, our approach to male hormonal health will evolve, bringing about new strategies for maintaining and improving men's health.   Buy the best-priced  gold standard ultrasensitive estradiol test on DiscountedLabs.com.   References:   1 https://www.healthline.com/health/estrogen-in-men 2 https://www.medicalnewstoday.com/articles/estrogen-in-men 3  https://academic.oup.com/ejendo/article/181/1/R23/6654090 4 https://tctmed.com/estrogen-in-men/ 5 https://www.news-medical.net/health/The-Role-of-Estrogen-in-Mene28099s-Health.aspx 6 https://my.clevelandclinic.org/health/body/22353-estrogen 7 https://eje.bioscientifica.com/downloadpdf/journals/eje/181/1/EJE-18-1000.pdf 9 https://www.testosteronewisdom.com/role-of-estradiol-in-men-and-its-management-2/ 10  https://www.news-medical.net/health/What-does-Estradiol-do.aspx 11  https://eje.bioscientifica.com/view/journals/eje/181/1/EJE-18-1000.xml  

TRT Side Effects: How to Manage Them What are the Main Side Effects of Testosterone Replacement Therapy (TRT)? Acne/oily skin  Hair loss Increased sex drive Unresolved erectile dysfunction Insomnia Sleep Apnea Testicular atrophy Enhanced assertiveness or reactivity High blood pressure/water retention Gynecomastia (male breast development)   Understanding Testosterone Replacement Therapy (TRT) Testosterone replacement therapy (TRT) is a medical treatment designed to restore normal testosterone levels in men with hypogonadism, a condition where the testicles do not produce enough testosterone. This therapy aims to alleviate symptoms such as low libido, fatigue, and decreased muscle mass, which are commonly associated with low testosterone levels. TRT involves administering testosterone through various methods, including injections, gels, patches, and oral medications. By restoring testosterone levels, TRT helps improve overall quality of life for men suffering from androgen deficiency syndromes. What are the Main Side Effects of Testosterone Replacement Therapy (TRT)? Like all treatments, testosterone therapy is associated with a number of known risks, particularly for men with testosterone deficiency. These risks should be communicated to patients prior to initiation of treatment. A key item is impaired spermatogenesis (sperm production) due to suppression of gonadotropins (LH and FSH). Men considered candidates for TRT should be questioned as to their desire to induce a pregnancy. Since sperm production may be reduced to zero, exogenous T alone should be avoided until fertility is no longer a concern. Treatment with hCG injections or oral clomiphene citrate may be considered in these men, as they do not suppress spermatogenesis. There is some limited data on the use of testosterone plus hCG for improvement of sperm quality and quantity in men. Acne may occur in younger men. Edema can be occasionally observed in middle-aged or older men due to the fluid-retentive properties of testosterone. Erythrocytosis (increased red blood cell count that causes high hematocrit) is infrequently seen with topical and injectable TRT treatments but is routinely observed in men treated parenterally with short-acting injections or implanted pellets. Although there is no evidence to date that T-induced erythrocytosis is associated with adverse events, it seems reasonable to prevent the hematocrit from rising excessively. Men whose hematocrit rises above 54% (or hemoglobin greater than 18 g/dL) should be considered for dose reduction, temporary discontinuation of T therapy, blood donation, or therapeutic phlebotomy. Read this first since it is the most common testosterone side effect: High hematocrit Acne/oily skin  Caused by Dihydrotestosterone (DHT) effect on increased oil production · Accutane– a powerful prescription item - 40 mg/day for one week sometimes stops acne if started at the first sign or as directed by your doctor. Accutane is potentially highly liver toxic and can lower testosterone. Do not use unless as last resort.· Sporanox—Effective for some acne-like eruptions that are caused by fungi. Some doctors also prescribe antibiotics, like tetracycline, for acne with good results.. Minocycline. Shower with Nizoral shampoo. Anti-bacterial soaps: use a scrubbing brush and wash twice a day, especially after sweating during a workout.· UV light or sunlight with moderation.. Zinc/copper supplements or zinc soaps may help some men with acne.. Other options: How to treat and prevent acne Hair loss Caused by DHT effect on hair follicles · Nizoral shampoo—Available by prescription and over-the-counter as a lower-dose product.· Rogaine—Available over the counter· Propecia - Available by prescription. A few males experience decreased erections with finasteride. Do not use. Increased sex drive · A problem? Sex drive is part of quality of life. Testosterone therapy may somewhat improve sexual function in men with low testosterone levels. This is not necessarily a bad side effect. Enjoy it. Unresolved erectile dysfunction · ED Medications: Available by prescription; enables robust erections. If you have sinus congestion or headaches/backaches, take non-drowsy allergy medication and ibuprofen. ED drugs can be combined with alpha-blockers and/or nitric oxide precursor amino acids (arginine or citrulline).· Yohimbine (Yocon) - Available by prescription; increases sex organ sensitivity. Can increase heart rate and blood pressure· Muse—Available by prescription; a pellet is inserted into the urethra to produce an erection. Unpopular· Trimix – Available by prescription from compounding pharmacies. The best and cheapest formula for injection into the penis for lasting erections.· Caverject - Available by prescription. An injection into the penis that produces an erection that can last 1 to 2 hours. Be careful with injecting too much since it can produce dangerously long erections that need to be treated in emergency rooms! Follow instructions from your urologist.· Papaverine—an older injectable medication, less expensive than Caverject.· Wellbutrin—prescription at 300 to 450 mg/day; increases dopamine.· HCG—First dose is 2,000 IU, then 250-500 IU twice or three times a week. No protocol has been proven in controlled studies yet. When Testosterone Replacement Doesn't Lead to Better Erections Insomnia Usually, this is caused by dosages that are too high. Find the least amount that gives you a good result. · Sleeping medications—e.g., Ambien, Sonata, Lunesta, Restoril· Melatonin: 1 to 3 mg before bedtime. If you wake up groggy after 6 hours, your dose should be lower.· Avoid working out too close to bedtime.· Limit caffeine, especially after 3 pm.· You may want to try a sleep formula with tryptophan, melatonin, and magnesium. Nutrients do not work as well as drugs, but they can help some people.Article: How to protect your circadian rhythm Unresolved Fatigue · Have your doctor prescribe a sleep study if you snore and wake up tired even after 7 hours of sleep. Some people may have to wear a C-PAP machine to breathe at night. Visit Home - SleepApnea.org for more information. There are also oral devices for those people who fail CPAP. Fatigue—When Testosterone Is Not Enough Testicular atrophy · HCG– One 2,000-unit injection per week for 2 weeks, followed by maintenance of 350-500 IU twice a week. Decrease testosterone dosage accordingly after starting hCG to reach levels around 500-1200 ng/dL while keeping all other lab work monitored. Watch this video on hCG and men Enhanced assertiveness or reactivity · Make sure you are getting enough sleep.. Count until 10 and be aware of your interaction with others.· Decrease caffeine.· Meditation, mindfulness, yoga; breathe from your belly for a few minutes when overreacting.· The testosterone dosage may be too high.· Ask yourself: Do I need to always be right?. Vent extra energy at the gym, sex, and sharing with your buddies at www.excelmale.com High blood pressure/water retention · Caused by sodium retention in the kidneys. Try to limit salt consumption. Caution is required due to potential water retention issues in patients with chronic kidney disease. . Blood pressure medications - Elevated blood pressure may be transient or not. Try ACE or ARBs since they seem to have fewer sexual dysfunction-related effects. · Magnesium (600 mg/day); vitamin B6 (100 to 200 mg/day); may help reduce water retention. · Water - Drink extra water every day to help flush the kidneys. . Check your estradiol to make sure it is not over 45 pg/ml. Treat if high with a low dose of anastrozole. . Make sure you are doing cardio exercise at least 3 times a week for 30 min. Sweat and lower your salt intake since TRT increases sodium retention in some men. Gynecomastia (male breast development) Caused by high estradiol in the presence of low testosterone. This is rare in men on testosterone replacement. · Arimidex inhibits estrogen production. Available by prescription. 0.25 mg per week. There is no agreement on what the highest E2 level is for men on TRT with high testosterone. Ensure that your estradiol does not go too low (under 20 pg/ml) if you use anastrozole since it is needed for bone, skin, brain, lipids, libido, good lipids and hair health.· Nolvadex (tamoxifen)– Competes with estrogen for receptors. Available by prescription, 10 to 20 mg/day. Use of Nolvadex during a steroid cycle may reduce the net anabolic effect, as it decreases the production of GH and IGF-1. High IGF-1 may be implicated in gynecomastia.. Severe cases may require removal of the breast tissue by surgery.· DHT cream- Some people have obtained great results by rubbing a 10% DHT cream on their nipples. Not available in the US but some people order it online from Germany. Read about medications/foods to avoid if you have gynecomastia.. Those who do know to respond to the above check other reasons. Find out how long it takes testosterone replacement to potentially show benefits For affordable blood tests in most cities in the U.S. : DiscountedLabs.com More information on TRT lab tests. Monitoring and Testing During TRT Regular monitoring and testing are essential during TRT to ensure safe and effective treatment. This includes: Regular blood tests to check testosterone levels, PSA, hematocrit, and liver enzymes Baseline bone density testing (DEXA) and bi-yearly bone density tests Monitoring of prostate health through PSA levels and DREs Regular check-ups with a healthcare provider to discuss any concerns or side effects These tests help in tracking the effectiveness of the therapy and in identifying any potential issues early, ensuring that the treatment remains beneficial and safe. When to Seek Care It is essential to seek medical attention immediately if any of the following occur during TRT: Symptoms of a cardiovascular event, such as chest pain or shortness of breath Severe side effects, such as acne, hair loss, or mood changes Changes in prostate health, such as increased PSA levels or abnormal DRE results Concerns about testosterone levels or overall health By understanding the benefits and risks of TRT, monitoring prostate health, and seeking care when necessary, men with hypogonadism can safely and effectively manage their condition and improve their overall quality of life. Regular communication with healthcare providers and adherence to recommended monitoring protocols are key to successful testosterone replacement therapy. References: [i]   Metzger, DL, et al. Estrogen receptor blockade with tamoxifen diminishes growth hormone secretion in boys: evidence for a stimulatory role of endogenous estrogens during male adolescence. J Clin Endocrinol Metab (1994) 79(2):513-518. [ii] el-Sheikh, MM, et al. The effect of Permixon (saw palmetto) on androgen receptors. J Acta Obstet Gynecol Scand (1988) 67(5):397-399. [iii] Suzuki, K, et al. Endocrine environment of benign prostatic hyperplasia: prostate size and volume are correlated with serum estrogen concentration. Scand J Urol Nephrol (1995) 29:65-68. [iv] Gann, PH, et al. A prospective study of plasma hormone levels, nonhormonal factors, and development of benign prostatic hyperplasia. The Prostate (1995) 26:40-49.   Buy your own on DiscountedLabs.com

Testosterone Replacement Therapy (TRT) has changed the lives of many men around the world.  Like any therapy, it can have great benefits if properly managed but negative side effects if not monitored.  This article will briefly and simply review the different TRT tests that most physicians use to monitor your progress while minimizing potential side effects.   Table of Contents How to Know if You Need TRT Follow Up Lab Tests After Starting TRT Avoiding or Lowering High Hematocrit on TRT Avoiding Low Ferritin and Iron Monitoring the PSA Test on Testosterone Monitoring Estradiol Test on Testosterone Avoiding High Blood Pressure and Water Retention on TRT Monitoring Kidney Function Avoiding High Liver Enzymes Monitoring Thyroid Tests Maintaining Good HDL Levels on TRT Prolactin in Men with Low Testosterone: The Forgotten Hormone Where to Buy Your Own TRT Tests: How to Know if You Need TRT The first thing doctors actually measure before you get on testosterone replacement is your total and free testosterone blood levels to find out if you have low testosterone. They will also ask you a few questions to see if you have low testosterone or hypogonadal symptoms. They include low sex drive, erectile dysfunction, fatigue, low mood, and issues with cognitive capacity and function. So, testosterone replacement therapy includes anything to increase testosterone levels with either injections or creams, gels, pellets, oral, nasal, and other TRT options. Follow Up Lab Tests After Starting TRT Once you get on testosterone replacement, your doctor will have you come back either at week six or eight to run another blood test to see if your dosage needs to be adjusted and/or you may require other medications to monitor or to modulate or change levels like estradiol, hematocrit, etc. The first one obviously is testosterone total and free. You come back at week six or eight, and your total testosterone is not over 500 nanograms per deciliter, your doctor will probably choose to increase your dosage or your frequency of injections in the case of injections. Free testosterone is usually around 2% of total or higher. If you have lower than 2%, your doctor will probably focus on any issues related to high sex hormone binding globulin (SHBG), which is a protein that binds to testosterone and does not free it up for action. Avoiding or Lowering High Hematocrit on TRT Hematocrit is the proportion of red blood cells in the blood. Testosterone tends to increase red blood cells.  Some men don't have that issue, but most men at least have a two to a three-point increase in hematocrit after starting TRT. Hematocrit increases a lot more in men on TRT who have sleep apnea and in smokers since these two can cause oxygen starvation.  High hematocrit can increase the viscosity of the blood and may cause cardiovascular issues. So, the magic number to go for is a hematocrit of 53 or below. When you're getting close to 53, you have to basically donate blood or go for what we call a therapeutic phlebotomy to bring down the red blood cell amount in the blood. And that's very important because as hematocrit goes up, your blood becomes more and more viscous, and your cardiovascular system gets compromised.  It's also very important not to let it go too high because above 52, most blood centers would not accept you as a donor, so you would have to require a special prescription for a therapeutic phlebotomy from your doctor for the blood centers to take your blood and dispose of it later. Keep in mind that donating more frequently than every three months may decrease your ferritin and iron stores considerably, which can cause fatigue and other issues. Here are some hematocrit lab panels, or you can buy them as part of the CBC panel. Avoiding Low Ferritin and Iron When your hematocrit is over 53, and you donate blood frequently than every three months, you can deplete your iron stores which makes you tired, depressed, and with no libido. Blood donations should not be happening that frequently because you'll lose iron. Some doctors will test your iron and your ferritin, and if you have low levels, they will put you on an iron supplement. Discounted Labs sells a blood donation panel that is designed to inform you if you can safely donate blood. Monitoring the PSA Test on Testosterone High PSA, prostate-specific antigen, is the only contraindication for testosterone replacement therapy if it is 4 or above. Obviously, physicians get very concerned that a man with higher PSA may have prostatic cancer, although it could be caused by an infection of your prostate (prostatitis) that could be easily treatable with an antibiotic. So, all high PSA tests do not mean you have cancer, but it could mean that you could have a treatable prostatic infection.  Your doctor may prescribe antibiotics and retest your PSA after your antibiotic cycle is finished.  He or she may need to refer you to a urologist if your high PSA test does not come down.  But if you do have a PSA of four or higher, you are not going to be allowed to use testosterone replacement unless your doctor can actually prove that it's an infection that will eventually be treated so that your PSA can come down. Monitoring Estradiol Test on Testosterone Estradiol (E2) is a very important hormone for men. We need it because estradiol is actually linked to bone health, cognitive functioning, cardiovascular health, even sex drive, and decreased fat mass. Having very low estradiol of under 20 pg/mL is actually not good for you since it can decrease bone density and cause other issues. Having very high estradiol in relation to your testosterone blood level may also have some consequences.  Several studies have different opinions and conclusions on what high estradiol means. About 0.3 to 0.4% of testosterone gets converted into estradiol by the aromatase enzyme. So obviously, the body increases the amount of estradiol as your testosterone goes up. There's nothing wrong with that. Estradiol balances testosterone to keep a better lipid (cholesterol) profile and to keep healthy sperm counts, just to name a few benefits. But what level of estradiol in men is too high? For example, if you have a testosterone level after you start TRT of 700 nanograms per deciliter, obviously, your estradiol is going to be higher than when before you started TRT. Is that cause for concern? Most men on testosterone replacement therapy do not need to take medications to lower estradiol. Estrogen blocker medications like anastrozole (Arimidex) are being overprescribed by many TRT clinics.  Men with a history of gynecomastia or breast enlargement may have issues with gynecomastia again if your estradiol's over 50 pg/ml, but in most studies where men with gynecomastia were followed, a lot of those men had low testosterone while they had high estradiol. A large study in adolescent boys showed that most of the ones with gynecomastia also had high IGF-1.  Some studies have shown that the ratio of testosterone to estradiol is really the important factor to monitor, with ratios over 12 being needed for healthy sperm production in men. But the management of estradiol in men is a very controversial topic as there is not a lot of agreement in the field.  Some doctors insist on keeping an E2 level of 20 to 40 picograms per milliliter no matter how high testosterone levels reach. We have learned in the past three years that the old immunoassay-based estradiol test tends to overestimate estradiol in men. Two studies have shown that the real estradiol value is better tested with a liquid chromatography-mass spectrometry sensitive estradiol assay. So, make sure that if your doctor is going to check your estradiol, you're using the right LC/MS E2 test. Discounted Labs offers several lab panels that contain sensitive estradiol.  Another concern of high estradiol is that some men feel that water retention is an issue, although that has not been proven by any studies. Most men with TRT-related water retention assume that their estradiol is high but fail to get it tested. Avoiding High Blood Pressure and Water Retention on TRT Some men on testosterone replacement therapy tend to have increased blood pressure related to water retention. There are some central nervous system effects that increase blood pressure and heart rate. These men can gain considerable weight during the first weeks of TRT.  Most lose most of that weight after a few weeks of therapy.  Some studies have shown that testosterone may decrease sodium excretion by the kidneys, which makes the body retain water to keep that sodium diluted. Ways to improve blood pressure are to lose weight, take a blood pressure medication, exercise, and decrease excessive sodium intake. Many men assume that their estradiol is high when they experience water retention. That assumption has not proven to be correct. Monitoring Kidney Function The estimated glomerular filtration rate, or eGFR, is a way to measure your kidney function. It's part of what we call a CMP blood test panel, and we are aiming at an eGFR over 60. Anything below that is indicative of a slowdown in the way your kidneys are filtrating toxins from your body. TRT does not really cause a decrease in eGFR. However, a lot of men taking creatine, exercising heavily, or eating very high protein intake tend to probably have artificial increases in creatine that decrease eGFR. You can Google eGFR formula and see how that's calculated. Avoiding High Liver Enzymes Current testosterone replacement therapy options have not been shown to increase liver enzymes; only the old oral forms of TRT used to cause that problem. However, doctors obviously follow it up. A very important distinction to make is that men that are exercising heavily with weights at the gym may artificially  increase in AST and ALT that has nothing to do with toxicity to the liver. Monitoring Thyroid Tests TSH, thyroid stimulating hormone, is also something else that most doctors follow up, although some actually do not. Low thyroid function (hypothyroidism or high TSH) may have the same symptoms as low testosterone. TRT medical guidelines groups around the world recommend different schedules for monitoring men on TRT, and a few of them agree with each other. Rarely do any guidelines mention thyroid function monitoring in men on TRT. TSH levels above 2.5 may indicate that you have hypothyroidism. If you have high TSH, doctors usually tend to use a comprehensive thyroid panel that includes free T3 and free T4, along with antibodies, to see if you have an autoimmune disease like Hashimoto's that may be inducing hypothyroidism. Maintaining Good HDL Levels on TRT High-density lipoprotein or HDL is another one of the variables most affected by testosterone replacement, especially at higher doses. When I say higher doses, anybody using 200 milligrams of testosterone replacement per week — cypionate or enanthate — tend to have a lowering of HDL. Low HDL has been shown to cause cardiovascular issues, so your doctor will always follow your lipids. Testosterone replacement has not really been shown to increase LDL, and there are some studies that show that TRT improves triglyceride blood levels because testosterone tends to improve the way the body metabolizes carbohydrates. There's very little we can do to increase HDL besides aerobic exercise, losing weight, decreasing TRT dose, and taking a supplement. Niacin supplementation is one of the ways to increase HDL, but some people get flushing of the skin and face. Last but not least, the use of anastrozole, an estradiol blocker, can also decrease HDL since estradiol is known to protect HDL levels. Prolactin in Men with Low Testosterone: The Forgotten Hormone Prolactin is not a hormone that is usually measured at TRT baseline or even at follow-up unless you have severe erectile dysfunction, even with good levels of testosterone. Men that have low testosterone at baseline, and I mean low testosterone, very low — under 150 nanograms per deciliter — are probably the best candidates to get a prolactin test. It is a hormone that women and men produce – obviously, women that are lactating produce it at higher concentrations in their bodies because it helps lactation. It also has some other benefits; otherwise, men would not have it. Prolactin has some immune-enhancing benefits and some cardiovascular benefits that are starting to show up in studies. So, prolactin is not an evil hormone, but it can, at higher concentrations, cause erectile dysfunction. The reason for high prolactin could be a benign tumor called pituitary adenoma (diagnosed by MRI), which can be producing a lot of pituitary output for prolactin, and that could actually impair your testosterone replacement therapy benefits. So, it's a hormone that is hardly looked at unless you are a man that has very low testosterone blood levels at baseline or do not respond well (unresponsive erectile dysfunction) after eight weeks or ten weeks of testosterone replacement therapy and/or you are having high prolactin symptoms, like lactation. That's actually a very rare symptom that actually occurs in men with pituitary adenomas. Where to Buy Your Own TRT Tests: DiscountedLabs.com provides very low-cost blood testing in most US states. You don't need to see a doctor because the company has in-house physicians that provide a prescription. After ordering your lab test online, you receive an email with the lab request form that you take to the closest lab near you. Once you go to a lab and get your blood drawn, you receive an email with your results within five to seven business days, depending on the blood test. For more information, visit DiscountedLabs.com   Visit ExcelMale.com to download Nelson's latest book: Beyond Testosterone   Click here for TRT Resources

Table of Contents 10 Top Hormone Panels You Can Order Today 1.   Hormone Panel for Men on TRT 2.   Women's Hormone Panel 3.   Basic Bodybuilder Panel 4.   Comprehensive Bodybuilder Panel 5.   Men/Women Hormone and Wellness Panels 6.   Ultimate Lab Test Panel for Men and Women 7.   Testosterone Panels 8.   Thyroid Panel 9.   Gynecomastia Panel 10.                Erectile Dysfunction Panel 20 Individual Labs Money Can Buy Today 1.   Anti-Mullerian Hormone Test 2.   Free Estradiol (Sensitive) 3.   Thyroxine-Binding Globulin 4.   Growth Hormone 5.   Cortisol Test 6.   Insulin-Like Growth Factor-Binding Protein 3 7.   ACTH Plasma Test 8.   Aldosterone Test 9.   Fasting Insulin 10.  Parathyroid Hormone PTH Test 11.   Prolactin Test 12.                DHEA-Sulfate Test 13.                DHT Test 14.                Sex Hormone-Binding Globulin 15.                LH and FSH Test 16.                Estrone Test 17.                Progesterone Test 18.                Insulin-Like Growth Factor 1 19.                Pregnenolone Test 20.                Thyroid-Stimulating Hormone   Order a Hormone Test Today! Hormones, enzymes, and other substances set the human body's intricate machinery in motion. Hormones are some of the most important elements, and they travel throughout your entire body to influence the function of organs and tissues. A hormone is basically a chemical messenger. Testing these hormones helps you find out important information about your health. Luckily, today's medical technology is able to identify and test more than 50 different hormones in the human body. Keep reading to learn more about hormone tests and why you should order them. This article provides you with valuable information on individual hormone tests as well as complex hormone panels. 10 Top Hormone Panels You Can Order Today Hormone panels are collections of hormones tested together to find out if you're struggling with some sort of deficiency or disease. In many cases, it's required to test more than one hormone to see if you have a thyroid problem, for example. A testosterone panel is another good example in this case. This type of panel usually allows you to test your total testosterone as well as its fractions, such as free testosterone, albumin-bound testosterone, or SHBG-bound testosterone. Here are some of the most popular hormone panels you can buy: 1.   Hormone Panel for Men on TRT Testosterone replacement therapy is increasingly popular in the United States and other developed countries around the world. It involves getting testosterone exogenously using creams, injections, pellets, nasal gels, orals, and other methods. This therapy is suitable for hypogonadal men, but it requires adequate monitoring and adjustments. The Hormone Panel for Men on TRT will test your DHEA levels as well as ultrasensitive estradiol, pregnenolone, progesterone, DHT, prolactin, total testosterone, and other hormones. Keeping track of all these hormones will increase your success with TRT. 2.   Women's Hormone Panel This panel is designed for women, and it contains a plethora of hormones as well. For example, you get a DHEA test as well as progesterone, pregnenolone, and testosterone tests. Included in this panel are also a few thyroid hormone tests, such as T3 and T4. You can also add LH and FSH tests separately if you want to. 3.   Basic Bodybuilder Panel Bodybuilders need to monitor their hormones to avoid polycythemia, which is a condition that involves blood thickening. The basic bodybuilding panel includes multiple hormone tests, such as total and free testosterone, hematocrit tests, a complete metabolic panel, and more. If you just started with bodybuilding, this panel would provide you with accurate insight into how your body is performing. It's important to keep track of all these hormones to avoid the risks commonly associated with bodybuilding. 4.   Comprehensive Bodybuilder Panel More experienced bodybuilders need to monitor additional hormones. This panel includes 14 different tests. Apart from the ones mentioned in the basic bodybuilding panel, this collection of tests also includes ferritin, a complete blood count, and IGF-1 labs, among others. The comprehensive bodybuilder panel is suitable for experienced bodybuilders as well as novice ones that want to keep all their hormones under control. 5.   Men/Women Hormone and Wellness Panels These panels are relatively similar, and they contain a plethora of hormone tests suitable for men and women alike. For example, the panels include a complete blood count, thyroid tests, liver, and kidney tests, as well as labs for sex hormones such as testosterone and estrogen. If you want a complete snapshot of your health, the men's or women's wellness panels are probably your safest bet and they provide excellent value for money. 6.   Ultimate Lab Test Panel for Men and Women This is probably the most comprehensive direct-to-consumer lab panel money can buy today. It's suitable for both men and women and it includes tests for your kidneys, liver, vitamin D deficiency, iron, inflammation biomarkers, sex hormones, thyroid hormones, etc. This type of panel is suitable for those who want to get a complete overview of their health. It will also save you a lot of money in comparison with ordering this collection of tests separately. 7.   Testosterone Panels You might be happy to find out that there are also various testosterone panels you can buy. The most basic one tests your testosterone and its fractions. However, some panels are a little bit more complex, and they can also test your estradiol, DHT, PSA, hematocrit, and/or prolactin levels. These panels are suitable for people on TRT who need to keep their hormones in check. For example, if you're worried about prostate problems, order the Testosterone + PSA panel to see if your prostate-specific antigen is too high. 8.   Thyroid Panel The thyroid gland is complex and important. It secretes hormones such as T3 and T4 which influence your entire body. Most thyroid panels test your T3, T4, as well as TSH (thyroid-stimulating hormone). This panel will help you diagnose any thyroid problem you might have and it saves you money in comparison with ordering thyroid tests separately. 9.   Gynecomastia Panel Gynecomastia is also known colloquially as "man boobs" and this condition might affect certain men on TRT. This happens when too much testosterone is converted into estrogen. The gynecomastia panel includes tests for testosterone, estradiol, DHT, prolactin, and other hormones. 10.                Erectile Dysfunction Panel ED is relatively common among hypogonadal men. It involves the inability to have an erection or maintain it to achieve satisfying intercourse. The ED panel includes tests for hormones that could be the cause of your ED such as testosterone, estradiol, thyroid hormones, DHEA, and others. If you currently struggle with erectile dysfunction, this panel might provide an insight into what treatment to follow to cure this problem. These are some of the most common hormone panels you can buy, and each one of them provides excellent value for money. Now it's easier than ever to find out exactly what your hormone levels are and what treatment options you have to improve them if necessary. 20 Individual Labs Money Can Buy Today We talked about complex hormone panels, but individual tests for specific hormones are equally important. Let's take a look at some of the most popular hormone tests you can use to learn more about your general health. 1.   Anti-Mullerian Hormone Test The anti-Mullerian hormone is important when assessing fertility status and ovarian function. Low levels of this hormone are related to difficulties conceiving a baby. Women might want to order this test to see if they currently struggle with unknown fertility issues. 2.   Free Estradiol (Sensitive) Estradiol is a female sex hormone with an important role in both men and women. This test uses LC/MS testing methods to determine your free estradiol levels as accurately as possible. Men on TRT, among others, might want to order this test to keep their estradiol in check. 3.   Thyroxine-Binding Globulin Thyroxine-binding globulin (TBG) links to thyroid hormones and helps them circulate freely in the body. Low levels of TBG don't show symptoms but could indicate underlying thyroid issues. You might need a TBG test to determine if you struggle with hypothyroidism or hyperthyroidism. 4.   Growth Hormone The growth hormone is important for muscle gain, exercise performance, and wound healing. A growth hormone blood test tells you if you have healthy levels of this substance or not. You might want to order this test if you fail to see muscle hypertrophy or if you feel lethargic all the time. 5.   Cortisol Test Cortisol is one of the main "stress" hormones in the body. It's secreted by your adrenal glands in response to various stimuli. You can order a salivary or blood cortisol test. This information is useful in assessing the risk for more complicated diseases that can be caused by excessive stress. 6.   Insulin-Like Growth Factor-Binding Protein 3 This hormone is an important carrier of IGF-1 and it's required to determine if you're producing healthy levels of human growth hormone. If this test returns abnormal results, your pituitary gland might not function correctly. 7.   ACTH Plasma Test ACTH stands for adrenal corticotropic hormone. It's a hormone produced by the pituitary to maintain the cortisol balance in your body. You might need an ACTH plasma test to see if you struggle with any diseases caused by too much or too little cortisol. 8.   Aldosterone Test Aldosterone helps adjust the mineral balance in your system. It maintains sodium and potassium levels in a healthy range. Excessive aldosterone is also associated with serious cardiovascular complications. You might need this test if your blood pressure is high most of the time. 9.   Fasting Insulin Insulin is a hormone secreted by the pancreas. It helps move blood sugar into cells to produce energy. A fasting insulin test is required to determine if you're predisposed to diabetes which is a life-threatening disease. 10.  Parathyroid Hormone PTH Test This hormone is released by the parathyroid glands. It maintains healthy calcium levels in your system. If you currently struggle with hypocalcemia, your doctor might order a parathyroid hormone test. This hormone is also helpful in diagnosing thyroid problems. 11.   Prolactin Test Prolactin is known to support lactation in women, but it also plays other important functions. For example, it plays a role in immune function and supports the production of testosterone by the Leydig cells. However, too much prolactin might lead to sexual dysfunction in men. 12.                DHEA-Sulfate Test DHEA-Sulfate is produced by the adrenal glands and it plays a vital role in the production of both male and female sex hormones. Abnormal levels of this hormone might indicate hormonal disorders. A DHEA test is required to find out if a patient is struggling with neurodegenerative disorders, excessive inflammation, etc. 13.                DHT Test Dihydrotestosterone is similar to testosterone. Too much of it can lead to hair loss and acne. Too little DHT might lead to sexual dysfunction. This test helps you find out if your DHT levels are within normal ranges. 14.                Sex Hormone-Binding Globulin SHBG is a protein carrier for testosterone. Most of the testosterone in the body is bound to SHBG. High levels of this hormone might indicate thyroid problems or anorexia. Too little SHBG is commonly associated with diabetes and ovarian complications. 15.                LH and FSH Test Luteinizing hormone and follicle-stimulating hormone are produced by the pituitary gland. These hormones indicate the onset of menopause in women and andropause in men. Low levels of these two hormones could also indicate that there is too much estrogen in your body. 16.                Estrone Test Estrone is one of the most important estrogens found in a woman's body. Its levels increase after menopause. Testing estrone might be required to prevent osteoporosis and other health problems commonly associated with post-menopausal women. 17.                Progesterone Test This is another important female sex hormone. It's also present in a male's body, but very small quantities. High levels of progesterone are commonly associated with depression, bloating, and other symptoms in women. 18.                Insulin-Like Growth Factor 1 IGF-1 is used to gauge the blood levels of human growth hormone in both men and women. This hormone is very similar to insulin when it comes to its structure. Your doctor might order an IGF-1 test to determine if your growth hormone is within normal ranges. 19.                Pregnenolone Test Pregnenolone is the hormone from which all other hormones are made, including estrogen and testosterone. Abnormal levels of pregnenolone might affect your mood, cognition, memory, and metabolism. This test uses LC/MS to accurately determine the levels of pregnenolone in your body. 20.                Thyroid-Stimulating Hormone The TSH is exactly what the name implies - a hormone that stimulates your thyroid to produce other hormones. This substance is secreted by the pituitary gland and it helps doctors determine if you have a thyroid problem. Order a Hormone Test Today! As you can see, there are numerous hormone panels and individual tests you can order from a reputable vendor. When you order a test, you are mailed a form that you use to go to a nearby clinic to draw a blood sample. This sample is analyzed in a laboratory and you get the results by mail in just a few business days. Your results are confidential and not shared with anyone. These results can be compared with reference values or you can ask your doctor to help you interpret them. Go to DiscountedLabs.com today and order your favorite test to find out more about your health!

Table of Contents SHBG and the Free Testosterone Relationship What Causes High SHBG? Other factors that can contribute to high SHBG include:   Get Your Levels Checked: SHBG Test, Free & Total Testosterone Test How to Lower SHBG Levels: Very Low SHBG : Low SHBG has also been associated with: Is SHBG an Enemy of Hormone? - Emerging Studies References: Testosterone is the primary and dominant male hormone. It is responsible for numerous functions within the human body in men and women, and when levels are too low, it can lead to multiple health issues. Unfortunately, as many know, testosterone levels naturally decline as we age. Numerous external factors can contribute to lower levels of testosterone. In either case, age or external, symptoms occur, problems arise, and solutions are needed to stop the decline. For many men, testosterone replacement therapy (TRT) is the answer to this problem.  Men should ensure that their testosterone free and total, estradiol and other hormone factors are within normal levels. One of those hormone tests to monitor is the Sex Hormone Binding Globulin (SHBG) test.   SHBG and the Free Testosterone Relationship   When our body produces testosterone or provides it exogenously, a set level of testosterone flows through the body. This testosterone blood level can be measured precisely through a simple blood test aptly referred to as the Total Testosterone blood test. For most adult men, when testing their total testosterone, if it falls in the 350 ng/dl to 1100 ng/dl range, this will be considered medically optimal. Such individuals, even exhibiting low testosterone symptoms, will often not be prescribed TRT. In some cases, this may be a correct diagnosis; in other cases, symptoms exist for different reasons, but in most cases, something else is at play, which makes SHBG important.   While useful, measuring total testosterone is only useful with also measuring Free Testosterone. Free testosterone is a small fraction of your total testosterone. It is often referred to as "unbound," meaning the testosterone your body will use for its intended androgenic function. Free testosterone is so important that if your total testosterone levels are within range, if free testosterone levels are low, in most cases, the man will be symptomatic of low testosterone. This issue is often due to high levels of SHBG in the body.   For this reason, many men will attempt to lower their SHBG or even fret over it. However, SHBG serves an essential purpose. As is with estrogen, too much can be problematic, but so can too little. SHBG is no different.   Of all the testosterone flowing through your body, only 2% is what we can refer to as unbound or free testosterone. From a layman's perspective, to increase free and unbound testosterone, they'd need to increase their total testosterone. Unfortunately, it doesn't always work that way – it often helps and often fixes the issue, but not always – and here's why: our testosterone is bound to albumin and sex hormone-binding globulin (SHBG). Approximately one-third of total testosterone binds to albumin, and the rest to SHBG.   Albumin is a protein that binds testosterone, and we can say it does so loosely. This protein carries testosterone through the bloodstream and releases it as needed. The testosterone detaches and becomes what's often referred to as bioavailable or free testosterone. The testosterone that separates from albumin becomes the testosterone that influences your body's functions from sex organs, muscle tissue, brain function, and a host of other areas of bodily function. Testosterone attached to SHBG cannot do this; it is attached and does not detach.   What Causes High SHBG?   As testosterone attached to SHBG is relatively useless, if SHBG levels increase within the body, there will be more attaches and less free testosterone to circulate. Conversely, lower levels of SHBG are associated with higher levels of free testosterone, which is often associated with positive influences on bodily functions, such as libido, mood, muscle mass, etc.   Numerous factors influence how much sex hormone-binding globulin we have in our bodies. Age is one of the primary factors that affect SHBG. Often as we age, SHBG levels increase, and as a result, free testosterone levels go down. Even if our total testosterone levels remain high or optimal, our bioavailable testosterone decreases if SHBG levels increase.   Other factors that can contribute to high SHBG include: Fatty Liver Excessive or what we might call chronic alcohol consumption can lead to a fatty liver and impending higher levels of SHBG and corresponding lower levels of free testosterone. The disease can also be a factor, such as cirrhosis or cancer. Thyroid issues An underactive and overactive thyroid can lead to elevated SHBG, not to mention issues associated with the thyroid. Overactive thyroid or hyperthyroidism is often associated with graves' disease, thyroid nodules, or thyroiditis. It can also exist due to abuse of thyroid medications, such as Cytomel (T3). Underactive thyroid or hypothyroidism may be caused by inflammation of the thyroid gland, pituitary damage, too little iodine in the diet, or genetic factors, along with other possible reasons. Elevated estradiol High levels of estradiol can occur for numerous reasons, which are not limited to using certain antibiotics, some mental health medications, obesity, and abuse of exogenous testosterone. Obesity & High triglycerides While not as expected of a factor for increasing SHBG, being overweight with a low lipid profile can negatively impact. Inflammation While some level of inflammation is necessary for general health in the fight against disease or injury, what we might call chronic inflammation can lead to increases in SHBG and corresponding lower levels of free testosterone   Get Your Levels Checked: SHBG Test, Free & Total Testosterone Test   Testing your SHBG levels along with both total and free testosterone is particularly important if one wants to get to the bottom of hypogonadism (low testosterone) symptoms they may be experiencing. Remember, a total testosterone test alone, which some physicians will run, is not enough. For most adult men, SHBG levels will run between 10 nmol/L and 60 nmol/L if in the optimal range. If SHBG levels are greater than 60 nmol/L and your free testosterone is less than 2% of your total testosterone, there is a good chance your SHBG levels are too high.   Discounted Labs sells several lab test panels that measure SHBG levels that you can buy without a doctor's visit:   Testosterone (Total and Free), SHBG, CBC - Hematocrit, Ultrasensitive Estradiol and PSA   Testosterone, Free, Bioavailable and Total (Upper Limit T 1,500 ng/dL) plus SHBG   CBC, CMP, TT, FT, Lipids, Prolactin, Ultra-Sensitive Estradiol, and SHBG   Testosterone, Free, Bioavailable, and Total, LC/MS (No Upper Limit) plus SHBG   As we now understand SHBG, our next question is what can be done to lower it, increasing free testosterone in the body? There is nothing we can do about aging. As each day passes, we grow older, but there are still things we can do that will improve this factor.   How to Lower SHBG Levels:   The most obvious answer to the problem of low free testosterone and high levels of SHBG is to increase testosterone. Exercise more, consume a cleaner diet, and lose weight; all of these things will increase your testosterone levels. Your levels may not increase massively, but some increase means a higher total to pull from and a greater amount of free testosterone based on the 2% fraction. If this isn't enough - perhaps you're not reaching a 2% fraction due to elevated SHBG – one may need to consider talking to their doctor about testosterone supplementation. However, even if supplementing with exogenous testosterone, the habits mentioned are good for overall health and can only have a positive impact.   Another possible solution, and one of the more commonly needed, is lowering estradiol levels in the body. We tend to think estrogen hormones are needed for females only, but they are also crucial for men, granted in smaller amounts. As it pertains to estrogen, too much estradiol can lead to elevated levels of SHBG. If testosterone levels are also low, this can lead to even more negative factors. But it's important not to get carried away as estradiol that's too low will bring with it numerous symptoms; in fact, your life could be miserable in that regard.   Many men who are at least somewhat familiar with testosterone have been wrongly been told that too much testosterone can lead to gynecomastia due to elevated levels of estrogen in the body due to the aromatization of testosterone to estrogen. But low levels of testosterone in the body with present high levels of SHBG and estradiol can have the effect of causing gynecomastia. In order to combat high levels of estradiol, avoiding certain foods, especially those that are soy-based, will be important. Equally important is living a healthy lifestyle and incorporating what was mentioned above: adequate exercise, a healthy diet, and getting enough sleep. These things will help lower estradiol. Some men will also need medical help through medications known as aromatase inhibitors if they have gynecomastia, although most men on TRT do not need an AI. Too many men have relied on aromatase inhibitors out of fear for too many years. In reality, most men who supplement with exogenous testosterone can, in fact, control estrogen via non-medicated factors.   Some studies have shown that supplementation with DHEA (Dehydroepiandrosterone) may also lower SHBG. However, more study is needed to understand this properly, as too much DHEA can prove problematic. High doses of DHEA supplements have been associated with increased estradiol, so you must speak to your doctor first before beginning such a supplementation regimen.   Very Low SHBG :   We are then left with one factor we've yet to discuss much because it isn't all that common: low SHBG, or rather, levels of SHBG that are too low. Levels of SHBG that are too low may be an indicator of other underlying health issues. This may be an indicator of a metabolic problem. Low levels of SHBG are a standard indicator of those with diabetes. It doesn't appear, as data suggests, that insulin resistance is caused by low SHBG, but it may be a useful marker. More data is currently needed on this topic.   An A1c test will be needed to know with certainty in terms of your diabetic health.   While low SHBG is not a common concern for most men, new data has produced interesting results and information. A recent study published in the Journal of Clinical Endocrinology and Metabolism provides such information.   The process showed a man with undetectable levels of SHBG and low levels of testosterone accompanied by nearly a decade of hypogonadism symptoms. They discovered a family with a missense mutation in the SHBG gene from studying this individual. Interestingly enough, they found this issue did not interfere with the individual's spermatogenesis or general gonadal development. This leads the study to conclude SHBG may not play a significant role in the maturation of the male species physiologically or sexually.   More interesting than the JCEM study is things that new data suggest may negatively impact all men. Low levels of SHBG have recently been associated with three medical conditions that are known to be the silent killers of many men: heart disease, metabolic syndrome, and diabetes. Again, currently, it is being viewed as a marker and not as direct causation, but this new information is important as it acknowledges that more studies must be done.   Low SHBG has also been associated with:   Obesity Obesity is a factor we all well understand and is an issue that leads to problems in many health areas, and often in numerous possible directions. Cushing Disease It is associated with extended exposure to high levels of cortisol. Hypothyroidism It is associated with an under-active thyroid. Excessive levels of growth hormone Exceedingly rare for most, although possible via genetic factors or abuse of exogenous forms. Abuse through anabolic steroids     Is SHBG an Enemy of Hormone? - Emerging Studies   As we mentioned, androgens like testosterone and DHEA and estrogens are transported to the sex hormone binding globulin (SHBG). SHBG is believed to keep sex hormones inactive and to control the amount of free hormones that enter cells by passive diffusion. Contrary to the free hormone hypothesis, some researchers have demonstrated that megalin, a receptor in ovaries and testicles, acts as a pathway for cellular uptake of biologically active androgens and estrogens bound to SHBG. We will see more data on this newly found receptor that actually enables the body to use hormones bound to SHBG in the near future.   In endocrinology, the body has no “harmful” or “good” hormone. Their balance and harmony with each other matters for the best health.     References:   Ding et al. Sex hormone-binding globulin and risk of type 2 diabetes in women and men. The New England Journal of Medicine. Aug 2009. Vos et al. Sex Hormone Binding Globulin Deficiency Due to a Homozygous Missense Mutation. Journal of Clinical Endocrinology and Metabolism. Sept 2014 SHBG and Free Testosterone - Everything You Need to Know Hammes et al. Role of Endocytosis in Cellular Uptake of Sex Steroids. Cell. Sept 2005  

A brief introduction to testosterone and its properties and benefits Testosterone is the most important male sex hormone responsible for correctly functioning multiple body processes. This anabolic steroid is directly involved in developing reproductive organs in men and developing secondary male sexual characteristics. Testosterone plays a vital role in the lives of women, too. Inadequate testosterone amounts can lead to numerous health issues, such as low bone density (and susceptibility to fractures), poor sex drive, and lack of concentration. Table of Contents A brief introduction to testosterone and its properties/benefits What is hypogonadism?   Serum testosterone tests (assays) Types of testosterone fractions in the blood Types of testosterone tests How is testosterone level measured? Dr. Wang's analysis of testosterone assays 4 Types Of Testosterone Tests You Can Buy Today Why should you test your testosterone levels? How to get a testosterone test? Normal testosterone levels in men are between 300 ng/dL and 1,000 ng/dL. Normal testosterone levels in women are usually between 15 ng/dL and 70 ng/dL. This number varies depending on various factors such as the moment of the day, mood, diet, exercise level, and more. However, certain men might have low testosterone levels (under 350 ng/dL) and experience symptoms such as fatigue, lack of sexual desire, and developing male breasts (gynecomastia). Testosterone replacement therapy might be helpful for men who have low testosterone blood levels. This treatment will help raise testosterone levels to average values. Inadequate testosterone amounts can also impair muscle development and slow one’s progress in the gym. Men usually have 40 times more testosterone than women, and keeping T levels in the normal range is essential to ensuring proper muscle growth. Declining testosterone levels in men over 45 are typical and often cause erectile dysfunction (ED). Androgen deficiency, or hypogonadism, affects roughly 40% of men aged 45 or older.  Two-thirds of these men present with symptoms. While some symptoms, like ED, indicate a deficiency, additional symptoms can be similar to those of other diseases, such as cardiovascular disease.  What is hypogonadism?   Male hypogonadism is a clinical syndrome that results from the failure of the testes to produce physiological levels of testosterone (androgen deficiency) and an average number of spermatozoa due to disruption of one or more groups of the hypothalamic-pituitary-testicular (HPT) axis. There are three types of hypogonadism: Primary-testicular dysfunction leads to low testosterone levels and high levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Secondary dysfunction of the HPT axis results in low testosterone, LH, and FSH levels. Who should be tested for low testosterone? Mixed—manifests a mixture of primary and secondary hypogonadism and can be observed in older men. Very small or shrinking testes. Inability to father children; low or zero sperm count. The more symptoms a patient has, the more likely he is to have low testosterone.    The production of androgens in excess is a defining feature of hyperandrogenism (high testosterone in women), and testosterone levels have an impact on it. The most common clinical manifestation of hyperandrogenism is hirsutism, or excessive hair growth in androgen-dependent body areas. Other clinical manifestations of hyperandrogenism include acne vulgaris, weight gain, menstrual irregularities, and, in some women, polycystic ovary syndrome (PCOS) and acanthosis nigricans. Measuring the testosterone level isn’t an easy task. Tests for free, bioavailable, and total testosterone are essential to help diagnose hypogonadism and rule out other conditions. For those who may be candidates for testosterone therapy and those already on treatment, testing can also help assess and monitor testosterone levels.   This hormone can be bound to specific proteins in the body, and measuring it becomes problematic when it’s outside the normal ranges. For example, it’s relatively easy to determine the exact testosterone level of a healthy man, but not that easy if he’s hypogonadal (has low T) and his testosterone levels are dangerously low. More sensitive tests are required to measure low T concentrations in men, women, and prepuberty children. Scientists and medical professionals have created some reliable testosterone-measuring methods. These are called testosterone assays.   Serum testosterone tests (assays) According to the dictionary, the word “assay” refers to testing a particular material, ore, or substance to find its composting ingredients. Serum testosterone assay refers to accurately measuring the testosterone levels in the body of a male or female. Accuracy is essential because it directly impacts the diagnosing a particular disease or health complication. Endocrinology is the discipline responsible for measuring hormone levels in the body. It encompasses a wide variety of assays that help the clinician confirm a diagnosis for a patient. For example, testosterone assays are used to determine whether a male patient has hypogonadism. Hypogonadism consists of reduced gonad activity. Men diagnosed with hypogonadism usually have low testosterone levels and experience different symptoms, such as low sex drive and gynecomastia (man boobs). Testosterone assays are also used to determine if confident boys have delayed puberty onset and to diagnose androgen deficiency. When circulating testosterone levels are very low, the sensitivity of some assays is diminished. That’s why picking the suitable testosterone assay is necessary to determine circulating T levels accurately.   Types of testosterone fractions in the blood As shown in the figure below, about 2 percent of the testosterone in the body is active.  This “free testosterone” is not attached to binding proteins that would prevent it from interacting with its receptor. About 40 percent of the body’s testosterone is attached to albumin. This is a protein that can release the hormone as the need for it arises in the body. Free testosterone and testosterone bound to albumin are “bioavailable testosterone.” In a healthy young male, about 60 percent of his testosterone is attached to sex hormone-binding globulin (SHBG). Hormones bound to SHBG can’t be used by the body and lose their anabolic effect.  As males grow older or if an illness is present, SHBG sweeps up more and more testosterone, lowering free testosterone and its benefits. Total testosterone is the sum of bioavailable testosterone and testosterone bound to SHBG. Measuring the total testosterone in the blood may not provide the whole picture and let you know how much “active” or usable testosterone you have. Types of testosterone tests Measuring the testosterone levels in one’s body is not that easy. One way to do that is by using Isotope dilution mass spectrometry. This assay measures total testosterone levels. Laboratories also use direct chemiluminescent immunoassays. However, these assays are less accurate when testosterone concentrations are too low. Liquid chromatography-tandem MS (mass spectrometry) and gas chromatography-MS are also used for more accurate results, mainly when testosterone levels are at the low and high extremes. Measuring free testosterone is done after it has been separated from the protein-bound forms. This can be done using equilibrium dialysis or ultracentrifugation. Equilibrium dialysis is the most common method, and it involves introducing testosterone isotopes into a patient sample. The free testosterone concentration is estimated based on the distribution of isotopes in the dialysis membrane. The bioavailable testosterone can be measured using ammonium sulfate, which influences the testosterone bound to SHBG. Assessing testosterone levels began approximately 30 years ago. Tests were done on small blood samples, but their accuracy could have improved. Current testosterone assays are more sensitive, require a smaller serum sample, and are more affordable. They can be done using nonradioactive methods in reference labs.   How is testosterone level measured? Up to 98% of the testosterone found in the bloodstream is bound to proteins such as albumin and SHBG. Just about 2% is free. Albumin-bound testosterone and free testosterone are known as bioavailable, and tissues can easily use them for androgen action. On the other hand, total testosterone can be measured using nonradioactive immunoassay and chemiluminescent detection. These methods offer accurate results if the male patient has testosterone levels in the normal range, such as 300-1000 ng/dL. However, these assays recorded low testosterone limits of approximately 132 ng/dL, which is not customary in healthy men. Clinicians have wondered why this happens and how they can improve the accuracy of testosterone assays when T concentrations are deficient. Regarding total testosterone assays, the gold standard is a steroid-free serum interacting with gravimetrically-determined amounts of testosterone. Independent measuring methods, such as liquid or gas chromatography with mass spectrometry, are also used. Susceptible tests are necessary for women to determine total and free testosterone levels because women have much lower amounts of testosterone in the bloodstream.   Dr. Wang's analysis of testosterone assays In a paper published in 2004, Dr. Wang and her colleagues compared multiple testosterone immunoassays (both manual and automated ones) with chromatography-tandem mass spectrometry. The results were very accurate for the latter option, and the test was performed on serum samples from patients with different testosterone levels (ranging from under 150 ng/dL to 1,500 ng/dL). This means that most of the automated and manual assays were accurate compared to LC-MSMS, but some tests provided inaccurate results. The authors concluded that most manual and automatic testosterone immunoassays are ideal for differentiating eugonadal men from hypogonadal men. Still, they weren't accurate for women or children who haven't reached puberty yet. It’s essential to notice that these automated and manual testosterone immunoassays are compared with gold standards of adult male reference ranges. These ranges are set by individual laboratories and are usually monitored by the College of American Pathologists. That’s why you’ll find several testosterone tests on the market. Getting the right one is essential to obtain the most accurate results.   4 Types Of Testosterone Tests You Can Buy Today There are four different testosterone assays you can choose from to determine the amount of testosterone in your bloodstream accurately.   #1 - TESTOSTERONE Total and Free (Regular) This test is ideal for people with testosterone levels in the normal range. It measures total and free testosterone using direct analog/radioimmunoassay (for free T) and electrochemiluminescence immunoassay (for real T). On the other hand, if you know you have deficient testosterone levels (hypogonadism and testosterone levels below 150 ng/dL) or very high testosterone levels (you are a bodybuilder with T levels over 1500 ng/dL). You might want to use the LC/MS test because it’s more accurate. If your testosterone levels are very high, the test will show above 1500 ng/dL, not the exact number (such as 1,700 or 1,800).   #2 - Testosterone Free and Weakly Bound (Bioavailable Testosterone) Bioavailable testosterone can be used for steroid-receptor interaction. This test measures the amount of free and weakly bound testosterone in the bloodstream. The test doesn’t look at the testosterone bound to SHBG because this type is biologically inactive as it has a high binding affinity. On the other hand, weakly bound testosterone is usually derived from albumin and has a low affinity, which means that it can quickly dissociate and become available for interaction.   #3 - Testosterone, Free, Bioavailable, and Total, LC/MS (No Upper Limit) This test has no upper limit for either type of testosterone, such as free, total, or bioavailable. It uses more complex measuring assays such as liquid chromatography-tandem mass spectrometry to determine testosterone levels accurately. However, this test is more suitable for bodybuilders, who are known to have very high testosterone levels. If you are not into bodybuilding or think you have below-normal testosterone levels, this test is not ideal for you. Other tests are more economical and can be used to determine your testosterone levels more accurately. If you are on testosterone replacement therapy, you might want to choose a test that has no upper limit on total testosterone and up to 50 ng/dL limit on free testosterone. An even more affordable test for people on testosterone replacement therapy has an upper limit of 1,500 ng/dL on total testosterone and a 50 ng/dL limit on free testosterone.   #4 - Testosterone, Total, LC/MS (No Upper Limit) This test measures only total testosterone by liquid chromatography or mass spectrometry. This test is ideal if your testosterone levels are deficient (both men and women). It is also suitable for high testosterone levels due to TRT or bodybuilding.  The test is the most accurate for testosterone concentrations under 150 ng/dL or above 1500 ng/dL for total testosterone.     Why should you test your testosterone levels? Measuring testosterone levels has become increasingly popular nowadays, thanks to direct-to-consumer labs that are affordable and easy to use. Males and females can buy one of the tests described above and determine the actual amounts of testosterone in their bloodstream. But why is this a good idea? First, if you have common testosterone deficiency symptoms such as fatigue or low sex drive, then measuring your testosterone levels is highly recommended. This will help you decide whether a lack of testosterone is the problem and whether you should try testosterone replacement therapy. Testosterone tests give you a broader insight into your hormonal health. Secondly, if you’re on testosterone replacement therapy already, the test results might provide good feedback on your progress. The clinicians who conduct these tests can give you valuable adviceLong-Term, such as how often to take testosterone gels or injections, whether you should reduce or increase the dosage, etc. If you’re a bodybuilder, keeping your testosterone levels in check also helps you monitor your progress. After all, testosterone is vital for muscle development, and if you have sufficient amounts of it, you’ll ensure muscle growth in the long run. Testosterone is essential for women too. This hormone is linked to mental alertness, good mood, and increased sex drive. Testosterone deficiency in women can also lead to low productivity at work and poor physical performance in the gym. Numerous advancements in the medical field coupled with improved testing devices make measuring testosterone levels a more affordable and accurate process.   How to get a testosterone test? Visit Discounted Labs, pick your favorite testosterone blood tests, and you’ll be able to get your results in a few business days. You can also order other blood tests to check your glucose levels, cholesterol, triglycerides, blood count, and more!