Estrogen & TRT

[Michael Scally MD]

Kacker R, Traish AM, Morgentaler A. Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency. J Sex Med. Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency - Kacker - 2012 - The Journal of Sexual Medicine - Wiley Online Library

Introduction. The role of estrogens in male sexual function and the pathogenesis of testosterone deficiency remain controversial and poorly understood.

Aims. To review the distribution of estrogens in normal and testosterone deficient men, their potential role in sexual function, and the clinical implications of elevated estrogens during testosterone therapy.

Methods. A comprehensive, broad-based literature review was conducted on the role of estrogens in male sexual function and testosterone deficiency.

Results. Estrogens elicit a variety of physiological responses in men and may contribute to modulation of sexual function. In the absence of testosterone deficiency, elevations in estrogens do not appear to be harmful and estrogens may help maintain some, but not all, sexual function in castrated men. While the therapeutic use of estrogens at pharmacologic doses has been used to suppress serum testosterone, naturally occurring elevations of estrogens do not appear to be a cause of low testosterone. During testosterone replacement, estrogens may rise and occasionally reach elevated levels. There is a lack of evidence that treatment of elevated estrogen levels during testosterone replacement has benefit in terms of male sexuality.

Conclusion. Further research on the importance of estrogens in male sexual function is needed. Current evidence does not support a role of naturally occurring estrogen elevations in testosterone deficiency or the treatment of elevated estrogens during testosterone therapy.


[I do not, yet, have the full-text. Once received, I will further detail the evidence provided.]

 

[Michael Scally MD]

In case you are not bewildered, this will help confuse the evidence!!!

His sexual identity and psychosexual orientation as assessed by questionnaire were heterosexual, and his libido was normal. He had spontaneous erections sufficient for intercourse. He lived with his parents and his behavior was very friendly. The patient was single, had no offspring, and was employed as a civil servant. His intellectual and physical capacities were normal.

Herrmann BL, Saller B, Janssen OE, et al. Impact of estrogen replacement therapy in a male with congenital aromatase deficiency caused by a novel mutation in the CYP19 gene. J Clin Endocrinol Metab 2002;87(12):5476-84. Impact of Estrogen Replacement Therapy in a Male with Congenital Aromatase Deficiency Caused by a Novel Mutation in the CYP19 Gene

Recent reports of the impact of estrogen receptor alpha and aromatase deficiency have shed new light on the importance of estrogen for bone formation in man. We describe a novel mutation of the CYP19 gene in a 27-yr-old homozygous male of consanguinous parents. A C to A substitution in intron V, at position -3 of the splicing acceptor site before exon VI of the CYP19 gene, is the likely cause of loss of aromatase activity. The mRNA of the patient leads to a frameshift and a premature stop codon 8 nucleotides downstream the end of exon V. Both parents were shown to be heterozygous for the same mutation. Apart from genua valga, kyphoscoliosis, and pectus carniatus, the physical examination was normal including secondary male characteristics with normal testicular size. To substitute for the deficiency, the patient was treated with 50 micro g transdermal estradiol twice weekly for 3 months, followed by 25 micro g twice weekly. After 6 months estrogen levels (<20 at baseline and 45 pg/ml at 6 months; normal range, 10-50) and estrone levels (17 and 34 ng/ml; normal range, 30-85) had normalized. Bone maturation progressed and the initially unfused carpal and phalangeal epiphyses began to close within 3 months and were almost completely closed after 6 months.

The bone age, assessed by roentgenographic standards for bone development by Gruelich and Pyle, was 16.5 at baseline and 18-18.5 yr after 6 months of treatment. Bone density of the distal radius (left), assessed by quantitative computed tomography, increased from 52 to 83 mg/cm(3) (normal range, 120-160) and bone mineral density of the lumbar spine, assessed by dual-energy x-ray-absorptiometry, increased from 0.971 to 1.043 g/cm(2) (normal range, >1.150). Osteocalcin as a bone formation parameter increased from 13 to 52 micro g/l (normal range, 24-70) and aminoterminal collagen type I telopeptide as a bone resorption parameter increased from 62.9 to 92.4 nmol/mmol creatinine (normal range, 5-54).

Semen analysis revealed oligoazoospermia (17.4 million/ml; normal >20) at baseline. After 3 months of treatment, the sperm count increased (23.1 million/ml) and decreased rapidly (1.1 million/ml) during the following 3 months. The sperm motility was reduced at baseline and decreased further during treatment.

Area under the curve of insulin, C-peptide, and blood glucose levels during oral glucose tolerance test decreased after 6 months (insulin: 277 vs. 139 micro U/ml.h; C-peptide 52 vs. 15 ng/m.h; area under the curve glucose: 17316 vs. 12780 mg/d.min). Triglycerides (268 vs. 261 mmol/liter) and total cholesterol levels (176 vs. 198 mmol/liter) did not change significantly, but the low-density lipoprotein/high-density lipoprotein ratio decreased from 5.37 to 3.56 and lipoprotein (a) increased from 19.9 to 60.0 mg/dl (normal range, <30).

In this rare incidence of estrogen deficiency, estrogen replacement demonstrated its importance for bone mineralization and maturation and glucose metabolism in a male carrying a novel mutation in the CYP19 gene.

 

[imrj]

Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of Test

i knew at least for me the whole E2 thing is bunk....never taken an AI and take 200mg Tcyp week with none of the E2 side effects.....

Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency - Kacker - 2012 - The Journal of Sexual Medicine - Wiley Online Library

 

[RedRec]

Re: Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of

What is your SHBG?

What is your free T?

I have a rough time with estrogens on TRT, I believe because my SHBG is 15 - 19, on the low end of normal. I am guessing yours may be on the high side.

 

[Antonek]

Re: Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of

how can I lower SHBG?

 

[xcraider37]

So are all the men on this forum just having a placebo effect when they have erection issues when they had elevated estradiol, then they get this under control the erection issues improve?

Seems to me we have the proof from the people using this forum that controlling estrogens during TRT is vital for sexual function.

 

[Michael Scally MD]

Men who experience such symptoms should consider temporary or permanent discontinuation of TRT, or the addition of an aromatase inhibitor. They do not recommend the routine use of aromatase inhibitors with TRT. In the absence of signs of estrogen excess, we also find no reason to recommend the use of aromatase inhibitors in men who experience positive benefits from TRT despite elevated or high-normal E2 concentrations. When an aromatase inhibitor is used, it should be titrated so that E2 levels remain above 40 pmol/L to preserve bone health, and monitoring of bone mineral density with DXA is recommended.

Kacker R, Traish AM, Morgentaler A. Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency. J Sex Med. Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency - Kacker - 2012 - The Journal of Sexual Medicine - Wiley Online Library