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Estradiol Ratio to Total T, Fact/Fiction?

I was interested in knowing if any of you guys have any experience targeting your Estradiol to Total testosterone ratio, instead of targeting the standard 20-30ish range.

I’m asking because over the past few months I have been on a tear trying to feel better, and I was convinced that I was letting my estradiol get to high, and therefore, I was not running right. I’m sure you know what I mean, low or no libido ED etc.

So I decided to start taking blood tests for sensitive estradiol more often, and noticed that I was getting scores of 40-50 which I thought was to high and once I was aware of the score started using AI’s to knock it down.

Well I finally got my score down to 27.1 based on todays results, and I feel like crap much worse than the higher levels. I have nothing going sexually, action or interest.

The I recalled that I read a post from Nelson Vergel, a TRT guru or so I’m told. In any event he was explaining that TRT guy needs to have the correct ratio between estradiol and total testosterone in order to get the desired response from the therapy.

According to Nelson, the formula is Total Test / 14 and again by 20 these two figures would be the proper range that you should keep your estradiol in.

For example: 1000 Total Test score / (divided) 14 = 71.1
/ (divided) 20 = 50.0
So this guy in the example would target his estradiol rang to 50-71.1

I was wondering if this sounds right to you guys. Personally, it makes perfect sense to me, but I don’t really know much about these matters, so I thought I would come to the experts.

Today my Total Test: 1419

Free Test: 33.7

Sen Estradiol 27.1

PSA 1.3

TSH 1.2

DHEA-S 161.7

RDW 15.6 High 12.3- 15.4

Hematocrit 48.1

If targeting a ratio is the best way to dial in estradiol than I should be running great with an estradiol range of 70.9 - 101.4 which frankly looks scary high to me but I’m a novice.

So I’m asking if this theory of balancing TT to E2 via a ratio make sense.

Your thoughts please, and I know my TT and FT are to high.

Thanks guys.

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Its more than a ratio. Any TRT will have a ratio. If you have high normal T levels as a TRT target and specified E2 targets and you feel better, those numbers work and yes, there is a ratio there too. If you have good T levels and are trying to get to a good E2 level, there are no lab tests for T:E ratios. All you need to do is seek the good E2 results.

Something seems wrong with your ratio material as well as your lab results vs how you feel.

Your FT:TT is low so elevated SHBG from elevated E2 is suspected. SHBG can take time to respond to E2 changes.

With lower E2, you are getting more effects from T. Thyroid or cortisol issues can be a factor. Your DHEA-S seems low. AM cortisol would be of interest as well as AM and PM oral body temperatures as per thyroid basics sticky. Yes, I noticed TSH=1.2

We know that TRT guys feel like crap with E2=40pg/ml and feel transformed at 22pg/ml.
Higher E2, the levels the ration suggest are associated with:

  • lower insulin sensitivity
  • heart/artery disease, high blood pressure
  • prostate enlargement +++
  • mood problems and depression
  • low energy
  • female like emotions
  • ED and low libido, even with good T levels
  • female fat patterns and weight gain

Hey KS Man thank you.

Oh, and yes I have low basil temp scores in the morning, and low saliva cortisol scores, actually there’re low through out the day.

I’m getting DHEA and Pregnenolone cream Monday 8/31/15. I think those two will bump up my thyroid / adrenals if I understood correctly.

Additionally, I have been gaining weight without over eating or consuming alcohol. So in my professional opinion, something is going on and you can quote me on that…Little TRT humor.

Ok, so I guess I’ll get an SHBG test done, and if your right, and I know you are, I’ll just keep doing what I’m doing and let SHBG and E2 find there correct levels.

Thanks again feel free to drop by anytime, I’ll be updating a couple of labs in a couple of weeks, and I’ll update you if interested.

Thank you again!

Progesterone is the step before cortisol, so may be better. You can get “KAL” brand [2%] progesterone cream at amazon, no Rx required.

Oral OTC DHEA works well most of the time.

When discussing these factors, rT3 blocking fT is considered. So your stress history and conditions that stress the body are a factor. More in the thyroid basics sticky.

Just my two cents (limited labs) but I know nothing about the theory of a ratio, only my experience.

This is after running the same regimen for months:
TT 1250
E2 101

I felt fine. My bodyfat/weight increased a little (from underweight to normal). My erections were fantastic, developed a little PE that I’ve never experienced before (kegels really do help a lot - pretty quickly too) and my orgasms were better than ever. I’d been saying it to a fairly disinterested partner for a while.

My body composition was better when I was at a ‘normal’ E2 (I don’t intervene if it stays below 40 and above 15).

Since these results I’ve been adding 0.5mg anastrozole/week, divided in two doses. No idea where my E2 is but I’ve made it a point to lose a little weight. Being underweight (BMI) I’ve always had my E2 stay ‘in range’ naturally.

Thanks for taking the time and sharing your insight. I find your labs, and your ability to run great at E2 101 amazing. I have heard lately that TRT guys should allow for a little more E2 in the world.

In fact last week, I was informed that my doctors office Defy Medical is recommending E2 around 50. Personally, I have limited experience with E2 at 50 and above, although I did let it run a bit to about 40 between January and March, and I was pretty frisky, but my prostate was uncomfortable.

I believe there is a debate going on about how prostate BPH and the big “C” are caused, and some say DHT and others say E2.

Personally I believe it’s all about E2,so I am making a greater effort to keep my E2 around 20ish, as suggested by KS Man, and simultaneously lower my SHBG.
This, seems like the best strategy for me right now, since I’ve been all over the place with my therapy.

I’m certainly not an expert, or even a very good novice frankly, but if you choose to run an E2 of 40ish (plus or minus) I’d keep a close eye on the PSA.

On the other hand you say your feeling pretty good, which is more that I can say for myself.

Thanks for the input, and best of health!

I think Nelson Vergil is correct. The 14-22 ratio makes so much more sense than E=22. My total test is 914, and my E2 is 48. I feel GREAT. I have played around with trying to lower it to the magical 20-30 range. I tried .25mg adex, and felt HORRIBLE. I have also tried .125 and still felt Horrible. I think if you are within the 14-20 ratio, then it’s really not worth your time and effort to try and fine tune it to E=22. I’m actually a bit tired of reading the E=22 Dogma. It just doesn’t make any sense to shoot for E=22 regardless of the total testosterone.

This is just my 2 cents based on my own experiences.


I thought I might copy and past this so everyone reading this thread knows what the original poster of the thread was referring to. The following is what Nelson Vergel says on the ratio subject.

As testosterone blood levels go up, so does estradiol. Adolescent boys have a lot of testosterone AND estradiol. Some studies say that testosterone to estradiol ratios of 14-20 are best for fertility.

So, assuming someone’s total testosterone is 1000 ng/dL, then a estradiol of 50-71 pg/mL (divide 1000 by 14 and 20) is to be expected. What causes gynecomastia is not having a high estradiol, but having a low testosterone-to-estradiol ratio.

That is why I am not in agreement with the use of anastrozole unless your T to E2 ratio is below 14.

I know this post will generate some discussion. I have read every single paper of E2 in men and I think this hype is nuts of treating E2 purely based on its value and not on how much testosterone we also have. Testosterone is the prohormone nature made to create estradiol and balancing the two is what matters.

I’ve read that SHBG levels have an impact on where ones e2 should be at. Lower SHBG requires e2 to also be lower and vice versa.

How do you believe that plays into this ratio? Or are you accounting for that with the range of 14-20?

I do believe that e2=22 is not the end all be all. I’ve had perfect e2 tests of e2 at 22 and still felt like crap. My latest e2 #'s have been in the mid to high 30’s. While I still don’t feel great, its better than at 22.

Seems like for me, any time I touch an AI, I end up feeling like crap for a couple months. I am fairly lean though. 6’2 225lbs at 13.6% body fat. This also can play a huge role in the amount of aromatase amounts from what I read.

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We still have guys that feel like crap with E2=~40 who feel a lot better, mentally and physically, nearer E2=22 pg/ml.

Defy Medical states: "Another concerning fact is that many clinics may be using the wrong estradiol test that may be over-estimating the levels of this hormone in men. An ultrasensitive estradiol test more accurately measures estradiol in men instead of the regular test that costs less. "

So we have to also keep there ratio suggestions in that context. Defy Medical states that very little data exists, but they in turn are making some very definite statements. It appears that they are making recommendations engineered to not treat E2 levels unless above normal lab ranges. We know from many many guys here that that is a recipe for disaster.

The bottom line is how an individual feels VS his E2 lab results and not all lab results are the same. We know what works well for most guys here. There are always exceptions, like guys who are anastrozole over-responders and testosterone hyper metabolizers, guys who have bad reactions to clomid. The best course of action is doing what works well most of the time, then refining doses to suit individuals. We can’t let the few who need E2 levels higher be making assertions that would be horrible for most guys.

So what is it about estrogens in males that affects mental health? During puberty, increased testosterone changes brain function and patterns. This is very disruptive and been a teenager can be a difficult transitionary process. Many brain circuits are pruned out and others inhibited. For many male, estrogen dominance leads to mood, intolerance, sexual and energy problems, with confusion as the brains adult configuration struggles when estrogens alter brain function. Just how ones brain circuits evolved to a male brain state and how the brain copes when supporting T and E states change is as individual as the the person. But larger patterns are obvious and easy to recognized.

I have read a two good books, not recalling the titles at this moment, that explore the differences of and between male and female brains and how these change and differentiate over ones life time. Women typically have more caring and nurturing circuits that develop under the domination of estrogens. Men have those circuits largely pruned out under the influence of testosterone and are better equipped to butt heads with other males and excel as warriors and hunters [not driven by empathy and caring]. When women loose estrogen levels they can become less caring. When men have lower T or some estrogen dominance they can become weepy, emotional and typically have a very difficult time of that.

Guys who are really doing better with high normal E2 levels on TRT, do not have the same brain characteristics of guys who would feel like crap with those lab numbers. There is not way to determine these things in advance and they need to struggle to find out what works for them.

SHBG: SHBG is created in the liver to scavenge hormones in blood circulation for return to the liver to be metabolized. The female blueprint controls this and greater estrogen levels cause the liver to produce more SHBG. If E2 is high, not only is E2 blocking E2 benefits, SHBG increases and more T becomes T+SHBG and FT levels decrease. So with more E2 and less FT, there is a double hit on E2:bio-T. And T often blocks estrogens at estrogen receptors and that may be why increased T levels tend to drive down SHBG, leading to more bio-T as there is less T–>SHBG+T. There are some medical conditions that increase/decrease SHBG levels. And a few here seem to have quite low SHBG levels with reasons unexplained.

            About my Free T ratio to Total T being too low

I thought I would do a little novice guy research, and see how low my FT to TT ratio was. I can tell you that lab Corp has my FT score flagged as HIGH, at 33.7

The Range is 7.2 pg/ml - 24.0.

Also, I found a chart from another source which shows that a non TRT guy age 25-34 have TT of 617 and FT of 12.3, and if you divide 12.3 by 612 you get a factor of .020

If I multiply my TT of 1419 by .020 I get a Free T score of 28.4, and my actual labs are 33.7 which would suggest that my FT score is better than guys 24-34.

This may be a little bit od voodoo science but I think it’s valid enough to say my FT isn’t low, but not helpful enough to say anything regarding my SHBG, which I’ll get tested next week.

About targeting 22 for an E2 score vs. the higher levels of like 40ish.

All my E2 scores are sensitive Estradiol scores.

I posted these labs on 8/28/15 and the blood was drawn on 8/24/15 and my E2 was 27.1, and I feel like crap. In an effort to give the lower E2 level a try I took a .10 Anastrozole to knock down my 27.1 score and then after I really did feel like crap. but it’s ok it’s for science.

Today it’s Tuesday and I would say based on half life and the small dose the AI is gone, and now I’m just going to let things go “naturally” and I’ll see when I start to feel good, then better, and then dangerous :slight_smile:

I expect to get to Lab Corp Monday 9/7/15 this could be all about high SHBG. A few years ago I had a E2 19 and a SHBG of 58, which the chart says is normal but on the high side but I don’t know anything about those numbers so it’s it a moot point.

Digging up this old thread because here I am with an E2 of 19.6, a total T of 1142, but my joints are clicky and popping, along with some other symptoms of low E2.

The T:E2 ratio thing makes perfect sense to me, whereas shooting for E2=22 seems dogmatic.

Without AI, my E2 was 40. I’m thinking about stopping anastrozole.

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I have been trying to get my E2 Level’s dialed in between 20-30 for 6 months now. I have never felt good during this time. I crashed my e2 once. Well I don’t know if I crashed it per say. But it was 9. I felt HORRIBLE. So the past month I have done what Nelson
’s formula has said. My recent test resujts were
TT= 1056
E2= 60.1
My dosage is 100mg cyp Monday mornings.
I’m thinking of injecting bi-weekly but I don’t want to mess up a good thing.

I’m right in the middle of the range of the equation. I actually have felt like a million dollars for once! Skin looks good. No sexual problems. I will never take an AI again unless I absolutely have to. I have seemed to lose weight and my nipples seem better than they were when E2 was between 20-30. I guess everything is working like it’s suppised to in my opinion I feel great.

I stopped my anastrazole I will never look back. My e2 is running 60 right now. And I’m taking 100mg cypionate once a week.