I have seen it mentioned countless times not to worry about the empirical E2 number (and certainly don’t try to modulate or suppress it); and i have seen other posts that say the ratio of the two is more important than the either level alone.

I used omnicalculator to calculate a ratio of 1.598 but i cannot find a meaningful range. There are several medical abstracts that reference a range, but not sure if they are valid for TRT patients or not. Is there a generally agreed upon “ideal” T:E2 ratio range within the TRT community?

I think the ideal T/E2 ratio when natural is Total T 800 and estrogen 20-30, this ratios are what I see in the men who are healthy, obese men will have higher estrogen, but on TRT because our levels are higher more often, estrogen tends to climb higher than it would naturally.

You need to focus less on your calculators and numbers and start focusing on dosing and injection frequencies and stop trying to aim for a particular number, if that’s what you are doing.

@rabbit_ears - what’s an omnicalculator and what does 1.598 represent? 1.598 the times the amount of testosterone to estradiol?

Ratio of 15-25:1 seems to be ideal. (15-25 T for every 1 E)

In reality though it’s where you feel best at. There’s a big difference between feeling ok and best.

There is unfortunately bit of a mess in the literature in how the T to E2 ratio is calculated.

Some use T in ng/dL and divide by E2 in pg/ml

And some use T in nmol/l divided by E2

in nmol/L (after calculating from pmol/L)

If one has T levels of 600 ng/dL (20.8 nmol/dL) and E2 levels of 23 pg/ml (84.5 pmol/L) than he has a T to E2 ratio of

- 26 using the first formula or
- 246 according to the second one

Strangely some even use the second formula and divide the result by 100. So you get 2.46

To keep it simple use the first one and than as @dextermorgan mentioned between 15 to 25 is good

So I guess you have a ratio than of 16 (in simple terms)

This is easily the most controversial topic in TRT. This and AI use.

Three camps:

Camp 1: E2 does not matter

Camp 2: Keep within ratio. I.e., 15-25 T for every 1 E.

Camp 3: Keep within range. I.e., 20-30 E2.

The tricky thing is there’s optimal patients in all three camps. Dudes with 100+ E2 feeling great, dudes within 15-25 T to 1 E feeling great, and dudes within 20-30 E2 feeling great.

Camp 1 is not necessarily different than Camp 2. More evidence looks like staying within a general ratio is best.

Best to pick a protocol and stick with it long enough (2-3 months) and either change the quantity of dose or quantity of injections and reassess until you’re optimal.

I’m fine with Camp 1 and Camp 2. With Camp 3, you may be feeling great ‘now’ but you are harming your health in the long run. You can’t have your E2 at 20 and your total at 1000. The ratio is way too high and we most definitely have literature demonstrating high ratios causing harm.

I agree with this, but many docs unfortunately are stuck at Camp 3.

Weird thing is I’ve met some people who claim to take AIs whenever they feel symptoms and somehow claim to feel great year after year on TRT. However, this didn’t work consistently in my experience.

This has confused the hell out of me. I was pulling up studies and they were showing ratios like .25 or 1.7 and I couldn’t even figure out how they were calculating that. Using the T in ng/dL and divide by E2 in pg/ml formula I get 818 ng/dL / 33 pg/mL = 24.79. What I was wondering is if they were using free T instead of total T in which case that formula would give .56.

Total T (ng/dl) to E2 (pg/ml)

15-25 T to every 1 E is how we on the forum calculate it.