@compaq 6764 wrote:

When it comes to brain health and estrogens and treating your male patients with aromatase inhibitors (that need them), what sort of estradiol levels do you try to reach in the effort to balance brain and body support from estrogen vs the common side effects such as gynecomastia, edema, etc?

Something not too high and not too low. Achieving this is complicated.

Generally, when using pg/mL for estradiol and ng/dL for testosterone, there is often going to be around a 20:1 to 30:1 ratio between testosterone and estradiol in men who don’t have hypogonadism. This gives me a range where I can predict the estradiol level from a given testosterone level during treatment. When estradiol is below a 20:1 ratio to testosterone, it may be in excess.

Another technique is to simply chose absolute levels to target for estradiol during treatment.

Note that “estrogen” side effect such as gynecomastia and edema vary a lot in occurrence with men at each level of estradiol. Some have gynecomastia, nipple sensitivity, etc. at low estradiol levels. Some have no effect at high estradiol levels.

When Estradiol goes too low in a male, frequently sexual dysfunction and loss of competitive drive may occur. This is one marker for excessive dosing of an aromatase inhibitor. However, whether or not there is going to be such a negative effect depends on other signals and metabolism.

The sensitivity of each male to estradiol’s effects will vary with the levels of other hormones, signals, and metabolic-nutritional status. For example, the estrogen signal, itself, may need adequate progesterone to stimulate the production of estrogen receptors. If hypothalamic-pituitary adrenal dysregulation is present, the estrogen signal is attenuated and symptoms of low estrogen may occur at higher levels. Additionally, thyroid hormone levels increase SHBG levels. The higher the SHBG, the higher the estradiol but less is free to function. Thus the estradiol signal is reduced despite the higher level. Once the other signal and metabolic-nutritional problems are addressed and signaling optimized in the other systems, the male may not have as large a negative effect from estradiol as prior to addressing the other problems first.

Thus each male treated needs to be considered individually in regard to the targets of treatment. Even with some guidelines, being flexible in approach necessary.

I think what Dr M was saying is that asking effectiveness of one specific treatment or medication isnt useful, there’s too many factors in each individual person at play to determine that….