TRT - Leave E2 ALONE!

[BigTex]

Great Video - patients taking testosterone + anastrozole did not reduce visceral fat mass when compared to testosterone alone. Testosterone by itself is anti-inflammatory AI's prevent this which can lead to cardiac damage.

What are the benefits of micro-dosing and IM vs sub-q?



https://youtu.be/BbqQgJbNOPw?si=d6oI7Um0v_vmTr3m


Ng Tang Fui M, Prendergast LA, Dupuis P, Raval M, Strauss BJ, Zajac JD, Grossmann M. Effects of testosterone treatment on body fat and lean mass in obese men on a hypocaloric diet: a randomised controlled trial. BMC Med. 2016 Oct 7;14(1):153. doi: 10.1186/s12916-016-0700-9. PMID: 27716209; PMCID: PMC5054608.
https://pubmed.ncbi.nlm.nih.gov/27716209/

https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0700-9

Conclusions
Among obese men with a low to low-normal testosterone typical for the majority of obese men, testosterone treatment augmented diet-induced loss of total fat and visceral fat mass, and preserved lean mass so that, in contrast to placebo-treated men who lost both lean and fat mass, diet-induced weight loss during testosterone treatment was almost exclusively due to the loss of body fat.

Discussion
The major novel findings of this RCT are that, among obese men with low to low-normal testosterone submitted to a weight loss program, testosterone treatment decreased total fat mass and visceral adipose tissue, and protected against loss of total and appendicular lean mass.

Holland AM, Roberts MD, Mumford PW, Mobley CB, Kephart WC, Conover CF, Beggs LA, Balaez A, Otzel DM, Yarrow JF, Borst SE, Beck DT. Testosterone inhibits expression of lipogenic genes in visceral fat by an estrogen-dependent mechanism. J Appl Physiol (1985). 2016 Sep 1;121(3):792-805. doi: 10.1152/japplphysiol.00238.2016. Epub 2016 Aug 18. PMID: 27539493.

Overall, these findings indicate that the lipolytic and antilipogenic effects of TEST are enhanced by aromatase activity, indicating both androgenic and estrogenic regulation of adiposity in male visceral adipose tissue. Future research evaluating the time-course responses of visceral adipose tissue to TEST administration with and without aromatase inhibition would assist in elucidating the androgen/estrogen-mediated pathways regulating adiposity.

https://journals.physiology.org/doi/full/10.1152/japplphysiol.00238.2016


Steiner BM, Berry DC. The Regulation of Adipose Tissue Health by Estrogens. Front Endocrinol (Lausanne). 2022 May 26;13:889923. doi: 10.3389/fendo.2022.889923. PMID: 35721736; PMCID: PMC9204494.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9204494/

Sebo ZL, Rodeheffer MS. Testosterone metabolites differentially regulate obesogenesis and fat distribution. Mol Metab. 2021 Feb;44:101141. doi: 10.1016/j.molmet.2020.101141. Epub 2020 Dec 9. PMID: 33307216; PMCID: PMC7772371.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7772371/

Juang PS, Peng S, Allehmazedeh K, Shah A, Coviello AD, Herbst KL. Testosterone with dutasteride, but not anastrazole, improves insulin sensitivity in young obese men: a randomized controlled trial. J Sex Med. 2014 Feb;11(2):563-73. doi: 10.1111/jsm.12368. Epub 2013 Nov 6. PMID: 24344872.

https://europepmc.org/article/MED/24344872

Cruz-Topete D, Dominic P, Stokes KY. Uncovering sex-specific mechanisms of action of testosterone and redox balance. Redox Biol. 2020 Apr;31:101490. doi: 10.1016/j.redox.2020.101490. Epub 2020 Mar 5. PMID: 32169396; PMCID: PMC7212492.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7212492/

ESTRADIOL Ultra Sensitive (LC/MS) Blood Test

This ultrasensitive estradiol test is recommended for men. The commonly used estradiol test may overestimate estradiol in men. That test uses immunoassay technology that cannot differentiate C-Reactive Protein (involved in inflammation) from estradiol, so it reads the combination of the two as estradiol. This ultrasensitive estradiol test is based on liquid chromatography/mass spectrometry (LC/MS), an assay technology that does not have that limitation

https://www.discountedlabs.com/estradiol-sensitive-lc-ms-ms

 

[Tiny]

“That test uses immunoassay technology that cannot differentiate C-Reactive Protein (involved in inflammation) from estradiol, so it reads the combination of the two as estradiol.”

I knew men should take the LC/MS testing that offered greater accuracy, but wasn’t sure why. I had assumed it was due to men having lower E2 levels than women so the inaccuracy increased the margin of error.

this is the first that I’ve seen that c reactive protein was the source of inaccuracy. Does anyone know if this hold true from women as well?

my TRT clinic pulls the standard E2 test and it annoys me. However the results I’ve seen from their labs are actually lower than some of the lc/ms testing that I’ve done on my own. If anything, I suspected that my results were understated, not inflated with the immunoassay test.