title: High estrogen in men after injectable testosterone therapy: the low T experience.
abstract: Testosterone replacement improves quality of life and is aromatized in men in adipose tissues to estrogen. Hyperestrogenism is believed to be harmful to male sexuality. This is a description of our experience of screening 34,016 men in the Low T Centers, of which approximately 50% were converted to treatment. Men were treated with injectable testosterone, and we have available data from 2009 to 2014. The data were extracted from our electronic health record (AdvancedMD) of 35 Low T Centers across the United States. In all, 7,215 (20.2%) out of the 34,016 patients had high estradiol levels defined as ≥42.6 pg/ml. Estradiol was measured using electro-chemiluminescence immunoassay. Of the patients who had high estradiol levels, the age distribution was as follows: 132/989 (13.3%) were older than 65 years, 3,753/16,955 (22.1%) were between 45 and 65 years; 2,968/15,857 (18.7%) were between 25 and 44 years, 7/215 (3.3%) were younger than 25 years. The difference between extreme age groups (<25 and ≥65) was statistically significant using a chi-square test (p = .013). The correlation coefficient of serum estradiol to age was .53, SD = 8.21. It was observed that practitioners used aromatase inhibitor and selective estrogen receptor modulator to treat symptoms of hyperestrogenism, irrespective of blood estradiol levels. Gynecomastia was rarely documented as a reason for the prescription. Our finding was that high estradiol levels were not associated with higher rates of low libido but established higher rates of documented low libido with those with normal or lower estradiol levels. The difference was statistically significant (p < .05).
authors.affiliation: Michael DeBakey VA Medical Center, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA University of Texas, Houston, TX, USA Opal Medical Clinic, Houston, TX, USA Low T Institute, Southlake, TX, USA opalmed@comcast.net.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Tan
authors.affiliation: Low T Institute, Southlake, TX, USA.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Cook
authors.affiliation: Low T Institute, Southlake, TX, USA.
authors.forename: William G
authors.initials: WG
authors.lastname: Reilly
mesh_terms: D000328:Adult; D000368:Aged; D000728:Androgens / Q000008:administration & dosage / Q000009:adverse effects; D047649:Andropause / Q000187:drug effects; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D057286:Electronic Health Records / Q000706:statistics & numerical data; D004958:Estradiol / Q000097:blood* / Q000502:physiology; D004967:Estrogens / Q000097:blood* / Q000502:physiology; D006177:Gynecomastia / Q000139:chemically induced*; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy; D007267:Injections; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012189:Retrospective Studies; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*; D013739:Testosterone / Q000008:administration & dosage / Q000009:adverse effects / Q000172:deficiency*; D055815:Young Adult
chemical_list: D000728:Androgens; D047072:Aromatase Inhibitors; D004967:Estrogens; D020845:Selective Estrogen Receptor Modulators; D013739:Testosterone; D004958:Estradiol
keywords: age; aromatase inhibitor/SERM; estrogen; gynecomastia; testosterone therapy