2009/12/23 Chris Hatlestad <email@example.com> writes:
I came across an older response to a testosterone question on the FACT website where you responded with a formula for the T:E2 ratio or A:E ratio. I have been following the FAI or free androgen ratio which is s-T*0.0347/SHBG with normal 0.7-1.0 and find most everyone low. However, I like the A:E ratio concept.
What is the 30 that you multiply to the s-T?. Also, I am typically measuring total estrogens which is E2+E3. What about using this number and including DHEA-s in the equation for a true A:E ratio.
Also, do you do any hormone implants and if so, how do you calculate or guestimate dosing, men or women? Sourcing for the implants beyond College Pharm?
Chris Hatlestad, MD
Integrative Medicine & Family Medicine, Center for Environmental Medicine
10748 NE Halsey Street Portland, OR 97220
503-261-0966 (office) 503-252-2691 (fax)
in the SI unit scale (which USA proposed switching to, then reneged on!), basal SHBG averages about 20-30 nmol/L. So I correct the A:E ratio back to a basal normative SHBG of 30… SHBG binds 1000 times more to TT than it does to estrogen… hence the higher the SHBG, the lower the free androgen ie FAI relative to estrogen. The FAI alone ignores estrogen. Its like ignoring T3 level in assessing thyroid function- one need the whole axis eg T3 xT4/TSH. .
on the one hand I prefer to use E1+E2+E3.
On the other, we can no longer get S- E1 measured here, there is too little demand . and remember that empirically, it is said that E2 is about ?7 times as potent as E1 and 80 times as potent as E3.
similarly, all the other androgens would have to be brought into the calculation at their disparate androgenic potencies. So for cumulative functional effect one would have a complex formula factoring in the potencies.
Hence, KISS- keep it simple – s-T x 30/ (E2 x measured SHBG).
DHEA is of course one parent hormone, and one never knows how far it is going to convert to androgens vs estrogens. So I measure it if affordable- but like Wiebke Arlt, find it useful to replace only in the old. at least with 7keto DHEA one knows that it cannot be bioconverted back to TT or estrogen- it is simply a weak androgen.
My late inspiration, breast surgeon Dr Roald Maartens here used a formula of 12 hormones for managing (pre)cancer hormone-related diseases. But not even experts like Leon Speroff, Bill Creaseman or David Dent could help him validate and spread his program. I tried to get his thesis validated and published posthumously, but his family jealously decided to let it die with him rather than risk someone else stealing his glory… such is science.
I have an English copy of his unpublished MS, but I cant find anyone who can understand the dense math. His brilliant son helped him with the computer formulae and the program that one of his acolytes still uses blindly, but as I say they blocked my offer to help spread his concept.
I gave up using profitable implants 20 years ago since they may be beneficial and acceptable for many patients, but have a double digit failure/complication rate; are costly; are dependent on how tightly they are compacted ie have widely varying release time- E2 perhaps 6 to 24 months, TT perhaps 3-4 months.
When I first met the woman (whom I married 4 years later), the local Emeritus Professor of Gyne had given her 300mg E2 and 150mg TT in 3 successive implant sessions in 5 months, turning her from chronic fatigue into a bloated over-estrogenized wreck. He never could explain why he defied physiology (as was taught by eg Hans Selye over 60 years ago), instead of giving her- as is normal with implants – at least twice as much TT as E2. (He is still bravely working in the local University menopause Clinic at over 80 years of age). Her s-E2 level was over 3000 pmol/L while her s-T was only about 6nmol/L. Since it is major hastle trying to dissect out implants, I simply balanced the excess E2 with depotestosterone injection every fortnight till her s-E2 dropped below normal after 2 years, since when (now aged 63 years) she has been happily on fortnightly sc 20mg:1mg TT:E2 depot injection a la William Masters & Grody’s 1953 formula. . If we had someone to make progesterone implants here, I would have used combined progesterone estradiol and testosterone implants, as Mannie Schleyer-Saunders in London did for decades with excellent results. You have brave compounding pharmacists there who do so, so go for it with triple implants or triple subcutaneous depot-sexhormone self-injection!
go see if you can get Leon Speroff there interested again in Maartens’ formula? I am delighted to see that Dr Speroff is still publishing prolifically, now validating depot hormones subcutaneously as I have been advocating at international congresses the past 6 years, and on this column.
Seasons Greetings- take care!
ndb in sunny Cape Town