Nearly every doctor and every patient believes that their sex drive or libido comes from their testosterone level and that restoring testosterone with injections, gels, or pellets will restore a man’s virility. The answer is yes and no. Yes, testosterone is responsible for a man’s sex drive but so is the ratio of testosterone to estrogen. A testosterone/estrogen imbalance can severely inhibit sexual desire and sexual performance.
In a man’s youth, low amounts of estrogen are used to shut down the powerful cell stimulating effects of testosterone. As estrogen levels increase with age, testosterone cell stimulation may be locked in the “off” position, thus turning off sexual arousal and sensation and resulting in a loss of libido in aging men.
Another concern is that aging men sometimes convert testosterone to estrogen. The increase in estrogen is taken up by testosterone receptor sites in the cells and prevents circulating testosterone from gaining access to the cells where it can do its greatest function.
Testosterone is responsible for the sex drive in both men and women. In order for testosterone to do its job, it must be in the free form and not bound to other circulating proteins like sex hormone binding globulin (SHBG). SHBG increases with age and grabs the free testosterone making it unavailable to the cells where it is needed to initiate sex-stimulating centers in the brain. Also excess estrogen increases the production of SHBG and blocks the testosterone-receptor sites. These are the two mechanisms that impact a man’s libido associated with aging.
Therefore, it is necessary to suppress excess levels of SHBG and estrogen while increasing free testosterone to the level of a younger more youthful man. By restoring the normal ratio of testosterone to estrogen ratio a man’s libido and sexual performance often improves.
One of the easiest ways to accomplish this restoration of the normal T\E ratio is to prevent testosterone from being converted into excess estrogen. Too much estrogen plays havoc with a man’s sex life by binding to testosterone receptor sites and also the associated increase in SHBG, which decreases the freely available testosterone.
Certainly estrogen is a necessary hormone for men just as testosterone is necessary hormone for women.
The problem of an abnormal ratio of T\E can easily be diagnosed with a simple blood test for estradiol. Levels that are greater than 30pg/ml are abnormal and would benefit from treatment that lowers the estrogen level and the SHBG levels.
Treatment of elevated estradiol in men can be accomplished with a prescription medication, Armidex, which is aromatase inhibitor and blocks the conversion of testosterone to estrogen. The dosage is 50mg\day. Studies have demonstrated that this dosage decreases the estrogen level in approximately one month.
Bottom Line: Testosterone deficiency is a common problem affecting many middle age and older men. Often this is due to an imbalance of testosterone\estrogen ratio. This can be easily treated with oral aromatase inhibitors. So if you are middle age and your doctor prescribed testosterone and it isn’t working, I suggest you speak to him or her about getting an estradiol level and if it is elevated, then treatment with an aromatase inhibitor.
Dr. Neil Baum is a physician practicing at Touro Infirmary and can be reached at his office, 504 891-8454, or via his website, http://www.neilbaum.com