Common and accepted medical belief was that testosterone was associated with libido. This was due to an association with low T and low libido. But those of us in the field of men's health recognized that low T did not tell the entire story. While some men with very low T AND low libido reported improved libido with normalized T levels, the improvements were inconsistent as best and not linear in nature. By that I mean that after a certain T level was reached, further increases in T did not result in further improvements in libido.
Estrogen: Estrogen and Testosterone are intimately related. Estrogen in fact comes from testosterone via conversion by aromatase, an enzyme. Men with low T will also have low E levels and increasing T levels with medication will also increase E levels. Rising E levels in a man on testosterone therapy can cause gynecomastia, which is breast development. As gynecomastia is an adverse outcome, doctors that do TRT monitor E levels and treat rising E with an aromatase inhibitor like Anastrozole. I used to do this as well, and still do but much less often than in the past. Why? Because I noticed that some of my men on Anastrozole began complaining of dimished libido. Research studies presented at this AUA14 supported what I noticed several years ago.
Conclusion: estrogen and testosterone are linked and both are needed for libido, but estrogen might be the more important of the 2 hormones in relation to libido. More studies are needed.
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