Blood Test Ratios

BLOOD TEST RATIOS

Target estrogen and progesterone and ratios on blood testing in women

-	PROG.	ESTROGEN	TOT E/E2	PROG/TOTAL EST
UNDER 50	2000- 14000 pg/ml2-14 ng/ml	180-200pg/ml	2.5 or lower (E2.40% or more ideally)	10-20
OVER 50	2000-8000 pg/ml	60-120pg/ml	2.5 or lower	10-20

Target testosterone in women (testosterone: estrogen ratio of 2-5)

Estrogen	total testosterone	free testosterone	testosterone/estrogen ratio
180-200pg/ml (under 50) 60-120pg/ml (over 50)	120-900pg/ml	1.2-3.0 pg/ml	2-5

STEROID HORMONE CONVERSION

DHEA

I

ANDROSTENEDIONE

I I

ESTRONE E1 TESTOSTERONE

I I I I

ESTRIOL E3 ESTRADIOL DHT (dihydrotestosterone)

BLOOD HORMONE LEVELS FOR MEN

Hormone	lab reference	target
Testosterone total	2700-9700pg/ml	6000-9000pg/ml
Testosterone (free)	18-40 pg/ml	25-35 pg/ml
Estrogen	40-115pg/ml	less than 100 pg/ml
Estradiol (E2)	21-50 pg/ml	20-40 pg/ml

Target hormone ratios

Testosterone/estrogen – 80-120
Estradiol/free testosterone – less than 1

Target progesterone levels and ratios for men

Progesterone – 1500-2500 pg/ml or 1.5-2.5ng/ml

Progesterone/estrogen ratio – 15-20

Thyroid	Coventional approach	anti-aging paradigm	TSH (mU/L)
TSH >5.5	Underactive thyroid	Increased risk of heart disease	TSH>4
0.2-5.5	“normal”	Increased risk of future thyroid deficiency	TSH 2-4
		Optimal thyroid function	TSH 1-2
<0.2	overactive thyroid	overactive thyroid	less than 1

Dosage guidelines for DHEA

	MALE	FEMALE
Start with	50mg/d	10mg/d
Increase by	5-10mg/d	5-10mg/d
Maximum	100mg/d	50mg/d

Optimal dhea:cortisol ratio = 15:1

Increase dhea: if low levels

dhea:cortisol < 15

no improvement in mood or energy

decrease dhea if : high level

restlessness, aggression, overstimulation

oily skin or acne, increased hair growth (in women)

RELATIVE POTENCY OF ANDROGENS

Testosterone – 100
DHT – 300
DHEA – 5
DHEAS – 5
ANDROSTENEDIONE – 10

BIOAVAILABLE TESTOSTERONE

Bioavailable = free testosterone + loosely bound testosterone to albumin

120-600ng/dl male

2-20 ng/dl female

DHT ng/dl 30-85 male
4-22 female
Optimal 15-40

Optimal 15-25
NB to Estradiol 15-45 pg/ml

measure and control in men

Testosterone male 350-1030 ng/dl
Female 10-55 mg/dl
10.4nmol/l = 300mg/dl
Nmol/l x 28.8 = ng/dl
Pmol/l x 0.0288=ng/dl

Remember reference ranges are not optimal ranges

Total Testosterone :

1. circadian

2. Draw in am

3. Automated, consistent

4. May not correlate with free testosterone depending on SHBG

5. May not correlate with bioavailable Testosterone depending on SHBG and albumin

SHBG binds T>E

20-60 mmol/l male

40-120 nmol/l female

Free androgen index = Testosterone x 1000/SHBG

Increases SHBG

Thyroid

Estrogen, progesterone

Aging

Decreases SHBG

Low testosterone

Glucocorticoids

Growth hormone

Insulin

Free testosterone: 8- 30ng/dl male=80-300 pg/ml

1.1-6.3 pg/ml female (fraction unbound to albumin and globulin)

Lab tests: equilibrium dialysis or ultracentrifugation

Inaccurate RIA

Dr Craige Golding
Specialist Physician & Anti Aging PhysicianMBChB (Cum Laude, Pretoria)
FCP(SA) Specialist physician/Internist
ABAARM: Board Certified Anti-Aging Physician – American Board of Anti-Aging and Regenerative Medicine
FAARFM :Advanced Fellowship in Anti-aging, Regenerative and Functional Medicine
Practice number 1811479

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