I think the correct answer may be both. Many of you reading this are aware that most endogenous E2 is due to aromatase conversion of T to E2. So while on ADT, there is little or no endogenous E2, often under 5 pg/mL (mine was < 2). The implication is that during ADT (or loT BAT cycles), a low dose add-back E2 patch could significantly improve interest in sex and sexual function if a link to E2 can be confirmed.
Anecdotally, my first ADT shot in Oct, ‘22 resulted in 6 mos of a nearly absent interest in sex. On a scale of 1-10, I’d say it was 1 or 2 at best. After a brief ADT vacation, the next shot came in Jan, ‘24. I applied my first low dose E2 patch a month or two later. For the last 12 months, I’ve used weekly E2 patches on every loT cycle of BAT. Sexual interest has jumped to a 6 or 7 out of 10 (not surprisingly, it’s 10 of 10 on hiT). It wasn’t placebo effect, as I had not read anything about the connection between E2 and sexual desire until recently.
Here’s a link to a technical paper that appears to confirm the role of E2 in men’s sexual health, including desire:
“The role of estradiol in male reproductive function” (see first couple of pages.)
pmc.ncbi.nlm.nih.gov/articl...
Unless I’ve missed it, I haven’t seen many (if any) posts on this topic in my 2 yrs on this forum. Why isn’t this discussed more?? Perhaps someone with access to Chat GPT can do a query to confirm the role of E2 in men’s sexual health. I understand why it’s unlikely to undergo clinical trials, but if there’s any reasonable evidence at all, I’d think many more guys on ADT would be asking their docs for a script. My MO promptly wrote one for me after I showed him this paper:
“Estradiol for the mitigation of adverse effects of androgen deprivation therapy”
erc.bioscientifica.com/view...
Here’s the answer to the question on sexual desire that I got from Google’s AI:
Yes, low estradiol levels in men can contribute to a loss of sexual desire, especially when combined with low testosterone levels, impacting libido and sexual function.
Here's a more detailed explanation:
Estradiol's Role:
Estradiol, a type of estrogen, plays a role in modulating libido, erectile function, and spermatogenesis in men.
Low Estradiol and Sexual Function:
Studies have shown that men with decreased estradiol levels report low libido and sexual activity, which can be improved by estrogen administration.
Testosterone and Estradiol Interaction:
Testosterone and estradiol work together to maintain healthy sexual function. When estradiol levels are low, it can disrupt this balance, potentially leading to reduced libido and erectile dysfunction.
Research Findings:
A study published in Nature found that in men with decreased libido and testosterone levels below 300 ng/dl, libido was significantly improved when the estradiol level was over 5 ng/dl.
pBAT update after two cycles.
PSA suppression