Muscular Development|June 2020

Do you have too much yin for your yang? In the human body, for everything there is balance.
Daniel Gwartney, M.D.

Too often, opposing forces are seen as competing factors – yet the opposing forces in the body are necessary and beneficial to promote function and health.

In our bodies, balance is demonstrated in many ways: insulin is released as blood sugar rises, opposing hormones (e.g., glucagon, growth hormone) are released when blood sugar drops; hunger signals are generated by one set of hormones, satiety by others; certain neurotransmitters create an excited mental state, others generate calm and sleep; and so on.

Testosterone is a potent hormone involved in metabolic balance, directly interacting with specific receptors in the cells and membranes of androgen-sensitive tissue. Testosterone is also a prohormone for its metabolites DHT (a more potent androgen) and estradiol (the primary estrogenic or “female” hormone).

If one considers the two primary functions of testosterone – androgenic (producing male features in sexual organs, skin, hair, fat distribution, etc.) and anabolic (e.g., building skeletal muscle, bone, heart, etc.), there are two distinct “opposing” hormones. The androgenic effects of testosterone are balanced by estradiol, whereas the anabolic effects are balanced by cortisol— a catabolic steroid hormone. DHT is much more potent and relevant in androgen-sensitive tissue compared to testosterone. Unfortunately, there is little value to measuring circulating (blood) concentrations of DHT, as it is typically generated within these androgen-sensitive tissues and metabolized (broken down) before being released into the bloodstream.1

Some athletes may have heard of the T/E ratio in sports-doping urine tests; this refers to the ratio of testosterone to epitestosterone – this has nothing to do with the T/E ratio relating androgenic to estrogenic effects (testosterone to estradiol). There has been a near-absence of discussion on the optimal testosterone to estradiol (T/E) ratio. Bear in mind, as one deviates further and further away from the physiologic range of these hormones (i.e., doping with anabolic-androgenic steroids aka AAS), absolute amounts will trump ratios in regard to the emergence of adverse side effects. Also, use of 5-alpha reductase inhibitors (e.g., finasteride, dutasteride) can “tip the scales” toward an estrogenic dominance by blocking the production of the previously mentioned strongly androgenic metabolite, DHT.2 Many AAS users self-administer this class of drug (5-alpha reductase inhibitors) to avoid accelerated hair loss or urinary problems due to prostate enlargement. It is also a commonly prescribed class of drug for the same purposes; there have even been some (misguided) suggestions to prescribe these drugs to reduce the risk of prostate cancer. Conversely, the use of non-aromatizing AAS (AAS that cannot be converted into an estrogen) can result in effects suggesting an exaggerated T/E ratio.

Man Boobs and Beefy Cattle

Discussions relating to the T/E ratio in medicine typically are directed toward men suffering from symptoms of estrogen excess (e.g., gynecomastia or “man boobs”), testicular atrophy (small balls) or infertility(inability to get a woman pregnant).3,4 There are extremely rare genetic conditions in which a man is born without aromatase enzyme or mutations in the receptors that respond to estrogens.5 Though these reports and studies relate to health conditions, there may be information to be gleaned that is of value in understanding conditions that optimize muscle hypertrophy or body composition.


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June 2020