Suppose you’d been told all your life that a football field was “120 long and 1920 wide” – you’d think it was way wider than long, right…? Well, the numbers are correct, but in different UNITS - I gave the length in yards, and the width in INCHES…
We (physicians) have been told (by the labs) that normal hormone levels for young healthy men and women are for women – an estrogen of maybe 200 or so, and a testosterone of maybe 50, depending on time in cycle. A male would have an estrogen of around 20, and a testosterone level of maybe 500. This 'made sense' to us, with each gender having a bunch more of 'their' hormone. There was no deception intended, but the labs usually try to use 'units' that are 2-3 digit whole numbers, just because they are easier to deal with - you wouldn't report the distance between Seattle and Indianapolis in feet, nor the dimensions of a desktop in yards.
But if the hormone levels were all reported in the same units as the woman’s estrogen, her testosterone level wouldn’t be “50”, but rather 500…! And the guy’s estrogen would be about 20, but his testosterone would be 5,000…! Depending on the lab used, the age of the woman, and the time in her cycle, a normal woman’s testosterone can be as much as ten times as high as her estrogen level…!
Each lab and clinic have different opinions and ‘ranges’, but a typical one is listed below – with translation to the same pg/ml for all:
Testosterone – male 300-1,000 ng/dl or 3,000-10,000 pg/ml – say ‘avg 6,500 pg/ml’
Testosterone - female 15-70 ng/dl or 150-700 pg/ml – say ‘avg 425 pg/ml’
Estrogen – male 10-40 pg/ml - say ‘avg 25 pg/ml’
Estrogen - female 56-214 pg/ml – say ‘avg 135 pg/ml’
Grouped by gender instead of hormone, just the averages of the same data:
Female Estrogen – 135 pg/ml and Testosterone - 425 pg/ml
Male Estrogen – 25 pg/ml and Testosterone – 6,500 pg/ml
Roughly - the rounded-off ratios are: Male Estrogen 1 vs Testosterone 250 and Female Estrogen 5 vs Testosterone 15
There are other subtleties, in that we often measure ‘free’ or ‘unbound’ hormones for more accuracy, we look at sub-types of estrogen (and sometimes testosterone), and the ‘desirable’ range is not the same as the ‘reference’ range – but the overall message is the same.
Two lessons here – First - estrogen is VERY potent – it clearly is able to make huge changes to the body (the only reason women have fancy breasts is their estrogen/testosterone level being higher at 1:3 versus a male at 1:250) even though it is only present it smaller amounts than testosterone. Secondly - the other lesson is that when we treated hormones in the past we messed up repeatedly:
Originally the majority of people died young, with an average lifespan of 40 or so, before aging/declining hormones did anything to us, and before we got cataracts or much arthritis. But sanitation and antibiotics and so on helped double lifespan over the recent hundred years or so, and now we nearly all tend to live long enough to get cataracts – which we fix, and arthritis – which we treat – and low sex hormones – which we ignore.
Since 'sex' hormones do FAR more than facilitate bedroom activities (they affect metabolism, heart disease, bones, brains, etc.), we began treating both genders for menopause, although at first just for ‘convenience’ – reducing hot flashes for women, and helping men perform in the bedroom. Since the body has a built-in safety mechanism to neutralize any hormones we might accidentally ingest (a pancreas full of insulin would be lethal), we started men out right, on injections of real human ('bioidentical') hormones, with no synthetics, but because shots were painful and embarrassing, and might make them spot if not given often enough, we gave women synthetic hormones we could give orally - and harmed them (by increasing heart disease, strokes, and cancers) for a whole generation. Then the next generation we were so scared due to the harm we’d caused that we didn’t give hormones at all, which was just as bad if not worse (still lots of heart disease, diabetes, strokes, and cognitive decline). Then, we realized if we used real human (bioidentical) hormones, using creams, we could give women the benefits we’d given men in terms of reducing cardiac and stroke risk, improving diabetes, delaying dementia, strengthening bones, and so on, and do it without any significant increase in cancers (actually reducing uterine and ovarian cancer deaths, and most likely not affecting breast cancer significantly one way or the other*).
But even now, we still see so many women enter older age much more frail than men do – without the ability to survive falls or even pneumonias, and without the vigor to do hobbies or yardwork that men often retain in older age. Now we are realizing that because we’ve only added testosterone to women’s postmenopausal regimens if they complained of bedroom/libido issues, it’s clear we may have once again done them wrong by omitting one of their most important hormones – they have less testosterone than men do, but in their prime of life they have more of it than they do estrogen. Why would we leave it out…? (Hint – because it takes time to explain such things and discuss them, and most people see doctors who are paid by insurance, and insurance pays for about 6-8 minutes of a physician’s time – past that the physician loses money if he ‘accepts insurance’).
I see many physicians who put themselves and their wives or husbands on hormone replacement, yet don't bother to even discuss it with patients, because that isn't going to fit into a 4-minute 99214 visit, and requires depth of discussion and trust that isn't often present in today's healthcare 'system'. So clearly there are other physicians out there who sincerely think that we shouldn't just let people have low levels of essential hormones when they get older, any more than we'd just let them have untreated cataracts or untreated arthritis.
Anyway - it will be interesting to see how this new 'epiphany' (that healthy women actually have more testosterone in their system than they do estrogen) affects the already-controversial area of hormone replacement. Full hormone replacement may not be ideal for everyone, but should at least be one thing, along with diet, nutrition, supplements, and exercise, that is part of consideration in trying to stay as healthy as possible for as long as possible.
* Of course everything in healthcare is 'controversial' and there is still lingering debate as to the impact of hormones on breast cancer - however if you dig beyond the hype, I think it becomes pretty clear that hormone replacement should not be ignored due to whatever risk there is or isn't concerning breast cancer - several references on that:
First a commentary on the great flaws in the Women's Health Initiative, which did NOT show that “estrogen causes breast cancer” (tended to show the opposite), but led to 50,000 or more women dying needlessly due to the irrational fears the media flamed by taking the data out of context and failing to use hormone properly, or even at all. - http://peterattiamd.com/caroltavris-avrumbluming/ - long but quite worth listening to...!
Even the Principal Investigator of the WHI study, Dr. JoAnn Manson, goes into how deeply flawed the WHI was, and how incredibly distorted and sensationalized not only the 'news' media coverage was, but the 'prestigious' medical journals like NEJM and JAMA went obligingly along with the party-line. - http://www.youtube.com/watch?v=8bRuzA-qd0s - not as up to date, actually, but something perhaps skeptics would find reveals that even those running the WHI knew it was deeply flawed.
Further, the numerous types of estrogen existing pre, peri, and post-menopausally in women can and should be looked at, and can be shifted by use of simple changes in diet, or supplements. https://dutchtest.com/video/an-integrat ... st-cancer/
). More often, the woman will have been given antidepressants and sleeping pills and told it is somehow normal to have a diminishing libido past age 40 - when odds are good that supplementing magnesium, iodine, progesterone, and perhaps melatonin (properly dosed) at bedtime, would do the job right, fixing the problems instead of just treating symptoms. Or I see dudes who heard "statins are bad" and because they WERE truly over-prescribed for a couple decades, refuse to take them despite oxidized LDL's through the roof, and omega-3 levels so low their peripheral vessles show calcification on xrays. Ironically the same patient whose (legitimate) distrust of Big Pharma has pushed them to refuse what might be an appropriate medication for THEM (even if not for many others), will not bother to address an elevated homocysteine due to MTHFR single nucleotide polymorphisms (which may be more dangerous than the lipids), because the MethylGuard Plus they need isn't a prescription medication from Big Pharma, so isn't covered by insurance. Most likely though - their doctor probably hasn't addressed any of those things to begin with, and since the patient feels ok, they don't know that the stroke they are going to have in 14 years could be easily delayed until 30 years, or that the breast or prostate cancer that will finally be found at age 60 and have a huge surgery/radiation/chemo fight with, could have been found way earlier - and fixed so much more easily - if they would have had their testosterone or progesterone addressed, or even in the case of women, simply been placed on an iodine supplement. 
