This study found that lower TT and E1 associated with more "poor health" as defined by questionnaire. The conclusion might lead one to think that Estrogen therapy is need in men. Eightly percent of estrogen production in men occurs from Testosterone. If Testosterone declines, then estrogen production will likewise decline. A simple fact that the authors did not comment on. Also, E1 binds with high affinity to ER alpha, which is pro-inflammatory and pro-proliferative: neither of which is a positive health benefit. This appears to point more to a broad HPA suppression as an association to the "poor health".
This study tried to see if questionnaires could replaced free Testosterone test to diagnosis hypogonadism. The answer of course is no. One needs both to properly assess a individual.
Testosterone levels appear to be more of a biomarker of poor health in older men that are obese with diabetes. More of these men had low free Testosterone (calc) versus Total Testosterone. Using QOL questionnaires, weak correlation (not statistically significant) with androgen deficiency symptoms and ED were found.
free Testosterone proves more useful than serum Total Testosterone, symptom questionnaire and testicular atrophy in the diagnosis of hypogonadism in men with ED.