Women have a ratio of 0.04 or less. For both genders with diabetes, we follow the testosterone, estrogen, sex hormone binding globulin, fasting insulin level and hemoglobin A1C to monitor improvement with hormonal treatment. Men with disease and aging have an increase in testosterone blockers. The two main blockers are estrogen and sex hormone binding globulin. Sex hormone binding globulin amplifies the amount of estrogen by preferentially tying up testosterone.
Estrogen turns off the brains signals to make testosterone.
Estrogens like estradiol and estrone block the action of testosterone in the cell. The individual shown below knows that he has to follow a diet low in processed carbohydrates and exercise. But in his mid-50's, he isn't going to change. He did start testosterone replacement with injections and then long-acting pellets. His fasting insulin levels dropped in half and the amount of stored sugar in his cells as related to Hemoglobin A1C improved dramatically.