Testosterone and oestradiol

End hormone or mediator · Aromatase 5-alpha reductase SHBG

The gonadal end hormones: theca and Leydig androgen, aromatised in granulosa cells to oestradiol. Both act on nuclear receptors and both feed back on the hypothalamus and gonadotroph.

Traced from the start

  1. Gonadotrophin-releasing hormone pulse generator (arcuate nucleus)
  2. Gonadotroph — luteinising hormone and follicle-stimulating hormone
  3. Leydig cells and ovarian theca cells (the LH target)Sertoli cells and ovarian granulosa cells (the FSH target)
  4. Testosterone and oestradiol

Detail

Amplification
5-alpha reductase converts testosterone to dihydrotestosterone in genital skin, prostate and hair follicle — the ligand of external virilisation and of benign prostatic hyperplasia
Transport
Both are largely SHBG-bound; SHBG rises with oestrogen and thyrotoxicosis and falls with obesity and insulin resistance, so total testosterone can mislead
Feedback direction
Oestradiol is inhibitory at low and moderate levels but becomes stimulatory when high and sustained — the one routine positive loop in this system
Bone
Oestradiol, in both sexes, closes the epiphyses and maintains bone density

When it goes wrong

Aromatase deficiency or an oestrogen receptor mutation in a man

The epiphyses never fuse: continued linear growth with osteoporosis, proving that oestrogen rather than testosterone closes the growth plate

Untreated hypogonadism of any cause

Loss of libido, reduced muscle mass, infertility and osteoporosis; in women also vasomotor symptoms and accelerated bone loss

Practise this structure

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