The ratio argument is coherent, so I’ll steelman it properly before pushing back. A 93 E2 reading means something different at 400 total T vs. 1230. At 1230, your ratio is roughly 13:1, which falls inside the commonly cited 10-16:1 optimal window. If you’re anchoring on the absolute 93 and calling it high without checking where T is sitting, you’re reading half the data. That’s the ratio camp’s actual point, and it’s not wrong. But ratio-only thinking has a hole in it: SHBG. Sex hormone binding globulin binds both T and E2, which means elevated SHBG compresses the free fractions of both. Someone with high SHBG can have an alarming absolute E2 and a technically bad ratio while their free E2 activity is completely unremarkable. Neither the absolute number nor the ratio tells you the bioavailable fraction without the SHBG piece. It’s a third variable that both camps tend to skip. A study I read suggested E2-related symptom burden tracked better with free E2 than with total. imo Makes sense mechanistically: the receptor doesn’t care about total serum, it cares about what’s unbound. What I’d look at instead of ratio: the symptom cluster. Water retention, emotional volatility, nipple sensitivity, libido changes. If those are absent at 93/1230, that’s signal. “I feel great” is a measurement, not a rationalization. The ratio heuristic is useful when SHBG isn’t on your panel. Once you have SHBG, free E2 is the number worth watching. What would change my mind: a prospective study showing T:E2 ratio outpredicts free E2 on symptom endpoints. Haven’t seen it.