MSPT98----Your endo is on the right track with the ratio thing. When we were younger, the ratio of "T" to estradipol was around 50:1.......as we get older, most of us start to convert, in varying degrees, to estradiol. The ratio decreases as the estradiol becomes more dominant. Mine had gotten close to the 10:1 range. So if, as your "T" increases, your estradiol increases at the same rate, that's no good. If it increases a little as "T" is climbing into the desired range, that's OK. So it's important to measure all those things as you progress. There is a concensus that ideal estradiol should be in the 20-25 range, with your "T" levels in the upper range of "acceptable or normal". Doing the math, if your E2 is 20, then a "T" level of 800-1000 would be ideal and still in the acceptable range, and the ratio would near 40:1/50:1
That said, I've gotten my "T" levels where I should be feeling like King Kong, and I've used Arimidex to pull the E2 down to a good level. But I stil don't feel the way I should. No libido, and less than optimal vitality for someone who takes care of himself and stays in shape. I've succeeded in getting an appt with Eugene Shippen on 7/11/12. and have just received some labwork from him that he wants done prior to the appt. He's looking at some thyroid markers as well as cortisol, DHEA-S (adrenal stuff) and possible Human Growth Hormone deficiency.
I've never used "gel" as in Androgel or Testim. What I used was bio-indentical cream which was concocted via a compounding pharmacy. I wish we had been montioring my E2 during that trials because I think it would have showed that I converted via the aromatse enzyme. But my physical symptoms were terrible, and that's when we switched to shots.............long story short, make sure your endo is measuring serum T, free T, estradiol, DHT, and SHBG. That should give you a pretty clear picture combined with your symptoms. (Oh.........and that little thing about checking your PSA fairly frequently as you go along----just a minor thing 
)
]
It sounds like he knows what he's talking about and is on the right track. You may not need any A-dex if you don't convert and you start to feel better. Keep me posted and good luck........I'm just marking time until my July appt and will report then.
Arnie