Why Men Need Estrogen

When on hormone replacement therapy via Testosterone, some men develop high Estrogen levels and often require regimen changes or Estrogen blockers to limit the levels from being too high. High Estrogen levels can lead to undesired side effects. Water retention. Mood swings. Gynecomastia. So naturally, many assume: lower estrogen = better optimization. But that assumption is just wrong, and clinically, it causes problems both in how they feel and problems they are more prone to develop later on. Think bone fractures related to osteoporosis, think liver dysfunction, think dementia. So let’s run through the ways low Estrogen levels can impact a man’s body and how he can avoid it.

Estrogen in Men Comes From Testosterone

Testosterone does three things within the body. Most of it stays Testosterone. Some of it converts into a metabolite called DHT (yep, the one associated with hair loss - more on that later). Some of it converts, or aromatizes, into Estrogen. This is a good thing. Men need Estrogen as much, or arguably more than they do Testosterone to be functioning on all cylinders. Another way men produce Estrogen is through fat tissue. Which is why obese men tend to have higher Estrogen to Testosterone ratios than non-obese men.

When a man on Testosterone therapy is managed well, with a good regimen and kept in a good therapeutic range (which is routinely monitored and adjusted) rising Estrogen levels can often be mitigated without having to add an Estrogen blocker. Sometimes it is unavoidable. Beware such blanket statements as “Estrogen blockers are always bad.” For some men this is a necessary addition. The key point is that the Estrogen is kept in that sweet spot range regardless of how it happens.

Why A Man Wants Estrogen

1. Libido/Sexual Function

Low estrogen is strongly associated with:

• Decreased libido

• Erectile dysfunction

• Reduced sensitivity; decreased orgasm quality

• Prolonged time to orgasm

Testosterone is the engine of the 🏎️ vehicle - it gets things turned on and operational.

Estrogen is the fuel that drives 🏁 performance and pleasure in the ride.

2. Joint and Connective Tissue Health

Estrogen is highly associated with :

• Collagen building

• Connective tissue strength

Estrogen limits 🦵🏼 joint pain, 🩼 risk of injury, and improves 🏋🏽‍♂️ exercise recovery

3. Brain Function and Mood

Estrogen helps maintain:

• Serotonin

• Dopamine

• Cognitive processing

Estrogen helps maintain ✨ pleasure in life, reduces the risk of 🧩 dementia, improves 😤 irritability and💡 brain fog/forgetfulness which allows you to think 🎯 straight/focus

4. Bone Density

One of Estrogen’s most overlooked roles:

• Slows the breakdown of bone

• Maintains bone density

• Supports bone remodeling/building

In fact, Estrogen is a huge component in preventing 🦴osteoporosis and 💥 bone fractures; 🧍🏾‍♂️maintaining posture

5. Vascularity

Estrogen up-regulates nitric oxide which impacts:

• Vascular tone and elasticity → improved blood pressure

• Improved circulation → including weird places like your oral mucosa (improving mouth sores/gum pain)

• 📈 gym gains → muscles fill with blood during training → stronger, fuller pumps

• Better penile filling → improved erectile dysfunction

Estrogen makes the 🩸 blood go round and round and 🔁 to the right places

The Problem With Over-Suppressing Estrogen

In an effort to optimize testosterone therapy, some patients are placed on Aromatase inhibitors (AIs) like Anastrazole to block the amount of Estrogen accumulation

• The goal → prevent Estrogen from rising

• The result sometimes can be → Estrogen drops too low

• And symptoms can look like:

  • Low libido

  • Reduced penile sensitivity → men will say “something feels off” or “it takes longer to have an orgasm”

  • Fatigue/apathy/poor motivation

  • Joint pain/longer post workout recovery

  • Mood changes

Clinically, this is one of the most common mistakes in Testosterone replacement therapy management

There Is a “Goldilocks Zone”

Estradiol in men is not something to eliminate.

Too low:

• Any of the above symptoms

Too high:

• Fluid retention

• Breast tissue sensitivity/growth

• Emotional swings / irritability

The goal is not suppression. The goal is balance.

So Why Is It So Common That The Estrogen Drops Too Low?

Typically speaking this is a poor regimen recommendation from providers and/or lack of proper follow up and management. Factors that impact this:

• Dosing for Estrogen blockers is sensitive. Small changes in doses lead to big changes in the patient, and all patients behave uniquely

  • Solution: Appropriate follow ups including a review of symptoms and serum lab levels

  • Solution: Often a change in the way and amount of Testosterone is taken can reduce the Estrogen enough that no blockers are needed

• Improper lab interpretation. A standard estradiol level is predicated on a woman’s normal range

  • Solution: An ultra sensitive estradiol level is more sensitive to a man’s true estrogen level. The downside is this is a much pricier test

• Additional patient factors which often change over time

  • Like body composition: Fat cells are an independent producer of Estrogen so the more fat a man has the more estrogen he tends to produce

  • Like alcohol consumption: Alcohol increases the amount of Testosterone that converts to Estrogen. It also damages the liver. The liver helps clear Estrogen from the body so when the liver is not working well → more Estrogen hangs out in the body

    • The presence of either of these factors means the man would require higher doses of Anastrazole (aromatase inhibitors) and then if there are changes in those factors over time the dose may be too high

  • Solution: A close relationship and proper follow ups with a provider who is assessing the whole person, not just the lab values

The Bottom Line

Estrogen is not the enemy. It’s an essential hormone that is needed to help a man feel his best possible right now and to prevent long term damage/disease development down the line. The real issue isn’t having too much estrogen. It’s mismanaging it.

🔍 Find a provider who is knowledgeable, engaged, willing to invest in the proper testing, and ask the hard questions to ensure your regimen is ideal for you 🕵🏻‍♀️

If you would like help optimizing your Testosterone replacement therapy schedule a consultation and rest easy knowing your case will be treated with the customized and thorough manner you deserve.

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Wood, H. Sizing up the CNS. Nat Rev Neurosci5, 900 (2004). https://doi.org/10.1038/nrn1569

The Endocrine Society Laureate Awards, Endocrine Reviews, Volume 34, Issue 4, 1 August 2013, Pages 597–598, https://doi.org/10.1210/er.2013-1002