How & When to use Estrogen Blockers for Men (Natural + Medications)
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How & When to use Estrogen Blockers for Men (Natural + Medications)

Do estrogen blockers really help to get you shredded or cut?

Is high estrogen the bane of your TRT existence?

In this post we will discuss the benefit of estrogen blockers including who should consider using them, how they should be used and other signs and symptoms associated with estrogen problems

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Estrogen in Men

When you think of estrogen you may be tempted to think that this hormone is only important for women. 

But estrogen, much like testosterone, is incredibly important in men. 

Estrogen works through hormonal cellular receptors found throughout the body. 

In men, these estrogen receptors are concentrated in the brain, penile vasculature, and the testes

Obviously, if these important areas have estrogen receptors then they must play an important role in sexual function. 

After all, why would the body have receptors for hormones if they served no purpose?

And we know, from several clinical studies, that both high and low estrogen is associated with alterations in libido, mood, and even testosterone levels

In many ways, estrogen is a Goldilocks-like hormone. 

Too much causes a big problem while too little causes problems as well. 

In reality, you want to have a sufficient level of estrogen to have normal sexual function and to prevent issues related to other hormones such as testosterone. 

Estrogen imbalance, predominately higher than normal estrogen levels, is becoming more and more prevalent among men. 

Estrogen is produced directly by the body but it is also created through a process known as aromatization

It turns out that fat cells (your adipose tissue) do more than just add love handles or a belly to your body. 

They are an active participant in your endocrinology (hormone balance) and part of this participation is taking testosterone and turning it into estrogen. 

Put simply:

The more fat cells you have, the more testosterone you convert to estrogen and the more estrogen you have in your body

Estrogen, in high levels, causes two major problems in men:

#1. It increases the production of another hormone called SHBG (sex hormone binding globulin) which binds to and inactivates testosterone

#2. It circulates back to your brain and reduces the production of pituitary FSH and LH which further reduces testosterone

Knowing that high levels of estrogen promote a problem in men there is now a huge market for what is known as "estrogen blockers". 

But do these blockers actually work to reduce estrogen in the body? 

Probably not in the way you are thinking. 

Estrogen Blockers Explained

So what exactly is an estrogen blocker?

An estrogen blocker is any compound or medication that blocks either the action of estrogen at the cellular level (cellular inhibition of the estrogen receptor) or a medication which reduces the total amount of estrogen in the body (reduced production). 

The problem with estrogen blockers is not that they don't work, but that most people don't understand how or why to use them. 

Using estrogen blockers simply because you are overweight and want to "get shredded" is not really the correct way to use them. 

Furthermore, you absolutely don't want to alter your estrogen levels, if they are normal, to begin with!

You have to remember that estrogen works in tandem with testosterone. 

In this way, it's important to have both optimal levels of testosterone AND estrogen.

But it's absolutely possible to have high estrogen and normal/low testosterone or normal estrogen and low testosterone. 

The only way to determine which problem you have is with serum testing of your hormones (more on that below). 

Suppressing your estrogen into oblivion is not the answer to whatever issue you are dealing with and is likely to cause other problems

What Causes High Estrogen in Men

There are certain conditions, however, that are known to cause high estrogen at a relatively high frequency. 

The presence of these conditions (one or more) may be an early sign that an estrogen blocker may be beneficial for your body. 

The most common causes of high estrogen in men include

Symptoms of high estrogen in men include

  • Breast tenderness or enlargement of breast tissue (nipples as well)
  • Bloating or retaining water
  • Increased emotion
  • Sexual dysfunction (erectile dysfunction)
  • Low energy
  • Lack of muscle tone or inability to increase muscle mass despite weight training
  • Female fat distribution (weight gain in the breasts, hips, thighs, etc.)
  • BPH or issues with urination

If you fit into these categories, or you are experiencing any of the symptoms listed above, then it is much more likely that you are experiencing some degree of high estrogen. 

The next step would be testing, or supplementation (if it makes sense) as a trial run. 

Estrogen Blockers with TRT (Testosterone Replacement Therapy)

Testosterone replacement therapy is a special situation in which the use of an estrogen blocker may be necessary. 

The use of bio-identical exogenous testosterone (meaning from a gel or a shot) may supply your body with the substrate that it can use to produce estrogen. 

Think about it this way:

Many men with obesity suffer from low testosterone (this is an undisputed fact). 

These men will obviously benefit from testosterone replacement therapy because it will not only help them lose weight but it will also promote a better quality of life. 

The problem with TRT in this situation is that your body can take that testosterone and turn it into estrogen with all of the excess fat cells that you have at baseline

In this way, you may be feeding the "aromatase conversion" fire by supplying your body with testosterone. 

This isn't a problem necessarily, but it is always something that needs to be looked at and evaluated on a case by case basis. 

Some men, due to genetics or due to how they are taking estrogen, will convert testosterone to estrogen at a high rate

These men tend to do better by taking estrogen blockers in conjunction with their TRT. 

The goal of using estrogen blockers is not to suppress your estrogen down to zero, but to find an optimal level which allows you to benefit from BOTH testosterone and estrogen

This may take some trial and error. 

Types of Estrogen Blockers

When we talk about estrogen blockers there are really two main categories that they fit into. 

The first is prescription medications. 

These medications need to be prescribed by a physician and should be taken cautiously because they tend to be more powerful than over the counter supplements. 

#1. Medications

Medications that work to balance estrogen include a medication class known as aromatase inhibitors. 

These medications work by blocking the enzyme aromatase (the one we discussed earlier)

Medications that fall into this category include Arimidex (anastrozole), Aromasin (exemestane) and Femara (letrozole). 

Believe it or not, these medications were developed and are most commonly prescribed to women with breast cancer. 

In women, they help to drop estrogen levels to very low amounts and can be used to treat estrogen receptor-positive breast cancer. 

In men, they serve a different purpose. 

The goal of using these medications is to balance estrogen levels by reducing the amount of estrogen your body converts (or creates) from testosterone

When used in men you should use a much smaller dose than what is "standard" for most women. 

This often will be 0.5mg to 1mg every 3-4 days

#2. Over the Counter Supplements

Over the counter supplements, work differently than estrogen-blocking medications. 

These supplements work to help your body metabolize and eliminate estrogen from circulation. 

They also help to promote the creation of healthy estrogen metabolites vs other more active metabolites. 

Remember that all of your hormones need to be metabolized or "cut up" by the liver into smaller and smaller pieces so they can be eliminated through the urine or the stool

Some of these pieces, after the main hormone has been cut up, have estrogen receptor activity

You can reduce the creation of some of these metabolites by increasing how efficient your body is at eliminating estrogen. 

Supplements which fall into this category include Diindolylmethane (DIM), Indole-3-carbinol and Calcium D-glucarate. 

These supplements are often referred to as "estrogen blockers" by those who are trying to sell supplements, but they are not as powerful as true estrogen-blocking medications (listed above). 

But just because they aren't powerful doesn't mean they aren't useful. 

DIM and indole-3-carbinol are found naturally in certain plants such as brassica vegetables

Eating plenty of vegetables (especially broccoli, cabbage and so on) can naturally provide your body with some of these nutrients.

While consuming them is a necessary approach it should also be supplemented with additional nutrients (taking over the counter supplements). 

It's not always possible to consume large enough quantities of vegetables to have a meaningful impact on estrogen metabolism, and, even if you do, it's difficult to stay consistent in consuming these foods day in and day out. 

How to use Estrogen Blockers & Estrogen Metabolizers

The best way to approach estrogen blocker therapy is to start with a set of labs at baseline (including Testosterone, Estradiol, and SHBG). 

In some cases, that may not be available or it may be difficult to obtain from your current physician. 

If you fall into this category and you remain convinced that you have high estrogen due to your symptoms or other risk factors, then your best bet is to start with a combination of estrogen metabolizers such as DIM + Calcium D-glucarate

The use of prescription estrogen blockers is probably only necessary for those on testosterone replacement therapy or for those with extremely high estrogen levels. 

You can use these dosages as a starting point: 

  • DIM - 200-400mg per day (combine with calcium d-glucarate)
  • Calcium D-glucarate - 500mg per day (combine with DIM)
  • Arimidex - 0.5mg to 1mg every 3-7 days (most men do fine on 1mg twice per week as baseline dose)

In most cases, using DIM + Calcium d-glucarate will not grossly alter your serum estrogen level. 

They may, however, act to improve your symptoms. 

So, when using supplements, make sure you follow your symptoms instead of your absolute estrogen level. 

Arimidex, on the other hand, will drop your estrogen level as you use it, so you will need to follow your serum estrogen level. 

Testing for Estrogen & Testosterone

Testing and evaluating sex hormones in men deserves its own blog post, but I can outline some of the basics here. 

When testing your sex hormones you need to be evaluating values in the context of other hormones. 

What this means is that you never just want to order testosterone by itself or estrogen by itself. 

In addition, there is really no such thing as "estrogen". 

Instead, you can focus on ordering the most biologically active estrogen which is known as estradiol

And, in men, you should make sure you order the ultra sensitivity estradiol test designed to evaluate low levels of estradiol in the serum. 

The "standard" estradiol test, which was created for women, is not as useful in men who need finer titration and regulation of estradiol. 

With these concepts in mind you will want to evaluate the following hormones (at a minimum): 

  • Ultra-sensitive estradiolOptimal levels will vary from man to man, but aim to get this value less than 25pg/mL. 
  • Total and free testosterone - Testosterone levels will vary from man to man, but optimal levels usually fall in the top 20% of the reference range. 
  • Sex hormone binding globulin - SHBG should be no higher than 30-35 nmol/L. 

Final Thoughts

When considering the use of estrogen blockers it's important to cut through the hype and marketing. 

In many cases, estrogen blockers can be an effective tool to help regulate both estrogen and testosterone in men, but they must be used correctly. 

Blind use of these supplements with the goal of weight loss in mind or in an attempt to build muscle will likely not yield the results you are looking for. 

Instead, careful evaluation of your hormones (including both estrogen and testosterone) while using estrogen blockers only as necessary, will yield much better results long term

Now I want to hear from you:

Are you struggling with high estrogen?

Are you also on TRT?

Have you used estrogen blockers with success in the past?

Have they worked for you?

Leave your comments below! 

Westin Childs
 

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders. He is trained in Internal Medicine, Functional Medicine and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances. You can read more about his own personal journey here.

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