Estrogen, along with testosterone, may be one of the most important hormones to monitor in men.
High estrogen can cause symptoms ranging from weight gain to nipple tenderness to water retention.
Learn the most common symptoms of high estrogen in men and how to deal with it in this guide:
The Importance of Testosterone & Estrogen Balance in Men
Traditionally, we tend to think of estrogen as a female hormone and testosterone as a male hormone.
What you may not realize is that both women and men have both testosterone and estrogen.
Not only do both sexes have both hormones, but each hormone plays an integral role in hormone balance.
We know for a fact that low testosterone reduces libido, but did you also know that both high and low estrogen can also cause libido issues?
High estrogen is also responsible for issues such as erectile dysfunction.
Estrogen receptors exist in important places such as the brain (important for libido), penis (important for erections), the testis and other organs in your body.
The fact that there are estrogen receptors in these places is evidence that estrogen is serving some (important) purpose in the male body!
When it comes to hormone balance you need to shift your thinking to include both testosterone and estrogen.
Gone are the days of focusing only on testosterone as a marker of youth or aging, and now are the days of integrating multiple hormone systems together.
But why are these hormones so important to your overall health?
It turns out that estrogen has an indirect impact on testosterone levels.
Estrogen is one of two hormones total that influence a binding protein is known as sex hormone binding globulin.
Sex hormone binding globulin, or SHBG for short, binds to and reduces the activity of sex hormones (which includes testosterone).
So high estrogen may stimulate SHBG release from the liver which may then bind to and inactive testosterone.
Estrogen also plays another more sinister role in reducing testosterone through something known as feedback loops in the brain.
Estrogen (estradiol) in your bloodstream circles back to an important organ in your brain, known as the pituitary gland, where it reduces the secretion of FSH and LH (both pituitary hormones) (2).
Through at least 2 pathways, estrogen can inhibit or further reduce testosterone in the male body.
Does that mean we should block estrogen all together?
It's best to think of Estrogen as a "Goldilocks" hormone in that you need just enough but not too much to function optimally.
So you can't just take an estrogen blocker and push your estrogen to zero without suffering symptoms.
Symptoms of High Estrogen in Men
There are really two ways that you can experience the symptoms of high estrogen.
The first is through high estrogen which causes issues from over stimulation of estrogen receptors in your body.
The second is through the inhibition of testosterone production.
In this way, high estrogen can cause the symptoms of low testosterone while also causing problems by itself.
So men with high estrogen may suffer from multiple sets of symptoms related to high estrogen.
When it comes to identifying and diagnosing high estrogen, your symptoms are just as important (if not more important) than your lab results.
This means you need to have a solid understanding of how estrogen may present in your body.
#1. Symptoms associated with high estrogen in men:
- Breast tenderness or enlarged breast tissue (Gynecomastia) (4)
- Feeling bloated or retaining water (5)
- Increased emotional feelings (Labile emotions) (6)
- Erectile dysfunction (You can usually obtain an erection but it may not be sustained) (7)
- Soft musculature and loss of muscle tone
- Female body fat distribution (Body fat on the breasts, hips, thighs, arms, etc.)
- Urinary symptoms from an enlarged prostate (8)
#2. Symptoms associated with low testosterone in men:
- Fatigue or low energy (9), inability to sustain workouts in the gym
- Weight gain, especially abdominal fat
- Loss of muscle mass
- Inability to sustain erections or erectile dysfunction
- Increased irritability
- Hair loss
- Inability to sleep
If you suffer from high estrogen you may experience some of the symptoms associated with high estrogen but also low testosterone.
Distinguishing these symptoms is particularly important if you are taking testosterone as part of a TRT program.
In this case, it's possible to have normal serum testosterone but still experience the symptoms associated with high estrogen (due to conversion).
Couple these symptoms with your lab tests for optimal results.
Causes of High Estrogen
If you know or suspect, that you have high estrogen what are you supposed to do about it?
Treating your estrogen is incredibly important and the best way to treat it is to identify the cause.
Even if you have trouble identifying the cause there are still some therapies that you can use to reduce it in a "shotgun approach", but it's best to know where it's coming from if possible.
If you understand the cause then it will help you with treatment.
I've included a list of the most common causes of high estrogen in men below:
#1. Obesity or Weight Gain
Even a small amount of adipose tissue can cause this issue in men.
But how does it work?
Your fat cells contain an enzyme known as aromatase.
This enzyme is responsible for taking testosterone and turning it into estrogen.
So the more fat cells that you have in your body the more likely you are to take testosterone and turn it straight into estrogen.
The more estrogen you have the lower your testosterone is and the more likely you are to gain weight.
This vicious cycle tends to continue until it is broken, usually with weight loss or testosterone replacement therapy.
If you don't want to explore TRT, or you aren't able to due to your location, then the next best step is to lose weight.
Losing weight may be enough to normalize your testosterone for your age.
#2. Excessive Testosterone (from TRT)
The idea here is that putting excessive testosterone into the body may act as a reservoir for aromatase which then leads to high estrogen.
Through this pathway, it is possible to have both high estrogen and high testosterone in the serum.
High estrogen may block any benefit to TRT by manipulating SHBG which then acts to bind to free testosterone in the body.
With this in mind, it's important to monitor BOTH your estrogen and your testosterone.
You can go reducing estrogen secondary to TRT by taking an estrogen blocker, increasing metabolism of estrogen through the use of supplements or by reducing your testosterone dose.
#3. Exposure to Endocrine Disruptors
Whether you realize it or not you are coming into contact with chemicals known as endocrine disruptors on a daily basis.
These chemicals are known as endocrine disruptors because they may stimulate hormonal receptors once ingested or absorbed.
These EDC's are not usually a problem for most people, but certain people may be very sensitive to them or have a hard time metabolizing them.
You can reduce your exposure to these chemicals by drinking out of glass containers, reducing the number of plastics and receipts that you come into contact with and by purchasing BPA free merchandise.
#4. Diet (Dairy and Soy products)
If you are a man and you are having trouble with estrogen or testosterone then it may be time to take a look at your diet.
Dairy, especially milk products, may contain hormones which can act to disrupt your HPA axis.
When in doubt ditch the dairy and soy products and monitor how you feel.
The problem with dairy is that not ALL men will be sensitive or experience problems with it.
Because of this, you may see a polarized response from the male community in which some people are convinced that dairy plays a role and others who insist that it doesn't.
If you aren't sure, just give yourself a 60-day trial and monitor how you feel.
If you have identified that you have the symptoms of high estrogen then your next step should be to evaluate your serum estrogen levels.
Believe it or not, assessing estrogen is not usually at the forefront of physicians minds.
This means you may have to ask for it.
The best way to test for estrogen is to order a high sensitivity estradiol serum level.
You can find the tests which you should order below (based on the lab company):
- Ultrasensitive Estradiol (Quest)
- Sensitive Estradiol (LabCorp)
These high sensitivity tests are superior to the standard estrogen tests which are primarily used for women, who have much higher baseline levels of estrogen and are less sensitive in men.
There are more estrogens in the body than just estradiol, but estradiol is the most biologically active of these estrogens and therefore the one to check.
More advanced tests, such as 24-hour urinary tests, can give you more insight into how your body is metabolizing estrogens, but starting with a serum estrogen may be sufficient for most men.
When assessing for estradiol look for a level which is less than 25 pg/mL.
But always remember to treat the estradiol level only if you are experiencing the symptoms of high estrogen.
Never treat the labs without looking at the patient (you) as you may cause more harm than good.
Treatments & Therapies to Reduce Estrogen
If you have high estrogen there are several therapies that you can use to block or help metabolize estrogen.
I've listed the most common below:
#1. Aromatase Inhibitors (Estrogen blocking medication)
Remember this is the enzyme that takes testosterone and turns it into estrogen, so blocking this enzyme usually helps drop estradiol levels in the serum.
This medication is primarily used in women who have breast cancer, but it works very well in men.
The dose of this medication that you need will depend on your body, your genetics and how much estradiol you need.
A starting dose may be anywhere from 0.25 to 0.5mg every 2-3 days.
Start at a low dose and monitor both your symptoms and your serum estradiol levels while taking this medication.
#2. Supplements that promote Estrogen Metabolism
In addition to using medications, you can also utilize certain supplements which help to metabolize estrogen.
Some of these estrogen metabolites may actually be beneficial in the body.
Alternatively, you can also naturally increase estrogen conversion by consuming loads of brassica vegetables such as broccoli, Brussels sprouts, and cabbage.
Brassica vegetables contain Indole-3-carbinol naturally and this is a way to help metabolize your estrogen through your diet.
How to use estrogen supplements:
#3. Weight Loss
Weight loss is another very important factor when considering hormone regulation.
The only issue with weight loss is that it will bring your testosterone to a more normal level for your AGE, but that may not be the most optimal level for you.
If you are a 50-year-old male with low testosterone from obesity, losing weight will only bring you to whatever is normal for your age (which is less than optimal when compared to your younger years).
In some cases, starting TRT may actually make weight loss easier as well.
TRT helps increase muscle mass, promotes energy, improves endurance at the gym and normalizes hormone levels, all of which can help with weight loss.
The way you approach weight loss is up to you but focus on your diet, exercise routine and hormone balance for the best results.
#4. Altering Testosterone Dose (if using TRT)
If your estrogen is high due to excessive testosterone replacement therapy then altering your dose may be sufficient to normalize your hormone.
This should ALWAYS be the first step that you consider (if you fit into this category).
It's never a good idea to oversaturate your body with hormones (even testosterone) if it isn't necessary.
So brute forcing your way to "high testosterone" will not lead to optimal results.
Try to find a balance between testosterone and aromatization without the use of estrogen supplements or aromatase inhibitors.
If this isn't possible THEN try to use supplements or medications to help curb estrogen.
Remember that your diet plays a role in how active your aromatase enzymes are, foods such as alcohol and caffeine may increase aromatase activity and increase estrogen levels (19).
#5. Stress Reduction
Stress is another factor, which is often ignored, that may increase estrogen in men.
Stress, even low levels of stress, from work life, family life or other places, may be causing both low testosterone and high estrogen in certain men.
Your ability to tolerate stress is known as your "stress resilience" and this resilience may fade over time and with hormone dysregulation.
Some stress, small stable amounts, is a good thing.
Consider the case of exercise and strength training:
Stress to your musculature is enough to promote an increase in muscle mass if it is consistent and controlled.
Overtraining your muscle groups will not allow for optimal growth.
This same concept applies, but to your entire body.
Manage your stress with meditation or other mindfulness techniques.
High estrogen is a sinister and relatively unknown issue that many men may be suffering from.
If you are experiencing abnormal symptoms such as fat accumulation in abnormal places, increased mood lability, urinary issues, and water retention make sure to have your serum estradiol levels assessed.
Likewise, if you are currently on testosterone replacement therapy and not feeling "optimal" make sure to assess your estrogen!
Whenever possible your goal should be to optimize your hormones without causing negative downstream effects, this means you may need to alter your dosing or add in estrogen metabolizers.
Now I want to hear from you:
Do you suspect you have high estrogen?
Are you experiencing the symptoms associated with high estrogen?
Are you taking TRT and still dealing with these issues?
Leave your comments below!
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