The Importance of Estrogen (Estradiol) in Men’s Health
Men are often unaware that estrogen (estradiol) plays a critical role in their day-to-day health.
Estrogen is found in small-but-critical concentrations in men. It needs to be in balance with the rest of your hormones, especially testosterone, for you to feel well.
- The Connection Between Low T and Estrogen
- Normal Estradiol Levels in Men
- Symptoms of Low Estrogen in Men
- Causes of High Estrogen (Estradiol) in Men
- Symptoms of High Estrogen (Estradiol) in Men
- The Importance of Monitoring and Controlling Your Hormone Levels
- Beginning Hormone Replacement Therapy
1. The Connection Between Low T and Estrogen
Estrogen levels and testosterone levels are closely related. In fact, one of the primary causes of low estrogen is actually low testosterone.
Men’s bodies produce estradiol, a form of estrogen, as a byproduct the breakdown of testosterone through an enzyme called aromatase. Aromatase is found in estrogen-producing tissue, such as the adrenal glands, the brain, fatty tissue, and even the testicles.
Estradiol is often referred to as E2 and is one hormone in a class of hormones called “Estrogens.” This class includes estradiol, estriol, and estrone, among others.
Estradiol is likely the main estrogen you need to worry about.
The production of estrogen in a male body is a completely normal and necessary process. Estrogen is required for the healthy physiologic functions of your brain and other important organs, including:
- Erectile function and sex interest
- Maintenance of bone health
- Regulation of fat mass vs. lean mass
- Brain functions
- Lipid metabolism
- Skin metabolism
Since the necessary level of estradiol that men require is derived from testosterone, a correlation develops.
If your testosterone is low, your body doesn’t have the raw materials needed create more estradiol. If you have low testosterone, you may have low estrogen (estradiol) too, probably leading to the symptoms of hormone imbalance.
That’s why low testosterone symptoms and low estrogen symptoms often look so similar: they’re occurring at the same time, and it’s hard to determine what’s causing what.
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2. Normal Estradiol Levels in Men
Normal total estradiol levels in men are somewhere between 20–55 pg/mL (2.0–5.5 ng/dL) and 10-40 pg/mL (1.0-4.0 ng/dL), depending on whom you ask.
The first range is based on a study of the total estradiol levels of 115 healthy men.
The same study with the same group of men found that free estradiol levels ranged between 0.3–1.3 pg/mL (0.03–0.13 ng/dL).
Keep in mind that these “normal ranges” aren’t exactly agreed upon throughout the medical community.
The truth is, human bodies vary so much that no one can really say for sure, and testing methods have changed over the years, leading to some discrepancy.
2.a. Falling Outside the Normal Estradiol Range
Numbers don’t tell the whole story. If you’re experiencing the symptoms of low estradiol, but your numbers don’t match up, you may still be a candidate for hormone replacement therapy.
Just like testosterone and other hormones, a level is only “low” if you’re experiencing symptoms.
Similarly, there are men who fall outside the range who nevertheless are asymptomatic. It all depends on you and your body.
If you’re experiencing symptoms, you’ll want to get a blood test to see precisely what’s going on. It’s possible your levels won’t fall outside the normal range, which may indicate something else is causing your symptoms.
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3. Symptoms of Low Estrogen in Men
Symptoms of low estrogen in men include:
- Fatigue
- Anxiety
- Irritability
- Depression
- Forgetfulness
- Oversleeping or sleeping too often
- Sexual dysfunction
- Water retention
- Bone loss
- Fat accumulation
Most of these, especially the symptoms related to how you feel on a daily basis, could appear on a list of either low testosterone or low estrogen symptoms. These are simply symptoms of overall hormone imbalance.
To summarize, you can have low testosterone by itself, or low estrogen by itself, but often, they go hand in hand. The symptoms are very similar, which means that it’s almost impossible to determine which hormone is insufficient without proper blood testing.
3.a. Treatment for Low Estrogen in Men
If you were to experience low estrogen along with low testosterone, in addition to prescribing testosterone treatment, we might also prescribe some form of estrogen, usually in the form of a gel or a cream.
Unlike testosterone, we want estrogen to be bioidentical to ensure it works properly.
For men, it is rare to find low estrogen levels unless that person is undergoing some kind of treatment to reduce estradiol directly.
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4. Causes of High Estrogen (Estradiol) in Men
In the setting of Testosterone Replacement Therapy (TRT), we are much more likely to deal with increased estradiol levels, called hyperestrogenism.
There are many reasons why your body may be producing too much estrogen. For instance, if you suffer from obesity, your excess fat can actually start producing additional estrogen beyond what your body already produces.
While we occasionally do see elevated estrogen levels prior to starting treatment for Low T, this is most often a problem that arises because of higher testosterone levels achieved as the result of TRT that’s practiced improperly, including the following poor practices:
- Your hormone levels are not being regularly or carefully measured
- You’re not receiving an aromatase inhibitor at appropriate levels
- Your medical provider isn’t extremely careful about his or her methods
In these cases, much of the extra testosterone being introduced into your body can be converted into excess estradiol.
5. Symptoms of High Estrogen (Estradiol) in Men
Symptoms to watch for include:
- Erectile dysfunction, loss of libido, infertility, and other types of sexual dysfunction
- Enlargement of, or development of, breasts
- Persistent fatigue or lack of energy
- Mood swings, anxiety, and/or depression
- Water retention
- Excessive sweating
- Insomnia
- Night sweats
- High blood pressure
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6. The Importance of Monitoring and Controlling Your Hormone Levels
Everything we’ve discussed so far leads to this conclusion:
As we begin to raise one level through hormonal replacement therapy, it’s really important to carefully monitor the therapy’s effect on your other hormones.
That’s why frequent screening is part of our therapy process at Testosterone Centers of Texas.
Most often, a medication named Arimidex (anastrazole), an estrogen blocker, is the treatment of choice to help reduce and control estradiol levels. This medication, when used and monitored appropriately, is safe, inexpensive, and very effective.
Once-per-week dosing is typically enough to reduce elevated levels back into the normal range.
Special care should be taken to monitor for side effects of persistent estradiol elevation and flushing, which may occur with the use of Arimidex.
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6.a. Proper Dosage
Because both male and female bodies naturally contain both testosterone and estrogen, just in different amounts, your body tolerates the “opposite” hormone rather well.
If you don’t tolerate the hormone well for any reason, we can easily reduce it.
Because we don’t implant or use hormone pellets (which can last up to six months) and instead use injections for testosterone and topicals for estrogen (which last no more than a week for each dose), we can easily titrate the dose to one your body tolerates more effectively.
Your body will react quickly to these adjustments, often in a matter of weeks or a handful of months.
7. Beginning Hormone Replacement Therapy
When you come into our clinic feeling like you have low testosterone, we check all your hormones.
Estrogen levels must be evaluated and managed the right way for Low T treatments to be safe. Ensure that anyone who treats you for low testosterone understands and explains all the known risks associated with therapy.
Being aware of potential issues and having a plan of action that prevents them from becoming problems during therapy will keep you both happy and healthy.
The staff at Testosterone Centers of Texas (TCT) look forward to helping you improve your quality of life.
Schedule a free consultation today.
Talk to a TRT expert and get back to feeling the way you're supposed to.
Now serving patients in all Texas cities.
I’ve been diagnosed with hypogonadism in the past,I have been taking testosterone for this problem. Recently they did blood work and I came up with low estradiol my #s were 11.26pg/ml. The base line was 23.8-60.7 pg/ml. The reason I had my testosterone checked I had gone into a depression ,I was told it was ptsd from 9/11,but a dr. And nurse suggested I get blood done to see if there was another cause ,my t #s came back very low,I received testosterone shots and seemed to come out of my depression ,this happened twice. I understand low estradiol can cause a variety of problems in males,depression,anxiety sleep problems etc. all of which I have been experiencing again.do you think this can be contributing to these problems and what can I do about it.
Thanks
Mike
Mike,
Typically, as you remain on testosterone replacement therapy, your estrogen levels will rise. In fact, keeping the from elevating too much is a concern we encounter. It’s not clear if you are on ongoing testosterone therapy, or just being given T episodically. If you need it, you will continue to need it. So, one way of treating both issues is to be on a well monitored TRT regimen in and ongoing fashion.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Hi Augie,
Can you comment on men with HIGH estradiol and DHEA levels or direct me to a post about it? I had bloodwork done in January and got 5.3 pg/mL Estradiol, 915.0 pg/mL DHEA, which were flagged as high. My cortisol was normal, my Free Testosterone was 192 mg/ML, flagged as High and likely a wrong result. My Thyroid test came back as normal. I was told to stop taking supplements and get work done at a later date.
I did that, and 10 months later got bloodwork done again. My testosterone came back normal at 122.0 pg/mL, my DHEA was still high but lowered to 630.0 pg/mL, but my Estradiol increased further to 5.9 pg/mL. I was told to “stop eating protein bars.”
It’s almost as if I can’t get a good answer to why these levels are higher and how to fix them. As for symptoms it’s difficult to narrow. I’ve always had anxiety/depression, and I’m experiencing low/moderate male pattern baldness but I’m 32 years old so that seems normal. I have vitiligo and have always suspected having some kind of thyroid issue since I have many symptoms of hyperactive thyroid but obviously results say otherwise. Should I be concerned and what do you recommend to further eliminate causes?
Thanks.
John,
“Workout” supplements often contain DHEA, so anything you might be taking is suspect for that, even if it isn’t listed. Protein bars, not so much, but some are “enhanced”. DHEA is a testosterone precursor, so a reduction in testosterone production could theoretically lead to an increase in DHEA too. High estrogen levels will suppress the hypothalamic/pituitary stimulation to produce testosterone. The root problem could be the estradiol. Estradiol is, in males, primarily derived from aromatization of testosterone. This conversion occurs at higher rates in people with more body fat, higher alcohol intake, higher insulin secretion, and advanced age (among other things). Also, the metric I prefer for measuring you testosterone is a calculated free T. For this you need a total serum testosterone, sex hormone binding globulin, and albumin level. The result is in ng/dL, and is normal between 9-30 ng/dL. Any direct lab test that shows your “free T” without using the standard algorithmic calculation (except perhaps an equilibrium dialysis test) should be disregarded. I have a video on hypothyroidism you may want to watch on our YouTube channel.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Hello, my estradiol sensitive test came back at 69. This is on cypionate 100 mg weekly with TT levels 978 and Free T 300.7 or 30.
My shbg is 17.
Do you suggest a cypionate reduction or take arimidex and if so how much?
Hello Ariel,
Unfortunately, I cannot give medication recommendations in this setting. Either of your proposed changes are viable options, but they need to be discussed with your provider, after a thorough assessment of your clinical presentation
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Hello,
I wanted to reach out to get a for some more information. I recently had completed a test and came back with a normal level of Testosterone, on the flip side of that I had a very high estradiol level. I received a treatment plan for Testosterone injections and Anastrozole. My issue is Testosterone treatment is for Low T but mine is normal. Is this a normal plan for someone who has what I have described?
Hello Vincent,
Unfortunately, there is quite a bit more to it. Without assessing your entire presentation, I can’t offer specifics. That said, if your individual makeup is such that you tend to convert/metabolize (aromatize) more testosterone to estrogen (E2, estradiol), then perhaps an aromatase inhibitor alone could be helpful. However, while that makes logical sense, I’ve never seen that work clinically. Also, a “normal” testosterone level can be misleading. In our practice, we focus on the calculated free testosterone level, as it has proven to be the most consistent predictor of therapeutic benefit, and potential side effects as they relate t specifically to androgen influence. Our goal is to optimize testosterone levels in order to significantly reduce the symptoms of Low T, while using the lowest effective dose and fewest interventions. This allows us to get the best and most consistent response, with the lowest rate of side effects. So, I would say that there is probably more to the story than just those two items. Definitely start asking questions, and if your provider can’t or won’t walk you through their decision making process in a way that makes sense, perhaps it’s time to seek a second opinion.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I’m 75, I just got my blood results back,my Estrogens count is 146 pg/ ml says normal range is 40-115 my dr said no problem,my Testosterone is 455,does this level of Estrogen seem ok
Hello, Fred!
Thank you for your question. Let me first say that numbers are only a small part of the big picture. Your symptoms are of utmost importance, as are safety parameters. I typically do not like to see estradiol levels elevated above normal, though there is quite a bit of academic literature that points toward estrogen being cardioprotective and beneficial. I prefer to manage based on testosterone/estradiol ratios and how that contributes to resolution of symptoms. If you are being judged solely by your numbers, it’s time to seek another opinion.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Are you able to work with patients out of state via Tele Medicine?
Hello Chris,
We are currently unable to prescribe out-of-state, but can offer remote consultations! Feel free to reach out via our website to contact me.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
“Special care should be taken to monitor for side effects of persistent estradiol elevation and flushing, which may occur with the use of Arimidex.”
Can you expand on this comment? I take Arimidex to lower estradiol primarily because I had prostate cancer and was told androgen receptors have a high affinity for some of the metabolites of testosterone like dihydrotestosterone and estradiol. Controlling DHT and estradiol may control the proliferation of the cancer. I am concerned about having estradiol too low (bones) or too high so generally try to keep it in the 20 – 30 range. However, knowing the Arimidex has a relatively short half life (45 hours +/-) means taking Arimidex (0.25mg) only once or twice a week will result in “elevation and flushing”. What are the side effects and consequences of that? Thank you in advance.
Hello Josh,
Thank you for your question. When I mentioned the side effects here, estradiol elevation and depletion are both included. Flushing is a symptom that can be seen with elevated estradiol levels but is more classically seen with low estrogen states. When anastrozole (Arimidex) is overused, it can lower estradiol (E2) to severely low levels, and this can be associated with hot flashes, joint pain, erectile dysfunction, decreased libido, and other symptoms. If E2 is too high, it could induce irritability, fluid retention, bloating, and gynecomastia, among other issues.
There are two active metabolites of testosterone, E2, and DHT. Arimidex will do nothing to curtail the amount of DHT available to the body. The class of drugs called 5-alpha reductase inhibitors (like finasteride) block that pathway. I recommend maintaining normal E2 levels for myriad reasons, but I don’t believe there is much protective benefit afforded by using anastrozole with regard to prostate cancer.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Hello there,
I ve been strugling with sexual side effects for 4 years after using high doses of testosterone for a competition.
For 2 years i tried almost everything (clomid, nolvadex, arimidex, hcg, aromasin) still nothing even though bloodwork showed everything optimal (not just in range). DIdnt know back then that while on clomid you have basically crushed your e2 in the brain, no matter what the bloodwork says.
For the last 1.5 years i am on trt and tried many protocols (100mg, 150mg, 200mg, 250mg per week). Only the higher doses did something for libido but nothing like before starting. No ai but some bloodworks gave me e2 of 30 so i thought i didnt need it.
Lately i found a protocol which finally gave me back consistently high libido and that was 180mg of injection split in three doses plus 1 click of test cream applied to scrotum every day. If you have a tough case in your clinic try that, it works.
Anyway the only issue was that while better i still cant reach 100% erection wise. Even on daily cialis 5mg
Could it really be higher e2 thats causing it. and that i need a higher dose with ai to function normally.
I mean i Ive done more than 20 bloodworks over these years and i ve seen e2 all over (high, mid, low)
I ve even done a doppler ultrasound to see if it was maybe physical but it came back normal.
I dont have bloodwork on this protocol yet but i bet at this dose e2 is gonna be high.
Have you seen in your practice people with high testosterone and high estriadol (but still good ratio) get better after adding ai and lowering e2??
I understand that mine is a complicated issue and question but any help will be appreciated.
Hello Tony!
Yes, some people do seem to improve after lowering their still-normal (but “high-normal”) estradiol levels. Also, issues like venogenic ED could still plague a patient with refractory ED, despite a normal ultrasound. There are different vascular issues that may be present.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I have prostate cancer problem. My M-testosterone is slightly high like 5.0 ng/dl. And the Prostate cancer live on Testosterone. We have to starve the Prostate cancer cell. May I control the testosterone level lower by putting the Estrogen cream to the body? Is it right thinking to decrease Testosterone by Estrogen cream? There is no resistance like the most ADT drugs?
The preferred method is to use gonadotropin-releasing hormone antagonists to curtail the stimulation pathways that drive intratesticular prostate production.
Best regards,
Augie Galindo, PA-C
Testosterone Centers of Texas | Managing Partner