Are Low T Symptoms Really Because of “Low E”?

A recent study has sparked a flurry of articles about how low estrogen levels are responsible for many of the symptoms of Low T. It is common knowledge that estrogen deficiency (think menopause) can cause a slew of symptoms in women, but what is the relationship between testosterone levels, estrogen levels, and symptoms like fatigue or erectile dysfunction?

The Link Between Low T and Estrogen

Most of the circulating estrogen (estradiol) in a man’s body is actually derived through an enzymatic process that converts testosterone (androgens) into estradiol. The name of this enzyme is aromatase. It can be found in estrogen producing tissue in the adrenal glands, brain, fatty tissue, and even the testicles. This is a completely normal process and despite the seemingly counterproductive relationship between these two hormones, men do need estrogen for normal physiologic function. 

Normal estradiol levels are important for things like erectile function, maintenance of bone health, and regulation of fat mass vs. lean mass. That being said, remember that estradiol is primarily derived from testosterone. Therefore, if you have severely Low T, you may in turn have low estradiol levels as well. Consider the following diagram.

Low T and Low E

Testosterone converted to estradiol.

How Low E is Managed

For men, it is rare to find low estrogen levels unless that person is undergoing some kind of treatment to reduce estradiol directly. In the setting of testosterone replacement therapy (TRT), we are much more likely to deal with increased estradiol levels called hyperestrogenism. While we occasionally do see elevated estrogen levels prior to starting treatment for Low T, is is most often a problem that arises because of higher testosterone levels.

The ratio of testosterone to estradiol remains stable whether someone is on TRT or not, so as Low T is corrected and T levels rise, estradiol levels often rise with it. It is just as important to keep estradiol levels normal as it is to keep testosterone levels normal. Neither should be neglected.

Specific Treatment

Most often, a medication named Arimidex (anastrazole) is the treatment of choice to help reduce estradiol levels. This medication, when used and monitored appropriately is safe, inexpensive, and very effective. Once weekly 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, flushing which may occur with the use of Arimidex, and for maintenance of normal estradiol levels during treatment. If estrogen levels drop below normal, Arimidex dosing should be suspended.

The Bottom Line

Essentially, estrogen levels must be evaluated and managed the right way for Low T treatments to be safe. This is not new information about “Low E” and rarely is and direct treatment needed to increase estradiol levels for men. Ultimately, if you are the right candidate, on the right treatment, for the right reasons then this is something that should be being addressed already. Ensure that anyone who treat 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 is what will keep you both happy and healthy.

Your total wellness is important to us at TCT, if you have any questions regarding this or any other aspect of Low T treatments, please CONTACT US! We look forward to helping you improve your quality of life and reclaim your vitality!


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(Augie) Juan Augustine Galindo Jr. MPAS, PA-C

(Augie) Juan Augustine Galindo Jr. MPAS, PA-C started his career in healthcare as a fireman/paramedic in West Texas where he served on the Midland Fire Department from 1998-2004.   He became interested in testosterone treatment after seeing how hormone replacement doctors helped those suffering from low testosterone.   After graduating from the Texas Tech Health Sciences Center Physician Assistant Program, he moved to DFW where he currently lives with his wife and three children.


  1. Eric Paluk on 08/26/2015 at 8:40 pm

    Is this something once started you will never be able to stop or will it help jump start your system back to normal?

    • Augie Galindo on 08/27/2015 at 10:40 am


      Unfortunately, TRT will not boost your natural production. This is a very slim chance that hCG therapy could lead to improved natural production, but it is a long-shot to say the least.

      Much like diabetics who need insulin, or those suffering with thyroid disease need replacement medications, once your body stops producing enough testosterone at adequate levels, typically replacement is necessary. If your numbers are borderline there is a chance that behavior modification can improve production, but this is also unlikely. You can stop therapy at any time, and you would be expected to return to baseline in weeks to months. But, if you continued relief from symptoms, then you will need continued therapy.

      Best regards,

      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

  2. Pete L. on 10/12/2015 at 11:54 am

    Hello, you mention that estradiol levels are rarely low. They are for me. With high SHBG, low free T, low LH. All else normal. But liver panel shows high bilirubin, and kidneys show slightly low eGFR. I have a 3 months wait to see a endicronologist. What are the possible causes for low estradiol? Any help/info is appreciated. Thanks.

    • Augie Galindo on 10/12/2015 at 12:19 pm


      Excellent question. Perhaps the more specific way of saying that estradiol levels are rarely low is, that they are rarely low in isolation. If total testosterone production is low and/or SHBG levels are elevated, you are likely to have low free testosterone levels. If free T levels are low, less is available to be converted to estradiol, therefore estradiol (E2) levels will also be low if there is no secondary influence such as obesity or aromatase induction.

      Finding of slightly elevated bilirubin and low eGFR are fairly common. These issues need to be evaluated in a comprehensive manner while paying attention to all hepatobiliary or renal indices. The differential diagnosis can be rather involved, and while it is unlikely to reveal anything grave, it is best done by an internist.

      I hope that helps!

      Best regards,

      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

      • Pete L. on 10/12/2015 at 12:28 pm

        Thank you for the quick and precise response. I am on the wait-list for an internist also. You mention that these results are not grave, but my libido is very low, heachaches and tiredness are persistent. Is there something I can do while waiting? Also, do you think that the hepatobiliary or renal levels/issues are related to the hormonal issues (SHBG is sourced in the kidneys I think)? I also have high MPO/inflammation markers. Thank you.

        • Augie Galindo on 10/12/2015 at 12:45 pm

          You’re welcome! The findings that I think do not represent grave issues are the elevate bilirubin and low GFR. Often changes like this are transient, but at first glance I do not think they are hormonal in etiology. The symptoms that one can experience from low free testosterone, and even low estradiol levels, can be quite profound. Finding a clinician who is experienced in handling TRT will be vital for you. Keep in mind, this is an endocrine issue, but not all endocrinologists focus on it. Unfortunately, with the prevalence of diabetes, that is what most endocrine practices focus on.

          MPO, high-sensitivity CRP, and other inflammatory markers can be very tricky. If not viewed within the right context, it can often send up red flags unnecessarily. At risk of “shotgunning” the approach, a cardiologist is best prepared to assess your cardiovascular risk.

          Making sure that your vitamin D levels are normal, getting enough Zinc, and utilizing high-intensity interval training may help boost testosterone levels in the meantime. Other possible aids include: reducing or eliminated alcohol intake, avoiding soy, reducing consumption of phytoestrogens, and maintaining plenty of “good fats” in your diet.

  3. Normal Estradiol Levels in Men on 09/27/2016 at 9:14 am

    […] Estradiol is not a “female hormone” — it’s something your body needs just as much as testosterone. In fact, some men who believe they’re suffering from low testosterone may actually be suffering from low estradiol. You can read more about it here. […]

  4. Mike on 10/13/2017 at 11:43 am


    I am a 28 year old male. Just had blood work done just to know where my levels were at. Only thing that came up as not normal was my estradiol level which showed it as low, 6.7 based on 7.6 – 42.6 range. I was hoping my test level would be higher for my age but it was 355 from a range of 264 – 926 based on the test I took. Any idea why I would have low estradiol and what does it signify? I am at the gym a lot and an avid weight lifter. Just trying to get some insight.


    • Mike,

      With a total testosterone of 355 (assuming ng/dl), it is likely that your calculated free testosterone is either borderline or low. If there is less testosterone than is optimal, then there is less to be aromatized (converted into estradiol), and that could cause low estrogen levels.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  5. Jacob on 05/25/2018 at 12:08 am

    Hi. I’ve been using Androgel 1.62% packets for several years now. I’m 22 years old. I typically use two of the 22.5g packets, but have used up to 3-4 a day in the past. What’s been going on recently is I’ve felt very tired, with poor concentration, shortness of breath, some chest pain occasionally, and have been sleeping quite a bit more than usual up to 11-12 hours a night. I’m super tired throughout the morning and early afternoon, but around 4 P.M. I start to feel more alert somewhat, but then at that time I also start to have breathing difficulties. My hands, nose, and feet are also cold and are cold very often, even in 89 degrees and 90% humidity. I’m 190 pounds and five foot seven inches tall, so I’m technically overweight. I also have sleep apnea diagnosed with primary hypogonadism, as well as am on several other medications including Hydroxyzine, Zoloft, Dexedrine, Androgel, Singulair, Propranalol, Albuterol ProAir Inhaler, Advair 500/50 inhaler, Flonase twice daily, often take 5000-10,000 IU of D3 daily, Lorazepam, Lunesta, and often take DHEA 5 mg capsules (1 of them). I’ve seen 3 doctors now, and none of them know why my extremities are cold all the time (which I’m guessing may be Raynaud’s Phenomenon). I’ve had two rounds of Prednisone recently within one month, and my shortness of breath got super bad. With Prednisone, DHEA, Androgel Packets, and Dexedrine my shortness of breath got so bad I was considering going to the E.R. several times. I was also taking Wellbutrin SR at the time as well as drinking mountain dew Kickstart drinks. I tried a month or so of taking Ashwaghanda and Omega 3’s hoping it would have positive effects for my adrenal glands and circulation, but they didn’t really do much. The other thing that is strange is the Dexedrine stimulant, Androgel, DHEA, caffeine, prednisone, and Zoloft all make me tired as crap. I feel much colder after having the Wellbutrin, Dexedrine, Zoloft, or Androgel. My doctor who prescribes the psychotropic drugs is extremely strict about me switching medicines, and will not let me switch off Zoloft. I also

    • Jacob,

      Complex medical histories pose quite a challenge when it comes to online advice. Let me apologize in advance for not being able to address your needs well. That being said, you are on many sedating medications that have negative impacts on energy levels. Under-treated sleep apnea can certainly have an impact here. Also, you may want to have your providers do a cursory check of your thyroid function. These issues probably eclipse the importance of dialing in your TRT, so I would recommend starting there.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

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