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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