Estrogen is a hormone that is often misunderstood. As men, we understand testosterone is the primary male hormone; however, women need it too despite men needing approximately ten times that of women. When we think of estrogen, we think of it as the primary female hormone; however, men need estrogen too. Both testosterone and estrogen are essential to the health and wellbeing of both sexes, and while the amounts we need may vary, inadequate amounts for any sex will prove extremely problematic. There are side effects of high estrogen, but equally there are side effects of low estrogen. For the man undergoing testosterone replacement therapy, he will need to ensure his levels remain proper as a sound balance between the testosterone and estrogen hormone is essential to successful treatment.
The Importance of Estrogen:
Estrogen plays a role in many areas of our body; in fact, the hormone is imperative to our health and wellbeing. One of the primary functions of estrogen in all human beings is in how it helps regulate lipids by aiding in the increase in HDL cholesterol (good cholesterol) and reducing LDL cholesterol (bad cholesterol). The hormone also plays a role on our sexual wellbeing; too little or too much can render one’s libido non-existent. If that’s not enough, the primary female sex hormone also plays a role on our immune system. The hormone undoubtedly plays a larger role on women than men, but as will see the side effects of high estrogen in men as well as low can be horrendous.
The Side Effects of High Estrogen:
The primary side effects of high estrogen include gynecomastia and excess water retention. This occurs through the relationship between testosterone and the aromatase enzyme. Testosterone is aromatized causing it to convert to estrogen. If estrogen levels go too high, it can promote these effects. Gynecomastia (male breast enlargement) is the one effect most men dread. This is due to the estrogen activating the receptors in the mammary tissue, and in turn causing breast growth. However, water retention can be even more problematic as severe levels of water retention can promote high blood pressure. It normally takes severe water retention for this to be a problem, and this is rare in cases of proper testosterone therapy. In fact, the side effects of high estrogen should never occur with proper testosterone therapy.
The side effects of high estrogen can be controlled during testosterone treatment through the use of Aromatase Inhibitors (AI’s) such as Anastrozole. These AI’s inhibit aromatization. They further reduce serum estrogen levels, which in turn makes the side effects of high estrogen impossible. Not all men will need an AI; some men will not experience a significant amount of aromatization. But the majority will need protection from some type of AI, but there is good news. The treatment of low testosterone is generally indefinite. If you have low levels, true low testosterone, you are not going to one day naturally produce an optimal level of the primary male hormone. However, as treatment continues and the body becomes accustomed to once again having optimal testosterone levels, many men if not most begin to experience less aromatization and need less and less AI’s. In fact, many men who once needed an AI end up needing none at all.
Beyond the side effects of estrogen related to aromatization, high levels can also reverse the benefits of your now increased testosterone levels. Many men with high levels begin to experience erectile dysfunction, lethargy and many other often related symptoms. There must be a balance between testosterone and estrogen. Without this balance, low testosterone treatment cannot be successful.
The Side Effects of Low Estrogen:
The side effects of low estrogen can be much worse than high levels, and in many cases, worse than low testosterone if severe. As with high estrogen, the side effects of low estrogen often include erectile dysfunction, a severely diminished libido and very low energy levels. In fact, such related symptoms are generally worse with low estrogen than high estrogen, and for some men even worse than with low testosterone. However, low estrogen goes even further as it will devastate lipids and weaken the immune system. Many will also find joint pain and discomfort to be extremely common.
The side effects of low estrogen are somewhat common in testosterone replacement therapy due to people not following their doctor’s orders. As mentioned, some men do not need an AI and those that do generally need very little. However, many are so petrified of gynecomastia and other high level symptoms that they’ll use AI’s when they don’t need them or far more than they do. Such individuals are only hurting themselves.
Balancing Estrogen with AI’s:
The vast majority of doctors that practice testosterone therapy do not look at estradiol, and as a result, do nothing to help control it. It’s not that they’re bad people; they simply don’t know or understand hormone balances. And then there’s the opposite, then there are doctors who are aware of aromatization and throw AI’s at a patient like it’s candy. In fact, there are physicians who have their testosterone patients taking up to 1mg of Anastrozole a day. That is an insanely high dose; that is the dose taken by breast cancer patients and there is no need for it in testosterone therapy.
The physician who will not consider the use of an AI subject their patients to potential high estradiol levels and the physician who pours it down their patient’s throat dooms him to a low estradiol level. Proper and successful testosterone replacement therapy calls for a balance between testosterone and estrogen levels. There is no harmony without this, only unsuccessful treatment and a host of unwanted effects.