Many men are using testosterone to treat symptoms of Low Testosterone and decreased testosterone levels as they age. There is a group of physicians that are also using testosterone therapy to help heal the brain secondary to traumatic brain injury, Alzheimers, and Dementia when testosterone levels are not optimal.

An optimal testosterone level is defined as 50% to 90% on the bell-shaped curve of the normal reference range for testosterone.  Using these parameters, the optimal testosterone level based on a reference range of 280 to 1100, is between 690 and 990.  If your testosterone is lower than 690 and you have symptoms of Low T, your testosterone is not optimal.

One of the outcomes treating low testosterone using testosterone injections or clomid is a concomitant increase in estrogen in the fatty tissues.  A reactive increase in estrogen as testosterone increases is a natural reaction in the body as testosterone converts to estrogen.  The amount of estrogen made from testosterone will vary from person to person depending on their ability to aromatize estrogen.

Sometimes Estrogen Levels go Above the Reference Range.  Is this harmful?

Currently, there is a lack of guidelines as to the critical level at which intervention is needed to treat high estrogen levels in a male induced by administered testosterone.  The decisions are practitioner based and individualized.  Reviewing the literature, there are no good prospective studies showing a higher estrogen level concomitant to increasing testosterone is harmful.   How high is too high has not been answered.  But will high estrogen cause any unwanted side effects?

What Happens if a Man’s Estrogen is too high?

A large number of physicians automatically put patients on an estrogen blocker to block the increased estrogen simultaneously as they treat the patient with testosterone.  Why?

The questions at hand are,

  • Is an increase in estrogen harmful to a man’s sexuality?
  • Is it harmful to the body in any other ways such as increasing the incidence of stroke?
  • Does it decrease libido (sex drive)?
  • Does it increase gynocomastia (breasts)?
  • Is age a factor in increased conversion of testosterone to estrogen?
  • Should this increased estrogen be blocked by estrogen blockers such as Anastrozole (Arimidex) or tamoxifen?

A Study Review:  High Estrogen in Men After Injectable Testosterone Therapy*

A retrospective 34,016 patient study published in 2015 in the American Journal of Men’s Health sought to answer some of these questions.  They found 20.2% of men being treated with testosterone with levels within the normal reference ranges, had above normal estradiol (estrogen) levels.

The age distribution for men with high estrogen level were,

  • 3% greater than 65,
  • 1% ages 45-65,
  • 7% ages 25-44,
  • 3% less than 25

The development of breast tissue (gynecomastia) in men appears to be directly linked to an increase in testosterone levels, estrogen levels, and obesity.  Interestingly, gynecomastia was rarely documented as a reason to write a prescription for an estrogen blocker.  The incidence of gynecomastia was less than 1% in men with increased estrogen levels.  Therefore, it is rare but present.

The study found high estradiol (estrogen) levels were not associated with low libido, but instead found higher rates of low libido with normal to lower estrogen levels. This study parallels other studies suggesting a positive role of estrogen in the functioning of male libido. Also, higher estrogen levels were not linked to diminished sexual performance or moodiness.

Some studies indicate an association but no causality of high estrogen linked to higher rates of heart attacks, strokes, and prostate cancer (Basaria et al., 2013; Kristal et al., 2012; Lerchbaum et al., 2011).  Most of these studies are in men >65 years old with low testosterone levels indicating a problem with aromatization of testosterone to estrogen which is most evident with obesity or alcoholism.

As an aside, Estrogen and Testosterone have a protective effect from the lung disease of Covid-19 as these hormones sit on the same receptor sites as Covid-19 in the lung.  Being cognizant of optimizing our hormones is critical for our health.



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