Do Men Need Estrogen Therapy?
Men need estrogen in the same manner that women need testosterone – balancing out the body’s hormones. Although a woman’s ovaries produce both testosterone and estrogen, a man’s testes do not carry out the same function. The difference is that once testosterone is produced in the testes, a process called aromatization (conversion) takes place that turns excess free testosterone into estradiol (estrogen).
That leads to the subject of estrogen therapy for men and its place as an essential part of male hormone replacement therapy. The majority of men have heard about or are familiar with testosterone replacement, and know it as being able to restore lean muscle and libido.
Maintaining a proper level of estrogen is essential in males. Estrogen effects help to promote proper bone mineral density, cognitive function, and even maintain the endothelium – the inner lining of arterial walls.
Research has shown that insufficient estrogen predisposes men to develop bone fractures as a result of osteoporosis. Hip fractures were shown to be three times higher in men with low estradiol levels. Those males who had elevated levels doubled their risks of stroke. In these types of cases, estrogen therapy for males is not performed by increasing estrogen supplies, but rather by blocking the conversion process that occurs.
How Do Men Make Estrogen?
Male estrogen production occurs when an enzyme called aromatase converts free testosterone into estradiol. The older a man becomes, the greater the aromatase activity in his body and the less testosterone is produced. This results in the transformation of too much testosterone into estradiol. The outcome of this process is low levels of testosterone and high estrogen levels that can throw the natural balance out of whack.
Conversely, some men lack the enzyme aromatase, and they suffer from an estrogen deficiency. In cases where a man does not produce enough testosterone for the conversion process, both Low T and low estrogen may be diagnosed.
Male obesity and estrogen tend to go together. Estrogen is produced at higher levels in fatty tissue. Obese males have been found to be suffering from Low T at a higher rate than their trimmer counterparts, and higher estradiol is often a link to this problem. Excess fat – primarily in the abdominal area – increases estrogen levels, and excess estrogen increases weight gain. This also increases the risk of coronary artery disease and diabetes as a man ages.
Why Balanced Estrogen Levels are Crucial for Men
A study that was published in JAMA – the Journal of the American Medical Association – measured the level of estradiol in the blood of 501 men with chronic heart failure. Males with high estrogen levels of 37.40 pg/mL or above were 133% more likely to die during a three-year follow-up than those in the normal range of 21.80 – 30.11 pg/mL.
While this shows that a high level of estrogen in a man’s body is not healthy, it is not the worst-case scenario. The study also showed that when male estrogen levels were too low – under 12.90 pg/mL – the death rate soared to 317%.
A different study that followed 3,014 men between the ages of 69 and 80 for four and a half years discovered that those individuals with low levels of testosterone had a 65% greater chance of all-cause mortality, and those males with low estrogen levels suffered 54% more deaths. The men who had both hormone levels low had a 96% increase in their mortality rates as opposed to those whose levels were in the optimal ranges. This means that they were almost twice as likely to die as their counterparts with proper hormone levels.
A significant number of bone fractures due to osteoporosis, strokes, heart attacks, and dementia cases may be preventable by maintaining the crucial hormonal balance in the body. The biggest concern is for men who have low levels of both testosterone and estradiol, as their risks are significantly greater, especially with a 6.5 times higher chance of hip fractures.
Controlling Estrogen Levels with Testosterone Treatment
It is first essential to assess the hormone levels in the bloodstream through blood analysis. The doctor – typically a hormone replacement therapy specialist – will order a serious of panels to be checked, including estradiol, free and total testosterone, and insulin growth factor 1 (IGF-1 to assess growth hormone levels). This is the only accurate way of checking male testosterone and estrogen levels for a deficiency or an excess.
The results of these blood tests will shed some light as to what is going on inside the body. The doctor will look to see if both testosterone and estradiol are low or elevated, or if one is high and the other is low. High levels of male estrogen combined with low testosterone readings may indicate that the problem lies in too much aromatization taking place.
The problem with excess aromatase in the male body is that it depletes testosterone supplies while exposing it to a risk of higher than desirable levels of estradiol. A male estrogen blocker can be used to inhibit the conversion process from taking place, freeing up more testosterone for use in the body while lowering the levels of estrogen in the bloodstream.
If both levels are low, then the need is there to increase testosterone, which will also aid in the conversion process. In most cases of Low T, treatment with some form of bioidentical testosterone will be beneficiary.
Once the aromatase conversion is suppressed, either by providing an estrogen blocker or increasing testosterone through replacement therapy, estrogen levels will be reduced to a safe and effective range. Free testosterone will then be able to provide its increased signals throughout the body.
Finding the Right Hormone Replacement Therapy
There are times when estrogen therapy for men does mean the need to administer a topical estradiol cream if the body is severely deficient in aromatase. Blood analysis will be conducted before and during treatment to ensure that a proper balance of testosterone to estrogen is maintained.
Most men who are diagnosed with Low T will benefit from receiving testosterone replacement therapy. The need for an estrogen blocker will be determined by the blood test results. Embarking on a course of hormone therapy for andropause (the male version of menopause) can be extremely beneficial. The right type of treatment can restore energy, vitality, libido, and a sense of purpose to one’s life. These are all problems that can accompany hormonal imbalance.
Many males find that they tend to gain weight, lose interest in activities they once enjoyed, and suffer from depression when their hormone levels are no longer in balance. The use of doctor prescribed estrogen therapy in males – no matter what the type – can make quite a difference in one’s life.
National HRT Staff
Please note that the information provided in this article is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.
- The Role of Estrogen in the Treatment of Men with Schizophrenia Int J Endocrinol Metab. 2013 Summer; 11(3): 129–136.Published online 2013 Jul 1
- The Role of Estrogen in the Treatment of Men with Schizophrenia Jayashri Kulkarni, Emmy Gavrilidis, Roisin Worsley, Tamsyn Van Rheenen, and Emily Hayes Cardiovascular Actions of Estrogens in Men Krishnankutty Sudhir Paul A. Komesaroff
- The Journal of Clinical Endocrinology & Metabolism, Volume 84, Issue 10, 1 October 1999, Pages 3411–3415,