By Mike Kocsis | 7 minutes read | Last updated: January 21, 2025 Categories: Men's Health Oestrogen Testosterone
Medically Reviewed by Dr. George Touliatos
It is known that Testosterone converts into Estrogen (estradiol) via the aromatase enzyme. Because of this, many men are worried that having Testosterone Replacement Therapy (TRT) will raise their Estrogen levels leaving them with distasteful symptoms. The truth is that some men can experience increased levels of Estrogen from TRT but if you have a good TRT doctor, the chances of this happening are very slim. Estrogen contributes a lot to the overall health of the body in both men and women and your Estrogen and Testosterone levels need to be balanced in order for proper sexual, mental and physical functioning.
Now let’s get into how abnormal estrogen levels may present itself in men – what symptoms you should look out for and what you can do about it!
Common Symptoms of High Estrogen in Men
Some of the main symptoms of high estrogen in men include:
- Infertility
- Erectile Dysfunction (ED)
- Stunted growth during puberty
- Gynecomastia
Estrogen, particularly in the form of estradiol, affects libido, erectile function, and the development of the sperm within the male reproductive organs. This is partly due to the fact that estrogen receptors are prevalent not only in a man’s sexual organs but in his brain as well. In theory, when estrogen is high, there’s a greater chance of erectile dysfunction.
High estrogen levels are also linked to higher chances of developing breast cancer in males, an international research collaboration participated in by Cancer Research UK reveals. Although the risks are low in the first place, men with the highest levels of estrogen are 2 ½ times more likely to develop breast cancer than those at the bottom of this scale.
Despite the bad rap it has been getting, estrogen is important to the male body as well.
It aids in boosting the libido and keeps the bones and muscles strong as well. And since estrogen helps in keeping your hormones balanced, it helps in regulating one’s weight.
Estrogen levels in adult males are typically 10-60 pg/ml or 10-40 pg/ml depending on which type is being measured. However, what is considered “normal” levels of testosterone or estrogen may vary depending on factors like age and health conditions such as diabetes.
If you think your testosterone or estrogen levels are off, natural ways of balancing testosterone such as switching to a healthier diet, changing your mindset, and engaging in regular exercise can help. Not only are these beneficial in raising your testosterone levels, but they also result in a better quality of life in the long run.
Ironically, the prospect of testicular shrinkage or reduced sperm count from TOT doesn’t seem to bother most men. But the thought of high estrogen side effects from testosterone makes most men want to run for the hills.
In fact, so many are scared of high estrogen that they will avoid testosterone therapy altogether – even though they desperately need it.
Other Symptoms of High Estrogen in Men
I get questions on a daily basis from men fretting about the high estrogen side effects of testosterone therapy. Let’s get one thing straight: Undergoing TRT does not automatically mean you will suffer from high estrogen!
Nevertheless, it pays to be vigilant because high estrogen side effects in men can be nasty. Typical symptoms of high estrogen in men on testosterone therapy can vary, but these are some of the most common:
- Water retention. Water retention, and puffiness or colloquially known as ‘moon face’ can sometimes occur as a side effect of testosterone therapy but it is up to debate if high estrogen is the direct cause. Androgens and their metabolites may disturb the electrolyte balance as well as the angiotensin pathway which may be the true cause of water retention in men from TRT. Estrogen sometimes gets the blame but it’s still uncertain if it’s a direct cause or only an association. It’s also important to note the ratio of oestrogen to androgens as its an important factor in determining the source of symptoms.
- Tiredness. Feeling tired all the time? Your estrogen levels may be to blame. High estrogen can cause fatigue by inhibiting thyroid conversion which can make it difficult for you to sustain your energy throughout the day. Estrogen that is too low may also be to blame. Some men using aromatase inhibitors have complained of tiredness for 3-4 days which may correspond with the half-life of these drugs which should be used sparingly if at all.
- Belly fat. Can’t seem to shake off that fat around your abdomen? It might be a sign of high estrogen. Elevated estrogen levels can increase body fat, with the most prevalent being in the belly area.
- Poor erection quality and low libido. Too much estradiol can cause weak erections and lower your libido.
- Moodiness. High estrogen has historically been blamed as the cause of mood swings and emotional outbursts. Crying spontaneously can become common. low mood is usually seen in men with low testosterone and low estrogen, or low testosterone to elevated estrogen ratio.
- Gynaecomastia. Gynaecomastia or ‘man boobs’ is an unsightly side effect of high estrogen in men. This involves the growth of excess fat and glandular tissue around the breast. But this is not an overnight phenomenon and tends to occur in stages.
- Loss of lean muscle mass. Feel a little weaker than usual? Notice a jiggle in the parts of your body that used to be firm? This is another symptom of low testosterone that you should watch out for.
- Depression. High estrogen in men can also cause depression regardless of one’s weight according to a scientific study.
If you already have high estradiol (estrogen) levels prior to testosterone therapy, it is more likely the introduction of testosterone will elevate your estradiol levels further compared to an individual with normal estrogen levels. This is due to the aromatisation of testosterone into estradiol.
The side effects of high estrogen can be mitigated and avoided altogether by diligent blood work and proper estrogen management. Your TRT doctor may suggest increased injection frequency to mitigate the conversion of testosterone into estradiol or the use of an aromatase inhibitor.
The use of an aromatase inhibitor should be considered when there is a clinical need – i.e. your estradiol levels are high and you have the symptoms of high estrogen.
There are also natural methods for balancing hormones. For starters, you can start by avoiding too much alcohol. Unknown to many, excessive alcohol consumption can cause your body to produce more estrogen. Likewise, you may also switch to an organic diet that includes more cruciferous vegetables. This will give you the assurance that there won’t be hormone-altering chemicals in your food. Also, avoid BPA and heating food in the microwave using plastic containers. BPA disrupts the body’s delicate hormonal balance so avoid it if you can. Lastly, you may also resort to resveratrol supplementation to keep your estrogen levels in check.
Conclusion
Estrogen plays a pivotal role in the male body. Among other things, it’s responsible for modulating libido, erectile strength and bone mineral density. Homeostasis is a finely tuned system of checks and balances. So, if you’re chasing lab numbers after having read about it on some online forum, you’re doing yourself no good! If one guy feels good at X level, doesn’t necessarily mean you will too, it’s about finding your optimal levels!
Not sure whether your hormone levels are balanced or not? Go to a doctor and get evaluated. He or she will then ask you to undergo estrogen testing. This blood test can measure three types of estrogen: estrone (E1), estradiol (E2), and estriol (E3). The type you’ll be tested for will depend on your symptoms. After which, you’ll be prescribed the most suitable treatment plan for your situation. Blood work is critical in evaluating your response to treatment. But remember – with testosterone replacement therapy how you FEEL is foremost and lab numbers are secondary.
If you feel you’re suffering from hormone imbalance and want to get in touch with a doctor, don’t hesitate to contact us. Our experienced doctors and team will work closely with you to identify a diagnosis and come up with a treatment that’s tailored to your specific needs.
BONUS:
If you would like to know more about TRT, testosterone and estrogen, I recommend you listen to this podcast. In this podcast, Jay Campbell and Dr John Crisler really dive deep into the subject. Dr John Crisler, one of the best in the TRT game, gives a very high-level overview of estrogen control methods.
https://www.youtube.com/watch?v=0ZyptAoqnJw
References/Citations/Further Reading/Bibliography
Michael Schulster, Aaron M Bernie, Ranjith Ramasamy.The role of estradiol in male reproductive function. Asian J Androl. 2016 May-Jun; 18(3): 435–440.
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About the Author: Mike Kocsis
Mike Kocsis has an MBA with a focus on healthcare administration and is an entrepreneur and medical case manager for Balance My Hormones which offers medical services in the UK and Europe. Mike has over 20 years of experience in the healthcare sector, much of that working with people who have hormone imbalances. Mike has appeared on podcasts and radio and is an expert speaker on the subject of hormone imbalance. He specialises in Testosterone Replacement Therapy and Hormone Replacement Therapy (HRT) and has helped thousands of people suffering from hormone imbalances recover and regain control of their lives. You can follow him on LinkedIn and on the Balance My Hormones YouTube Channel.
Last update: January 21st, 2025
