Role of Estradiol (Estrogen) in Men and Its Management

Check your estradiol (sensitive) blood levels cheaply: DiscountedLabs.com


REGISTERED MEMBERS: DOWNLOAD ATTACHED ESTRADIOL LECTURE HANDOUT AT THE BOTTOM OF THIS POST

To view this content we will need your consent to set third party cookies.
For more detailed information, see our cookies page.

Accept third party cookies

Click here for a comprehensive article about the 18 things you should know about estradiol in men


By Nelson Vergel, BsChE, MBA

Note: This thread has 54 posts (3 pages).

Testosterone is the precursor hormone for estradiol. Estradiol is a hormone more abundant in women than men that are produced by the aromatization of testosterone in the liver, fat, and other cells. Nature created it for a reason. It has been shown to be responsible for healthy bone density but its role in men's sex drive, body composition, and other variables is a source of great debate.

When the HPT hormonal axis senses that testosterone or estradiol is high, it automatically decreases or shuts down testosterone production.

Many anti-aging or men's health clinics prescribe anastrozole, a blocker of estradiol production, to men who start testosterone replacement (TRT). Higher estradiol blood levels in the presence of low testosterone not only can cause breast tissue growth and possibly other issues. Some people speculate that high estradiol can also lead to erectile dysfunction but no scientific papers have been published on this subject. Since higher testosterone blood levels can originate higher estradiol levels, the belief is that using anastrozole will prevent breast tissue growth and erectile dysfunction by lowering any potential increase in estradiol. However, we have no data on how high is too high when it comes to this hormone in men using testosterone therapy. Some even speculate that low testosterone-to-estradiol ratios may be more closely correlated to gynecomastia and erectile problems than estradiol alone.


The truth about these speculations is starting to emerge but we still do not have enough data to say what the upper value of the optimal range of estradiol really is. We have a lot of evidence about the lower side of the optimal range since it has been found that estradiol blood levels below 10-20 pg/ml can increase bone loss in men. A recently published study also nicely demonstrated that low estradiol can be associated with higher fat mass and lower sexual function in men. So, be very careful when a clinic wants to put you on this drug without first justifying its use.

To view this content we will need your consent to set third party cookies.
For more detailed information, see our cookies page.

Accept third party cookies

Another concerning fact is that many clinics may be using the wrong estradiol test that may overestimate the levels of this hormone in men. A sensitive estradiol test more accurately measures estradiol in men than the regular test, which costs less.

Sensitive Estradiol Blood Test: The Only Accurate Assay for Men

Fortunately, most men on TRT do not develop gynecomastia even without using anastrozole (gynecomastia is common in bodybuilders who may use high doses of testosterone, however). Those that have gynecomastia at TRT doses (100-200 mg of injectable testosterone or 5-10 grams of testosterone gel per day) may be genetically predisposed to having more aromatase activity or have liver dysfunction. Treating all men who start TRT with anastrozole from the start may be counterproductive since this may lower estradiol to very low levels. Some physicians monitor estradiol blood levels after 6-8 weeks of having a man start TRT alone using the ultrasensitive estradiol test to determine if anastrozole use is warranted. Doses range from 0.25 mg per week to some clinics using excessive doses of 1 mg three times per week. After 4-6 weeks on anastrozole, its dose can be adjusted to ensure than estradiol is not under 20 pg/ml. Fortunately, many men on TRT do not need anastrozole at all.

What to Do if You Crashed Your Estradiol?

Treatment of estrogen (estradiol) levels in men on TRT: An anonymous doctor survey

Estradiol is an Important Hormone for Men

www.excelmale.com

Estrogen is Essential for Muscle Growth in Bodybuilders

William Llewellyn’s, ANABOLICS Estrogen Aromatization Testosterone is the primary substrate used in the male body for the synthesis of estrogen (estradiol), the principal female sex hormone. Although the presence of estrogen may seem quite unusual in men, it is structurally very similar to...

www.excelmale.com

My opinion is that:

1- AIs should not be prescribed at TRT start.

2- Sensitive estradiol should be measured after 6-8 weeks

3- A ratio of testosterone to estradiol of 14 and higher is not a cause of gynecomastia (divide ng/dL by pg/mL). All men on TRT have that kind of ratios.

4- Unless you have strong genetic predisposition to gynecomastia, AI's should not be used. If AIs are used, most men do not need doses over 0.25- 0.5 mg per week.

5- Water retention and sensitive nipples are usually NOT a symptom of high estradiol.

6- Using AIs have never been proven to decrease water retention. Water retention on TRT is caused by sodium retention.

7- It is not easy to recover from crashing your estradiol. Low estradiol can decrease sex drive and penis sensitivity, bone density and increase fat mass.



Why is estradiol important for men?

One of the most common problems reported on ExcelMale: I crashed my estradiol

More articles on estradiol in men: Click here

Estradiol in Men: Impact on Cognitive Function and Heart Disease during Testosterone Therapy | Discounted Labs

Estradiol in Men on TRT: Impact on Brain and Heart

Estradiol's Role in Men's Health: Top 18 Facts

Estradiol Blood Level in Men: Why It is Important

Is Estradiol a Friend or Enemy of Men?

Men’s Heart Disease Partly Due to Low Estrogen

To view this content we will need your consent to set third party cookies.
For more detailed information, see our cookies page.

Accept third party cookies

How to Predict Estradiol and DHT at Different Testosterone Doses

I was able to come up with a table using the predictive model equation derived from data in this study: The Effects of Injected Testosterone Dose and Age on the Conversion of Testosterone to Estradiol and Dihydrotestosterone in Young and Older Men Summary This video discusses a research paper...

www.excelmale.com

Estradiol is an Important Hormone for Men

www.excelmale.com

Estradiol in Men: Libido and Brain Function

Role of estradiol in the brain The effect of estradiol on libido is seen at various levels of regulation, starting with direct effects in the brain (Figure 1). Areas of the brain that control sexual behavior in mammals are thought to do so via pheromones that induce specific sexual effects on...

www.excelmale.com

Testosterone Needs to Be Converted into Estradiol to Prevent Fat Accumulation

www.excelmale.com

 

To view this content we will need your consent to set third party cookies.
For more detailed information, see our cookies page.

Accept third party cookies

Estradiol in Men: Friend or Enemy?

Allison Woodworth from www.PrimeBody.com reviews data on estradiol in men and discusses the use of anastrozole to manage it. She stresses the need for proper blood testing and management.

 

This study used a high dose of 1 mg per day of anastrozole.

Aromatase Inhibition Reduces Insulin Sensitivity in Healthy Men -

Aromatase Inhibition Reduces Insulin Sensitivity in Healthy Men | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic

 

The Significance of the Estrogenic Environment to Bodybuilding

It has been estimated that aromatase inhibitor users suffer from mood disorders, mood swings, being emotionally unstable and occasionally have symptoms of melancholy, or even depression. It is also known that methandrostenolone/methandienone (D-bol) users can become addicted to the euphoric effect it has upon the users psychology. This is due to the fact that estrogen give you the feeling of well being. Lack of estrogen may affect mood and emotional stability in general. Menopausal women seem to have mood swings and be rather unstable to their emotional status. As a result, a similar brain chemistry would affect a male bodybuilder. Estrogens also are an important factor for a proper libido too. Aromatase inhibitors such as exemestane, letrozol and anastrozol have a negative impact on sexual drive during a steroid cycle. While it seems that testosterone is the main reason for an enhanced libido, the truth is far from it. Female hormones, estrogens, play a significant role on a male’s libido too. This was experimentally demonstrated by two groups of men who were under testosterone treatment, while another group took testosterone and an anti-estrogenic agent. The final conclusion was that men who did not used the anti-estrogenic treatment, had an improved sexual drive. Consequently, it becomes obvious that lower than optimal levels can lead to depression, osteoporosis and lack of sexual interest. Of course after a typical PCT, the use of both is critical in order estrogens to get lower, when we stop using SERM’s. Lower estrogens will then give a signal to hypothalamus for GnRH release."

© 2016 Anabolic.org. Read more Anabolic Steroids & Substance Info at: http://www.anabolic.org/the-significance-of-the-estrogenic-environment-to-bodybuilding/

 

DHT and estradiol correlate to slowdown of biological aging

Read more at: https://www.excelmale.com/forum/sho...iol-correlate-to-slowdown-of-biological-aging

 

Testosterone Side Effect Management Table

 

Low Estradiol May Cause Hot Flashes and Night Sweats in Men

 

This recent study reinforces the conclusion made by a study discussed in the first post of this thread. Low estradiol can cause increased fat mass.

Short-Term Estrogen Withdrawal Increases Adiposity in Healthy Men -

See more at:

Short-Term Estrogen Withdrawal Increases Adiposity in Healthy Men | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic

Abstract

Context:

Testosterone deprivation increases risk of insulin resistance in men, but whether this risk is independent of changes in body composition is unknown. Further, the metabolic roles of testosterone and its metabolite estradiol have not been clearly defined in men.

Objective:

To establish the effects of selective sex steroid withdrawal on insulin sensitivity in healthy men

Design:

Double-blinded, placebo-controlled, randomized trial

Setting:

Academic medical center

Participants:

56 healthy men, 19-55 years of age

Interventions:

Subjects received the GnRH antagonist acyline plus one of the following: placebo gel (Castrate), 1.25g testosterone gel (Low T/E), 5g testosterone gel (Normal T/E), or 5g testosterone gel with letrozole (Normal T/Low E) daily for 4 weeks. Body composition and glucose tolerance were assessed at baseline and end-of-treatment.

Main Outcome Measure:

Insulin sensitivity quantified by the Matsuda index

Results:

Predicted circulating sex steroid concentrations were achieved in all treatment groups. The time-by-group interaction for Matsuda index did not achieve significance in overall repeated measures analysis of variance (baseline vs. week 4, p=0.16). A significant time-by-group interaction was observed for fat mass (p=0.003), with changes in fat mass attributable predominantly to estrogen exposure in linear regression analysis (p=0.016). A time-by-group interaction also was observed for lean mass (p=0.03) and influenced by androgen exposure (p=0.003).

Conclusions:

Short-term sex steroid withdrawal in healthy men causes adverse changes in body composition. These findings support the role of estradiol as a determinant of adiposity in men.


Affiliations

1Center for Research in Reproduction and Contraception and
2Diabetes Institute, Division of Metabolism, Endocrinology, and Nutrition and
3Division of Gerontology & Geriatric Medicine, Department of Medicine, University of Washington School of Medicine
4The Fred Hutchinson Cancer Research Center; and
5the Geriatric Research, Education and Clinical Center, V.A. Puget Sound Health Care System, Seattle, WA
- See more at: Short-Term Estrogen Withdrawal Increases Adiposity in Healthy Men | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic

 

Does low estradiol cause joint pain in men because of inflammation?

 

The role of estradiol in male reproductive function

 

How much testosterone is converted to estradiol?

 

Estradiol in Men: Interview with Urology Professor Dr Ranjith Ramasamy

 

Should We Be Managing Estradiol and Hematocrit in Men on Testosterone Replacement?

 

The role of estradiol in male reproduction, libido and erectile function

 

New article. Click here: THE ROLE OF ESTRADIOL IN MALES: IMPLICATIONS FOR LIBIDO AND TESTOSTERONE REPLACEMENT THERAPY.

 

Click: The effect of estrogen on tendon and ligament metabolism and function

 

Estrogens and Body Weight Regulation in Men



Our understanding of the metabolic roles of sex steroids in men has evolved substantially over recent decades. Whereas testosterone once was believed to contribute to metabolic risk in men, the importance of adequate androgen exposure for the maintenance of metabolic health has been demonstrated unequivocally.
A growing body of evidence now also supports a critical role for estrogens in metabolic regulation in men. Recent data from clinical intervention studies indicate that estradiol may be a stronger determinant of adiposity than testosterone in men, and even short-term estradiol deprivation contributes to fat mass accrual.
The following chapter will outline findings to date regarding the mechanisms, whereby estrogens contribute to the regulation of body weight and adiposity in men. It will present emergent clinical data as well as preclinical findings that reveal mechanistic insights into estrogen-mediated regulation of body composition. Findings in both males and females will be reviewed, to draw comparisons and to highlight knowledge gaps regarding estrogen action specifically in males.
Finally, the clinical relevance of estrogen exposure in men will be discussed, particularly in the context of a rising global prevalence of obesity and expanding clinical use of sex steroid-based therapies in men.
Rubinow KB. Estrogens and Body Weight Regulation in Men. Advances in experimental medicine and biology 2017;1043:285-313.https://link.springer.com/ch…/10.1007%2F978-3-319-70178-3_14



Full paper (for registered members):

 

Article: Lecture: Estradiol in Men: Roles and Management

 

The latest research on estradiol in men.

Click here:
ESTRADIOL IN MEN: IMPACT ON COGNITIVE FUNCTION AND HEART DISEASE DURING TESTOSTERONE THERAPY

 

THE ROLE ON ESTROGEN IN MEN:

From: The Decline of Androgen Levels in Elderly Men and Its Clinical and Therapeutic Implications


There is a rapidly growing body of evidence that a number of physiological actions of testosterone in men are mediated by the ERs (estrogen receptors) after its biotransformation by the aromatase cytochrome P450 enzyme in the tissues (59). Documented estrogen-mediated actions of testosterone in men include a role in the feedback regulation of LH (60, 61), a role in the regulation of skeletal homeostasis (62, 63), as well as a role in lipid metabolism and cardiovascular physiology (64, 65); among other possible estrogen actions in men, there are indications for a role in the brain (66) and in spermatogenesis (67). These estrogenic actions in men can be exerted by blood-borne estrogens as well as through local aromatization of testosterone in, or in close vicinity of, the target cell. The expression of the CYP19 gene encoding the aromatase enzyme can be differentially regulated according to the tissue (68, 69).

The conversion rate of testosterone to estradiol is around 0.2%. Up to 80% of plasma estradiol originates from aromatization of testosterone and androstenedione, mainly in (sc) fat and striated muscle, although aromatase activity is present in many other tissues, including bone and the brain; no more than 20% of estradiol in the circulation is secreted by the testes. Estradiol serum concentration in the adult male is around 20 to 30 pg/ml (70 to 110 pmol/liter), with a production rate of around 45

THE ROLE ON ESTROGEN IN MEN:

From: The Decline of Androgen Levels in Elderly Men and Its Clinical and Therapeutic Implications


There is a rapidly growing body of evidence that a number of physiological actions of testosterone in men are mediated by the ERs (estrogen receptors) after its biotransformation by the aromatase cytochrome P450 enzyme in the tissues (59). Documented estrogen-mediated actions of testosterone in men include a role in the feedback regulation of LH (60, 61), a role in the regulation of skeletal homeostasis (62, 63), as well as a role in lipid metabolism and cardiovascular physiology (64, 65); among other possible estrogen actions in men, there are indications for a role in the brain (66) and in spermatogenesis (67). These estrogenic actions in men can be exerted by blood-borne estrogens as well as through local aromatization of testosterone in, or in close vicinity of, the target cell. The expression of the CYP19 gene encoding the aromatase enzyme can be differentially regulated according to the tissue (68, 69).

The conversion rate of testosterone to estradiol is around 0.2%. Up to 80% of plasma estradiol originates from aromatization of testosterone and androstenedione, mainly in (sc) fat and striated muscle, although aromatase activity is present in many other tissues, including bone and the brain; no more than 20% of estradiol in the circulation is secreted by the testes. Estradiol serum concentration in the adult male is around 20 to 30 pg/ml (70 to 110 pmol/liter), with a production rate of around 45 g/d. Plasma estradiol is also bound to SHBG but with only half the affinity of testosterone. Total plasma estradiol levels in adult men do not vary significantly with age; indeed the decrease in precursor levels (i.e., testosterone and androstenedione) is compensated by an increase of fat mass and tissue aromatase activity with age (36, 70, 71). As a consequence of the age-associated increase in SHBG binding capacity, the serum concentrations of free estradiol and non-SHBG-bound or “bioavailable” estradiol do show a moderate age-associated decrease (36, 71, 72) (Fig. 3). It can be pointed out that estrogen serum levels in elderly males are higher than those in postmenopausal women (63).

 

STUDY LOOKING AT THE EFFECT OF ESTRADIOL ON FAT MASS, SEX DRIVE AND ERECTILE FUNCTION


There was a recently published groundbreaking study about the role of estradiol in men. No optimal ranges of estradiol were noted but low levels were associated with increased fat and decrease in sexual desire and erectile function compared to higher levels (the highest average estradiol was 35 pg/ml, unfortunately, so no conclusions can be made for levels above this).

Men had their hormones blocked by a gonadotropin-releasing hormone antagonist. All of them then received testosterone supplementation with Androgel. Half were also treated with anastrozole to block estradiol conversion from the testosterone. Please refer to the attached graphs.

All participants (Cohorts 1 and 2) received goserelin acetate (Zoladex, AstraZeneca), at a dose of 3.6 mg subcutaneously at weeks 0, 4, 8, and 12, to suppress endogenous gonadal steroids (testosterone and estradiol). All participants (Cohort 1 and 2) were then randomly assigned to receive 0 g (placebo), 1.25 g, 2.5 g, 5 g, or 10 g of a topical 1% testosterone gel (AndroGel, Abbott Laboratories) daily for 16 weeks. Participants in cohort 2 also received anastrozole (Arimidex, AstraZeneca) at a dose of 1 mg daily to block the aromatization of testosterone to estrogen. Participants were unaware of the study group assignments.

Findings:

Higher blood levels of testosterone decreased the percentage of body fat (P = 0.001), intra abdominal fat area (P = 0.021), and subcutaneous fat area (P = 0.029), and increased sexual desire (P = 0.045) and erectile function (P = 0.032).

Low blood level of estradiol was associated with significant increases in the percentage of body fat (P<0.001), subcutaneous fat area (P<0.001), and intra abdominal fat area (P = 0.002), and relative less improvement in sexual desire (P<0.001) and erectile function (P = 0.022). These findings provide additional evidence of an independent effect of estradiol on these variables.

"Our finding that estrogens have a fundamental role in the regulation of body fat and sexual function, coupled with evidence from prior studies of the crucial role of estrogen in bone metabolism, indicates that estrogen deficiency is largely responsible for some of the key consequences of male hypogonadism and suggests that measuring estradiol might be helpful in assessing the risk of sexual dysfunction, bone loss, or fat accumulation in men with hypogonadism. For example, in men with serum testosterone levels of 200 to 400 ng per deciliter, sexual desire scores decreased by 13% if estradiol levels were 10 pg per milliliter or more and by 31% if estradiol levels were below 10 pg per milliliter. "

Reference:

Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men
N Engl J Med 2013;369:1011-22.


STUDY LOOKING AT THE EFFECT OF ESTRADIOL ON FAT MASS, SEX DRIVE AND ERECTILE FUNCTION


There was a recently published groundbreaking study about the role of estradiol in men. No optimal ranges of estradiol were noted but low levels were associated with increased fat and decrease in sexual desire and erectile function compared to higher levels (the highest average estradiol was 35 pg/ml, unfortunately, so no conclusions can be made for levels above this).

Men had their hormones blocked by a gonadotropin-releasing hormone antagonist. All of them then received testosterone supplementation with Androgel. Half were also treated with anastrozole to block estradiol conversion from the testosterone. Please refer to the attached graphs.

All participants (Cohorts 1 and 2) received goserelin acetate (Zoladex, AstraZeneca), at a dose of 3.6 mg subcutaneously at weeks 0, 4, 8, and 12, to suppress endogenous gonadal steroids (testosterone and estradiol). All participants (Cohort 1 and 2) were then randomly assigned to receive 0 g (placebo), 1.25 g, 2.5 g, 5 g, or 10 g of a topical 1% testosterone gel (AndroGel, Abbott Laboratories) daily for 16 weeks. Participants in cohort 2 also received anastrozole (Arimidex, AstraZeneca) at a dose of 1 mg daily to block the aromatization of testosterone to estrogen. Participants were unaware of the study group assignments.

Findings:

Higher blood levels of testosterone decreased the percentage of body fat (P = 0.001), intra abdominal fat area (P = 0.021), and subcutaneous fat area (P = 0.029), and increased sexual desire (P = 0.045) and erectile function (P = 0.032).

Low blood level of estradiol was associated with significant increases in the percentage of body fat (P<0.001), subcutaneous fat area (P<0.001), and intra abdominal fat area (P = 0.002), and relative less improvement in sexual desire (P<0.001) and erectile function (P = 0.022). These findings provide additional evidence of an independent effect of estradiol on these variables.

"Our finding that estrogens have a fundamental role in the regulation of body fat and sexual function, coupled with evidence from prior studies of the crucial role of estrogen in bone metabolism, indicates that estrogen deficiency is largely responsible for some of the key consequences of male hypogonadism and suggests that measuring estradiol might be helpful in assessing the risk of sexual dysfunction, bone loss, or fat accumulation in men with hypogonadism. For example, in men with serum testosterone levels of 200 to 400 ng per deciliter, sexual desire scores decreased by 13% if estradiol levels were 10 pg per milliliter or more and by 31% if estradiol levels were below 10 pg per milliliter. "

Reference:

Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men
N Engl J Med 2013;369:1011-22.