Role of Estradiol (Estrogen) in Men and Its Management

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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.

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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




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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

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The article "Estradiol as a Male Hormone" gives an overview of the role of estradiol (E2) in men's health, with a focus on its effects on reproductive function, growth hormone, insulin-like growth factor-1 (GH-IGF-1) axis regulation, bone growth and maintenance of skeletal health, body composition and glucose metabolism, vasomotor stability, and brain function.

An enzyme called aromatase converts testosterone and androstenedione into E2 in men. Evidence shows that E2 is an important hormone in men because it controls the hypothalamic-pituitary-testicular axis, reproductive function, the GH-IGF-1 axis, bone growth and keeping the skeleton healthy, body composition and glucose metabolism, and vasomotor stability.

One of E2's main jobs in the male reproductive system is to control the process of making sperm. The enzyme aromatase creates E2 in the Sertoli cells of the testis. There, it works as a paracrine factor to help germ cells mature and divide. E2 also affects the way the hypothalamic-pituitary-gonadal axis works, which controls how much testosterone is made and how sperm are made.

It has also been shown that E2 affects how the GH-IGF-1 axis works in men. In healthy guys, the level of E2 is linked to the level of IGF-1 in the blood. Also, E2 may control how much GH is made by stopping it from being made.

E2 is a hormone that is important for men's bones to grow and stay healthy. It works in a roundabout way by encouraging the differentiation and activity of osteoblasts, which are the cells that build bone, and by stopping the differentiation and activity of osteoclasts, which break down bone.

E2 also has an impact on men's body types and how they use glucose. In particular, E2 seems to encourage body fat to build up in the peripheral (i.e., subcutaneous) areas while stopping it from building up in the central (i.e., abdominal) areas. Also, E2 has been shown to improve the way hypogonadal guys use glucose.

Men's vasomotor steadiness is also kept in check by E2. Nitric oxide (NO) production is believed to be the cause of E2's effects on blood vessels. E2 may also help control blood pressure by blocking the renin-angiotensin-aldosterone system (RAAS), which is a key regulator of blood volume and blood pressure.

Lastly, E2 has been shown to affect how men's brains work. During growth, the brain needs E2 in order to become more masculine. Less is known about what E2 does to the brain when a person is an adult. But it has been suggested that E2 may have something to do with how guys think and feel, as well as how their brains work.
Overall, E2 is an important hormone for regulating male reproductive function, the GH-IGF-1 axis, bone growth and maintaining skeletal health, body makeup and glucose metabolism, vasomotor stability, and brain function. Even though more research is needed to fully understand how E2 affects men's health, the evidence so far shows that E2 is a key player in these processes and has important clinical implications for the diagnosis and treatment of male health conditions.
 
 
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