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Estrogen excess in men

What do we know about estrogen in men? We know a lot. More than just tanking men’s testosterone levels, estrogen excess is related to other health problems. Let’s look at symptoms of estrogen excess in men, why it develops, and its associated health risks. Treatment of estrogen excess in men  

Symptoms of estrogen excess in men
Aandropause is the common condition in men in which natural testosterone levels drop too fast as we age, starting in our 30’s.  Andropause is not optimal health.

Because testosterone can be converted enzymatically to estradiol by the activity of the enzyme aromatase, estradiol excess can be the very cause of low testosterone levels in men. The most common signs and symptoms of estrogen excess in men include:
Sexual dysfunction (low libido, decreased morning erections, decreased erectile function)
Enlarged breasts
Increased abdominal fat
Loss of lean muscle
Moodiness such as sadness, worry, despair
Easy fatigue
Urinary tract symptoms associated due to an enlarged prostate
Type 2 diabetes

Why estrogen builds up in men
First off, cholesterol is the parent molecule in sex hormone metabolism. After several metabolic changes, cholesterol eventually becomes testosterone.  I don’t know of any man who naturally has too much testosterone (and who complains about it), I know many patients with low testosterone.

In addition to genetic predisposition, there are a few reasons why testosterone conversion to estradiol is increased:
Advancing age increases aromatase activity. It I not uncommon for older men have higher estrogen levels than age-matched postmenopausal women.
Fat tissue contains aromatase and also nicely stores estradiol. Men create testosterone in their testes, but then it circulates and become converted to estrogen predominately in body fat. Therefore, increasing body fat (due to inactivity and poor diet) increases aromatase activity and helps store estradiol.
Testosterone therapy (injections, creams, troches, pellets) can trigger increased conversion to estradiol, especially if dosed too high in overweight men.
Hormone feedback in the brain can also function poorly. Elevated estradiol levels can trigger even lower testosterone production, thus worsening the estrogen dominant condition and symptoms.  

Any health risks to estrogen excess in men?
Because of the relationship between estrogen excess in men and low testosterone, consider the health risks of testosterone deficiency in men:
Increased risk of cardiovascular disease.    
Increased risk of all-cause mortality.        Researchers conclude that a decrease of 2.1 standard deviations from normal total serum testosterone level predicts a 25% increase in death rate.
Low testosterone is found in as high as 40% of patients with type 2 diabetes. The Endocrine society recommends routinely screening for low testosterone in men who have type 2 diabetes, metabolic syndrome (now nearly 1 in 3 American adults have this), chronic lung disease, osteoporosis, HIV infection, alcohol abuse, and those who have prolonged treatment with steroids, opiate pain relievers, or anticonvulsants.
Consider the other health conditions that improve with testosterone replacement: low skeletal muscle mass and strength, pain and death resulting from sarcopenia (degenerative loss of skeletal muscle mass), osteoporosis (loss of bone density),  declining cognitive function, memory, and verbal fluency, elevated total cholesterol, libido, sexual appetite, frequency and firmness of erections, energy and feeling of well-being, anxiety/fear/depression, loss of self-confidence, anemia, heart and blood vessel strength, blood pressure, and even blood clots.

In addition to experiencing the most common signs and symptoms listed above, a recent study was presented suggesting that age-related estrogen excess in men may be the main trigger behind inguinal hernias. This condition is common in elderly men and is a leading cause for surgery in men. To date, there is no identifiable root cause for inguinal hernia.

This study in mice showed that abdominal wall scar tissue weakened and hernias developed significantly with increased estrogen levels in just the male mice. By eliminating estrogen it prevented hernia formation. The researchers concluded that it might make sense to treat estrogen excess in at-risk aging men.

I’ll address treatment for male estrogen excess in my succeeding article on the subject.

To long term health and feeling good,
Michael Cutler, M.D.

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