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Testosterone and Estrogen

When a male decides to undergo testosterone replacement therapy (TRT) due to low T levels and symptoms such as fatigue, low libido, and erectile dysfunction, many effects occur within the body. The vast majority of these are positive, such as increases in lean muscle mass, elevated mood, stronger erections, and weight loss to name a few, but unfortunately negative side effects can and do occur in some men. One of the most common and treatable side effects is an increase in your estrogen levels. 

Estrogen is the predominant sex hormone in females but it is vital in the health of men as well. Estrogen is important in maintaining bone density, glucose metabolism, and cholesterol and vascular health. Therefore it is imperative to monitor your estrogen levels to fully optimize your health during TRT.

Estrogen is naturally produced in men from testosterone. A portion of circulating testosterone is converted into estrogen via an enzyme called aromatase found in peripheral tissue, such as bone and adipose tissue (fat). This is another reason why excess fat is bad for your testosterone level. More fat equals more aromatase which converts your testosterone into estrogen. So the more fat you have, the more estrogen conversion will occur that lowers your testosterone even further, which then leads to even less muscle mass and more fat gain and the cycle goes on and on. Its no wonder why so many aging men have low testosterone levels and sub-optimal health!

During TRT, some men aromatize more then others and will subsequently have elevated estrogen levels. Symptoms of high estrogen are numerous but are usually benign in nature. These include increased water weight (usually temporary), nipple sensitivity, moodiness, night sweats, insomnia, low libido, brain fog, and weakened erections. The good news is is that this is preventable and treatable with careful monitoring which is standard procedure at Alpha Medical. 

If your estrogen is found to be elevated and you are symptomatic, there are numerous ways of lowering estrogen levels. First line intervention is to either lower the testosterone dose or to split the dose into twice weekly injections. If this does not work, taking supplements such as DIM and Calcium d-Glucarate can help prevent aromatization and remove estrogen from the body. We also prescribe aromatase inhibitors such as Anastrazole to some men with elevated estrogen. This works by inhibiting the aromatase enzyme from converting testosterone to estrogen, which in turn lowers estrogen levels. 

Many healthcare providers fail to monitor estrogen levels during TRT. This often time results in sub-par results and a frustrated patient. Our goal is optimize your health during TRT, which is why we prefer the term testosterone optimization therapy instead. This requires routine lab work and monitoring to ensure we catch problems early to prevent bothersome symptoms. If you are interested in optimizing your health, please contact us today for a consultation.

Justin Montgomery, NP

Clinical Director, Alpha Medical