Men’s Health: The Relationship Between Estrogen and Testosterone

by Lindsey Szczepanski, NP

Have you ever wondered if there is a relationship between estrogen and testosterone in men? The answer is yes. Men need estrogen for many processes within the body. It is not just a hormone for women! Estrogen in men is vital for bone health, cardiovascular health, mood regulation, fat distribution, muscle maintenance, male fertility, and sexual function, systems also affected by testosterone. And since testosterone and other androgens are estrogen precursors, their levels are closely related. As with anything there needs to be a balance between the two hormones as too much or too little can lead to issues.

Aromatization

Most estradiol (a potent estrogen) in men comes from testosterone through an enzymatic process called aromatization. Aromatization can occur in the adipose (fat) tissue, brain, and other organs. If testosterone levels are high, estradiol levels can be high. And vice versa, if testosterone is low, estradiol can be low.

Aromatization rates are influenced by age, body fat percentage, alcohol intake, and overall health. For example, someone with obesity can encounter increased aromatase activity, resulting in higher estrogen levels. Also, things like alcohol intake can increase aromatase activity and raise estrogens. When the rate of aromatization increases, available testosterone declines in favor of turning it into estrogen.

If testosterone starts to over-aromatize to estradiol, testosterone levels drop and estrogens soar – making it feel like one minute you were lifting weights and grilling steaks, to the next minute crying all alone in your basement during a heartfelt karaoke session. And on the other hand, if aromatization is inhibited or blocked, estrogen levels could drop, and unwanted side effects can occur leaving you to feel like a constant grumpy troll, even if testosterone levels were in optimal ranges.

Estrogen Levels

Factors such as age, low testosterone levels, genetics, medications, supplements, poor diet, excessive exercise, and stress can all lead to low estrogen levels. A common mistake seen in men’s health is the use of aromatase inhibitors (drugs that block the conversion of testosterone to estrogen) without first evaluating estradiol levels. These drugs are often prescribed alongside testosterone hormone therapy. If estrogen levels are already low or low-end of range and then aromatase is inhibited, estrogen levels can drop even lower. This is why it is important to “test and not guess” when it comes to hormone prescribing.

Men with decreased estradiol report low libido and sexual function. A study by Ramasamy et al. demonstrated that in men with decreased libido and testosterone levels below 300ng/dl, their sex drive was markedly improved when the estradiol level was over 5ng/dl.

Men also reported low libido and erectile dysfunction with elevated estrogen levels. Chen et al. noted that the estradiol level was significantly higher in the erectile dysfunction group, however other types of sexual dysfunction had significantly lower estradiol levels compared to control groups.

Estrogens, whether levels are high or low, contribute to the regulation of body weight and adiposity in men, and recent studies showed estradiol deficiency, even short term, contributing to fat mass accrual, with estradiol being a stronger determinant in adiposity than testosterone in men (Rubinow, 2017). Growing evidence shows estrogen plays a critical role in metabolic regulation, glucose uptake, and lipolysis (fat breakdown).

Common factors that can lead to high estrogens include obesity, stress, alcohol intake, certain medications, excess testosterone use, and oral DHEA supplementation. Although androgen prescriptions, such as testosterone and DHEA, are important for numerous health benefits, they can affect estrogen levels negatively if mismanaged. For example, in a small study by Wiebke et al., they noted that serum testosterone and DHT remained unchanged after oral DHEA administration, however estrogens (estradiol and estrone) significantly increased in a dose-dependent manner (50mg vs 100mg). Excessive testosterone dosing can also lead to elevated estrogen levels directly through normal aromatization.

Keeping Balance in Mind

Balance is the key to all hormones and estrogen levels in men is no different. If estrogen is too high or too low, it can result in the same outcomes such as complaints of low libido and weight gain. It is all about harmony - a healthy balance between testosterone and estrogen can have you feeling like you have enough energy to be the life of the party, full of vitality and enthusiasm, but also with the safety of knowing you have a designated driver to get everyone home safely and avoid any unnecessary brawls. When hormones are balanced, the night can go without too many crazy dance moves and no regrets the next day.

To learn more about the DUTCH Test and to gain access to more expert clinical education, comprehensive patient reports, and validated and peer-reviewed research, become a DUTCH Provider .

References

Chen, T., Wu, F., Wang, X., Ma, G., Xuan, X., Tang, R., Ding, S., & Lu, J. (2020). Different levels of estradiol are correlated with sexual dysfunction in adult men. Scientific reports , 10 (1), 12660. https://doi.org/10.1038/s41598-020-69712-6

Jones, J. M., Kohli, M., & Loprinzi, C. L. (2012). Androgen deprivation therapy-associated vasomotor symptoms. Asian journal of andrology , 14 (2), 193–197. https://doi.org/10.1038/aja.2011.101

Rachdaoui, N., & Sarkar, D. K. (2013). Effects of alcohol on the endocrine system. Endocrinology and metabolism clinics of North America , 42 (3), 593–615.

Ramasamy, R., Scovell, J. M., Kovac, J. R., & Lipshultz, L. I. (2014). Elevated serum estradiol is associated with higher libido in men on testosterone supplementation therapy. European urology , 65 (6), 1224–1225.

Rosa-Caldwell, M. E., & Greene, N. P. (2019). Muscle metabolism and atrophy: let's talk about sex. Biology of sex differences , 10 (1), 43. https://doi.org/10.1186/s13293-019-0257-3

Rubinow K. B. (2017). Estrogens and Body Weight Regulation in Men. Advances in experimental medicine and biology , 1043 , 285–313. https://doi.org/10.1007/978-3-319-70178-3_14

Stanikova, D., Luck, T., Bae, Y. J., Thiery, J., Ceglarek, U., Engel, C., Enzenbach, C., Wirkner, K., Stanik, J., Kratzsch, J., & Riedel-Heller, S. G. (2018). Increased estrogen level can be associated with depression in males. Psychoneuroendocrinology , 87 , 196–203. https://doi.org/10.1016/j.psyneuen.2017.10.025

Swerdloff RS, Ng JCM. Gynecomastia: Etiology, Diagnosis, and Treatment. [Updated 2023 Jan 6]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279105/

White, D. L., Tavakoli-Tabasi, S., Kuzniarek, J., Pascua, R., Ramsey, D. J., & El-Serag, H. B. (2012). Higher serum testosterone is associated with increased risk of advanced hepatitis C-related liver disease in males. Hepatology (Baltimore, Md.) , 55 (3), 759–768. https://doi.org/10.1002/hep.24618

Wiebke Arlt, Joachim Haas, Frank Callies, Martin Reincke, Doris Hübler, Michael Oettel, Michael Ernst, Heinrich Maria Schulte, Bruno Allolio, Biotransformation of Oral Dehydroepiandrosterone in Elderly Men: Significant Increase in Circulating Estrogens, The Journal of Clinical Endocrinology & Metabolism , Volume 84, Issue 6, 1 June 1999, Pages 2170–2176, https://doi.org/10.1210/jcem.84.6.5789