Estradiol is a hormone that is more abundant in women than men and is produced in men by the aromatization of testosterone in liver, fat, and other cells. Estradiol is responsible for healthy bone density and cholesterol, but its role in men's sex drive, body composition, and other variables is a source of great debate. Many men on testosterone replacement therapy (TRT) initially fear high estradiol levels since they fear it causes water retention and gynecomastia. Below, we will discuss why most men on TRT do not have to be overly concerned about the estradiol lab ranges that are ill-fitted for men on TRT, as the ranges of LabCorp and Quest were not derived from a dataset of men on TRT who usually have higher total testosterone blood levels.
What is Estradiol and Why is it important for Men's Health?
Estradiol is a type of estrogen hormone that plays a crucial role in men's health. It helps regulate bone density, cognitive function, libido, and mood. However, high levels of estradiol in men can lead to negative effects like decreased muscle mass, increased body fat, and hormonal imbalances.
Men's liver, fat, and other cells aromatize testosterone to produce estradiol, a hormone that is more prevalent in women than in men. Estradiol is responsible for healthy bone density and cholesterol, but its role in men's sex drive, body composition, and other variables is a source of great debate. Many men on testosterone replacement therapy (TRT) initially fear high levels of estradiol since they fear it causes water retention and gynecomastia. We will talk about why most men on TRT do not need to worry too much about the estradiol lab ranges that do not work well for them because LabCorp and Quest did not get their ranges from a group of men on TRT who usually have higher total testosterone blood levels. High levels of estradiol in men are associated with abdominal obesity and an increased risk of cardiovascular disease.
What is High Estradiol?: Predicted Blood Levels in Young and Older Men on TRT
Video Transcript (Watch video below).
Hello, guys. Nelson Vergel is here from DiscountedLabs.com. I decided to do a video on the highest levels of estradiol in men on testosterone replacement therapy (TRT). There needs to be more clarity on the subject since LabCorp and Quest have very narrow, sensitive estradiol test ranges. Those estradiol test ranges were primarily derived from men not on testosterone replacement therapy. Men on TRT tend to have higher testosterone levels than men not on testosterone replacement. So, believe it or not, a paper published many years ago predicts estradiol and DHT levels in men given different doses of testosterone. This study examined what happens to blood levels of testosterone, estradiol, and DHT when injecting different testosterone doses in young and older men. This study was very nicely done at the Boston University School of Medicine by well-known testosterone researchers. Dr. Basin is one of them and has done excellent work for the last 30 years.
Testosterone is the precursor hormone for estradiol. The aromatization of testosterone in the liver, fat, and other cells, including the testes, results in estradiol, a hormone that is more prevalent in women than men. Nature created it for a reason. It is responsible for healthy bone density and cholesterol, but its role in men's sex drive, body composition, and other variables is a source of great debate.
Many anti-aging or men's health clinics prescribe aromatase inhibitors (AIs) to men who start testosterone replacement therapy (TRT). Higher estradiol blood levels in the presence of low testosterone can cause breast tissue growth (gynecomastia) in some men and possibly other issues. Some people speculate that high estradiol levels can also lead to difficulty achieving or maintaining an erection, but no scientific papers have been published on this subject. Since higher testosterone blood levels can result in higher estradiol in men, the belief is that using an AI 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. Emerging data show that low testosterone-to-estradiol ratios may correlate more closely to infertility, gynecomastia, and erectile problems than high estradiol levels alone.
The truth about these speculations is starting to emerge, but we still need more data to say what the upper value of the optimal range of estradiol in men 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 could be associated with higher fat mass and lower sexual function in men. So, be careful when a clinic wants to put you on an aromatase inhibitor without first justifying its use.
Increased Aromatase Activity May Increase Estradiol in Men
Aromatase is an enzyme that converts testosterone to estradiol, a form of estrogen. In men, aromatase activity is typically low, but certain conditions can increase it. For example, obesity and aging are associated with increased aromatase activity. This can lead to higher levels of estradiol in the body, which can have negative effects like decreased libido and muscle mass. However, some studies suggest that moderate increases in estradiol may have cardiovascular benefits. It's important for men to maintain healthy levels of both testosterone and estradiol for optimal health.
Estradiol in Men After Different Testosterone Doses: Study Details
This study’s findings were published in the Journal of Clinical Endocrinology and Metabolism in 2010. The fantastic thing is that nobody has reviewed it, even though it's probably the most important paper on what happens to estradiol and DHT in men on TRT. The study enrolled 51 young men aged 19 to 35 and 52 older men aged 59 to 75. These men were given a gonadotropin-releasing hormone agonist to shut down their gonadotropins, LH and FHS, testosterone, estradiol, and DHT.
So, these were courageous volunteers who were willing to have their hormones wholly shut down. So, why did they do this? They did it because the researcher wanted to start from zero regarding hormones. So, those men were given injections of different doses of testosterone enanthate, 25, 50, 125, 300, and up to 600 milligrams a week for five months. And the researchers measured the testosterone, estradiol, and DHT blood levels. Unfortunately, they used the old estradiol test based on immunoassay. This estradiol test may not be the best for accurate estradiol testing . The use of an ultra-sensitive estradiol test is more accurate since it has no interference from CRP or inflammatory markers Usually, the sensitive estradiol is 20% lower than the estradiol levels measured by the old test.
Let's assume that most of these men did not have inflammation. Here are their baseline characteristics. Interestingly, they were even exposed to such high doses of testosterone. So, after a four-week controlled period, they were given a testosterone blocker, the gonadotropin-releasing hormone agonist that shuts down gonadotropins. This drug is used for prostate cancer. They were randomized to receive weekly injections of testosterone enanthate for 20 weeks. The researchers found an issue with the higher testosterone dose in older men, with a few more side effects. They stopped a few men from continuing with the 600 milligrams of testosterone weekly. And then the randomization was limited to 25, 50, 125, and 300 milligrams of testosterone injections weekly.
I've warned people not to use high testosterone doses, especially older people with comorbidities and heart problems. Increased blood pressure and tachycardia are some of the side effects listed in the study paper.
So, what you see here are serum estradiol E2:T ratios. We talk about ratios on ExcelMale.com. Here are the opposite DHT and T ratios from what I typically talk about when dividing T by E2. And the black bars are younger men, and the white bars are older men. So, this is total estradiol, free estradiol, total DHT, and free DHT. And when we talk about free, what does that mean? It is the unbound estradiol and unbound DHT that aren’t bound by sex hormone-binding globulin.
And those two free estradiol and free DHT tests are rarely tested in clinics. DiscountedLabs.com does provide a free estradiol test for those who are interested. But since there are no studies about free estradiol blood levels in men, it's hard to say what a good free estradiol level is.
Why Are Men on TRT Concerned About High Estradiol?
Most men on TRT initially fear high estradiol since they fear it causes water retention and gynecomastia. They feel puffy; they may have more sensitive nipples. I will discuss this in another video because those symptoms are usually not connected to high estradiol per se when men have moderate to high testosterone levels. The most common cause of edema, or the problem of holding onto water weight, is a slowdown in sodium metabolism in the kidneys brought on by testosterone and androgens. Sodium (salt) retention happens in the first few weeks, especially with higher TRT doses in older men. The stimulating effects of testosterone may be to blame for the sensitive nipple issue, which typically does not cause gynecomastia. However, it is important to note that symptoms of high estrogen in men can also include swelling or enlargement of breast tissue, erectile dysfunction, infertility, depression, and delayed puberty.
So, as you can tell, total E2, free E estradiol, and DHT increase with increasing testosterone doses, and this increase is much more pronounced in older men. It’s good to mention that these volunteers were not fat men. The increased fat mass has been linked to increased estradiol levels. These are men with a BMI of around 26, which is not a high number. But anyway, we do see an increase. And older men, in white, tend to have a higher estradiol increase. DHT is the same thing. Although the differences were not as noted between young and old, you can tell here the free DHT. When you divide estradiol into testosterone, that's when you see a decrease. Estradiol increases to a higher degree than testosterone, so the ratio of E2 divided by T decreases. The total DHT to T ratio is the same; it decreases as we increase the testosterone dose, but not as fast as the estradiol.
It is essential to mention that 0.4% of testosterone is aromatized into estradiol. That's a very tiny amount; that's 0.4%. The conversion of testosterone to DHT by 5 alpha-reductase is around 10%. That's why you see the scales a little more prominent on the DHT side.
What to Know About Estrogen in Men
Estrogen is commonly associated with women, but men also have this hormone in their bodies. The testes and adrenal glands are primarily responsible for producing estrogen in men. Estradiol is a type of estrogen that plays an important role in maintaining bone health, regulating cholesterol levels, and supporting brain function. Low levels of estradiol in men can contribute to a variety of health issues, such as decreased libido, erectile dysfunction, and osteoporosis. It's important for men to understand their hormonal balance and work with a healthcare provider to address any imbalances or concerns related to estrogen levels.
Buy an affordable ultrasensitive estradiol test:
Understanding Androgens and Estrogens
Estradiol is a type of estrogen that is found in both men and women. While it is often associated with female reproductive health, estradiol plays an important role in male health as well. In fact, it is responsible for regulating bone density, cholesterol levels, and even mood. When levels of estradiol are too low or too high in males, it can lead to a variety of health problems. Understanding the balance between androgens (male hormones) and estrogens (female hormones) is key to maintaining optimal health for both men and women.
Risk Factors of Having High or Low Estrogen Levels in Males
Estrogen is often associated with females, but it also plays a crucial role in men's health. High or low levels of estrogen in males can have negative impacts on their overall health. Men who have higher than normal levels of estrogen may experience breast enlargement, erectile dysfunction, infertility, and an increased risk of prostate cancer. On the other hand, men with lower than normal levels of estrogen may experience decreased bone density, muscle mass, and sex drive. It is important for men to maintain balanced estrogen levels through proper diet, exercise, and medical treatment if necessary.
How Men Can Keep Their Estrogen Levels Balanced
Estrogen is typically associated with women, but men also have this hormone in their bodies. Estradiol is the most potent form of estrogen in men and plays a crucial role in maintaining bone density, sperm production, and sexual function. However, too much or too little estradiol can cause various health problems. Men can keep their estrogen levels balanced by maintaining a healthy weight, avoiding exposure to environmental toxins, managing stress levels, and getting enough sleep. A balanced diet rich in fiber and phytoestrogens may also help regulate estrogen levels in men.
Normal Estrogen Levels in Men
Estrogen is often thought of as a female hormone. However, it's also present in men, just at lower levels. One type of estrogen found in men is estradiol. Normal levels of estradiol in men vary depending on age and other factors. In general, levels range from 10 to 60 pg/mL. If levels are too high or too low, it can lead to health issues such as osteoporosis, sexual dysfunction, and mood changes. Men should discuss their estrogen levels with their healthcare provider to ensure they are within a healthy range for their age and overall health status.
Why Estrogen Balance is Critical to Aging Men
Estrogen is a hormone that is typically associated with women, but it also plays an important role in men's health. As men age, their levels of estradiol, a type of estrogen, can decrease. This imbalance can lead to a variety of health issues, including decreased bone density, increased risk of cardiovascular disease, and decreased libido. It's important for aging men to maintain a healthy balance of estrogen to support their overall health and well-being. Consulting with a healthcare provider and making lifestyle changes such as exercise and a healthy diet can help maintain optimal estrogen levels in aging men.
Gynecomastia and Estradiol in Men
Gynecomastia is a condition that causes men to develop breast tissue. One of the underlying causes of gynecomastia is an imbalance of hormones, including estradiol. Estradiol is a form of estrogen that is typically found at higher levels in women. However, men also have small amounts of estradiol in their bodies. When the balance between estradiol and testosterone is disrupted, it can lead to the development of breast tissue in men. Treatment for gynecomastia may involve addressing the hormonal imbalance through medication or surgery, depending on the severity of the condition. You can buy a gynecomastia lab test panel on Discounted Labs.
Low Estradiol Can Cause Loss of Libido
One of the significant impacts of estradiol deficiency in men is the loss of libido. Low levels of estradiol can lead to decreased sex drive, which can cause problems in relationships and affect overall quality of life. However, it's essential to note that there are other factors that can impact libido as well, such as stress, depression, and low testosterone levels. If you're experiencing a loss of libido, it's important to talk to your doctor to determine the underlying cause and discuss possible treatment options.
A Study Helps to Predict Normal Estradiol in Men and DHT Test Levels
Most men on TRT don't have to be so concerned about the LabCorp or Quest estradiol ranges that usually scare people because they're always high.
And there is statistical significance in the baseline values of young and older men. DHT increases were higher in older men. In younger men, usually, that's also connected to total testosterone and is also related to higher libido. Older men had lower DHT, which was also linked to their lower testosterone. Sex hormone-binding globulin (SHBG) is also higher in older men.
The researchers in this study came up with a model with factors to predict the estradiol and DHT response curves. They provided two equations for young men (Estradiol and DHT) and two for older men. Using those equations, you can roughly estimate the predicted estradiol and DHT levels for different testosterone blood levels. These equations enable us to see what is considered a “normal” estradiol level instead of using estradiol lab ranges that are ill-fitted for men on TRT. As previously mentioned, the estradiol ranges of LabCorp and Quest were not derived from a dataset of men on TRT who usually have total testosterone blood levels over 600 ng/dL (many men on TRT have T levels of 1000 ng/dL or more!).
The Importance of Preserving Proper Levels of Estradiol in Men
Our bodies transform 0.4% of testosterone into estradiol to balance the potentially negative effects of testosterone alone on lipids and other variables. If you have “high” testosterone, your estradiol should be “high.” Treating that estradiol with an aromatase inhibitor may not be needed and can potentially crash your estradiol level.
Estradiol has essential roles in men, including the regulation of hormone levels. Estradiol comes in to protect us from higher testosterone and helps improve lipids, HDL, and endothelial function. Women tend to live longer than men because they have more estrogen to protect them against the cardiovascular risks we are all exposed to. So, don't freak out when you see the 60s, even in the 70s, depending on how high your testosterone is. And the only problem we're having in this field is that we still need to do a study that goes after symptomology depending on estradiol blood levels when we control testosterone. We know that estradiol levels under 15 picograms per milliliter cause problems with bone density and even fat gain. Many members of ExcelMale.com say that their penile sensitivity decreases when they have low estradiol.
Regarding high estradiol, we do not know what high value can cause issues in men on TRT with relatively high testosterone blood levels. If somebody is, let's say, at 1,275 ng/dL of testosterone and 64 pg/mL of estradiol, is there any consequence to that? We don't know. And the problem I'm seeing is that most of you guys are assuming too much; you're assuming that because you're holding water or you have sensitive nipples, you have high estradiol. And you start treating with an AI without even testing your blood levels of estradiol, especially using the sensitive assay. That concerns me because once you start treating with an AI, you can crash your estradiol. “Crashed estradiol” has become one of the most significant traffic source keywords for ExcelMale because people are experiencing that more and more.
I hope you enjoyed the presentation. I've put together a free testosterone book (over 400 pages) that I use when I train physicians. Please remember to subscribe to the ExcelMale forum and the ExcelMale YouTube channel, and make sure that you click on that little bell that will tell you when I upload new videos. Thanks a lot, and stay safe.