Nathan Goodyear, M.D.
So when we talk about estrogen, it’s that word men whisper in secret when the women in their lives seem a little hormonal, right? When people find out that my wife and I have 3 daughters, the resulting comment is usually, “Wow, that’s a lot of estrogen in your household!” (Thankfully, I have a son, too, who helps balance the estrogen to testosterone ratio at our house!)
I’m sorry to burst your bubble, guys, but estrogen is not exclusive to women. We make estrogen, too. In fact, some of us make a LOT of estrogen. Too much, in fact. And it creates some serious problems.
But before we talk about estrogen, we need to talk about testosterone. Testosterone levels in American men are at an all-time low! There are four major reasons for that: stress, weight, endogenous estrogens, and xenoestrogens. In this post, I’ll address three of those – stress, weight, and endogenous estrogen.
So let’s get started learning four important facts about testosterone, estrogen, and men!
What problems do high estrogen levels create in men?
1. High estrogen = low testosterone. One of the primary causes of low testosterone is a high estrogen level. Estrogens can be endogenous (produced by your body) or exogenous (from the environment, also known as xenoestrogens). Estradiol and Estrone (two of the three kinds of estrogen produced by your body) feed back to the hypothalamus and pituitary and shut off testosterone production.
2. High estrogen = inflammation. Not only do high estrogen levels decrease testosterone in men, they also increase inflammation. And this is VERY significant. Inflammation, just like stress, is a biochemical process.
Inflammation is the natural result of the immune system. Remember the last time you got a paper cut? It was incredibly painful, probably red, warm and swollen, all cardinal symptoms of inflammation. Inflammation, in the right setting, is actually the body protecting itself. However, when the immune system becomes imbalanced or chronically activated, the immune system causes damage through inflammation. For example, chronically activated immune cells in the brain (glial cells) play a pivotal role in the development of Alzheimer’s, Parkinson’s, and Multiple Sclerosis.
Inflammation is a SERIOUS issue. Chronic inflammation has been linked to many of the chronic diseases of aging: Type II Diabetes, obesity, hypertension, and cancer. In fact, a new term has been coined to describe inflammation arising from the gut which results in many of the above listed disease states - metabolic endotoxemia.
We’ve established that high estrogen levels are bad for men, shutting down testosterone production and causing chronic inflammation leading to disease.
What causes high estrogen levels in men?
1. High aromatase activity = high estrogen. First, high endogenous estrogen levels in men come from high aromatase activity. Aromatase is the enzyme that converts androstenedione and testosterone into estrone and estradiol respectively. Aromatase is present in many different tissues. But in men aromatase is highly concentrated in that mid-life bulge.
Unfortunately, aromatase activity in men increases as we age due to stress, weight gain, and inflammation. None of us are going to get away from aging (it’s right there with death and taxes). And who do you know that has NO stress? (Remember, it is estimated that 90% of doctor visits are stress-related.) Typically, as we age we gain weight and have more inflammation.
That “age-related” tire around the mid-section is more than just unsightly. It is a hormone and inflammation-producing organ. Remember metabolic endotoxemia, the disease-producing state I mentioned earlier? Metabolic endotoxemia is inflammation arising from the GI system which causes obesity and then turns right around and produces inflammation. It’s a vicious cycle! And guess what is concentrated in fat? If you guessed aromatase activity, then you are absolutely correct. Aromatase activity in men accounts for 80% of estrogen production.
Hormones are not just about numbers, but balance and metabolism as well (read my recent post on the topic).
2. Overdosage of testosterone = high estrogen. As mentioned earlier, testosterone levels in men are at an all-time low. And the mass solution for this problem with most physicians is to increase testosterone without evaluating or treating the underlying causes for low testosterone. Unfortunately, this complicates the entire low testosterone problem. Overdosage of testosterone increases estrogen production.
What? You mean you can dose too high on testosterone? Yes, and most of the patients I see who are being treated with testosterone have been, in fact, overdosed.
In fact, at Seasons Wellness Clinic and Seasons of Farragut, we have seen many men must donate blood due to excess production of hemoglobin and hematocrit, a by-product of testosterone overdosage. A 20-22 year old male normally produces 5-10 mg daily of testosterone. It is during this age range that men are at their physical peak of testosterone production. For me, this was during my college football years.
Does it make sense for 40-and-up men currently taking testosterone, that they did not need to donate blood monthly during their peak years of natural testosterone production, but are currently required to donate blood regularly with their current regimen of testosterone? Of course not. So, if you didn’t have to donate blood with your peak testosterone production in your 20′s, you shouldn’t have to donate with testosterone therapy in your 40′s and beyond either. Something is wrong here, right?
The starting dosage for one of the most highly-prescribed androgen gels is 1 gram daily. Men, we didn’t need 1 gram of testosterone in our early 20′s, and we don’t need it in our 30′s and beyond.
80% of a man’s testosterone occurs from aromatase activity, and aromatase activity increases as we age. So high doses of testosterone don’t make sense. Doctors are just throwing fuel on the fire with these massive doses. More is not better if it’s too much, even when it is something your body needs.
Then, there is the delivery of testosterone therapy. The body’s natural testosterone secretion follows a normal diurnal rhythm. Testosterone is known to be greatest in early morning and lowest in the evening. But with many prescribing testosterone therapy today, it is very common to get weekly testosterone shots or testosterone pellets. This method of delivery does NOT follow the body’s natural rhythm. The shots and pellets delivery method of testosterone produce supra physiologic (abnormal) peaks. If the purpose of hormone therapy is to return the body to normal levels, then that objective can never be reached with this type of testosterone therapy.
The effects of Testosterone to estrogen conversion in men and women are different. That’s certainly no surprise. In men, high aromatase activity and conversion of testosterone to estrogen has been linked to elevated CRP, fibrinogen, and IL-6.
Are these important? CRP is one of the best indicators of future cardiovascular disease/events (heart attacks and strokes), and is associated with metabolic syndrome. And yes, it is more predictive than even a high cholesterol level. Fibrinogen is another marker of inflammation that has been associated with cardiovascular disease and systemic inflammation. IL-6 is an inflammatory cytokine (immune signal) that has been implicated in increased aromatase activity (conversion of testosterone to estrogen) and at the same time is the result of increased testosterone to estrogen activity.
So, what’s the big deal? The studies are not 100% conclusive, but it is clear that inflammation increases the testosterone to estrogen conversion through increased aromatase activity. And the increased estrogen conversion is associated with increased inflammation in men. It’s a vicious cycle that will lead to disease states such as insulin resistance, hypertension, prostatitis, cardiovascular disease, autoimmune disease, and cancer, to name a few.
You may be thinking, “Is the testosterone I need leading me to disease?”
The answer is, “Yes, it sure can.” If your testosterone therapy includes prescription of supra physiologic levels of testosterone, lack of follow-up on hormone levels, and no effort to balance hormones and metabolism, then yes, it sure can.
Is there a safe and effective way to balance hormones, lower estrogen and increase testosterone for men?
Effectively administering hormone therapy requires the following:
- A physician with extensive training in hormones and body biochemistry.
- The best and most accurate testing possible to determine current hormone levels and to track hormone levels after therapy is administered.
- Hormones that most closely replicate the natural ones produced in your body — bioidentical hormones.
- A therapy plan with the objective of returning your body to normal, not super-charging the body with unnatural levels of testosterone or any other hormone.
Our patient experience begins with an initial consultation to evaluate symptoms and develop an evaluation plan.
The next step is testing. In the case of hormone imbalance, we evaluate hormones with state-of-the-art hormone testing via saliva, not just blood. As stated in a 2006 article, “plasma levels of estradiol do not necessarily reflect tissue-level activity.” Saliva has been shown to reveal the active hormone inside the cell at the site of action.
After initial testing and a therapy program, hormone levels are re-evaluated to ensure the progression of treatment and necessary changes are made to the treatment program. Testing and follow-up are key to proper balance of hormones (read my recent post). At Seasons of Farragut, our approach to treatment and therapy is fully supported in the scientific research literature, and we’re happy to share that research with you if you’d like to educate yourself.
The way estrogens are metabolized plays an equally pivotol role in hormone risk and effect. At Seasons of Farragut, our system of testing, evaluating, and monitoring is the only way to ensure that testosterone therapy for men is raising the testosterone and DHT levels instead of all being converted to estrogen. Hormone therapy is safe, but for it to work effectively, it must be properly evaluated, dosed, followed, and re-evaluated.
If you have questions or comments, please post them below and I’ll respond as soon as possible. What is your experience with testosterone therapy? How has your physician tested and re-evaluated your therapy program?
For more information about the Seasons approach to wellness or to schedule an appointment, please contact our office at (865) 675-WELL (9355).
