Low testosterone in men is widely studied and discussed. However, doctors often overlook the importance of balanced estrogen in men, even though estrogens are active in almost all body tissue.
Read on to learn about how estrogen relates to men’s health, why estrogen might go out of balance, and what to do if your levels aren’t in line.
Estrogen in Men: You Need Balance
Though estrogen is largely associated with women’s health, this sex hormone regulates many essential aspects of men’s health, too. The importance of maintaining balanced estrogen begins in the womb and extends across a man’s lifetime. (1) Estrogen influences sperm production, male brain development, male libido, and much more. (2)
Estrogen balance is important for women … and men. Find out why you need to make sure you have enough of this hormone, especially as you age. #functionalmedicine #wellness #chriskresser
In a process called “aromatization,” the enzyme aromatase synthesizes estrogens from testosterone and other male sex hormones, known as androgens. Estrogen receptors are present in almost all tissues of the body. (3) In women, estrogens are synthesized mainly in the ovaries and other reproductive tissues. In men, the testes produce 20 percent of total estrogens. (4) Bone, blood vessels, brain tissue, and fatty tissue also produce estrogen.
As men start to age, their testosterone levels steadily decline. By age 35 to 40, they fall, on average, one to two percent per year in a phenomenon often referred to as “andropause,” or so-called male menopause. (Some have even called it “manopause.”) (5)
The Risks: Cardiovascular Disease, Cancer, and More
In a study of over 3,000 older men (ranging in age from 69 to 80), low levels of estrogens were associated with increased risk of mortality in a four-and-a-half-year follow-up, compared to men with adequate levels of estrogen. In men with low levels of both estrogen and testosterone, the risk of death nearly doubled. (6)
Imbalanced estrogen levels have also been linked to:
- Cardiovascular issues (7, 8, 9, 10)
- Prostate cancer (11, 12, 13)
- Osteoporosis and bone fractures (14, 15)
- Alzheimer’s disease and depression (16, 17)
How Your Estrogen Can Fall out of Balance
Hormone imbalance is one of eight core pathologies that I believe underlie all chronic disease. Here are the most common causes of estrogen imbalance in aging men. In many cases, more than one cause may be present—so it’s important to address all that apply if you want to regain your health.
You Could Have Chronic Inflammation
Estrogens exhibit both pro- and anti-inflammatory properties, depending on what triggers the body’s immune response, the organ or organ systems involved, and other health factors. Estrogens suppress inflammation in many animal models of chronic diseases, but they can also be pro-inflammatory in chronic autoimmune diseases. (18)
Inflammation itself is not a bad thing. As part of the body’s immune response, it initiates healing after a harmful stimulus. Chronic inflammation, on the other hand, causes damage over time. It’s an underlying cause for some of the most prevalent chronic diseases, including:
In a study of men over age 50, researchers tested participants for high-sensitivity C-reactive protein (hs-CRP) in the blood, a reliable marker for inflammation. Serum hs-CRP correlated with estrogen levels, suggesting that inflammation and excess estrogen go hand in hand. (19) Other research has confirmed associations between estrogen and inflammatory pathways. (20, 21)
Your Gut Isn’t Healthy
Scientists have confirmed the gut’s role in hormone metabolism and its influences on the rest of the body. If your gut’s microbiome is unhealthy, it can impact how much estrogen circulates in your body.
The process starts with the liver. Your liver processes estrogen, so it can be excreted in the bile, urine, and feces. Along the way, certain gut bacteria can interrupt that process and allow estrogen and estrogen-like molecules to re-enter circulation. (22)
Gut dysbiosis can affect which estrogen byproducts, or metabolites, are reintroduced to the body. Some bacterial species generate metabolites that are potentially pro-cancerous, while others produce protective metabolites. (23) Estrogen imbalance from gut dysbiosis has been linked with breast cancer development in women and prostate cancer in men. (24, 25, 26, 27)
You’re Experiencing Chronic Stress
The hypothalamic–pituitary–adrenal (HPA) axis controls the body’s response to stress and also helps regulate the immune system, digestion, metabolism, hormone production, and more. High cortisol production from chronic stress can lead to hormone resistance. This resistance in turn depresses pituitary function, and as a result, testosterone and sperm count can decrease. When testosterone levels are low, a man’s estrogen levels can often be low, too.
Chronic stress from sleep restriction is a good example of how stress can influence hormone levels. In an experimental study, restricting sleep to only five hours per night decreased testosterone levels by 10 to 15 percent in young men. (28) Sleep apnea yields similar results. (29)
The relationship between insulin and estrogen is somewhat complex. Insulin helps your body synthesize estrogen from testosterone. (32) Since estrogen plays a role in glucose metabolism, low levels of the hormone can lead to or worsen insulin resistance. Researchers have witnessed this phenomenon in people with a genetic mutation that deactivates the aromatase enzyme, which causes undetectable levels of estrogen. (33, 34, 35) By a similar mechanism in women, insulin resistance and obesity often follow the decline in estrogen that occurs in menopause. On the other hand, high estrogen levels can also cause insulin resistance, again indicating the need for balance. (36)
In both men and women, high levels of insulin can upregulate aromatase, which increases the conversion of testosterone to estrogen. In men, this can cause enlarged breast tissue and abdominal fat accumulation. In women, it can cause or contribute to polycystic ovary syndrome (PCOS).
You’re Dealing with a Toxic Burden
Estrogens are predominantly metabolized in the liver. (37) If your liver’s ability to detox your body is compromised, it may only be able to partially metabolize hormones like estrogen. Certain amino acids like glycine, and antioxidants like glutathione, are required for proper detoxification. If your toxic burden—the amount of environmental toxins your body is trying to process and clear—is already high, you might need help to detox safely. I recommend speaking to a Functional Medicine practitioner to help you with this process.
Seven Ways to Balance Your Estrogen
We have to be cautious when we want to make a connection between disease and serum estrogen levels. One caveat is that serum levels don’t necessarily reflect estrogen concentration in a particular tissue. For example, in estrogen receptor-positive breast cancer, the cancerous tissue itself can have a high concentration of estrogen while serum levels remain low. (38)
However, serum hormone levels still provide a lot of information, especially about what is occurring systemically. Saliva tests are generally much cheaper but can only measure “free” hormones, those which are not yet bound to a specific receptor. Blood tests measure both free (active) and protein-bound (inactive) hormones.
In conventional medicine, a doctor treats a hormonal imbalance using the “replacement model.” For instance, if testosterone is low, then a doctor might prescribe a testosterone cream. I’m extremely cautious about this method. These testosterone creams contain the free form of testosterone, which means that the body has no control over how much testosterone enters tissues as it normally would. Excess testosterone cream could also increase estrogen levels excessively if not properly monitored. Over time, the hormone receptors become somewhat resistant to the constant influx of testosterone, meaning you would eventually need an increased dosage. If you’ve been using the cream for an extended period of time, you need to be slowly weaned off—and that process can be difficult.
Depending on your specific needs, the following strategies can help balance estrogen and other hormone levels.
1. Reduce Your Stress
Chronic stress can disrupt the HPA axis and contribute to chronic inflammation and hormonal imbalances, but managing your stress can help. Meditation and getting enough sleep are good places to start. You can also try some herbal remedies like ginseng, rhodiola, ashwagandha, and eleutherococcus. These botanicals increase cortisol when it’s low and decrease it when it’s too high.
2. Stabilize Your Blood Sugar
Magnesium, green tea extract, and alpha lipoic acid may help fight insulin resistance and level out your blood sugar. Make sure you’re eating quality carbohydrates, not refined carbs. Proper sleep is also important for glucose control.
3. Cut Inflammatory Foods Out of Your Diet
Eliminate inflammatory foods like industrial seed oils and refined sugars. You should also avoid soy, which is a phytoestrogen (a plant-derived estrogen). Make sure your diet includes dietary cholesterol, which is a precursor to all hormones.
To ensure proper hormone metabolism, liver detox support is crucial. One supplement I suggest is Pure Encapsulations DIM Detox. DIM, or diindolylmethane, in particular promotes healthy estrogen metabolism. Milk thistle extract, another ingredient, also helps metabolism estrogen. (39)
5. Heal Your Gut
Maintaining a healthy gut with a rich, biodiverse microbiota will support proper estrogen metabolism. Reducing gut inflammation and fixing a leaky gut are other important steps.
6. Avoid Endocrine Disruptors
Toxins that disrupt your endocrine system should be avoided at all costs. This includes BPA and BPA-free plastics, phthalates, soy, and more.
7. Fix Over-Aromatization
In the case of low testosterone and high estrogen in men, if other sources of phytoestrogen are absent, over-aromatization may be the culprit. That means the enzyme aromatase is synthesizing too much estrogen. The most important way to fix excess aromatization is by first fixing insulin resistance (see the section on insulin resistance above). If that isn’t enough, DIM (see above, under “Detox”) and the herb chrysin, under the supervision of a medical professional, can both sometimes help.
Now I’d like to hear from you. Have you experienced any estrogen imbalance with age? What steps have you taken to get back in balance? Let me know in the comments!