High Estrogen Levels In Aging Men And Its Implications On General Health

Estradiol is a molecular variety of estrogen – the primary female sex hormone. Clinical research indicates that estradiol is biologically more active in men and is mainly produced endogenously via conversion of testosterone in fat tissues via aromatization process.

The secretion of androgen declines gradually in men with physiological aging (both from (from gonads and adrenal gland), but aromatization of testosterone to estradiol continues, which may sometimes lead to a state of estrogen-excess. Besides aromatization, age related fat accumulation in belly is also responsible for this imbalance. The subcutaneous fat in abdomen mimics the action of secretory glands and produces high levels of estradiol in blood via peripheral conversion (thereby reducing the bioavailability of testosterone for vital biological activities).

In obese males, increased aromatization of testosterone may lead to noticeable complaints or symptoms; either due to excess amount of estradiol and/or insufficient levels of testosterone.

The symptoms of excessive estrogen includes (2):

• Weight gain and abdominal obesity
• Development of breast tissues in males (gynecomastia)
• Negative changes in the muscle mass
• Unexplained fatigue
• Emotional disturbance (depression, anxiety etc.)
• Diabetes or abnormal glucose metabolism

These symptoms are also suggestive of low serum testosterone levels, which may sometimes delay the diagnosis of estrogen excess (1).

Estrogen Should Not Be Lowered Too Much!

Adopting strategies to reduce estrogen levels may seems like a logical step, but very low levels of serum estrogen are not healthy because men require estrogen in moderation for various vital activities; such as:

• Regulation of intellectual and cognitive functions
• Maintenance of bone-mineral density
• Stabilization of endothelial lining i.e. inner lining of walls of the artery.

The ideal range of serum estradiol is an aging male ranges from 20 to 30 pg/ml; while levels above 30pg/ml can increase the risk of cardiovascular dysfunction or stroke. On the other hand, risk of developing osteoporosis increases when estradiol drops below 18pg/ml.

Bone Mineral Density In Men And Estrogen

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Estrogen Deficiency

Most people believe that only aging women are at risk of developing osteoporosis, but in reality, elderly males are equally at risk of bone-mineral deficits. In fact, according to a new study, risk of morbidity and mortality due to osteoporosis is higher in aging men as compared to women. Lower the levels of estradiol, greater will be the risk of developing hip fractures and other related complications.

Conflicting Data

A great deal of confusion and contradiction exists in the medical literature regarding serum testosterone levels and risk of cardiovascular diseases. Many studies have shown that high testosterone levels are protective against cardiovascular diseases (1). However, a number of studies also indicates that testosterone replacement can aggravate the risk of myocardial ischemia, myocardial infarction or even sudden cardiac death. It has also been observed that elderly males with high serum estradiol are less likely to develop cardiovascular diseases.

How Can Excess Estrogen Get Reduced?

Healthy and natural strategies can be utilized to restore normal testosterone- estradiol balance in order to achieve fruitful results; some helpful tips are:

• Adopt healthy weight loss strategies to shed fat and especially reduce waist line because large quantities of estradiol are synthesized within the adipose tissues of abdomen.
• Belly fat can be reduced by replenishing testosterone levels and this can be done by increasing the intake of nutrients which are responsible for inhibition of enzyme aromatase (responsible for conversion of testosterone to estradiol).

However, inhibition of aromatase alone may not be sufficient to restore testosterone levels because testosterone levels decline naturally with advancing age.  There are some topical formulations of testosterone that can help in delivering small quantities of testosterone via dermal absorption (but risk of conversion to estradiol persists in men with high aromatase activity). In such situation, 0.5mg of Arimidex, an aromatase inhibiting drug can also be used at least twice a week.

What Happens If Estrogen Levels Are Too Low?

Estrogen level can get too low due to many reasons. In some men aromatase activity is not sufficient to make right amounts of estrogen. Other common reasons include, consumption of high doses of aromatase inhibiting drugs or other similar drugs. Needless to say that in all such cases, dose of active drug should be reduced. In order to boost estrogen levels, topical cream of estradiol can be applied on skin, several times a week. After every 30 to 45 days blood test should be done to check estradiol levels to minimize the risk of overt complications.

It is always a good idea to seek consultation from an expert urologist to know what options are best for you.

References

1. Yeap, B. B., Alfonso, H., Chubb, S. P., Handelsman, D. J., Hankey, G. J., Almeida, O. P., ... & Flicker, L. (2013). In older men an optimal plasma testosterone is associated with reduced all-cause mortality and higher dihydrotestosterone with reduced ischemic heart disease mortality, while estradiol levels do not predict mortality. The Journal of Clinical Endocrinology & Metabolism, 99(1), E9-E18.

2. Jasuja, G. K., Travison, T. G., Davda, M., Rose, A. J., Zhang, A., Kushnir, M. M., ... & Vasan, R. S. (2013). Circulating estrone levels are associated prospectively with diabetes risk in men of the framingham heart study. Diabetes care, 36(9), 2591-2596.

3. Yeap, B. B., Alfonso, H., Chubb, S. P., Gauci, R., Byrnes, E., Beilby, J. P., ... & Norman, P. E. (2014). Higher serum undercarboxylated osteocalcin and other bone turnover markers are associated with reduced diabetes risk and lower estradiol concentrations in older men. The Journal of Clinical Endocrinology & Metabolism, 100(1), 63-71.