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Q: estrogen ( Answered,   0 Comments )
Subject: estrogen
Category: Health > Men's Health
Asked by: anonymous777-ga
List Price: $100.00
Posted: 29 Jan 2003 08:59 PST
Expires: 28 Feb 2003 08:59 PST
Question ID: 149981
what are all the good and bad effects of high estrogen in a man???
what can it do to a man and what blood work do i need to get tested
for to check it out?? do i check estrogen,estrodial,what ?????
Subject: Re: estrogen
Answered By: kevinmd-ga on 29 Jan 2003 10:09 PST
Thanks for asking this interesting question.  You asked the following:
"what are all the good and bad effects of high estrogen in a man???
what can it do to a man and what blood work do i need to get tested
for to check it out?? do i check estrogen,estrodial,what ?????"

1) What are all the good and bad effects of high estrogen in a man?

a) Adverse effects of estrogen in men

From International Antiaging Systems:
"Along with this decline in testosterone with age and lifestyle, many
men also experience increases in the levels of estrogen. The result is
a testosterone/estrogen imbalance that directly causes many of the
debilitating health problems associated with normal aging. The vast
majority of men are surprised to learn that estrogen (a ‘female’
hormone) is also present in their bodies. It is produced in very small
amounts as a by-product of the testosterone conversion process. In
fact, balanced levels of estrogen in men are essential to encourage a
healthy libido, improved brain function, protect the heart and
strengthen the bones . . . high levels of estrogen can cause reduced
levels of testosterone, fatigue, loss of muscle tone, increased body
fat, loss of libido and sexual function and an enlarged prostate.

Other problems associated with excessive levels of estrogen include

(1) The shut down of normal testicular production of testosterone.
Excess estrogen can saturate testosterone receptors in the
hypothalamus in the brain therefore reducing the signal sent to the
pituitary gland. This in turn reduces the secretion of luteinizing
hormone, which is necessary for the gonads to produce testosterone.

(2) Increasing the body's production of sex hormone-binding globulin
(SHBG). SHBG binds testosterone therefore reducing the amount of the
clinical important free testosterone in the blood available to cell
receptor sites.

(3) A reduced effectiveness of the testosterone replacement therapy
due to excess aromatization of testosterone medications to estrogen.

(4) Long-term health risks including an increased risk of diabetes,
heart disease, and some cancers."

From LE Magazine:
"Through a variety of mechanisms, aging men suffer from the dual
effects of having too little testosterone and excess estrogen. The
result is a testosterone/ estrogen imbalance that can severely inhibit
sexual desire and performance. In youth, low amounts of estrogen are
used to turn off the powerful cell-stimulating effects of
testosterone. As estrogen levels increase with age, testosterone cell
stimulation may be locked in the "off" position, thus reducing sexual
arousal and sensation and causing the common loss of libido so common
in aging men . . . Estrogen overload is a serious problem in aging
men. One report showed that estrogen levels of the average 54-year-old
man are higher than those of the average 59-year-old woman. Estrogen
is a necessary hormone for men, but too much causes a wide range of
health problems. High serum levels of estrogen also trick the brain
into thinking that enough testosterone is being produced, thereby
slowing the natural production of testosterone."

From RenewYouth:
"Estrogen is a necessary hormone for men, but too much causes a wide
range of health problems. The most dangerous acute effect of excess
estrogen and too little testosterone is an increased risk of heart
attack or stroke.  High levels of estrogen have been implicated as a
cause of benign prostatic hypertrophy (BPH) and one mechanism by which
nettle extract works is to block the binding of growth-stimulating
estrogen to prostate cells.

If your blood tests reveal high estrogen and low testosterone, here
are the common factors involved:
Excess Aromatase Enzyme men age, they produce larger quantities of an
enzyme called aromatase The aromatase enzyme converts testosterone
into estrogen in the body. Inhibiting the aromatase enzyme results in
a significant decline in estrogen levels while often boosting free
testosterone youthful levels. Therefore, an agent designated as
"aromatase inhibitor" may be of special value to aging men who have
excess estrogen.
Liver Enzymatic Activity- A healthy liver eliminates surplus estrogen
and sex hormone-binding globulin. Aging, alcohol, and certain drugs
impair liver function, and can be a major cause of hormone imbalance
in aging men. Heavy alcohol intake increases estrogen in men and
Obesity- Fat cells create aromatase enzyme, especially abdominal fat.
Low testosterone allows the formation of abdominal fat, which then
causes more aromatase enzyme formation and thus even lower levels of
testosterone and higher estrogen (by aromatizing testosterone into
estrogen). It is especially important for overweight men to consider
hormone modulation therapy.
Zinc Deficiency- Zinc is a natural aromatase enzyme inhibitor. Since
most Life Extension Foundation members consume adequate amounts of
zinc (30 to 90 mg/day), elevated estrogen in Foundation members is
often caused by factors other than zinc deficiency.
Lifestyle changes (such as reducing alcohol intake) can produce a
dramatic improvement in the estrogen-testosterone balance, but many
people need to use aromatase inhibiting agents to lower estrogen and
to improve their liver function to remove excess SHBG. Remember,
aromtase converts testosterone into estrogen and can indirectly
increase SHBG. SHBG binds to free testosterone and prevents its from
exerting its biochemical effects in the body."

From the Drug Information Handbook, a comprehensive description of
adverse effects is given (obviously some of the risks are
"WARNINGS / PRECAUTIONS — Unopposed estrogens may increase the risk of
endometrial carcinoma in postmenopausal women. Use with caution in
patients with diseases which may be exacerbated by fluid retention,
including asthma, epilepsy, migraine, diabetes, cardiac or renal
dysfunction. Use with caution in patients with a history of
hypercalcemia, cardiovascular disease, and gallbladder disease. May
increase blood pressure. Use with caution in patients with hepatic
disease. May increase risk of venous thromboembolism. Estrogens may
increase the risk of breast cancer (controversial/currently under
study). Estrogen compounds are generally associated with lipid effects
such as increased HDL-cholesterol and decreased LDL-cholesterol.
Triglycerides may also be increased; use with caution in patients with
familial defects of lipoprotein metabolism. Estrogens may cause
premature closure of the epiphyses in young individuals. May increase
size of pre-existing uterine leiomyomata. Before prescribing estrogen
therapy to postmenopausal women, the risks and benefits must be
weighed for each patient. Women should be informed of these risks and
benefits, as well as possible effects of progestin when added to
estrogen therapy. Safety and efficacy in pediatric patients have not
been established.

ADVERSE REACTIONS — Frequency not defined. 

Cardiovascular: Edema, hypertension, venous thromboembolism 

Central nervous system: Dizziness, headache, mental depression,

Dermatologic: Chloasma, erythema multiforme, erythema nodosum,
hemorrhagic eruption, hirsutism, loss of scalp hair, melasma

Endocrine & metabolic: Breast enlargement, breast tenderness, changes
in libido, increased thyroid-binding globulin, increased total thyroid
hormone (T4), increased serum triglycerides/phospholipids, increased
HDL-cholesterol, decreased LDL-cholesterol, impaired glucose
tolerance, hypercalcemia

Gastrointestinal: Abdominal cramps, bloating, cholecystitis,
cholelithiasis, gallbladder disease, nausea, pancreatitis, vomiting,
weight gain/loss

Genitourinary: Alterations in frequency and flow of menses, changes in
cervical secretions, endometrial cancer, increased size of uterine
leiomyomata, vaginal candidiasis

Hematologic: Aggravation of porphyria, decreased antithrombin III and
antifactor Xa, increased levels of fibrinogen, increased platelet
aggregability and platelet count; increased prothrombin and factors

Hepatic: Cholestatic jaundice 

Neuromuscular & skeletal: Chorea 

Ocular: Intolerance to contact lenses, steeping of corneal curvature 

Respiratory: Pulmonary thromboembolism 

Miscellaneous: Carbohydrate intolerance

CARDIOVASCULAR CONSIDERATIONS — It is important to recognize that
estrogens may induce or worsen hypertension. These problems are less
severe with lower doses. Furthermore, estrogens may precipitate
thromboembolic events, particularly in women who smoke. It is
important that patients on long-term estrogens undergo monitoring of
blood pressure and avoid cigarette use." (1)

UptoDate discusses some complications of increased estrogens in men:
"The most life-threatening complications are cardiovascular sequelae,
which include myocardial infarction, cerebrovascular accident, and
pulmonary embolism. As with most androgen ablation therapies,
estrogens are associated with a loss of libido, impotence, and
lethargy. Gynecomastia and nipple soreness can be particularly
troublesome and can be avoided to some extent by prophylactic breast
irradiation. Prophylactic therapy may be necessary because
gynecomastia and nipple tenderness do not respond well to irradiation
once estrogen therapy is begun, and usually persist even if estrogen
is discontinued." (2)

b) Beneficial effects of estrogen in men

Estrogen may have beneficial effects in men with heart disease:
"Although many studies have found that estrogen treatment can reduce
or control heart disease in women, few studies have established
similar benefits in men. One of the few was reported today in CHEST,
the peer-reviewed journal of the American College of Chest Physicians

Researchers at the University of Pittsburgh reported that conjugated
estrogen (estrogen and progesterone) improves myocardial ischemia that
is caused by exposure to the cold. Environmental exposure to cold is a
common trigger of myocardial ischemia-an insufficient supply of blood
to the heart-particularly in people with existing coronary artery
disease. In these patients, they noted, cold exposure may decrease the
myocardial oxygen supply by constricting the arteries while increasing
the demand for such oxygen which is carried in the blood."

Estrogen is also used to treat metestatic prostate cancer:
From UptoDate:
"Estrogens exert their effect on prostate cancer growth primarily by
negative feedback on the hypothalamic-pituitary axis; high levels
reduce the release of LHRH from the hypothalamus, thereby suppressing
LH release from the anterior pituitary. As a result, the testicular
Leydig cells stop producing testosterone, although it may take one to
two weeks to achieve castrate levels. High dose estrogens also compete
with androgens for the androgen receptor, and may have a direct
cytotoxic effect on both androgen-sensitive and androgen-insensitive
prostate cancer cells." (2)

Johns Hopkins Arthiritis suggests in this study that estrogen plays a
role in prevention of osteoporosis in men:
"These data indicate that E clearly exerts a dominant regulatory
effect on bone resorption in normal elderly men. T may have small
effect, although not significant. Both E and T are important in
maintaining bone formation.

Editorial Comment: This study challenges the traditional concept that
testosterone is the critical sex hormone for maintaining bone density.
There may be a role for low dose estrogen or selective estrogen
receptor modulators (SERMs) in the treatment of osteoporosis in aging

The American Society for Bone and Mineral Research links osteoporosis
with low estrogen levels in men:
"In studies begun in 1992 of 400 men with low bone mineral density,
many suffering from tumors or drug-induced (gluco-steroids)
osteoporosis, findings of estrogen depletion were about as frequent as
among postmenopausal women. A combined lack of testosterone and
estrogen was found at least as often as a deficiency in testosterone

2) How do I get tested for estrogen levels?

Lab tests online gives a good description of the various types of
estrogen tests.  Estradiol and estrone would be most relevant in men
(estriol is mainly found in pregnant women).  A blood test would be
"Estrone tests may be done to aid in the diagnosis of an ovarian
tumor, Turner’s syndrome, and hypopituitarism. In males, it may help
in the diagnosis of gynecomastia or in the detection of
estrogen-producing tumors.

Estradiol levels are used to help evaluate ovarian function. Etradiol
helps diagnose the cause of precocious puberty in girls and
gynecomastia in men. Its main use has been in the differential
diagnosis of amenorrhea (for example, to determine whether the cause
is menopause, pregnancy, or a medical problem). In assisted
reproductive technology (ART), serial measurements are used to monitor
follicle development in the ovary in the days prior to in-vitro
fertilization. Estradiol is also sometimes used to monitor menopausal
hormone replacement therapy.

Estriol, along with alpha-fetoprotein (AFP maternal) and human
chorionic gonadotropin (hCG) tests, are used to assess the risk of
carrying a fetus with certain abnormalities, such as Down syndrome."

I would concur with an apporach suggested at this website - it is a
broad-based approach.  They suggest the following initial tests to
look for mail endocrinologic abnormalities:
"The following initial blood tests are recommended for any man over
age 40:
Complete blood count and chemistry profile (to include liver-kidney
function, glucose, minerals, lipids, thyroid (TSH) etc.)
Free and Total Testosterone 
Estradiol (estrogen) 
Luteiizing hormone (LH) 

Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.   
Kevin, M.D.     
Internet search strategy using
estrogen excess in men
estrogen excess
estrogen prostate cancer
estrogen osteoporosis in men
estrogen excess adverse effects
estrogen in men
estrogen benefits in men

1) Lacy.  Conjugated estrogens.  Drug information handbook, 2002.
2) McLeod.  Initial hormone therapy for the treatment of metestatic
prostate cancer.  UptoDate, 2002.

Medline Plus - Estrogen

Lab Tests Online - Estrogen

Request for Answer Clarification by anonymous777-ga on 29 Jan 2003 11:44 PST
i ask this because i am on avodart 2.5 mg. as a doctor i think you
might here of it. its for bph but i use it for hair loss! it redeuces
dht levels by 94% and scalpe dht by 80%!! but with this much dht gone
testorone goes up and estrogen goes up. i am 21 and conernd with
getting high levels of estrogen because of so much aromatisation(sp).
any thoughts???

Clarification of Answer by kevinmd-ga on 29 Jan 2003 12:29 PST
I am aware of Avodart, also known as Dutasteride.  It is similar to
Finasteride (Propecia):
"Dutasteride is the generic name for a new dual 5 alpha-reductase
inhibitor made by GlaxoSmithKline. The drug is set to be marketed
under the name Avodart™ in the US and Avolve™ in Europe in December

The FDA has approved Dutasteride for treating BPH (Benign Prostate
Hyperplasia), the same condition that Proscar™, by made Merck, is used
for. Dutasteride like Finasteride, the active ingredient in Proscar
and Propecia, also has the added benefit of being able to be used to
treat genetic hair loss in men also known as MPB or Androgenic

You may want to note that it is not FDA approved yet for alopecia:
"It's important to note that the FDA has not approved Dutasteride for
the treatment of hair loss but Glaxo has completed Phase 2 trials for
its use in treating hair loss."

It is true that Avodart suppresses DHT levels more than Finasteride. 
You are correct to be concerned about long-term effects of a higher
estrogen/androgen ratio.  However, there are no studies on the long
term effects of these medications.  In commenting on Finasteride
(which has been around longer), Dr. Roberts says that Finasteride is
relative safe, however there are no studies looking at long term
effects past 6 years:
"Some of the clinical studies with finasteride for the treatment of
men with male pattern hair loss have been ongoing for as long as 6
years, allowing those of us involved with these studies to observe our
subjects over a long period."

A common side effect of estrogen excess would be gynocomastia
(enlarged breasts).  There have been some case reports of gynocomastia
in people on Finasteride:
"It is known that a regimen of 5 mg/d of oral finasteride can produce
gynecomastia so it is not surprising then to find the same effect with
1 mg/d of the drug."

So far, Avodart has an acceptable safety profile:

Appropriate studies on the long term effects of an increased
estrogen/androgen ratio have not been done yet - in the meantime, we
can only hypothesize about the long term effects of an increased
estrogen/androgen ratio (i.e. the cardiovascular effects).

Kevin, M.D.
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