Estrogen: it’s the word that men worldwide love to hate on.
We associate high levels of estrogen with being feminine, being weak and extremely disconnected from being a masculine man.
Many male-focused health authorities are honed in on the best strategies for keeping our estrogen levels low and our testosterone levels high.
But this can be a very dangerous path to take.
This article will show you EXACTLY why men need an optimal amount of estrogen to function properly.
What Is Estrogen?
Before we talk about whether we should be lowering or elevating our levels of estrogen, we need to understand what estrogen really is and how it works.
Dr. Rob Kominiarek has the best working definition of estrogen:
"Estrogen is a pleiotropic hormone that provides numerous health benefits, which include bone and mineral metabolism, cardiac and vascular function, cognition, memory, mood, and neuroprotection."
(“Pleiotropic” is a fancy way of saying that something has multiple effects)
And believe it or not, there are actually 3 different forms of estrogen in the human body:
When we talk about estrogen in the context of hormonal optimization, it’s about estradiol (E2).
How does estradiol get made?
It is synthesized when testosterone is aromatized into estradiol via the aromatase enzyme:
Unfortunately, this is where the majority of pro-testosterone physicians go wrong.
Especially when they say one should lower their body’s estrogen production when increasing their testosterone levels via therapeutic means.
How 'Estrogen Dominance' Isn't a Real Thing (It's INFLAMMATION Dummy)
You should know by now, chronically elevated levels of inflammation are massively detrimental for male health.
In fact, you can readily see the outcome in people who are FAT!
I said it best in a guest article I wrote for Ben Greenfield:
"Obese individuals (+25% body fat) have increased aromatase activity, insulin resistance and excess visceral fat, each of which create cytokine storms, leading to high levels of systemic inflammation, further suppressing their testosterone levels"
In fact, being fat literally inhibits your ability to experience optimal results while using therapeutic testosterone.
A higher body fat percentage means you have significant levels of systemic inflammation as visceral fat is the most inflammatory substance in the human body.
Which means MORE testosterone - whether in your body or administered therapeutically (TOT)- can cause your body to become even more inflamed in it's biological response to the testosterone .
I’ve even gone on record to say that men should be under AT LEAST 20% body fat before they even start thinking about using testosterone.
This way, they can minimize any side effects caused by insulin resistance (IR) and high levels of systemic inflammation experienced from their poor lifestyle (which caused the high body fat to begin with) .
And what are the side effects of high systemic inflammation?
- Increased fat deposition
- Moodiness(emotional imbalance)
- Water retention
- Poor erectile strength
- Elevated blood pressure
- Reduced insulin sensitivity
- Difficulty sleeping at night
Notice how I didn't list 'gynecomastia' ie sensitive nipples as a side effect?
Gynecomastia can be caused by a massive host of issues and even though using therapeutic testosterone can cause inflamed breast tissue to present, it is still coded in your genes.
But it’s not just being grossly overweight that’s the issue.
The core issue is living a unhealthy lifestyle where you’re binge-drinking alcohol, eating processed GMO foods, never stepping foot into the gym, stressed out 24/7, and refusing to get a good night’s sleep.
Sadly, our lifestyle involves never-ending exposure to hormone-suppressing phytoestrogens, endocrine-disrupting chemicals like bisphenol A (BPA), and environmental pollutants.
To make matters worse, there’s no escaping it: If you live in a modern-day society, you’re already being contaminated.
An infamous study from Hebrew University predicts the fate of humanity if we don’t correct course ASAP:
“Sperm count in men from North America, Europe, Australia and New Zealand declined by 50-60% between 1973 and 2011
…if the data on sperm counts is extrapolated to its logical conclusion, men will have little or no reproductive capacity from 2060 onwards”
If you want to go deep down the rabbit hole on everyday artificial estrogens, watch this podcast I did with Dr. Anthony Jay:
While you’re watching it, read his book Estrogeneration and start implementing the action tips in the Appendix IMMEDIATELY!
Why Low Estrogen Levels Are The Greatest Danger (And What Happens)
Contrary to what you’ll hear on Internet forums, estrogen is a vital part of male health.
For instance, I outlined in The TOT Bible how estrogen is necessary for optimal male sexual function and libido.
Unfortunately when I wrote The TOT Bible in 2018, the great Dr. Neal Rouzier hadn't put forth his landmark information regarding 'estrogen dominance' actually being 'insulin resistance' due to high levels of systemic inflammation.
Most of the people screaming about 'estrogen dominance' online don't understand it's really insulin resistance (IR) which is causing high levels of systemic inflammation.
As I've said many times before and will continue to say, INFLAMMATION IS THE CULPRIT to just about everything negative in the human body.
Many of the same symptoms that arise from being inflamed are also present in low estrogen levels:
"This is because estrogen imbalances can result from hypogonadism, a condition that results in a lack of hormone production in your body.
Hypogonadism can lower levels of estrogen, testosterone, and other hormones"
Here’s a short list of the things which can happen when your estrogen levels are chronically low:
- Sexual dysfunction (lack of interest)
- Inability to get an erection
- Brain fog
- Mood instability
- Loss of bone mineral density
- Visceral body fat deposition
If you recall my description of estrogen from earlier, you’ll remember that it’s essential for bone strength, cardiovascular health, cognition, and many other essential bodily functions.
And there’s no better resource for explaining why men NEED estrogen than the 3 groundbreaking podcasts I did with Dr. Neal Rouzier.
PODCAST #1 - Estrogen In Men: Good, Bad, Indifferent?
This is the best primer you will see for explaining how the estrogen hysteria came about.
Rampant misinformation in the medical community is one major factor.
More specifically, a failure to understand the role estrogen plays in people taking therapeutic doses of testosterone versus supra-physiologic doses (i.e. bodybuilders injecting copious amounts of steroids).
PODCAST #2 - The Role Of Estradiol In Fat Accumulation & Sexual Function
Part 2 of my series with Dr. Rouzier examines exactly what happens when you try to block the conversion of testosterone into estrogen.
Increased intra-abdominal fat, sexual dysfunction, breast swelling, and the list goes on.
Believe me when I say you will be LUCKY to experience the above symptoms.
There are serious short-term and long-term consequences to suboptimal estrogen management.
PODCAST #3 - The Relationship Between Estrogen, Bone Density, Body Composition & Prostate Cancer
Dr. Rouzier shows you how suppressing your estrogen levels(via aromatase inhibitor medications) can make your bones more fragile and increase your risk of prostate cancer.
If this final part of the series doesn’t convince you, then nothing will.
By now, I hope you’re starting to understand the key message:
Testosterone MUST be converted into estrogen in order to manifest its numerous therapeutic benefits to the body's many biological systems.
In fact, every single study conducted in the past 80 years showcasing the benefits of testosterone DID NOT involve the blocking of estrogen.
There is ZERO THERAPEUTIC VALUE in artificially lowering estrogen levels in men.
Now, you may be asking “what is the OPTIMAL lab reading of estrogen I need to avoid the side effects of low or high estrogen levels?”
Unfortunately, this is the wrong question.
It’s not so much that estrogen levels need to be an an “exact” number.
It’s about maintaining an optimal balance between testosterone levels and estrogen levels.
One in which there are no symptoms or side effects suffered by the end user.
In men not using therapeutic testosterone, the case of 'higher estrogen levels' is a result of imbalance - estradiol levels are increasing and testosterone levels are decreasing due to insulin resistance (IR) from high levels of systemic inflammation.
And the same goes for low estrogen levels, which normally only happens when one elevates their testosterone levels via therapeutic measures while simultaneously suppressing estrogen levels.
So the right question to ask is “how can I optimally manage my estrogen levels so I have the appropriate balance between testosterone and estrogen”?
Unfortunately, the first solution that comes to a hormone optimization physician’s mind is the use of an aromatase inhibitor (AI).
The REAL Truth About Aromatase Inhibitors (AIs)
What is an aromatase inhibitor?
An aromatase inhibitor is a medication that inhibits the aromatase enzyme and prevents the conversion of testosterone into estradiol (E2).
While initially used to treat breast cancer in women, they have seen increased use in managing male endocrine systems.
In situations where a doctor won’t prescribe an AI, they may instead opt for a Selective Estrogen Receptor Modulator (SERM).
While a discussion of every single AI and SERM is beyond the scope of this article, here are the 6 main estrogen-suppressing & modulating medications you need to know about:
- Nolvadex (SERM)
- Clomid (SERM)
- Toremifene Citrate (SERM)
- Raloxifene (SERM)
- Arimidex, a.k.a. Anastrozole (AI)
- Aromasin (AI)
These drugs are very commonly prescribed by doctors, but for the wrong reasons.
It primarily stems from a total misunderstanding of biological processes and the science of aromatization.
Often times, doctors will use them to resolve “estrogen-related symptoms” and/or keep the patient in a very narrow “range” of estrogen.
Bodybuilders are equally to blame for the overuse of AIs, who themselves oftentimes are also ignorant about estrogen management.
Since they’re using supra-physiologic doses of testosterone, they need to offset the over production of estrogen and its various side effects (water retention, mood imbalance, etc).
This requires them to use AIs, but as you now already know, this leads to disastrous consequences. (We're not talking about BB in this article.)
But here’s the catch: If a testosterone optimization therapy program is appropriately managed by an experiential-based physician, you should almost NEVER require the use of an AI.
Barring men with a specific clinical need to use an AI and sometimes morbidly obese men as the exception, a proper dosing schedule should not require any use of an AI.
If a patient experiences symptoms of 'excess estrogen' (which is actually the body's inflammatory response to too much testosterone), reducing the dosage and/or increasing the frequency of the testosterone delivery system will normally eliminate the symptoms.
But what is it about AIs that make them so dangerous in the first place?
I made a video last year summarizing the health-destroying effects of AIs, but I want to go deeper in this article.
One of the major health risks with using AIs is bone mineral degradation.
I’ve even had progressive physicians tell me stories of men who “look good” on the outside yet have the bone health of 90-year-old women!
And think about the bodybuilders: They’re setting themselves up for osteoporosis (bone loss) and osteopenia (weaker bones), and one day they will end up paying the price.
(SIDE NOTE: If you are ever required to take AIs, get a bone densitometry scan (DEXA) done prior to starting therapeutic testosterone, and another one 1 year after to assess any bone mineral loss or spinal degradation)
If weaker bones doesn’t convince you of the dangers associated with AIs, here are some other negative side effects of using them:
Overall lifelessness, frequent lethargy, poor cholesterol profile, lowered libido, heart disease, and ZERO sex drive.
I highly recommend you watch this lecture Dr. Rob Kominiarek gave on the dangers of estrogen inhibition in men using testosterone:
To make a long story short, ALL studies done on AIs conclusively demonstrate no health benefits associated with their long-term use.
When Are Aromatase Inhibitors Absolutely Necessary?
It is imperative for you to avoid AI usage altogether unless there is a CLINICAL NEED to do so.
As I said in The TOT Bible, the need for estrogen control must be proven first via blood tests.
This involves seeing how your body’s endocrine system is affected by testosterone alone.
Doing so gives your physician a clear picture of how a single medication is affecting your testosterone levels and estrogen levels.
If you’re experiencing any inflammation-induced side effects, the next step is following Dr. Keith Nichol’s NO FAILURE PROTOCOL:
- Reducing the dose of testosterone administration
- Increase the frequency of testosterone administration
- Lowering visceral body fat to minimize aromatization
- Eliminating inflammatory lifestyle factors that promote aromatization (alcohol use, sugar consumption, smoking weed, etc.)
- Continually manipulating dosage and frequency of testosterone until all symptoms and side effects are eliminated.
If you did all that and you STILL experience 'estrogenic side effects' ( really just an inflammatory response to the exogenous testosterone) (this only happens to 0.01% of people), your doctor can perhaps consider using an AI.
Should you find yourself in this situation, follow the minimum effective dose (MED) principle.
That means NO MORE than 0.25mg taken once or twice per week, with the goal of titrating off the AI altogether as soon as symptoms and side effects resolve.
Remember: AIs are nothing more than a very temporary last-resort solution and must be treated as such, as even microdosing AIs can be fatal to your long-term health.
And in the majority of cases involving therapeutic testosterone, the easiest way to manage estrogen is to simply leave it alone.
How You Can Optimize Your Body's Estrogen Levels
When it comes to hormone optimization in the context of testosterone and estrogen, you have two primary goals:
Balance the ratio between testosterone and estrogen, and improve your happiness (i.e. “I feel great, full of energy and ready to take on the world”).
When you do this, you will have found the optimal range of estrogen for your body.
This is not a set-in-stone number, as we are all biochemically unique.
The way you feel - in combination with blood work - is far more important to examine when attempting to optimizing your body’s estrogen levels.
Getting to this point of total health optimization requires regular blood work, honest feedback, and a productive relationship between the patient and the doctor.
But on top of using therapeutic testosterone, there are other things you can do to reduce inflammation:
- Weightlifting and cardiovascular exercise
- Eating a diet consisting of whole foods (meat, veggies, etc.) while eliminating processed junk
- Sleeping 7-8 hours a night uninterrupted
- Optimizing your supplement stack
- Putting your feet on bare earthen soil for 10-20 minutes a day
- Reducing your body fat as much as possible
Beyond this article, those books will give you the in-depth doctor interviews, podcasts and detailed observations you need to make the right decision.
Look for an upcoming Podcast with Dr Keith Nichols and Dr Scott Howell where the 3 of us will go supremely deep on EVERYTHING in the world of Therapeutic Hormone administration and optimization.
This will likely be the TOT Bible V2.