Addressing Potential Testosterone Replacement Therapy Side Effects -- By Dr. Stephen Stevenson
Ironically, testosterone replacement can increase a man’s estrogen levels (among other things) as the body breaks down testosterone into estrogen. This is useful, because even though we consider estrogen to be a female hormone, males also need it, albeit in much smaller concentrations than women.
One of the main enzymes that convert testosterone into estrogen is aromatase, which is found in higher concentrations in fatty tissue. This means that men who are overweight typically make more estrogen from testosterone and are more likely to have abnormal elevations of estrogen.
If estrogen levels are not monitored and remain elevated, they can cause significant side effects, such as breast enlargement, which can sometimes be irreversible.
Elevated estrogen levels also counteract several of the beneficial effects of taking testosterone, so when estrogen levels become elevated the TRT (Testosterone Replacement Therapy) benefits, particularly some of the sexual benefits, diminish or stop altogether. Elevated estrogen levels can also cause emotional irritability and increased “weepiness.”
When regularly monitored, elevated estrogen levels can be addressed early and the side effects avoided.
Sometimes lowering the dose of testosterone will bring an elevated estrogen level down into the normal range. Keeping someone in the lower end of the therapeutic range rather than the upper end may be all that’s necessary to normalize the estrogen.
Because aromatase, the enzyme that converts testosterone into estrogen, is more predominant in fatty tissue so weight loss can effectively lower estrogen levels, diet can make a significant difference. Estrogen levels can increase up to four times following modest alcohol consumption so limiting alcohol intake can make an effective difference. Cruciferous vegetables (such as cabbage, broccoli and cauliflower) help increase the healthy metabolism of estrogen, which aids in lowering estrogen levels.
Some supplements promote the healthy metabolism of estrogen, including Diindolylmethane (DIM) and Indole–3–Carbinol (I3C), can be useful for lowering elevated estrogen levels.
If the above measures are unacceptable or not completely effective, then a prescription medication called Arimidex can be used. Arimidex, which was initially used in postmenopausal women, blocks the conversion of testosterone into estrogen. Much smaller doses used in men are generally quite effective at lowering estrogen levels. Like most prescription medications it is not without potential side effects so I generally like to recommend it as a last resort rather than a starting point.
Dr. Stephen Stevenson specializes in, among other things, hormone balancing. Come see him or our other practitioners. Your first (free) visit at 785/760-0695.