Can a man have low estrogen
Traditionally, testosterone and estrogen have been considered to be male and female sex hormones, respectively. However, estradiol, the predominant form of estrogen, also plays a critical role in male sexual function. Estradiol in men is essential for modulating libido, erectile function, and spermatogenesis. Estrogen receptors, as well as aromatase, the enzyme that converts testosterone to estrogen, are abundant in brain, penis, and testis, organs important for sexual function.SEE VIDEO BY TOPIC: Your hormone level is not the problem! - Estrogen/progesterone too low/high?
SEE VIDEO BY TOPIC: High levels of estradiol in older men may be associated with young biological ageContent:
- Testosterone and the Symptoms of High Estrogen in Men
- Low testosterone? Low estrogen too may cause problems for men
- Low Estrogen Explains Some Hypogonadal Symptoms in Men
- Male Hormone Restoration - Testosterone, Estrogen, Prostate - Life Extension Health Concern
- Could You Have Low Estrogen?
- Low Estrogen In Men Could Be More Dangerous Than You Think
Testosterone and the Symptoms of High Estrogen in Men
Traditionally, testosterone and estrogen have been considered to be male and female sex hormones, respectively. However, estradiol, the predominant form of estrogen, also plays a critical role in male sexual function. Estradiol in men is essential for modulating libido, erectile function, and spermatogenesis. Estrogen receptors, as well as aromatase, the enzyme that converts testosterone to estrogen, are abundant in brain, penis, and testis, organs important for sexual function.
In the brain, estradiol synthesis is increased in areas related to sexual arousal. In addition, in the penis, estrogen receptors are found throughout the corpus cavernosum with high concentration around neurovascular bundles. Low testosterone and elevated estrogen increase the incidence of erectile dysfunction independently of one another.
In the testes, spermatogenesis is modulated at every level by estrogen, starting with the hypothalamus-pituitary-gonadal axis, followed by the Leydig, Sertoli, and germ cells, and finishing with the ductal epithelium, epididymis, and mature sperm.
Regulation of testicular cells by estradiol shows both an inhibitory and a stimulatory influence, indicating an intricate symphony of dose-dependent and temporally sensitive modulation. Our goal in this review is to elucidate the overall contribution of estradiol to male sexual function by looking at the hormone's effects on erectile function, spermatogenesis, and libido. The effect of estradiol on libido is seen at various levels of regulation, starting with direct effects in the brain Figure 1.
Areas of the brain that control sexual behavior in mammals are thought to do so via pheromones that induce specific sexual effects on the autonomic nervous system, including changes in mood and sexual arousal.
The preoptic area and anterior hypothalamus contain the highest levels of aromatase and estrogen receptors ERs in male rodents. Serotonin receptors follow a pattern of distribution similar to that of ERs in the brain. Finally, aromatase activity is highest in the brain during development. Thus, not only does estradiol modulate sexual behavior in the adult male, it also appears to organize the early brain to program sexual behavior. To discern the effect of estradiol, it is important to evaluate its effect on libido at both low and normal levels of circulating testosterone.
Decreased testosterone is clearly associated with low libido in males. Similarly, patients with prostate cancer treated with androgen deprivation therapy ADT serve as a good model for the influence of estrogen on libido. In addition, administering estradiol to men undergoing ADT for prostate cancer could possibly reduce damage to areas of the brain associated with sexual performance.
Thus, an overall increase in sexual quality of life could be achieved. While estradiol has been shown to have a positive effect on libido at low levels of testosterone, a limited number of studies have looked into the effect of estradiol supplementation in eugonadal men and reported conflicting results.
One study with continuous estradiol administration in men who had normal testosterone levels showed decreases in sexual interest, fantasy, masturbation, and erections. Uncontrolled case reports also have shown conflicting results. A man with aromatase deficiency was noted to have a relevant increase in sexual behavior with estrogen supplementation, 13 while other aromatase-deficient men noted no change in their sexual function.
Perhaps, most relevant to the discussion is the use of testosterone supplementation therapy TST. The goal of TST, regardless of the method used, should be to maintain not only physiologic levels of testosterone, but also its metabolites, including estradiol which optimizes libido. In men with secondary hypogonadism functioning testes and relatively low levels of luteinizing hormone [LH] and testosterone , clomiphene citrate was used to increase testosterone by acting centrally on the ER weakly.
In , Finkelstein et al. They found that the administration of testosterone with and without aromatase inhibitors markedly impaired sexual function when aromatization was inhibited.
It might be reasonable that while prescribing TST one should monitor the levels of both testosterone and estrogen and their relationship to each other. Clearly, the effect of estradiol on male sexual desire is linked to testosterone levels, as there are different outcomes when estrogen is administered at low and normal testosterone levels. Another example of this duality is seen in men with androgen resistance, where unfettered estrogen is able to stimulate subsequent breast development. However, in men with normal androgen receptor activity, estradiol is unable to stimulate breast development.
Finally, the effect of estradiol on mood must be considered. As mood can correlate with sexual interest, it is reasonable to consider these data when discussing the role of estradiol on libido. While cognition, well-being, and depressive symptoms improve in men whose low testosterone levels were corrected, 24 , 25 , 26 higher levels of estrogen also have been associated with less depression in older patients of both sexes.
Erectile function is multifaceted with a necessary combination of nerve, vessel, and endocrine actions that work together to produce subsequent penile structural changes in a coordinated fashion. Smooth muscle, endothelium, and cell-to-cell communications via gap junctions are essential to erectile function, and thus pathology in any one of these can lead to ED.
Estrogen in animal models impedes normal penile development, including reduced bulk of the bulbospongiosus muscle, reduction of the spaces in corpus cavernosum, and an accumulation of fat cells within existing spaces that lead to ED in adult life. Notably, the reported exposure was limited to early development, and rats that were exposed to exogenous estradiol after day 12 of life showed no structural abnormalities.
A case—control study of male outpatients with ED with venous leakage showed that the only difference between the men with and without ED was an increased estradiol level. The authors concluded that estradiol increases venous vascular permeability via VEGF and has a detrimental effect on erectile function through increased venous leakage.
Estrogen also acts at the level of the brain to influence erectile function. Estrogen inhibits the hypothalamus-pituitary axis and subsequently follicle-stimulating hormone FSH and LH, thus reducing circulating testosterone. This was demonstrated in animals, where exogenous estrogen administration not only reduced testosterone levels, but also diminished the structural integrity of the corpus cavernosum with less viable smooth muscle and an increase in connective tissue.
The effects of estrogen on erectile function discussed above largely occur as a function of its ability to decrease circulating testosterone. In addition, increased severity of ED, assessed with the International Index for Erectile Function, 48 in men with low testosterone levels is worsened with high estrogen levels implying an additive effect by the two hormones. Evidence from animal models demonstrates this independent role of estradiol in erectile function.
Stimulation of ER receptors has been shown to have anti-apoptotic effects on endothelium, and the loss of this function in the crura was associated with ED. Testosterone has long been known to be the dominant sex hormone in men. However, estrogen is found at detectable levels at multiple points of development and contributes to spermatogenesis Figure 1. Sperm retrieval rates were seen to increase 1. In addition, varicocele has long been known to have an adverse impact on fertility and sex hormone production, and while the mechanism of this affect is unknown, estrogen has been linked.
Estradiol has been shown to exist not only in the reproductive tract of the adult male, but in the brain as well. Leydig cells, under the influence of LH, secrete testosterone, which in turn acts on Sertoli and peritubular cells, as well as vasculature, allowing them to nurture the budding spermatogonia to spermatozoa. However, they remain in small numbers in the adult testes as a distinct cell population that is important for the generation of their adult counterparts.
Furthermore, there is evidence suggesting that estrogen inhibits the LH effect on Leydig cells 68 and that excess estrogen exposure reduces serum testosterone levels via this inhibition. The subsequent reduction of testosterone in turn reduces the number of viable sperm.
While a major source of estrogen in the adult testes is the Leydig cell, Sertoli cells produce most of the estrogen in the immature testes. A reduction of sperm production with poor motility was also dose-dependent, with the upper range doses of estradiol producing complete azoospermia. These changes are androgen-dependent and have been linked to a down regulation of ARs on Sertoli cells via the effect of estradiol on the coexisting ERs.
It has been shown that FSH in combination with estradiol is necessary for the mRNA transcription of N-cadherin, the protein responsible for cell-to-cell adhesion. Testosterone produced by Leydig cells and FSH from the anterior pituitary are necessary for Sertoli cells to transduce signals and produce factors that nurture germ cells.
Aromatase has been confirmed in the cytoplasm surrounding elongated spermatids, as well as ejaculated sperm, and a link exists between estradiol production in sperm and capacitation and the acrosome reaction. When placed in a noncapacitating medium, only estradiol and aromatizable steroids were able to increase sperm motility and migration, making estradiol necessary for sperm maturation and successful fertilization.
In the neonatal period, the major portion of estradiol is synthesized by Sertoli cells, and germ cell precursors are stimulated through plasma membrane ERs. Unlike estrogen's inhibitory influences on Leydig and Sertoli cells, as described above, a stimulatory effect is seen with germ cells.
Like Sertoli and Leydig cells, ERs and aromatase are found in germ cells, again suggesting the production of as well as modulation by estradiol. Thus, estrogen has proven to be a potent hormone necessary for germ cell survival. An interesting case report from the New England Journal of Medicine describing a man with an estrogen receptor mutation with normal sexual development and relatively normal semen parameters warrants discussion. The authors did not address that, however this point once again addresses the complexity of estradiol on male sexual function and demonstrates why further study is needed.
The exact role of estradiol in each area of male sexual function including libido, erectile function, and spermatogenesis, is difficult to determine. A complex balance of testosterone, estradiol, aromatase, and ERs in the testes, penis, and brain confirms an indispensable and highly regulated hormonal interaction of estrogen in the male.
ERs and aromatase share topographic locations with pheromones in the brain, making it clear that estrogen contributes to early sexual development as well as sexual behavior in adulthood. Estrogen can sustain libido as well as affect the amount of serotonin receptors in the brain modulating mood, mental state, cognition, and emotion. Erectile function is adversely affected by estrogen exposure in early penile development, and exposure to estradiol in the mature penis leads to increased vascular permeability with increased ED.
ED from increased estradiol exposure is independent of testosterone level. In addition, spermatogenesis is dependent upon estradiol to some extent, as all cells involved in the process of sperm production contain aromatase and express ERs.
Finally, estradiol levels should be considered when treating men with TST, as estradiol levels below 5 ng dl -1 correlate to a decrease in libido.
Considering the complexity and taking into account some conflicting data, more research is necessary so that when better understood, estradiol can become clinically useful in treating diminished libido, ED, and perhaps even oligospermia. National Center for Biotechnology Information , U. Journal List Asian J Androl v.
Asian J Androl. Published online Feb Author information Article notes Copyright and License information Disclaimer. Correspondence: Dr. R Ramasamy ude. This article has been cited by other articles in PMC. Abstract Traditionally, testosterone and estrogen have been considered to be male and female sex hormones, respectively.
Keywords: estrogen, testosterone, spermatogenesis, erectile function, estrogen receptor, aromatase. Open in a separate window. Figure 1. Estradiol effect at low testosterone levels To discern the effect of estradiol, it is important to evaluate its effect on libido at both low and normal levels of circulating testosterone. Role of estradiol in eugonadal men While estradiol has been shown to have a positive effect on libido at low levels of testosterone, a limited number of studies have looked into the effect of estradiol supplementation in eugonadal men and reported conflicting results.
Role of estradiol in hypogonadal men treated with testosterone supplementation therapy Perhaps, most relevant to the discussion is the use of testosterone supplementation therapy TST. Figure 2.
Leydig cells — self-regulation and testosterone control via estradiol Leydig cells, under the influence of LH, secrete testosterone, which in turn acts on Sertoli and peritubular cells, as well as vasculature, allowing them to nurture the budding spermatogonia to spermatozoa. Sertoli cells — contributions of estradiol to the immature testes and sperm maturation While a major source of estrogen in the adult testes is the Leydig cell, Sertoli cells produce most of the estrogen in the immature testes.
Low testosterone? Low estrogen too may cause problems for men
CBS News Symptoms of so-called "male menopause" may be triggered not only by declines in testosterone, but in the female hormone estrogen as well, according to a new study in the New England Journal of Medicine. The study of men ages 20 to 50 found that estrogen in men is important for keeping fat down and testosterone is important for muscle size and strength -- and that both are involved with sexual desire, Dr. When researchers lowered estrogen in the study, men got more body fat and when estrogen was higher, they had less body fat. And as for sexual function, the combination of testosterone and estrogen was much better for sexual desire and functioning than testosterone alone.
Researchers have discovered that, just as women go through menopause due to a dramatic decrease in estrogen production, middle-aged men undergo estrogen-related changes in body composition and sexual function. The researchers say that traditionally, when a diagnosis of male hypogonadism has been made — a drop in reproductive hormone levels that are high enough to cause physical symptoms — it has only been based on blood testosterone levels. However, they say there has been little understanding of the levels of testosterone needed to support certain functions. According to the study authors, a small proportion of the testosterone made by men is usually converted into estrogen by aromatase — a type of enzyme. The higher the testosterone level in a man, the more testosterone is converted into estrogen.
Low Estrogen Explains Some Hypogonadal Symptoms in Men
Read original article here. Health Protocols Male Hormone Restoration The significance of testosterone for male sexual function is apparent to most Life Extension customers. New insights, however, underscore the critical role testosterone plays in maintaining youthful neurological structure, alleviating depression, as well as inducing fat loss in those who are unable to reduce body weight regardless of diet and exercise. Restoring testosterone to youthful ranges in middle-aged, obese men resulted in an increase in insulin sensitivity as well as a reduction in total cholesterol, fat mass, waist circumference and pro-inflammatory cytokines associated with atherosclerosis, diabetes, and the metabolic syndrome Kapoor et al , Malkin et al , Heufelder et al Testosterone therapy also significantly improved erectile function Fukui and improved functional capacity, or the ability to perform physical activity without severe duress, in men with heart failure Malkin et al Thus, levels of DHEA can have a role in determining levels of estrogen and testosterone, though DHEA alone is seldom enough to sufficiently restore testosterone levels in aging men. Aromatase: One of the most important factors that affect testosterone levels and the ratio between testosterone and estrogen is the aromatase enzyme. Aromatase converts testosterone to estrogen, further depleting free testosterone levels and increasing estrogen levels. Obesity: Obesity and associated hyperinsulinemia suppress the action of luteinizing hormone LH in the testis, which can significantly reduce circulating testosterone levels Mah and Wittert , even in men under the age of 40 Goncharov et al
Male Hormone Restoration - Testosterone, Estrogen, Prostate - Life Extension Health Concern
Androgens are essential for male physical activity and normal erectile function. Moreover, estrogens also influence erectile function, and high estrogen levels are a risk factor for erectile dysfunction ED. In this review, we summarize relevant research examining the effects of the sex hormone milieu on erectile function. Testosterone affects several organs, particularly erectile tissue. The mechanisms through which testosterone deficiency affects erectile function and the results of testosterone replacement therapy have been extensively studied.
But while the benefits of testosterone replacement therapy are numerous, side effects are still a matter of course with any drugs or medical treatment. Although, when done properly the side effects of testosterone optimisation therapy are minimal. Nevertheless, in spite of this there is still one potential side effect that scares men more than any other:.
Could You Have Low Estrogen?
Estrogen is likely the most widely known hormone—and possibly the most loved and hated. On the good side, it is responsible for the growth and development of female sexual characteristics and reproduction. But, when it fluctuates wildly—like nearing puberty, during pregnancy and around menopause—women can come to loathe what is typically thought of as a female hormone.
A new study presented at the Endocrine Society's annual meeting now shows a strong association between serum estradiol, testosterone, and sex hormone? This study looked at men aged years who had participated in phase 1 of the Third National Health and Nutrition Examination Survey. Men with lower estradiol levels, lower free testosterone levels, and higher circulating SHBG concentrations were more likely to have low BMD. This relationship held true even when taking into account other risk factors known to influence BMD. Everyone thinks only in terms of testosterone as good in the bones, and that is why men have a higher bone mineral density than women do, but in reality it looks like estradiol is even more important at the bone level," said coinvestigator Adrian Dobs, MD, professor of medicine and oncology, Division of Endocrinology and Metabolism, Johns Hopkins School of Medicine. These findings are the first to show such an association in a large, nationally representative sample of civilian, community-dwelling men across a wide age range.
Low Estrogen In Men Could Be More Dangerous Than You Think
There is little doubt that androgens are crucial for phenotypic expression of gender differences. Androgens and estrogens were, for a long time, considered as two opponents using two different receptors with mainly antagonistic effects. However, are these hormones so different from each other? Androgens, indeed, also have the puzzling feature of being prohormones for estrogens. The aromatase enzyme complex CYP19 has the unique ability to convert androgens into estrogens via a multistep enzymatic process 1. Therefore, the relatively low serum concentration of estrogens in men may not accurately reflect their intracrine and paracrine actions of estrogens.
When we started offering comprehensive blood test panels, men did not understand why we were checking their estrogen levels. Back in those days, estrogen was considered a hormone of importance only to women. We tested estrogen based on published data indicating that when estrogen levels are unbalanced, the risk of degenerative disease in aging men skyrockets.
A drop in testosterone levels can lead to a gain in body fat, a loss of muscle mass, and a decreased sex drive. Men and women produce both hormones, but men have far more testosterone, and women more estrogen. So when researchers gave a group of healthy men shots that stopped them from producing testosterone for 16 weeks, as expected, the men had less lean muscle mass. When they blocked estrogen production in another group, the men had increased body fat.
Men are often unaware that estrogen estradiol plays a critical role in their day-to-day health. Estrogen is found in small-but-critical concentrations in men. It needs to be in balance with the rest of your hormones, especially testosterone, for you to feel well. Estrogen levels and testosterone levels are closely related.
Testosterone deficiency in men accounts for decreases in lean mass, muscle size, and strength, whereas estrogen deficiency primarily accounts for increases in body fat, according to a new study. Deficiency of both hormones contributes to a decrease in sexual function. Joel S. Finkelstein, MD, and colleagues at Massachusetts General Hospital in Boston, studied healthy men aged years who were given goserelin acetate to suppress endogenous testosterone and estradiol cohort 1. They randomized subjects to receive a placebo gel or 1.
Testosterone is powerful--in the male human body and in the American pharmacological marketplace. The new research explored what mix of hormone levels in healthy younger men might bring on the hallmark symptoms of male hypogonadism: loss of energy and strength, sexual dysfunction and depressed libido and changes in body composition that add flab and sap muscle tone. So they recruited more than healthy men between 20 and 50 and tinkered with their hormonal balance to see what the effects would be. All the men had their testosterone hormone production suppressed by four monthly injections of the drug goserelin marketed as Zoladex and either a placebo testosterone replacement or actual testosterone replacement that ranged across four levels, from very little replacement to complete replacement. These men were further divided into two groups: half getting a medication that blocks the conversion of testosterone to estradiol, the other half not. The results also flesh out the levels of testosterone loss that are typically necessary to induce symptoms such as low sex drive, body composition changes and flagging energy.