Stillpoint Integrative Men’s Health
Testosterone and Estrogen: Finding the Right Balance
How are testosterone and estrogen related?
In men, a small portion of testosterone naturally converts to estrogen through an enzyme called aromatase. Estrogen is essential for bone, brain, and cardiovascular health, but when levels rise too high—often from excess body fat or testosterone therapy—symptoms like water retention, mood changes, and low libido can appear. Monitoring and balancing both hormones ensures optimal results during testosterone optimization therapy (TOT).
Understanding the Relationship Between Testosterone and Estrogen
When men begin testosterone replacement therapy (TRT)—or what we call testosterone optimization therapy (TOT)—many positive changes follow: increased energy, improved mood, leaner muscle mass, stronger erections, and greater confidence.
However, one common and easily managed side effect is an increase in estrogen levels.
This occurs because testosterone and estrogen are interconnected—your body naturally converts a portion of testosterone into estrogen through a process called aromatization.
Why Men Need Estrogen Too
Although estrogen is often thought of as a “female hormone,” men need it for optimal health as well.
Balanced estrogen supports:
- Bone density and strength
- Healthy cholesterol and vascular function
- Cognitive sharpness and mood stability
- Glucose regulation and metabolism
When estrogen is too low, men can experience joint pain, low mood, or reduced libido. When it’s too high, unwanted symptoms can occur—so balance is key.
How Estrogen Is Produced in Men
A small percentage of circulating testosterone is converted into estrogen by an enzyme called aromatase, which is found in body fat and certain tissues such as bone and the brain.
Here’s the catch:
The more body fat you carry, the more aromatase you produce—and the more testosterone gets converted into estrogen.
This cycle can become self-perpetuating:
- Increased fat → higher estrogen → lower testosterone → more fat gain.
Over time, this leads to reduced muscle mass, diminished energy, and worsening hormonal imbalance.
Recognizing Symptoms of Elevated Estrogen
Some men convert (or aromatize) testosterone more aggressively during therapy, leading to high estrogen levels.
While these symptoms are typically mild and reversible, they can include:
- Temporary water retention or bloating
- Nipple tenderness or breast tissue sensitivity
- Mood changes or irritability
- Night sweats or insomnia
- Brain fog or fatigue
- Low libido or weakened erections
These effects are not uncommon and, when monitored properly, are easily managed.
Managing and Preventing High Estrogen
At Stillpoint Integrative Psychiatry & Wellness, we routinely monitor estradiol (E2) levels as part of every testosterone protocol. If estrogen rises beyond optimal levels, several effective options are available:
1. Adjust the Testosterone Dose or Frequency
Reducing the dose slightly or splitting injections into twice-weekly doses can help minimize estrogen spikes.
2. Support Natural Detoxification
Supplements such as DIM (diindolylmethane) and Calcium D-Glucarate assist in metabolizing and clearing excess estrogen safely.
3. Use Aromatase Inhibitors When Needed
In some cases, medications like anastrozole are prescribed to block the aromatase enzyme, preventing testosterone from converting into estrogen. These are used conservatively and only when clinically indicated.
Through consistent lab work and proactive management, most men maintain excellent results without complications.
Why Monitoring Matters
Unfortunately, many healthcare providers overlook estrogen monitoring during testosterone therapy, leading to frustrating symptoms and suboptimal outcomes.
At Stillpoint, we take a precision-based approach—balancing testosterone, estrogen, and other key markers to ensure you feel your best without unwanted effects.
Optimization means balance—not too little, not too much.
If you’re experiencing fatigue, mood swings, or other hormonal symptoms, schedule a consultation today. We’ll assess your full
hormonal profile and create a plan tailored to your physiology, not just your lab numbers.
Explore the full Testosterone Optimization Therapy guide to learn how Stillpoint customizes treatment plans, monitors safety, and optimizes hormonal balance for lasting results.
Frequently Asked Questions About Testosterone and Estrogen
Why do men need estrogen?
Estrogen helps maintain bone density, cardiovascular health, mood, and glucose metabolism in men. Without enough estrogen, men can experience joint discomfort, low mood, and reduced libido.
How does testosterone convert into estrogen?
The enzyme aromatase, found mainly in fat tissue, converts some testosterone into estrogen. The more body fat a man has, the more aromatase activity occurs—raising estrogen and lowering testosterone levels.
What are the signs of high estrogen in men?
Common symptoms include water retention, nipple tenderness, mood swings, brain fog, insomnia, low libido, and weakened erections. These effects are temporary and easily managed with monitoring and treatment adjustments.
How can high estrogen be treated or prevented?
Adjusting testosterone dosage or injection frequency, using supplements like DIM and Calcium D-Glucarate, and in some cases, prescribing an aromatase inhibitor can effectively balance estrogen levels. Routine lab monitoring ensures safety and precision.