What Causes Estrogen Imbalances in Men?

Usually when the topic of estrogen is mentioned, men’s health is not the first thing that comes to mind. After all, estrogen is only important for women, right? It’s testosterone that men need to be concerned about. Well, although it is true that estrogen is the predominant female sex hormone, and testosterone is the predominant male sex hormone, the reality is that men and women need both hormones to function properly. The key, depending on gender, is to maintain the optimal balance of estrogen and testosterone. This article explores the role estrogen plays in men’s health and ways to keep it in balance.

The role of estrogen in men

It is important to note that estrogen and testosterone are not opposites of one another – the relationship is more complex than that. Testosterone, as the predominant male sex hormone, is integral for male sexual development (particularly during adolescence), accounting for the emergence of the male characteristics of increased facial and body hair, muscle mass and definition, and changes to a lower, deeper voice. Testosterone is produced primarily in the testicles and is associated with key body functions, including bone density, fat metabolism and distribution, muscle mass and strength, red blood cell production, sperm production, and libido.

Estrogen is also essential for male sexual development and overall optimal male health, because it too plays an important role in maintaining healthy function of practically every system in the body, including the neurological, cardiovascular, musculoskeletal, and immune systems. Men typically produce estrogen from the breakdown of testosterone by the aromatase enzyme (also known as estrogen synthase or estrogen synthetase). Aromatase is present in fat tissue, the adrenal glands, the brain, and the testicles.

How do hormones normally fluctuate with age?

As men age, testosterone levels normally begin to decrease. One study suggests testosterone levels can decline yearly by 0.4-2.0 percent after age 30.¹ Furthermore, as men age, there can be an increase in estrogen levels. This is a natural occurrence and shouldn’t cause concern unless estrogen levels are abnormally high or low, or if such changes cause adverse symptoms.

Normal estrogen levels in men vary with age and stages of development. The following tables, derived from Mayo Medical Laboratories, provide a general reference range of estrone and estradiol for males and females.²

Estrogen reference ranges for males

General Age Range	Estrone	Estradiol
0 – 9 y/o	Undetectable – 16 pg/mL	Undetectable – 13 pg/mL
9 – 11 y/o	Undetectable – 22 pg/mL	Undetectable – 16 pg/mL
11 – 12.5 y/o	10 – 25 pg/mL	10 – 26 pg/mL
12.5 – 14 y/o	10 – 46 pg/mL	10 – 38 pg/mL
14 – 18 y/o	10 – 60 pg/mL	10 – 40 pg/mL
Adult	10 – 60 pg/mL	10 – 40 pg/mL

Estrogen reference ranges for females

General Age Range	Estrone	Estradiol
0 – 9 y/o	Undetectable – 29 pg/mL	Undetectable – 20 pg/mL
9 – 11 y/o	10 – 33 pg/mL	Undetectable – 24 pg/mL
11 – 12.5 y/o	15 – 43 pg/mL	Undetectable – 60 pg/mL
12.5 – 14 y/o	16 – 77 pg/mL	15 – 85 pg/mL
14 – 18 y/o	17 – 200 pg/mL	10 – 350 pg/mL
Adult (Premenopausal)	17 – 200 pg/mL	15 – 350 pg/mL
Adult (Postmenopausal)	7 – 40 pg/mL	< 10 pg/mL

Estrogen imbalance in men

Interestingly, the signs and symptoms are much the same for high or low estrogen levels, including:

1. Infertility
2. Gynecomastia (enlargement of a male’s breast glandular tissue)
3. Erectile dysfunction
4. Low libido
5. Low sperm count
6. Increased fatigue
7. Depression
8. Hair loss
9. Osteoporosis

Causes of estrogen imbalance in men 

Hypogonadism

Given the connection between testosterone and estrogen, it should be no surprise that one of the primary causes of estrogen imbalance is low testosterone. And one of the main causes of low testosterone in men is hypogonadism, a condition where the testicles do not produce sufficient testosterone, which in turn can lead to imbalances in the production and levels of estrogen and other hormones. This can result in various symptom presentations.

There are essentially two types of male hypogonadism:  primary and secondary

1. Primary – Indicates the issue lies in the testicles. There is insufficient production of testosterone by the testes.
2. Secondary – Indicates the issue originates in the part of the brain (specifically the hypothalamus or the pituitary gland) that signals the testicles to produce testosterone. Normally, the hypothalamus produces gonadotropin-releasing hormone (GnRH), which signals the pituitary gland to make follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Luteinizing hormone then signals the testes to produce testosterone.³

Primary or secondary hypogonadism can be caused by a congenital trait, or by something that is acquired, such as an injury or an infection, or as part of the natural process of aging. Both types can actually occur together.^1,3

Other causes

Other causes for estrogen imbalance in men include:

1. Obesity or weight gain
2. Stress
3. Medication (antibiotics, antipsychotics)
4. Tumor
5. Environmental/exogenous exposure

Potential risks of estrogen imbalance in men

An estrogen imbalance places males at higher risk for the following conditions:

• Diabetes
• Blood clots
• Stroke
• Breast cancer
• Postate cancer

Managing healthy estrogen balance

There are several ways to achieve and maintain estrogen balance, including the following considerations:

Medication

1. In cases of increased estrogen, a group of medications known as “aromatase inhibitors” are a possible option. These drugs keep aromatase from converting androgen hormones into estrogen, thereby reducing estrogen levels.
2. Testosterone replacement therapy can be indicated to help with overall estrogen balance.

In either instance, a physician’s recommendation is necessary to determine which use is clinically appropriate.

Diet and lifestyle

Practical diet and lifestyle changes can help balance estrogen levels:

1. Avoid foods high in saturated fats.
2. Avoid meat products from animals that have been treated with synthetic hormones.
3. Eat cruciferous vegetables (such as broccoli, Brussels sprouts, and daikon radish) because they contain phytochemicals that increase estrogen metabolism.
4. Eat shiitake and portobello mushrooms because they reduce aromatase naturally.
5. Drink green tea, which is rich in polyphenol antioxidants. Polyphenols are able to bind to estrogen receptors α (ERα) and β (ERβ) and potentially mimic or inhibit the action of endogenous estrogens – even at low concentrations.⁴
6. Avoid plastic wraps or plastic containers to store your food – certain plastics have chemicals that can be absorbed into food and act like estrogens in the body.
7. Avoid personal hygiene products (shampoos, conditioners, deodorants, and lotions) that contain parabens because parabens act like exogenous estrogens when absorbed in the body.
8. Stay physically active and fit to help maintain healthy estrogen balance:
9. Incorporate daily physical activity that can be done consistently. Consider a mix of cardio and weight training.
10. Even a simple 15-30 minute workout daily is a good starting point from which to build.

Key nutrients that support estrogen balance

Diindolylmethane (DIM)

DIM is a compound derived from cruciferous vegetables like broccoli, Brussels sprouts, and cauliflower.  DIM supports healthy estrogen metabolism by favoring the production of a less-reactive (healthier) form of estrogen called 2-hydroxyestrone instead of the more reactive (less healthy) 16α-hydroxyestrone.* An elevated 16α-hydroxyestrone level in males has been linked to gynecomastia, decreased libido, and prostate gland problems.* In addition, DIM can inhibit aromatase, the enzyme that converts testosterone to estrogen.*⁵

Sulforaphane glucosinolate (SGS)

Another beneficial compound from cruciferous vegetables is sulforaphane glucosinolate (SGS). Broccoli seeds and sprouts are rich in SGS (also known as glucoraphanin). When orally consumed, SGS reacts with the healthy microflora in the gut to produce its active form, sulforaphane, which is a potent natural inducer of phase 2 detoxification enzymes.*^6,7 During phase 2 detoxification, the liver uses one of two key enzymatic pathways to transform potentially toxic substances – like drugs, chemicals, and excess or exogenous estrogens – into less toxic substances that the body can excrete more readily. This allows SGS to play a chemoprotective role in the body, supporting the inhibition of abnormal cell cycle progression and inducing apoptosis (cell death) of abnormal cells.*^8-10 SGS also acts as a long-lasting, indirect antioxidant, activating the body’s antioxidative processes to protect healthy cells from free-radical damage.*^11-13 

Pomegranate extract

Pomegranate extract is a rich source of phytoestrogens – plant compounds that are structurally similar to estrogens, like estradiol. Phytoestrogens compete with estradiol for binding to estrogen receptors, thus reducing their potentially harmful effect.*¹⁴ Pomegranate is also rich in polyphenols, particularly ellagitannins. Ellagitannins have been shown to inhibit aromatase activity, thus suppressing estrogen production.*¹⁵ A review of biologically active compounds in pomegranate found that pomegranate extract can act as a selective estrogen receptor modulator (SERM).*¹⁴    

Thorne’s new DIM Advantage contains DIM, SGS, and pomegranate extract.

When to see a health-care practitioner

You should contact your health-care practitioner when you experience signs or symptoms of estrogen imbalance. Diagnostic testing can usually determine the cause. Many conditions associated with estrogen imbalance in men can be treated successfully when identified early.   

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References

1. McBride J, Carson C, Coward R. Testosterone deficiency in the aging male. Ther Adv Urol 2016 Feb;8(1):47-60. doi: 10.1177/1756287215612961.
2. https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/84230 [Accessed Oct. 12, 2020]
3. https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/symptoms-causes/syc-20354881 [Accessed Oct. 12, 2020]
4. Cipolletti M, Solar Fernandez V, Montalesi E, et al. Beyond the antioxidant activity of dietary polyphenols . . . : the modulation of estrogen receptors (ERs) signaling. Int J Mol Sci 2018;19(9):2624. 
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6. Zhang Y, Talayay P, Cho C, Posner G. A major inducer of . . . protective enzymes from broccoli: isolation and elucidation of structure. Proc Natl Acad Sci 1992;89:2399-2403.
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9. Gamet-Payrastre L, Li P, Lumeau S, et al. Sulforaphane, a naturally occurring isothiocyanate, induces cell cycle arrest and apoptosis in ht29 human . . . cells. Cancer Res 2000;60:1426-1433.
10. Dos Santos P, Machado A, De Grandis R, et al. Transcriptome and DNA methylation changes modulated by sulforaphane . . . in human liver . . . cells. Food Chem Toxicol 2020;136:111047. 
11. Fahey J, Talalay P. Antioxidant functions of sulforaphane: a potent inducer of phase II detoxification enzymes. Food Chem Toxicol 1999;37:973-979. 
12. Zhang Y, Talalay P. . . . [A]ctivities of organic isothiocyanates: chemistry and mechanisms. Cancer Res 1994;54:1967s-1981s.
13. Tanito M, Masutani H, Kim Y, et al. Sulforaphane induces thioredoxin through the antioxidant-responsive element and attenuates retinal light damage in mice. Invest Ophthalmol Vis Sci 2005;46:979-987.
14. Sreekumar S, Sithul H, Muraleedharan P, et al. Pomegranate fruit as a rich source of biologically active compounds. Biomed Res Int 2014;2014:686921. 
15. Adams L, Zhang Y, Seeram N, et al. Pomegranate ellagitannin-derived compounds exhibit anti-proliferative and anti-aromatase activity in breast . . . cells in vitro. Cancer Prev Res (Phila) 2010;3(1):108-113.