From the Guidelines
Checking estradiol and estrone levels in a comprehensive male bloodwork panel is crucial for evaluating hormonal balance, particularly in men with symptoms of hypogonadism or those taking medications that might affect hormone levels, as evidenced by the 2018 AUA guideline 1. When evaluating male patients, it is essential to consider the role of estrogens in their health, despite being traditionally associated with female physiology.
Key Points to Consider
- Elevated estrogen levels in men can contribute to gynecomastia, erectile dysfunction, decreased libido, and increased body fat, while also potentially indicating underlying conditions such as liver disease, obesity, or certain tumors.
- The 2018 AUA guideline recommends measuring serum estradiol in testosterone deficient patients who present with breast symptoms or gynecomastia prior to the commencement of testosterone therapy 1.
- Additionally, estrogen testing helps evaluate hormonal balance in men with symptoms of hypogonadism or those taking medications that might affect hormone levels, as supported by the 2024 standards of care in diabetes 1.
- Understanding both testosterone and estrogen levels provides a more complete picture of a man's hormonal health than testosterone measurement alone.
Clinical Implications
- Estradiol levels should be measured in men with total testosterone levels of <150 ng/dL, particularly if they present with breast symptoms or gynecomastia, to evaluate for underlying conditions and to monitor the effects of testosterone replacement therapy 1.
- Men with elevated baseline estradiol measurements should be referred to an endocrinologist for further evaluation, as recommended by the 2018 AUA guideline 1.
- The typical reference range for estradiol in adult males is approximately 10-40 pg/mL, though this varies by laboratory and testing method.
- Clinicians should be aware that symptomatic gynecomastia or other breast symptoms are uncommon in men with elevated estradiol levels, and a period of monitoring based on clinical judgment should be considered if breast symptoms develop during testosterone therapy 1.
From the Research
Estradiol and Estrone in Male Bloodwork
- Estradiol and estrone are forms of estrogen, which are typically associated with female hormones, but they are also present in men 2, 3.
- In men, estradiol is produced through the conversion of testosterone by the enzyme aromatase, and it plays a role in regulating testosterone levels and sperm production 2.
- Checking estradiol and estrone levels in a comprehensive male bloodwork pattern can help diagnose and monitor hypogonadism, a condition characterized by low testosterone levels 4, 5.
- Studies have shown that clomiphene citrate, a medication used to treat hypogonadism, can increase testosterone levels and improve the testosterone/estrogen ratio in men, which can help alleviate symptoms of hypogonadism 2, 6, 3.
- Monitoring estradiol and estrone levels can also help identify potential side effects of testosterone replacement therapy, such as an increase in estrogen levels, which can lead to symptoms like gynecomastia and erectile dysfunction 4, 5.
Importance of Estradiol and Estrone Measurement
- Measuring estradiol and estrone levels can provide valuable information about the balance of hormones in the body and help diagnose hormonal imbalances 2, 3.
- Estradiol and estrone levels can also be used to monitor the effectiveness of treatments for hypogonadism and adjust medication dosages as needed 5, 6.
- Additionally, measuring estradiol and estrone levels can help identify potential health risks associated with hormonal imbalances, such as osteoporosis and cardiovascular disease 4, 3.
Clinical Applications
- Checking estradiol and estrone levels can be useful in clinical practice to diagnose and manage hypogonadism, as well as to monitor the effectiveness of treatments like clomiphene citrate 5, 2, 6, 3.
- Estradiol and estrone measurement can also be used to identify potential side effects of testosterone replacement therapy and adjust treatment plans accordingly 4, 5.
- Overall, measuring estradiol and estrone levels can provide valuable information about hormonal balances and help clinicians make informed decisions about diagnosis, treatment, and management of hypogonadism in men 2, 3.