From the Guidelines
Men with elevated estradiol levels may experience symptoms such as gynecomastia, decreased libido, erectile dysfunction, and reduced sperm production, which can be addressed by seeking medical evaluation and treatment to restore hormonal balance. The symptoms of hyperestrogenism in males can be diverse and impact various aspects of health, including reproductive, emotional, and physical well-being. According to the most recent guidelines, serum estradiol should be measured in testosterone deficient patients who present with breast symptoms or gynecomastia prior to the commencement of testosterone therapy 1.
Common Symptoms
Some common symptoms associated with high estradiol levels in men include:
- Gynecomastia (enlarged breast tissue)
- Decreased libido
- Erectile dysfunction
- Reduced sperm production leading to infertility
- Mood changes, such as depression, anxiety, or emotional instability
- Physical symptoms like increased body fat, decreased muscle mass, and fatigue
- Hair loss or thinning
- Hot flashes
- Reduced testicle size
These symptoms are a result of the disruption of the normal hormonal balance, affecting the hypothalamic-pituitary-gonadal axis, which is crucial for testosterone production and other male characteristics 2.
Importance of Medical Evaluation
If experiencing these symptoms, men should seek medical evaluation to identify the underlying cause, which could include obesity, liver disease, certain medications, or other hormonal disorders. Treatment typically involves addressing the root cause of the elevated estradiol levels. For instance, men with hyperprolactinemia should be evaluated for the etiology and treated accordingly 2. Additionally, for men interested in preserving their fertility, a reproductive health evaluation should be performed prior to treatment, including a testicular exam and measurement of serum follicle-stimulating hormone 1.
Treatment Approaches
Treatment approaches may vary depending on the underlying cause and the individual's health status. For example, aromatase inhibitors, human chorionic gonadotropin, selective estrogen receptor modulators, or a combination thereof may be used for infertile men with low serum testosterone 2. However, testosterone monotherapy should not be prescribed for men interested in current or future fertility 2. It's essential to consult with a healthcare provider to determine the best course of treatment.
From the Research
Symptoms of Hyperestrogenism in Males
The symptoms of hyperestrogenism, or elevated estradiol levels, in males can be varied and may include:
- Cardiovascular disorders 3
- Insulin resistance and type 2 diabetes mellitus 3
- Erectile dysfunction 4
- Orgasmic function impairment 4
- Gynecomastia (although this was rarely documented as a reason for prescription in one study) 5
- Infertility or impaired spermatogenesis 6
- Decreased libido (although one study found that high estradiol levels were not associated with higher rates of low libido) 5
- Severe erectile dysfunction 4
- Hypogonadism 4
Associated Factors
Hyperestrogenism in males has been associated with:
- Increased age 5, 4
- Higher rates of comorbidities 4
- Higher serum total testosterone values 4
- Abnormal testosterone/estradiol (T/E) ratios 6
- Metabolic disorders 3
Treatment and Management
Treatment and management of hyperestrogenism in males may involve: