From the Guidelines
If a male on testosterone therapy has elevated estrogen levels despite good testosterone levels, the most appropriate course of action is to consult with a healthcare provider about adding an aromatase inhibitor, such as anastrozole or exemestane, to block the conversion of testosterone to estrogen, as recommended by recent guidelines 1. When managing elevated estrogen levels in males on testosterone therapy, it's crucial to consider the potential risks associated with high estrogen levels, including gynecomastia, water retention, mood changes, and decreased libido, as well as potential cardiovascular risks.
- The goal of testosterone therapy is to achieve a total testosterone level in the middle tertile of the normal reference range, while also improving symptoms or signs, as stated in the evaluation and management of testosterone deficiency guideline 1.
- Regular blood work is essential to monitor both testosterone and estrogen levels while on therapy, with follow-up measurements recommended every 6-12 months while on testosterone therapy 1.
- Lifestyle modifications, such as maintaining a healthy weight, limiting alcohol consumption, and avoiding environmental estrogens, can also help mitigate the effects of elevated estrogen levels.
- Adjusting the testosterone dosage or administration method may also be considered, as certain delivery systems can lead to different rates of estrogen conversion.
- The use of aromatase inhibitors, such as anastrozole (0.5-1mg once or twice weekly) or exemestane (12.5-25mg every other day), can help block the conversion of testosterone to estrogen, thereby reducing estrogen levels and associated symptoms.
From the Research
Elevated Estrogen Levels in Men on Testosterone Therapy
If a male's estrogen level is elevated while on testosterone therapy, but their testosterone level is good, there are several steps that can be taken:
- Monitor estrogen levels regularly to ensure they are within a healthy range 2
- Consider prescribing antiestrogenic medications, such as aromatase inhibitors, to reduce estrogen levels 3, 2
- Adjust the dosage or type of testosterone therapy to minimize the risk of elevated estrogen levels 4
- Consider alternative therapies, such as selective estrogen receptor modulators (SERMs), although more research is needed to evaluate their effectiveness and safety 5
Treatment Options
Treatment options for elevated estrogen levels in men on testosterone therapy include:
- Aromatase inhibitors, such as anastrozole, which can reduce estrogen levels by inhibiting the enzyme aromatase 3, 5
- Selective estrogen receptor modulators (SERMs), which can block the effects of estrogen on certain tissues 5
- Adjusting the dosage or type of testosterone therapy to minimize the risk of elevated estrogen levels 4
Important Considerations
It is essential to note that: