I recently reported about the symptoms and signs of estrogen excess in men. As I mentioned in that article, there is actually more to that story, because recent science[i] has shown us that estradiol has both inhibitory and stimulatory influences on male sexual function in an intricate and dose-dependent fashion.

Let’s now look at ways to manage estrogen excess (or estrogen deficiency, which also can cause declines in sexual arousal and erectile function).

Treatment of estrogen excess

There are dietary/lifestyle and natural therapies to keep estrogen in balance with testosterone in men.

First, be aware that the following associations with increased estradiol in men where it is not needed:

• Excess body fat. It is generally understood that estrogen is generated and stored in body fat tissue, with some varying effects depending on the location. Fat tissue contains aromatase so that testosterone can be converted into estradiol easily there.

• In men, low levels of testosterone are associated with increased visceral fat.[ii] This is the fat located around your internal abdominal organs. This kind of fat (VAT) is known to increase your risk of heart disease and diabetes.[iii]

• Hyperinsulinemia increases estrogen

• zinc deficiency contributes to aromatase activity, which increases estrogen

• inflammation, stress, and alcohol consumption all encourage aromatase activity

• isoproterenol (a heart medication)
   

These foods and supplements help catabolize (breakdown and decrease) estrogen:

• Cruciferous vegetables contain glucosinolates which are transformed naturally into the bioactive compounds Indole-3-carbinol (IC3) and 3,3′-diindolylmethane (DIM). These metabolize estrogen and decrease its activity. Cruciferous vegetables include bok choy, broccoli, Brussels sprouts, cabbage, cauliflower, turnip greens, etc.

• IC3 (e.g. 200 mg daily) and DIM (e.g. 100 mg daily) supplementation.

• Vitamin B12 (as methylcobalamine), folate, betaine and choline help with methylation, which is important for estrogen metabolism. Foods such as chicken, eggs, fish, shellfish, beets, quinoa and spinach are high in these important nutrients.

• Vitamin B12 (methylcobalamine), folate, betaine and choline supplementation.
   

Forskolin[iv] (Indian coleus) at 250 mg of 10% forskolin extract taken twice daily for 12 weeks proved to increase testosterone levels and lean muscle mass while reducing body fat.

The following are known to decrease the aromatase activity to help decrease estradiol.

If needed, consider supplementation with one or more of the following:

• flaxseed

• procyanidins

• flavonoids

• EGCG

• epilobium

• vitamin C

• chrysin

• stinging nettle
   

If you have one or more of the symptoms of low testosterone as I previously reported, then have your blood estradiol and testosterone levels checked by your doctor or by tests offered online. If supplements and lifestyle interventions do not effectively improve your blood tests, then consider the following medicines known to decrease estradiol:

• metformin.

• Aromatase inhibitors such as anastrazole (Arimidex), exemestane (Aromasin) and trozole (Femara).
   

What about estrogen deficiency in men?

As mentioned earlier, estradiol has both inhibitory and stimulatory influences on male sexual function. One recent study looked at estrogen’s role in regulating body fat and sexual function in men and found that when estrogen was too low, symptoms included dramatic declines in sexual arousal and erectile function.[v] As you would predict, even men with estrogen deficiency (like women) will have decreased bone strength and an increased risk for fractures.[vi] This is another reason why it is best to have your blood estradiol and testosterone levels checked.

After all this, you can see that treatment for estrogen excess is not so clear-cut. It takes monitoring levels of both estrogen and testosterone to get it balanced.

To long-term health and feeling good,

Michael Cutler, M.D.

[i] Schuster M, Bernie AM, Ramasamy R. The role of estradiol in male reproductive function. Asian J Androl. 2016;18(3):435-40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854098/

The Abstract reads, “Estrogen receptors, as well as aromatase, the enzyme that converts testosterone to estrogen, are abundant in brain, penis, and testis, organs important for sexual function. Low testosterone and elevated estrogen increase the incidence of erectile dysfunction independently of one another. Regulation of testicular cells by estradiol shows both an inhibitory and a stimulatory influence, indicating an intricate symphony of dose-dependent and temporally sensitive modulation.

[ii] Marin P. Testosterone and regional fat distribution. Obes Res. 2010;3:s609–s612. [PubMed]

[iii] Seidell JC, Bjorntorp P, Sjostrom L, Lvost H, Sammerstedt R. Visceral fat accumulation in men is positively associated with insulin, glucose, and C-peptide levels, but negatively with testosterone levels. Metabolism. 1990;39:897–901.[PubMed]

[iv] Godard MP, Johnson BA, Richmond SR. Body composition and hormonal adaptations associated with forskolin consumption in overweight and obese men. Obes Res. 2005 Aug;13(8):1335-43. PubMed PMID: 16129715. https://www.ncbi.nlm.nih.gov/pubmed/?term=16129715

[v] N Engl J Med. 2013 Sep 12;369(11):1011-22

[vi] Vandenput L, Lorentzon M, Sundh D, Nilsson ME, Karlsson MK, Mellström D, Ohlsson C. Serum estradiol levels are inversely associated with cortical porosity in older men. J Clin Endocrinol Metab. 2014 Jul;99(7):E1322-6. PubMed PMID: 24694340. https://www.ncbi.nlm.nih.gov/pubmed/24694340