Estrogen Balance in Men on TRT: Where Should My Estradiol Be?

December 20, 2018


We often get asked by male patients about estrogen and the importance that it plays in hormone replacement therapy. Many patients have misconceptions about estrogen and where their levels should be. Estrogen Balance in Men on TRT is not too difficult to understand and estrogen is not necessarily a bad thing for men to have however It’s important that a male’s estrogen levels remain balanced while on testosterone replacement therapy and are monitored. The importance of seeking help from trained, experienced medical professionals is extremely important for patients on TRTand the value of getting proper blood tests performed is necessary to optimize health and wellness.

If you would like to schedule an appointment to speak with our physician who is experienced and licensed in anti-aging and hormone replacement therapy,  clinkthis link and we will reach out to set up your appointment. or call/text us at 561-277-8260 with any questions.

There are many studies that have been published with data showing that when estrogen levels become out of balance there is an increased risk of many chronic diseases for aging males. Also remarkable are studies that have been able to link elevated estrogen levels to atherosclerosis. Men with elevated estrogen levels will double their risk of stroke and had statistically have significantly higher occurrences of coronary artery disease as well. It has also been shown that men with benign prostate enlargement or prostate cancer had elevated blood estrogen levels often in conjunction with low free testosterone levels. On the other side of the fence, men with abnormally low estrogen levels are predisposed to having fragile bones which often fracture and are at a higher risk of osteoporosis. Most men do not know what their estrogen levels actually are, and this is a large concern considering the effect that it has on the overall health and wellness of men and the increase in age related diseases occurring as a result.

The Journal of the American medical Association or JAMA recently published a study which measured the blood estradiol (a dominant form of estrogen in men) in 501 men with chronic heart failure. Comparing the estrogen levels across the population of test subjects, men in the lowest quartile of estrogen levels (the bottom 25%) were 317% more likely going to die during a follow up appointment within three years of having started this research study. These patients had estrogen levels under 12.9 pg/mL. Men in the highest quartile (top 25%) were 133% more likely to die with estradiol levels of 37.4 and above, whereas the men who were in the middle range of 21.80 to 30.11 pg/mL had the fewest deaths reported. At NovaGenix our goal is to keep your estrogen levels between 20 and 30 for this exact reason. To optimize your overall health. In another study, 3014 men between the ages of 69 and 80 had their serum testosterone and estradiol levels measured with an average follow up period of 4.5 years. Men who suffered from low testosterone had a 65% higher all-cause mortality rate while the men with low estradiol levels suffered 54% more deaths then those with optimal levels. In the male body, aromatase, an enzyme turns testosterone into estradiol. Aging males often have too much of this enzyme activity that may cause they’re testosterone to be more easily synthesized into excess estrogen. Not only does this take away from the body is testosterone levels but will also increase estrogen into ranges that are sub optimal and leave a patient more likely to suffer from some of the aforementioned unwanted health conditions.

For patients on testosterone replacement therapy, it is important to get their hormone levels tested often and understand their testosterone/estradiol balance. Many patients on TRT being prescribed testosterone have also been prescribed an aromatase inhibitor such as Arimidex or Anastrozole with a goal of suppressing estradiol levels into what are considered more normal ranges between 10 and 40 pg/ml. Like all medications, there may be side effects associated with an AI. When thinking about starting HRT, speaking to a medical provider about the benefits of TRT as well as any possible negative effects are important when weight out the risk/benefit of starting any medications. There are other medications that can increase testosterone, like Enclomiphene. Enclomiphene (Androxal), in development by the pharmaceutical manufacturer Repros Therapeutics Inc, is a non-steroidal estrogen receptor antagonist which promotes the secretion of gonadotropin-dependent testosterone by the testes in males.  non-steroidal estrogen receptor antagonists are antiestrogens, also called estrogen antagonists or estrogen blockers. They are a class of medications that prevent estrogens such as estradiol from mediating their biological influences and effects on the body. They work by blocking the estrogen receptors (ER) and/or shutting down or suppressing the production of estrogen in men. Enclomiphene is similar to Clomid, (clomiphene citrate), a drug that has been prescribed for several decades for the treatment of female ovulatory dysfunction in women but also for fertility treatment and HRT in men. Because of the antagonistic effects of enclomiphene, the drug has the potential to increase serum testosterone levels in men with secondary hypogonadism by restoring through stimulation of the testes, physiological endogenous testosterone production while maintaining testicular size and, potentially, sperm production (spermatogenesis). Clinical trials conducted have demonstrated significant efficacy in the ability of enclomiphene to physically restore the testosterone levels in males with secondary hypogonadism.  There is some debate as to whether or not suppression of estradiol is needed in most men on TRT as the balance between testosterone and estradiol is regulated naturally. Seeking guidance from a qualified medical provider is needed to provide hormone balance and optimization. For more information on testosterone replacement therapy and the importance of estrogen balance for man on TRT, please visit and call 561-277-8260 to schedule an appointment to speak with our doctor today.

Our office is located at 609 N. Hepburn Ave. Suite 106 Jupiter, FL 33458. Give us a call and let us know how we can help you today.

The information mentioned is not intended as medical treatment, but information only. We advise you to seek the advice of a trained and licensed medical professional to perform a proper evaluation.


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Blood Work Request Form

This subsequent lab panel is necessary for males undergoing Testosterone Replacement Therapy (TRT) through NovaGenix Health and Wellness. It allows physicians to assess the patient's response to prescribed medications, covering sex hormone levels, thyroid function, adrenal health, hematocrit, and liver and kidney function. The panel includes tests such as:

  • Complete Blood Count
  • Comprehensive Metabolic Panel
  • Testosterone (Free and Total)
  • Estradiol Sensitive
  • Thyroid Stimulating Hormone
  • Prostate Specific Antigen

Each test serves a specific purpose in monitoring overall health and treatment effectiveness. When required, Dr Mackey may require LH and FSH (Luteinizing hormone, follicle stimulating hormone) SHBG (Sex hormone binding globulin) or any other tests which may be important for your health and optimizing your hormones.

The Comprehensive Hormone and Wellness Panel for Women offers a foundational assessment of sex hormones, thyroid function, adrenal health, metabolic activity, and overall well-being. This panel serves as a diagnostic tool for identifying testosterone and estrogen deficiencies, assessing health risks, and detecting potential thyroid issues before considering hormone replacement therapy. Additionally, it includes insights into hematocrit (red blood cell volume), as well as liver and kidney function. The panel encompasses various tests such as:

  • Complete Blood Count (CBC)
  • Complete Metabolic Panel
  • Testosterone (free and total)
  • Estradiol
  • Thyroid Stimulating Hormone (TSH)
  • Progesterone

When indicated, Dr. Mackey may require additional tests such as Follicle Stimulating Hormone (FSH), and IGF-1 and Cortisol.

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609 N Hepburn avenue suite 106. Jupiter, Florida 33458

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609 N Hepburn avenue suite 106. Jupiter, Florida 33458