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Low to High: How elevated testosterone levels can increase estrogen in men on TRT

Updated: Dec 26, 2023

What is high testosterone?
How High is TOO High?

Testosterone Replacement Therapy (TRT) helps men not only normalize but optimize their testosterone levels. The key word here is "optimize". Each man is different. A 5'5" man and a 6'5" man have different testosterone needs.

A 25-year-old will have different testosterone levels than a 75-year-old man. See the Age-Adjusted Testosterone Level blog post.

There has to be an upper limit, right? The short answer is yes.

When total testosterone starts to tip over >1800, men start to experience the reverse of the positive effects of TRT. Levels above this range are not physiologic, meaning we, as humans, can't get much above this naturally without the use of exogenous testosterone.

This point can be argued; however, we at Vitali-T Men's Health Clinic find that the sweet spot for most men lies between 900 to 1500 ng/dL for total T and a Free T between 25-30 ng/dL (or 250-300 pg/mL).

One of the first things that happens is that men's estrogen levels start to spike into the 100s ng/dL when their total T skyrockets. A man's estrogen levels should optimally be around 25-35 ng/dL. Some men's levels can get upwards of 200 ng/dL.

The ratio of Testosterone to Estrogen is in balance when it is roughly a 30:1 (a 30 to 1) ratio.

Estrogen is important for the following: bone and brain health, sleep, mood and mental clarity, sex and sex drive, as well as erection quality.

In order to maintain proper health in men, we never want estrogen levels below 15 ng/dL.

Some men are what we call high aromatizers, where aromatization causes estrogen levels to spike when on TRT, even if the total testosterone levels are within acceptable ranges. Men who carry extra weight or adipose tissue can have higher estrogen levels due to this activity.

Estrogen levels can spike in relationship to testosterone level increases
When T goes up, so does E

Here's how estrogen levels rise:

Men whose T levels spike to excessive levels start converting testosterone to estradiol by increasing the aromatization activity by the aromatase enzyme.

How Testosterone is converted to Estrogen through aromatase
The converstion of T to E via Aromatase.

There are some ways to help a man normalize his T and estrogen levels.

The most widely used medication for men on TRT who spike their estrogen levels is Armidex or anastrozole. Known as aromatase inhibitors (AI), these AIs reduce estrogen by inhibiting aromatase, but they do allow some estrogen to be produced.

The key here: Anastrozole elevates testosterone levels, especially the most important type of testosterone, the bioavailable testosterone--the T a man's body has for functional use.

Other medications block estrogen receptors in tissues and glands. These are SERMs. Medications like Clomid/clomiphene citrate and Tamoxifen are similar to Armidex.

The gist is that SERMs improve the ratio of testosterone and estrogen in the body.

Other natural, over-the-counter medications lower estrogen levels too. We recommend starting with one of the abovementioned medications first, given their known mechanism of action on men who are on TRT.

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