HOW DID ESTROGEN GET SUCH A BAD NAME?

About the time men began using testosterone and other anabolic and androgenic steroids (AAS) was about the same time estrogen began to get a bad wrap in the bro community. Before the introduction of aromatise inhibitors in the PED space, there were cases of gynecomastia in every hardcore gym. Gross looking “bitch titties” that seemed to be extra visible when a competitive bodybuilder was shredded on stage. It seemed to ruin the entire physique. Even now, among many the hormone stigma is this black and white way of thinking: “women do not need testosterone” and “men do not need estrogen.” Of course, both statements could not be further from the truth. Not that bro’s like to look at any data much, but if we take a look at the data, what do we find?

There is some evidence that a “high” level of estradiol (most active form of estrogen in males for this context) may contribute to the following:

– Water retention

– Nipple sensitivity

– Mood changes

– Gynecomastia

– Erectile Dysfunction

– Prostrate Cancer

The issue with this evidence is the quality of the evidence. Points to consider:

1) Most studies have used the outdated method of analysing estradiol levels (Immunoassay) instead of the LC/MS method (aka sensitive assay).

No upper limits of estradiol have been studied in men on TRT with healthy testosterone levels.

2) Ironically, a minimum lower limit of estradiol is just about confirmed to prevent bone less, mental function, cardiac function and sexual function. ~ 40-50 pmol/L of estradiol or greater is required for basic health.

3) Weak data for T/E2 ratios has been explored. Needs more research to form any conclusions.

4) Most of the data comes from men with total testosterone under 12          nmol/L, not men on TRT or men with healthy testosterone levels. Therefore, any “high estradiol” side effects are hard to pin point when testosterone is low which could be the culprit.

And then it is said that anastrozole improves libido so that must be due to low E2 levels, right? The problem with this statement is that only 2 questionable papers have shown for anastrozole at 1 mg daily (crazy dose) to improve libido—sort of.

The reality is this. Estradiol is involved in the maintenance of bone density, HDL cholesterol, cognitive function/mood, inflammation regulation and ironically—maintaining erectile function and penile sensitivity. If estrogen is so important and the data is clear, how then did it receive such a bad name in the general public eye? There are so many natural products on the market that are designed to lower estrogen—and thank fuck they don’t really work. There is no solid evidence that an upper limit of estradiol has been established as a cut-off point before one should intervene. In fact, doing so could cause health issues by lowering estradiol too far. As seen in the evidence, an estradiol level too low is downright dangerous and will likely have you feeling like crap.

If your testosterone and androgens are within physiological (normal) ranges, then the chances of you needing some kind of estrogen control treatment are low—very low. If you look the weight of the evidence, not one study paper or anecdote; the number on men who form gynecomastia in TRT treatments is very low and the number would be even lower if the TRT treatment protocol in these studies was more nuanced *sighs*.

Aromatise inhibitors that control estradiol levels are best left for rare cases or those who are using doses of androgens higher than normal, such as body-builders and competitive athletes who are using aromatising anabolic steroids. Even then, they will only benefit from an aromatise inhibitor at the right dose to control estradiol to within normal limits or to a blood level that does not cause any unwanted side effects. There will also be many AAS users who will never require an aromatise inhibitor. There is also this talk of an “estradiol sweet spot” in the TRT community that many men seem to be seeking to find. This perceived  sweet spot is supposed to somehow solve all of their life’s dilemmas if they can just pin point their estradiol within a 10-20 pmol/L margin. I find this concept and report of experiences to be one that is likely controlled by placebo, or nocebo. Hormones fluctuate within the normal range daily, perhaps even by the minute. To suggest that everyone has a magic number is not based on good science. If your estradiol has been tested via the LC/MS (aka sensitive assay) and the score is within normal ranges, then the chances are your estradiol levels are fine and further “fine tuning” your number is unlikely to provide any benefit. Keep things simple. Keep things evidence based. Avoid super high estradiol if you’re using AAS with sensible aromatise inhibition. If you are a natural or on TRT, do not obsess about your estrogen level and even be happy if your estradiol score is on the upper end. Stop the madness. Estradiol is like any other hormone in the body. It is beneficial under normal conditions and small deviations here and there are likely nothing to worry about. Just keeping it real. I’ve got a lot more to say about estrogen, but that is enough for one morning.

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