Testosterone Replacement Therapy and the Symptoms of High Oestrogen in Men

TRT and high oestrogen symptoms

Testosterone Replacement Therapy and the Symptoms of High Oestrogen in Men

Testosterone is one of the key hormones in human males that affect various aspects of physiology, including sexual functions and development. Unfortunately, thousands of men suffer from low testosterone levels resulting from reduced hormone production. Testosterone Replacement Therapy (TRT) can help such men by optimising the hormone in their bodies. 

While TRT might have some side effects, it is perfectly safe and can help men reverse the effects of low testosterone when done correctly. However, of the side effects of TRT that many men are wary about is an elevation of oestrogen. 

Oestrogen is a female sex hormone that has a role to play in the male body, but its overproduction can negate any benefits of TRT and can even cause other problems.

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How can TRT increase oestrogen levels?

A study appearing in the peer-reviewed journal ‘American Journal of Men’s Health‘ found that testosterone replacement therapy spikes the level of oestrogen in men. One of the reasons for this is that the excess testosterone in your body can be converted into oestrogen by a hormone called aromatase. 

An elevation of oestrogen level in your body might have various effects, including-

  • Erectile dysfunction
  • Gynecomastia
  • Infertility 
  • Shrinking of testicles

Oestrogen can also hurt your body’s ability to make testosterone and cause spermatogenesis (sperm production) issues. Estrogen receptors are present in the sex organs of males and other organs, including the brain. Consequently, an elevated level of oestrogen can even cause erectile dysfunction. 

Another effect of an elevated oestrogen level is an increased risk of developing breast cancer in men. Although the risk of developing breast cancer in males is inherently low, men with high oestrogen are 2.5 times more likely to develop breast cancer. 

While the facts that we discussed above don’t necessarily paint oestrogen in a good light for men, it is crucial for men’s health when present in the right amount. Estrogen in males controls the sexual libido and keeps bones and muscles healthy. The hormone also helps regulate the effects of testosterone on metabolism and plays a role in maintaining a healthy body weight. 

The oestrogen levels in adult males are between 10-60 picograms/ml. However, you must keep in mind that hormones, including oestrogen, are affected by several factors, including age. 

An imbalance between testosterone and oestrogen can have serious health implications. If you think that your hormones are in a state of imbalance, clattering your lifestyle, eating healthy and regular exercise can certainly help. All these measures can help you increase the level of testosterone in your body and restore hormonal balance.   

Many men avoid or skip TRT even if they desperately need it fearing the effects of elevated oestrogen from the treatment.

Other symptoms of oestrogen on male physiology

One of the first questions that men have when considering TRT is whether it will cause an elevation of oestrogen in their bodies. Let’s try to answer this very important question once and for all. 

Opting for TRT does not automatically elevate your oestrogen levels. Every person’s physiology is different, and while some people might experience an elevation of oestrogen, most men on TRT won’t. 

Optimization of the TRT is one of the most important aspects of the therapy. It is a science that deals with tailoring the treatment to offer the maximum benefit with minimum side effects. 

At Optimale, we work hard to provide TRT that is safe and efficient.

Whatever the case, it does make sense to still be vigilant for the early signs of high oestrogen post-TRT. While the severity of the symptoms can vary between men, some of the most common symptoms of high oestrogen in men on TRT include the following-

Water retention

One of TRT’s most common side effects includes the development of what is called ‘a moon face’. It happens due to the increased tendency of the body to retain water rather than expelling it out via the kidneys. However, whether fluid retention is due to high oestrogen is still uncertain. Androgen (male sex hormones) metabolites have been shown to disturb the body’s electrolyte balance, which might cause fluid retention. Testosterone can also interfere with the Angiotensin pathway in the body, leading to fluid retention. 


An elevated oestrogen level might be responsible for you feeling tired all the time. Oestrogen can make you feel fatigued by interfering with several metabolic pathways in your body, including the ability of the thyroid to produce its hormones. 

Men on TRT have usually prescribed aromatase inhibitors that might also cause some tiredness. While elevated oestrogen is bad for your ability to maintain energy, lack of oestrogen is also not good. The hormone needs to be in the optimal range to prevent side effects. 

Fat deposition

Elevated oestrogen is also attributed to fat deposition, especially in the belly area. A rise in oestrogen hampers the lipid metabolism of your body and increases the tendency of the body to accumulate fat in the abdomen region. 

Erectile dysfunction

Elevated oestrogen can also make it difficult for men to maintain an erection during sexual intercourse. There is also evidence that estradiol, the most potent form of oestrogen, can reduce your libido.

Mood swings

Oestrogen can cause mood swings and make men on TRT a bit temperamental. The effects are more pronounced if the oestrogen: testosterone ratio is elevated.


One of the most common effects of elevated testosterone is developing a condition called gynecomastia, commonly referred to as ‘man boobs.’ The condition involves the deposition of fat and glandular tissue growth in and around the breasts. While this happens over time and not suddenly, one should watch for this unsightly side effect of TRT. 

Loss of muscle mass

Oestrogen can sometimes cause your body to lose muscle tone and mass. You might start feeling parts being jiggly or less firm than they used to be before the initiation of TRT. You should also keep an eye out for this symptom while on TRT. 


Both testosterone and oestrogen do play a critical role in mental health. An elevation of oestrogen can cause you to feel gloomy and depressed. Although the cognitive effects of high oestrogen are only seen at significantly higher levels than normal, you should be aware of this side effect if you are considering TRT. 

If you already have an elevated level of oestrogens (oestradiol, in particular), you stand at a higher risk of developing high oestrogen due to TRT. As testosterone is introduced into your body, the aromatase hormone starts to convert the excess testosterone into oestrogen that contributes to the already high levels of the hormone in your body leading to side effects. 

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Managing oestrogen

The negative effects of elevated oestrogen can be better dealt with or eliminated if proper oestrogen management is done while undergoing TRT. Appropriate blood work before starting the therapy can reveal whether you already have elevated oestrogen and might need additional intervention to manage it. 

The first way of managing oestrogen on TRT that is proposed by your doctor should be a change in dose or frequency of injections. In most cases this can help to reduce oestrogen levels by reducing spikes in testosterone and oestrogen levels. In some men who convert a lot of testosterone to oestrogen, an aromatase inhibitor is required.

Aromatase inhibitors- the medicines that inhibit the enzyme aromatase that converts testosterone into oestrogen, can greatly help reduce the effects of high oestrogen. If your bloodwork shows that you have a higher oestradiol level before you begin the TRT, you should consider aromatase inhibitors. These are also often required in men who are overweight or genetically predisposed to high oestrogen levels.

You can also take some measures while on TRT to balance your hormones naturally. Limiting your alcohol intake is one of the easiest things you can do to prevent your hormones from getting out of whack. Alcohol stimulates the body to make more oestrogen by increasing levels of aromatase, so limiting its consumption can help restore the oestrogen-testosterone balance.

Your diet also plays an important role in establishing hormonal balance. Opting for organic, hormone-free meat can go a long way in preventing high oestrogen side effects if you are planning TRT. Ensure that your diet contains a lot of green leafy veggies and cruciferous vegetables. 

Another thing you can do is avoid BPA (Bisphenol A), a common ingredient in plastics. The chemical has been shown to hurt your hormone balance system. If you use plastic containers to store food, make sure they are labelled BPA-Free. Also, avoid heating your food in a plastic container. 

DIM, a natural compound found in leafy, green, vegetables, can also help balance your hormones. It is available as a dietary supplement, and it might be a good idea to include it while you undergo TRT. 

To conclude

To be completely clear, oestrogen is not bad for men.

The hormone plays a vital role in your body as a male and is essential in running a healthy male body.

It is important for arterial health, as well as joint and bone health. It also plays a big role in libido and general well being,

It is worth remembering that what is ‘normal’ for someone might not be normal for you. So, if you are chasing the lab numbers, you are doing a huge disservice to your body. Having an oestrogen level slightly higher or lower than what someone thinks is optimal may be normal for you.

If you are interested in starting TRT, the first step is to get your bloodwork done. You can order an extensive blood work panel from the Optimale website. We offer a variety of blood tests that can help you better understand your body before starting your TRT, including a review of your current oestrogen levels.

If you want to read more about how TRT can help you and how you can get the most out of it, head on to our well-researched, informative article archive.

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