How can I balance my hormones?








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Do I need to balance my hormones?

Your hormonal system is a very complex combination of feedback loops and cascades that is carefully interlinked. If your hormones are abnormal or disrupted then this can have a huge knock-on effect on several processes in the body. Sometimes TRT requires careful balancing of these hormones to ensure that it is optimised. So how can I balance my hormones?

Which hormones should I balance?

How can I balance my hormones? Which hormones do I need to consider if I do balance my hormones?

For men there are several key hormones that need to be considered for careful optimisation.



Oestrogen is typically considered to be a ‘female hormone’. It is present in higher amounts in the female body – about 10 times as much –  as in men. It is the primary female sex hormone and causes the development of female sexual characteristics such as breast and hip/pelvis bone development.

In men it also has many important effects. It is important for bone and joint health as well as mood, libido and even erection strength! Abnormal levels can also lead to water retention, cardiac issues and hot flushes.

Therefore it is extremely important to balance this hormone, particularly for men who are considering testosterone replacement therapy.

Men can often experience low oestrogen when they have low testosterone. This is because oestrogen is converted in the male body from testosterone. The enzyme aromatase is responsible for converting oestrogen to testosterone to balance the hormones in the male body, if testosterone is low then this conversion is reduced leaving the man with lower oestrogen levels. This can cause low mood and joint pain.

Some men experience the opposite whereby testosterone is over converted to oestrogen by aromatase in the body. This is frequently caused by an abundance of body fat. Overweight or obese men have higher levels of aromatase. These men may struggle to lose weight, be emotionally labile (more emotional for no reason) and have gynecomastia (breast tissue development – this is why you see more overweight men with breasts).

How do I balance my hormones – oestrogen?

Fear not for oestrogen levels can be controlled in men and aromatase activity can be reduced.

Breast cancer in women is exacerbated by high levels of oestrogen. As a result the pharmaceutical industry has produced several medications that can be used to reduce the amount of oestrogen in the body and/or its effects on certain tissues.

Interestingly breast cancer in men is associated with higher levels of oestrogen. Another reason to balance this important hormone.

These medications are ‘off-license’ for men as they are originally licensed for use in women with breast cancer. However, TRT doctors can prescribe this medication after explaining the reason for their prescription of the drug to the patient. These medications work by either blocking the activity of aromatase (the enzyme that converts testosterone into oestrogen) or by binding to certain tissues that oestrogen wants to bind to thereby preventing their action.

SERMs (Clomifene or Nolvadex) – Selective (o)estrogen receptor modulators – these bind to breast and other tissue receptors to prevent the oestrogen molecule from binding instead.

Aromatase inhibitors (anastrazole, arimidex, letrozole) – these inhibit (prevent the action of) aromatase by binding either temporarily or permanently to the enzyme and preventing it from acting on testosterone. These can increase the levels of testosterone in the body indirectly for this reason.


Testosterone is the primary male sex hormone and is responsible for muscle development, bone health, mood, libido, erectile function as well as development of male characteristics such as penile and testicular growth, jaw development and upper body development.

Low levels of this in men or women can cause low mood, poor sexual function, poor athletic performance, fatigue, reduced muscle mass, increased adipose tissue (particularly around the abdomen) and even reduced height due to reduced bone density.

Higher levels of oestrogen in the male body can affect the production of testosterone via a negative feedback loop in the pituitary. This causes reduced output of LH which reduces the production of testosterone in the testes.

How do I balance my hormones – testosterone?

Testosterone levels can be improved in two ways:

Stimulating increased production – Clomid/HCG: These medications either increase release of luteinising hormone (LH) in the pituitary (Clomid) which stimulates the release of increased testosterone by the testes or are an analogue of LH (HCG) which has the same result.

Exogenous testosterone: Testosterone replacement therapy is where a man balances his testosterone levels by administering testosterone to replace his own levels via an injection/gel/pellet which releases testosterone into the body.

These medications are licensed for use in men and are prescribed by TRT doctors see here to get TRT in the UK.

Improving testosterone levels in men has to be balanced with other hormones in the body to ensure proper functioning. Blood tests should be performed after roughly 6 weeks (and then every 6-12 months after) to ensure that a man’s hormone levels are balanced effectively and safely.

In some men who start TRT the increased levels of testosterone result in a higher level of oestrogen being converted. This can cause symptoms similar to low testosterone can cause many men to feel that the TRT is not effective. These men may either require a reduction in dose or the prescription of aromatase inhibitors to reduce this conversion.


Think you might have low testosterone?


Prolactin is a lesser known hormone that is found in both men and women. In women it is mainly responsible for the development of the mammary glands (breasts) and milk production around child birth.

Interestingly it is commonly increased in men and women when they have children but also with new puppies and kittens!

Prolactin has many more effects than we give it credit for and is extremely important pre and during testosterone replacement therapy.

It counteracts the effects of dopamine in men and women reducing the reward system in the brain.

Increased prolactin secretion can suppress the secretion of FSH (follicle stimulating hormone) and GnRH (gonadotropin releasing hormone), leading to hypogonadism (low testosterone production) and sometimes erectile dysfunction/loss of libido.

If prolactin is very high then this can be an indicator of a prolactinoma (a tumour in the pituitary gland). This requires further input by an endocrinologist, often including an MRI of the pituitary. This is why all TRT providers should always test your prolactin levels before starting TRT! Ignoring high prolactin levels can have serious consequences if it indicates an untreated prolactinoma.



Causes of raised prolactin

  • After sex/coitus
  • Exercise
  • Lactation
  • Pregnancy
  • Sleep
  • Stress
  • Depression
  • Oestrogen
  • antihistamines
  • SSRIs
  • Antipschotics
  • Neuroleptics
  • Opiates
  • Antihypertensives
  • Prolactinomas and other tumours


How to balance my hormones – prolactin

If prolactin is slightly raised it is usually not a grave concern. If it is raised too much it may impact on the release of testosterone in the male body as well as libido and erection strength.

Cabergoline is the most common medication used to reduce raised prolactin levels. It is commonly used to treat prolactinomas but is also used in patients with early Parkinson’s disease.

Do I need to balance my hormones from the start?

No, in most cases the simplest form of TRT or treatment is the best. Everytime you add in a new medication it increases the number of side effects, cost and inconvenience.

This is why at OptiMale we use the best TRT doctors in the UK to ensure you are getting the best deal and most effective treatment from the start!

If you are interested in TRT but aren’t sure where to start, then why not take our ADAM questionnaire.

Alternatively you can get a blood test to see where your total and free testosterone, oestrogen, thyroid hormones and prolactin are.

Or Contact Us to learn more or ask us any of your questions.