It is an undeniable fact that testosterone levels decline naturally as a man ages. While aging is certainly at the top of the list of the causes of low testosterone, other factors such as inflammatory, genetic or endocrine conditions, excessive body weight, a western type diet, alcohol, drugs, physical and emotional stress and lack of sleep also have an impact on testosterone production. Testosterone deficiency is a common condition and many people are now considering testosterone replacement therapy.
Signs and symptoms of testosterone deficiency include anemia, depressed mood, reduced bone density with increased osteoporosis risk, reduced energy and well-being, decreased muscle mass and strength, impaired cognition and fatigue. The sexual symptoms include reduced libido, erectile dysfunction, difficulty achieving orgasm, reduced intensity of the experience of orgasm and decreased sexual penile sensation.
To ensure safety, testosterone replacement therapy should be monitored by a physician. On a regular basis, the physician will evaluate testosterone blood levels, liver functions, lipid levels, hematocrit and prostate-specific antigen (PSA) levels as well as perform a physical examination including digital rectal examination. This close monitoring is important to make sure that your testosterone levels stay within the acceptable range.
However, estrogen monitoring should also be performed, considering the connection between these two hormones.
Testosterone converts in the body into other hormones and metabolites. For example, testosterone converts into estrogen through a process called aromatization (an enzyme called aromatase is involved in this conversion). During testosterone replacement therapy, there is more testosterone in the body and therefore higher amounts of this hormone can be converted into estrogen. Therefore estrogen levels can be increased during testosterone replacement therapy, and therefore should be monitored and maintained within reference ranges to avoid side effects caused by excessive estrogen.
Estrogen, the female hormone, is a very important hormone for men. It plays an essential role in bone, hair, skin, and brain health. Too much estrogen may cause mood swings, enlarged breasts, fat gain particularly in the lower half of the body, and excessive water retention. Estrogen levels are usually evaluated based on blood estradiol levels. Scientists believe that the optimal level of estrogen (measured as estradiol) for aging men is between 20 and 30pg/mL. The estrogen/testosterone ratio is also important and therefore should also be taken into consideration because most side effects of a male hormone imbalance are, in fact, due to an increased level of estrogen relative to low levels of testosterone.
If a man has an increased level of estradiol (higher than 30 pg/mL) before staring the testosterone replacement therapy, two causes should be suspected. First, increased aromatase activity usually due to increased abdominal fat. Or secondly, the liver is damaged (usually due to chronic excessive alcohol consumption) and can’t eliminate the excess estrogen. In both cases, testosterone replacement should be postponed and excess estrogen should be corrected by using aromatase inhibiting drugs (such as Arimidex) or natural supplements such as chrysin, zinc, muira puama or quercetin. Of course, lifestyle modifications such as a healthy diet, eliminating excess weight and limiting alcohol consumption are always recommended.
Beside estrogen, DHT (dihydro testosterone, a metabolite of testosterone) should also be monitored because excessive DHT leads to acne, hair loss and inflammation of the prostate.