A good balance of hormones helps to maintain a healthy body and mind. The sex hormones estrogen and testosterone are responsible for sexual reproductive and other functions in men and women. As men age, their body produces less and less of these hormones.

This often results in a severe hormonal imbalance which leads to various symptoms or health conditions including low testosterone or hypogonadism, andropause, excess weight gain or obesity, and gynecomastia.

Testosterone can deplete naturally or decline due to the body’s natural conversion of testosterone to estrogen. Estrogen is primarily a female hormone but is also needed for certain functions in men. In fact, it helps regulate sexual functions in men.

How Estrogen Causes Low Testosterone in Men

The three estrogens are estrone, estradiol, and estriol. Estradiol is the most potent of them all. The conversion of testosterone to estrogen is a common reason for a decline in testosterone. This happens when the body aromatize testosterone and androgens (another sex hormone) and convert them into estrogen. While testosterone decreases estrogen increases and may cause the following symptoms:

  • Low sex drive
  • Low sperm count
  • Infertility
  • Hot flashes
  • Night sweats
  • Bloating
  • Trouble sleeping
  • Water retention
  • Fatigue or lack of energy
  • Excessive sweating
  • Weight gain
  • Weak orgasms
  • Erectile dysfunction (ED), e.g., trouble getting or keeping an erection
  • Gynecomastia or enlarged breasts (also called “man boobs”)


Low T in men

How to Know if You Have Low Testosterone

You may have low T if you experience one or more of the symptoms related to high estrogen or estradiol. However, low T can be accurately diagnosed by your doctor. Your doctor will assess your medical history and symptoms and will need to run blood tests to determine the level of the hormone in the body. If you receive a positive diagnosis, your doctor may recommend one or more treatments including testosterone replacement therapy by injections.

Treatment Option for Testosterone Replacement

Testosterone replacement therapy is used to boost testosterone levels. It is best and most effectively administered by intramuscular injections. Depending on the patient’s individual needs, the treatment can be done with or without aromatase inhibitors.

Aromatase inhibitors (AIs), or estrogen blockers, are a class of drugs used to prevent the body from converting testosterone to estrogen, especially estradiol. These drugs, for example, anastrozole, letrozole, and exemestane are used off-label in men undergoing testosterone replacement therapy. By blocking estrogen, aromatase inhibitors help to boost testosterone levels.

It is not necessary for all men taking hormone replacement therapy to receive aromatase inhibitors. Your doctor will make this determination based on the baseline level of estradiol. For example, treating you with an AI when your estradiol is high will cause uncomfortable symptoms. Your doctor will also need to test your blood regularly to monitor hormone levels.

Is Testosterone Therapy Right for Me?

While testosterone replacement can be done through the use of skin patches, skin pellets, gels, or implants, hormone replacement by injections remain the most effective way of treatment. However, testosterone replacement therapy is not right for everyone due to potential health risks. For example, men planning to have children should avoid TRT since it can lead to a drop in sperm count or infertility.

You may need to take the treatment for a lifetime, otherwise, once you stop taking it your hormone levels will drop. Furthermore, persons with the following conditions should avoid this therapy:

  • Sleep apnea
  • Untreated heart problems
  • Prostate cancer
  • Breast cancer

The results of TRT vary from patient to patient. Some men with low T who undergo testosterone replacement reportedly see improvement in energy levels and sex drive as well as an increase in sexual functions and performance. Some men say they feel youthful and rejuvenated, experience hair regrowth, and see an increase in muscle mass.

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