We talked about testosterone – the main male sex hormone – in the first part of our series of BHRT for men.

We talked about progesterone and its importance in men in part II.

It is now the time to bring Estrogen into discussion .

• The main question is:” do men need estrogen?”

The short answer is: “yes”. The correct answer is: “Yes, but only when in balance with testosterone”.

• Why is estrogen important for men?

Estrogen plays an important role in men’s cardio-vascular system, prostate health, and bone structure.

Too little estrogen can predispose men to osteoporosis and lead to bone fractures.

Slightly elevated levels double a man’s risk of stroke and creates an even higher incidence of coronary artery disease.

Men with higher blood estrogen levels may be at higher risk for enlarged prostate or prostate cancer, especially if they have low free testosterone blood levels.

Here are some relevant numbers from studies to support these statements:

A study published in the Journal of the American Medical Association measured the blood level of a type of estrogen, estradiol, in 501 men who had chronic heart failure. The men with the lowest estradiol levels were 317% more likely to die in the next following years compared to men with a balanced estradiol level. Men in the highest estradiol group were 133% more likely to die. This shows that, optimal health depends on hormone levels that are just right and in balance with the others.

• Where do men get their estrogen from?

Men produce estrogen through an enzyme called aromatase, which transforms testosterone into estradiol.

Estrogen can be made in the liver, brain, muscle, and fat cells.

Chances are, if estrogen goes out of balance, it will be in higher amounts much more often than lower because there are so many factors that contribute to its production. The reality of the current environment brought many scientists to the same conclusion: there is an over-abundance of estrogen and estrogen like substances (xenoestrogens) both in women and in men that is referred to as estrogen dominance. This estrogen dominant environment is responsible for a vast number of today’s health problems.

Dr. John R. Lee, Dr. Jesse Hanley and Dr. Peter Eckhart – just to mention a few of the pioneers in the field – believe that it is this excessive exposure to estrogen that is the primary cause of BPH (benign prostate hypertrophy or prostate enlargement) and prostate cancer.

These are some of the environmental estrogens (xenoestrogens) that all of us are almost constantly exposed to:

• commercially raised beef, chicken and pork,
• birth control pills, spermicides,
• detergents, pesticides, insecticides, herbicides,
• plastics in many shapes, forms and purposes, plastic drinking bottles,
• personal care products, canned foods and lacquers, etc.

And these are some of the internal sources of too much estrogen:

• Obesity contributes to the increased production of estrogen.
• Diabetes also tend to increase the levels of estrogen.
• Too much aromatase activity means more estradiol converted from testosterone.

So far, we understand that estrogen is important for men, but most importantly – the right amount of estrogen and in the right ratio in relation to testosterone in particular – is the key information to remember here.

Because excess estrogen is the real concern rather than estrogen itself, we’ll re-direct our focus to the hormones that will help lower the levels of estrogen to correct the imbalance.

The male hormone, testosterone, is an antagonist to estradiol (E2). It is made from progesterone. Men normally continue to produce relatively normal level of testosterone well into their seventies. What happens to the testosterone is more important than how much testosterone is produced, particularly as men age.

Contrary to common perception, testosterone does not cause prostate cancer. Young men have high levels of testosterone and old men low levels. If testosterone were the cause of prostate cancer, young men would be dying of prostate cancer. Studies had shown that men with the highest level of testosterone have the least prostate enlargement. Conversely, men with the highest level of estrogen have enlarged prostates.

Declining testosterone from aging, together with increasing levels of estrogen, are the most likely reasons for prostate enlargement and prostate cancer in men.

During the aging process, progesterone levels fall in men, especially after age 60.

Progesterone is the chief inhibitor of an enzyme called 5-alpha reductase that is responsible for converting testosterone to dihydrotestosterone (DHT), a much more potent derivative that is linked to prostate cancer. When the level of progesterone falls in men, the amount of conversion from testosterone to DHT increases.

When the level of testosterone decreases, the relative level of estradiol in men increases. Estradiol takes oncogenic metabolic pathways and increases the risk of prostate cancer if adequate amounts of progesterone are not there to counteract its effect.

Benign prostatic hyperplasia (BPH), a prostate enlargement condition, is a common condition affecting many men above age 50. Prostate cancer is a leading cause of cancer in men. It is slow growing, with a doubling time of 5 years.

Medical literature abounds in numerous anecdotal reports of reduction of BPH and reversal of prostate cancer through the use of natural progesterone supplementation.

Medical literature abounds in numerous anecdotal reports of successfully correcting osteoporosis with progesterone supplementation.

In conclusion, we learned that estrogen is an important hormone for men, but it needs to be watched closely to ensure it is in the right ratio to testosterone. If a man will need hormone replacement therapy:

 Testosterone,

+/- aromatase inhibitor,

+/- HCG or Clomiphene,

+/- Progesterone,

will most likely be part of the formulation(s).

Key things to remember when considering BHRT, no matter if it is for women or men:

• Understand physiology and respect it.
• Physiology does not need double blind placebo-controlled studies.
• Physiology is in itself evidence-based medicine

                                                              Nurten Rasid, MD – Compounding Clinical Consultant @Haldey

Disclaimer: The statements listed are provided for educational purposes only. The material listed here is not to be interpreted as a promise, guarantee or claim of therapeutic efficacy or safety. The information contained herein is not intended to replace or substitute for conventional medical care or encourage its abandonment.

References:

•  John R. Lee’s book “Natural Progesterone”. The multiple roles of a remarkable Hormone.
• The John R. Lee, M.D. Medical letter (March 2002); Prostate Disease and Hormones. Journal List Asian J Androl 18(3); May-Jun 2016 PMC4854098, 435–440. The role of estradiol in male reproductive function Michael Schulster,¹ Aaron M Bernie,¹ and Ranjith Ramasamy²
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