Source: Excerpts from "High Estradiol in Men on TRT: What to Do" by Nelson Viegel (excelmale.com)
1. The Role and Importance of Estradiol in Men
Core Idea: Estradiol, often misconstrued as a solely "female hormone," is crucial for male health and is a natural byproduct of testosterone conversion. Aggressive reduction of E2 is often unwarranted and can lead to significant negative health outcomes.
Natural Conversion: Estradiol is produced from the conversion of testosterone via the aromatase enzyme, primarily in the liver and subcutaneous fat cells.
"Estradiol is produced from the conversion of testosterone through the aromatase enzyme in the liver and in fat cells mostly subcutaneous fat cells under skin."
In healthy men, "3% of testosterone converts to estradiol."
Essential Functions: E2 has receptors in various male tissues and is vital for:
Bone density and health.
Reproductive function, including sperm production.
Liver metabolism and cardiovascular health.
Lipid profiles, mood, and sexual function.
"Estradiol is needed for bone density health for reproductive sperm production... liver metabolism cardiovascular health... and mood and sexual function."
Evolutionary Significance: The body's natural conversion of testosterone to estradiol underscores its importance. "Like women need testosterone men also need estradiol and evolution would not have put it downstream from testosterone."
Self-Regulation: The body naturally regulates hormone levels, including E2, through the HPTA (hypothalamic-pituitary-testicular) axis. TRT, however, suppresses this natural production.
"Testosterone has been shown to send signals to the upstream glands hypothalamus and pituitary gland to slow them down or increase their activity depending on the levels of so the body actually self-regulates."
When on TRT, "we're basically shutting down this cascade the body says well we don't need to produce any testosterone."
2. Dangers of Low Estradiol (Crashing Estradiol)
Core Idea: Research strongly indicates that low estradiol levels are detrimental to men's health, impacting sexual function, body composition, and bone density. Over-treating E2 is a significant concern.
Negative Impacts of Low E2:Sexual Function: Decreased libido and sexual function. "Lowest and testosterone were linked to increase in fat mass and also decreases in sexual function libido etc."
Body Composition: Increased fat mass.
Bone Density: Bone loss. "Low estradiol can also cause bone loss."
Cognitive Issues: Potential cognitive problems.
Consequences of Aggressive Treatment: Many clinics and individuals "are treating estr [estradiol] too aggressively crashing it which is not good."
"Do not over treat be careful with anything you do to reduce because you actually may lose sexual function get fatter and lose bond density and there's also some cognitive issues."
3. Misconceptions and Speculation Regarding High Estradiol Symptoms
Core Idea: Many commonly attributed symptoms of "high estradiol" are not scientifically proven to be directly caused by high E2 and may instead be related to other issues or misinterpretations.
Nipple Sensitivity/Gynecomastia: While high E2 can be a factor in gynecomastia (breast tissue growth), nipple sensitivity itself is often linked to testosterone increases and not definitively proven to be only an E2 issue.
"There is actually little to no data that most of nipple sensitivity testosterone increases sensitivity of the nipple area in many men so men actually freak out they think it's they're going to get gynecomastia."
Water Retention/Bloating: Often assumed due to women's data, there is "not a single study in men that actually proves that [water retention] we're speculating."
Decreased Libido: Conversely, low E2 is linked to decreased libido, and "we have not a single one single study that shows that high [estradiol] causes decreases in libido. We just don't have data, we're just speculating."
Cardiovascular Issues: While excessive estradiol can cause issues like cardiovascular problems and gynecomastia, "nobody has really proven that show high estradiol causes anything in particular there's only one study I'll be talking about."
4. Important Studies and Data Interpretation
Core Idea: Understanding the methodologies and limitations of E2 research, particularly regarding testing methods, is crucial to avoid misinterpreting results and making inappropriate clinical decisions.
New England Journal of Medicine (2013) Study: A well-controlled study demonstrating the negative effects of low testosterone and low estradiol on sexual function and body composition in young, healthy men.
"Proved that lowest E2 and testosterone were linked to increase in fat mass and also decreases in sexual function libido etc."
Polish Observational Study (Older Men): This study, while often cited to justify E2 concerns, used an old, less accurate ECLA test (immunoassay based) that overestimated E2 levels. It also involved older men with pre-existing chronic heart disease.
"This study actually used the old test... used to overestimate in men with higher serum blood levels tend to have artificially high estradiol."
Key Finding: Men with low estradiol (under 12.9 pg/mL) had the lowest 3-year survival rate (44.6%), while men with high estradiol (over 37.4 pg/mL) had a higher survival rate (65%). The "control group" (E2 20-30 pg/mL) had the highest (82%). This suggests a U-shaped curve, where both very low and very high levels may be problematic, but low E2 appears more directly linked to negative outcomes in this specific, ill population.
"Men with low estradiol died their chances their survival rate was 44.6 and men with really high over 37.4 had also actually a higher instance of sorry survival rate the control group... 82% or so."
Caution: This observational study's findings should not be overgeneralized to healthy men on TRT due to the old testing method and the health status of the participants.
Modern Testing (LC/MS): Liquid Chromatography-Mass Spectrometry (LC/MS) is the preferred method for accurate estradiol measurement, providing a "better indication the actual number."
Higher E2 with TRT is Expected: When on TRT, testosterone levels are higher, leading to increased E2 conversion. This is a natural physiological response and not necessarily a problem if asymptomatic.
"Most men are actually sitting around 800 to 1,000 ng/dL so their E2 is high... So don't freak out just because your E2 has gone up when you're on TRT because it is a response from the body to balance the effects of and boost effects of testosterone."
Testosterone to Estradiol Ratio: Some suggest this ratio as an indicator, but "there's no agreement I don't think any really follows the ratio. Most studies like to see more obviously the ratio of testosterone." More research is needed here.
Age and E2 Levels: Older men tend to produce more E2 per mg of testosterone than younger men, possibly due to increased fat mass or metabolic issues.
5. Managing Estradiol: Anastrozole and Other Considerations
Core Idea: Anastrozole (Arimidex) is an aromatase inhibitor (AI) often overused in men on TRT, leading to harmful low E2 levels. Its use should be cautious, low-dose, and symptom-driven, not based solely on high numbers.
Anastrozole (Arimidex): A cancer drug used off-label in men to decrease estradiol.
Overdosing is Common: "Men are being overdosed with Anastrozole... their doctors are putting 1 mg a day or 1 mg of Anastrozole three times a week and obviously their estradiol is zero."
Recommended Cautious Dosing: If needed, a starting dose of "very low .25 mg a week maybe and retest four weeks after you do this to make sure that person the man does not have under 20 pg per milliliter."
Not Always Needed: Many men, including the speaker, "have never taken Anastrozole in 25 years" and "some of us just don't have to take it if our levels and even if we had I believe that if you have a of 50 or 60 and you have no symptoms you shouldn't be treating it."
Long-term Risks: Blocking E2 receptors can have "long-term effects on cognitive function bone density and even sexual function."
Other Potential Causes of High E2:Age: Increased aromatization in older men.
Obesity: More fat tissue leads to more aromatization.
Liver Issues: Liver disease or certain medications can affect E2 metabolism.
Alcohol Consumption: Excessive alcohol, particularly beer, may increase E2.
Nutritional Deficiencies: Zinc and potentially Vitamin C deficiencies have been linked to increased E2.
Environmental Toxins: Xenoestrogens from plastics and environmental toxins, as well as substances like lavender, tea tree oil, and excessive flaxseed consumption.
Severe Gynecomastia Treatment: For severe cases, surgery may be the only option. Tamoxifen (Nolvadex) is another drug sometimes used for E2-related issues.
Supplementation (DHEA): DHEA can increase estradiol, so E2 levels should be monitored if using DHEA, especially if E2 is a concern.
HCG (Human Chorionic Gonadotropin): HCG can boost testosterone and, consequently, E2 levels. It is also used to preserve testicular function and fertility while on TRT. "The effect of HCG on sexual function the boosting of sexual pollution has to do a lot with the boost in E2 level."
6. General Recommendations and Philosophy
Core Idea: A conservative approach to estradiol management is advocated, prioritizing symptom-based treatment over numbers alone and avoiding aggressive intervention.
Conservative Approach: "I tend to be very conservative when it comes to the topic of estradiol. I think a lot of clinics are treating estr too aggressively."
Focus on Symptoms, Not Just Numbers: "If you have an E2 of 50 or 60 and you have no symptoms you shouldn't be treating it."
Education and Data-Driven Decisions: The speaker emphasizes the importance of understanding the available research and challenging speculative claims in the field.
Patient Education: Encourage men to be informed and question aggressive E2 treatment protocols.
Conclusion
Estradiol is a vital hormone for male health, crucial for bone density, sexual function, and overall well-being. While very high levels can cause issues, the prevailing trend of aggressively lowering E2 in men on TRT is largely unfounded and can lead to significant health detriments. Clinicians and patients should prioritize symptom-based treatment, accurate E2 testing (LC/MS), and a conservative approach to aromatase inhibitors, avoiding unnecessary and potentially harmful interventions.
I decided to do a video on what the highest levels of estradiol should be for men on testosterone replacement therapy (TRT). There's a lot of confusion on the subject since LabCorp and Quest have very narrow sensitive estradiol test ranges. Those estradiol test ranges were derived mostly from men not on testosterone replacement therapy. Men on TRT usually tend to have higher testosterone levels than men that are not on testosterone replacement. So, believe it or not, there is actually a paper that was published many years ago that predicts estradiol and DHT levels in men given different...
Estrogen on TRT: How High is Too High? Nelson Vergel, engineer and founder of ExcelMale, and Greek physician–researcher Dr George Tuliatos sat down to tackle what Vergel calls the “estrogen madness” that has shadowed testosterone-replacement therapy (TRT) for three decades[1]. The conversation cuts through the myths, explains why many U.S. clinics still hand out aromatase inhibitors (AIs) like anastrozole by default, and asks the unanswered question: where is the real upper limit for estradiol? Why Men Need Estradiol · Estradiol (E2) supports mood, cognitive function, endothelial health, joint integrity, libido and bone mineral density[1]. · Women outlive men partly because of estrogen’s vascular protection, a reminder that E2 is not “just a female hormone”[1]. · Crashing estrogen—common when AIs are overdosed—causes fatigue, loss of penile sensitivity, libido drop-off and long-term bone loss[1]. How the AI Craze Began · U.S. “cash-only” TRT clinics built a three-drug starter pack—testosterone, HCG and anastrozole—because insurance would not cover AIs and the cookie-cutter model was easy to copy[1]. · Doctors admit they pre-emptively prescribe an AI because fielding early-phase patient emails about “high estrogen” bloats clinic workload[1]. · The practice gained momentum after a single, weak observational study on heart-failure patients suggested estradiol above ~35 pg/mL raised cardiovascular risk—data taken from men with low testosterone and serious comorbidities, not from men on TRT[1]. Three Myths That Keep AIs Alive
1. “Water retention always equals high estrogen.” Most clinics never confirm this with labs[1].
2. “Nipple sensitivity means gynecomastia is inevitable.” Sensitivity is common, gyno is not[1].
3. “Erectile dysfunction signals excess E2.” In reality, low E2 can cause the same problem[1]. Absolute Numbers vs. Ratios · Vergel argues the testosterone-to-estradiol ratio (T/E2) matters more than any single value; studies that exist suggest a ratio ≥14 (using ng/dL for T, pg/mL for E2) tracks best with sperm production and overall balance[1]. · Because only 0.3–0.5 % of circulating testosterone aromatises, E2 naturally rises when T is pushed higher on TRT; fixed lab ranges built on unmedicated men become meaningless[1].
Scenario
Total T (ng/dL)
Estradiol (pg/mL)
T/E2 ratio
Action
Symptomatic low E2
600
10
60
Avoid AIs; consider lowering AI dose or adding HCG[1]
Evaluate symptoms, clotting risk, consider Tamoxifen or LOW-dose AI[1]
*No hard data define this threshold; it is clinical judgment. Alternatives to High-Dose Anastrozole · Tamoxifen blocks the receptor without crushing circulating E2 and may protect lipids and IGF-1 signalling[1]. · DHT analogs such as proviron (not FDA-approved in the U.S.) can oppose estrogen at the receptor and often improve libido and physique hardness with less impact on bone[1]. · Micro-dosing an AI—0.25 mg once or twice weekly—can tame extreme E2 spikes while sparing bone and HDL; most problems arise when men take 1 mg or more per dose[1]. Bodybuilding vs. Longevity
Competitive bodybuilders deliberately crash estrogen with multi-milligram AI pulses and add diuretics to deepen muscle “dryness” before a show; Tuliatos warns the same protocol is “catastrophic” for joints, vascular function and bone if extended long term[1]. The Research Gap
Neither speaker could quote a trial that defines a precise estradiol ceiling on TRT. Until dose-controlled studies deliberately push E2 higher and track thrombosis, bone and quality-of-life outcomes, clinicians must rely on symptoms, ratios and common sense[1]. Key Takeaways · Estradiol is essential for male health; the goal is balance, not elimination[1]. · Lab “high-flags” for E2 are written for unmedicated men and scare TRT users unnecessarily[1]. · Most side-effects blamed on high estrogen are either myth or can also be caused by low estrogen[1]. · Reserve aromatase inhibitors for documented, symptomatic excess—then use the lowest effective dose[1]. · More research is needed to define “too high,” but crashing E2 is already proven harmful[1].
In short, Vergel and Tuliatos urge clinicians and patients to replace reflex AI use with data-driven, symptom-guided care. The estrogen story, they agree, is far from over—yet the evidence so far points toward moderation, not suppression[1].
Estradiol is the most important female sex hormone and it plays a significant role in developing female secondary sexual characteristics. It also plays a vital role in maintaining proper bone density, regulating body fat, and ensuring a strong erection in men.
This type of hormone is one of the three estrogens found in the human body. The other two are called estrone and estriol. Estradiol is the most important and strongest of the estrogen hormones and it is primarily made in testicles, fat cells, and liver.
Approximately 80% of the estradiol found in a man’s body...
Relation of Testosterone, Dihydrotestosterone, and Estradiol with Changes in Outcomes Measures in the Testosterone Trials (2022) Alisa J. Stephens-Shields, PhD, Peter J. Snyder, MD, Susan S. Ellenberg, PhD, Lynne Taylor, PhD, Shalender Bhasin, MB, BS Abstract Context. Many effects of...
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Debunking Myths About Estradiol and Testosterone Therapy
Insights from a Groundbreaking Study on Older Men
Hello everyone, Nelson Vergel here from ExcelMale.com and DiscountedLabs.com. Today, I want to dive into a topic that continues to spark debate—estradiol and its impact on men undergoing testosterone replacement therapy...
