MultiGen Wellness Health Article #31 – Estrogen Management in Men & Anastrozole Therapy
“I am on Testosterone, but I still feel moody, emotional, confused and I don’t understand!!!”
I am Joshua G. Crampton and I formed MultiGen Wellness Hormone Therapy Online. I love educating and learning the art and science of managing the body and the hormones. I hope this article brings you some clarity!
Today when you speak to someone about Hormone Therapy, you’re probably going to hear the words TRT, or HRT or some other variation. You will also notice the conversation is always focus on TESTOSTERONE. However, after seeing 1,00’s of blood tests and consulting with 100’s of men I have learned that Testosterone is vital to identity, inner strength and physical strength it by no means is the BIGGEST indicator of a man’s stability and resolve. There are over 20 hormones or panels that we check and monitor. Estrogen is one of the most IMPACTFUL of those monitored.
CONSFUSION TO CLARITY:
I love bringing a patient from confusion to CLARITY! 98% of the time when a new patient signs up, they are suffering from symptoms and don’t understand or know why. That why we are science and blood focused at MultiGen.
It’s not enough to raise the testosterone. You must also lower or raise the Estrogen. Rarely do I see a patient with too low of estrogen. Most often it’s the reverse, and the estrogen is very high and needs to be systematically brought down over 2-3 weeks.
If you raise a man’s testosterone to 900 – 1,200 and his estrogen also rises to over the target range of 12 – 20 then the good effects of the high testosterone will be counter acted and disrupted by the high estrogen. I think its better for a man to be low on estrogen than high. The man low on estrogen is reserved, withdrawn, dry and emotionless. The man HIGH on estrogen is over emotional, too expressive and his emotional waves are too much for him to handle.
In this article I will cover the basics of Estrogen and Testosterone Management.
Understanding Estrogen in Men on TRT
When men undergo testosterone replacement therapy (TRT), managing estrogen levels becomes crucial. Although estrogen is typically seen as a female hormone, men also need it for bone health, metabolism, and sexual function. If estradiol (a form of estrogen) rises too high on TRT, it can cause problems like gynecomastia (enlarged breasts) and water retention. However, dropping estrogen too low can lead to other issues, including joint pain, low libido, and mood swings. The goal is to keep estradiol in a balanced, healthy range—typically between 12–25 pg/mL.
Emotional and Mental Effects of Low vs. High Estrogen in Men
Estrogen doesn’t just affect the body—it also plays a crucial role in a man’s emotional well-being and mental state. Both low and high estrogen levels can cause significant shifts in mood, energy, and overall mental health.
- Low Estrogen (0-1 pg/mL):
When estradiol levels drop too low, men often report feeling mentally “foggy” or emotionally drained. Low estrogen can contribute to feelings of irritability, anxiety, and even depression. With estrogen being important for mood regulation, its absence can leave men feeling disconnected or emotionally flat. Energy levels also plummet, making it hard to stay motivated or engaged with daily activities. Low estrogen can make a man feel disconnected from his own sense of vitality, leading to a lack of enthusiasm or pleasure in things he once enjoyed.
- High Estrogen (50-55 pg/mL):
Conversely, when estrogen is too high, men may experience emotional instability. This can manifest as heightened anxiety, mood swings, or even feelings of being overwhelmed. Some men feel emotionally “out of control,” with fluctuating emotions that feel hard to manage. The mental fatigue from high estrogen can leave men feeling mentally weighed down, as though their emotions are dictating their thoughts and actions. They may also struggle with self-confidence, feeling embarrassed or frustrated by physical changes (like gynecomastia), which only adds to emotional distress.
For both high and low estrogen, the emotional and mental effects can deeply impact a man’s overall quality of life, making it essential to maintain a balanced level of estrogen for emotional stability and well-being.
How Anastrozole Helps
Anastrozole (Arimidex) is a medication commonly used to manage high estradiol in men on TRT. It works by blocking the conversion of testosterone into estrogen, which helps keep estradiol levels in check. While there are no official guidelines for routine anastrozole use in TRT, many doctors prescribe it if estradiol levels exceed 60 pg/mL or if symptoms like breast tenderness or bloating appear. It’s important to only use anastrozole when necessary and avoid over-suppressing estrogen.
Dosage Guidelines and Adjustments
Doctors usually start with a low dose of anastrozole, typically 0.25–0.5 mg per dose, given 1–3 times a week. For example, a man on 200 mg of testosterone per week might start with 1 mg of anastrozole weekly. The dose is adjusted based on blood test results, with typical effective doses ranging from 0.25 mg twice weekly to 0.5 mg every other day. The maximum safe dose is 1 mg per day, but most men on TRT need far less. It’s important to adjust the dose gradually and check blood levels frequently to avoid both high and low estrogen levels.
Risks of Low Estrogen
While managing estrogen is essential, it’s crucial not to go too far and drop estradiol too low. Low estrogen can cause various issues, such as reduced libido, poor mood, joint pain, difficulty building muscle, and even bone density loss. Men with very low estradiol are also at increased risk for cardiovascular problems. The key is to find a balance where estradiol is in the optimal range—not too high, but not too low either.
Monitoring and Adjusting Treatment
Regular monitoring is vital when using anastrozole. Blood tests should be done every 4–6 weeks initially to check estradiol levels and adjust the dose if necessary. Once estradiol levels stabilize, tests can be done every 3–4 months. It’s also important to listen to how your body feels—symptoms like low libido or joint pain could signal that estrogen is too low. The goal is to adjust treatment based on both lab results and how you feel to maintain a balanced hormone level that supports overall health.
By working closely with your healthcare provider, adjusting dosages slowly, and monitoring your symptoms, you can effectively manage estradiol while on TRT, ensuring the best outcomes for your health.
