Many middle-aged men coming for treatment for various physical and mental health issues are in fact over-oestrogenised and are afflicted with a type of male menopause arising from metabolic disarray. In these cases, the male hormone testosterone level is often found to be within the normal range, so they are informed that there is no problem with their hormones and often the issue is regarded as psychological even if the progressive loss of potency, vigour and vitality are being experienced. This condition is not a simple testosterone deficiency and cannot be addressed by testosterone replacement through pills, creams, patches or injections. Actually, testosterone replacement therapy can often worsen this type of andropause as it could perpetuate hormonal imbalance. The culprit is not too little testosterone, but the excessive conversion of testosterone into oestrogen causing a wide spectrum of adverse effects on men. Its effects on sexual function and many other aspects of the male metabolism are almost entirely negative.
Oestrogen in man
Just as a woman has a small amount of testosterone in her hormone profile, it is natural for a man to have a small amount of oestrogen in his. Man produces oestrogen through a process involving an enzyme called aromatase that transforms testosterone into oestrogen (oestradiol). This small amount of oestrogen plays a critical role in male sexual functions such as libido, sexual arousal, erectile function and spermatogenesis. It counterbalances testosterone’s driving effect on the receptors throughout the system, especially on the brain and testis. Oestrogen imparts both an inhibitory and stimulating influence and modifies male sexual behaviour in a dose-dependent manner. Without this sensitive modulating effect of oestrogen, the impact of testosterone alone would be unsustainable.
Testosterone to Oestrogen ratio out of kilter
In young men, the conversion of testosterone to oestrogen by aromatase is controlled to a low level but in older men, oestrogen levels can rise to unhealthy heights. This is because either the action of aromatase increases or the control of aromatase enzyme action declines. Although oestrogen levels are rising, the ability to eliminate oestrogen also declines in older males. The resulting negative ratio of testosterone to oestrogen is the key to understanding and treating the male menopause transition. Oestrogen dominance with depletion of vital testosterone not only causes an increase in the incidence of sexual dysfunction, lowered mood, fatigue, but studies demonstrate it is associated with a variety of symptoms and diseases long thought to be part of “normal ageing” such as atherosclerosis, coronary artery disease, stroke, benign or cancerous prostate diseases. Testosterone decline is partially responsible for these changing ratios but increases in oestrogen are more significant. This leads to a vicious cycle as an inappropriately high oestrogen level suppresses the hypothalamus-pituitary to inhibit gonadotropin secretion and a resulting testosterone deficiency that establishes secondary hypogonadism.
Emasculation – the result of uncontrolled aromatase activity?
As a man ages, aromatase activity increases and testosterone converts to excess oestrogen. Apart from age, being overweight is a crucial factor for oestrogenisation in men. Since fat cells contain aromatase, an increase in fat mass will cause increased testosterone to oestrogen conversion rate. Moreover, obesity has been associated with lower testosterone production at all ages. It is therefore not surprising that overweight men almost invariably show signs of unfavourable testosterone to oestrogen ratio. If a man with excessive aromatase activity undergoes testosterone replacement treatment, the supplemental testosterone will convert to oestrogen over a period of time and the ratio of testosterone to oestrogen will be even worse than before the treatment occurred.
Natural treatment towards male hormone balance
Oestrogen is a catabolic hormone that breaks down muscle mass and leads to an increase in body fat and aromatase. Testosterone is an anabolic hormone that promotes lean body mass. If a man wants to remain slim, muscular and vigorous, the testosterone level should be maintained high, aromatase activity inhibited and the oestrogen level lowered. Insulin, the fat accumulating hormone, should be lowered by tackling blood sugar dysregulation. Avoiding environmental oestrogens (xenohormones common in personal care products and pollutants), reducing alcohol intake, improving liver function and detoxification and proper nutrition all play important roles and should be part of the hormone recovery plan. Plant flavonoids and lignans, various natural products old and new and historically established male tonic formulae can be applied to suppress aromatase and recover male hormone balance.
The reality is a typical middle-aged man who wants to maintain an ideal hormonal balance is being hit hard on many fronts simultaneously. The network of hormonal effects in a man’s metabolic disarray compounds to generate wide-ranging, unpredictable and varied physical and mental consequences. It is a complex problem that requires a more considered, multi-layered approach addressing lifestyle.