Estrogen doesn’t get much attention in men’s health, and when it does, it’s usually for the wrong reasons. Most guys hear the word and immediately associate it with something they need to block, lower, or avoid. But the truth is, estrogen plays a critical role in male physiology—especially when testosterone levels start shifting, either naturally or through TRT.
In my practice, I see it all the time. A guy comes in on testosterone from another clinic. His labs look great, numbers are solid, but something’s still off—libido isn’t there, sleep sucks, joints hurt, and mood’s flat. Nine times out of ten? No one’s been tracking his estrogen. Or worse, it’s been intentionally squashed out of fear of “man boobs”.
If you’re already on TRT or considering it, understanding how estrogen works—and why it matters—could be the missing piece between “meh” and actually feeling like yourself again.
What Is Estrogen Doing in Men Anyway?
In men, estrogen is made by converting testosterone through an enzyme called aromatase. It’s not produced directly—it’s created from your testosterone levels. So naturally, when you go on TRT and boost your testosterone, some of that will aromatize into estrogen.
That’s normal. That’s expected. And in the right amount, that’s actually a good thing.
Estrogen plays a major role in:
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Protecting your joints
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Supporting libido
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Regulating mood
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Maintaining bone strength
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Keeping your brain sharp
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Supporting cardiovascular health
This isn’t theoretical or just my “clinical opinion”. There are real studies (and a ton of real patient cases) showing that low estrogen in men is associated with poor libido, joint pain, emotional flatness, and even increased cardiovascular risk. It’s not just a women’s hormone—it’s a human hormone.
When Estrogen Gets Too Low
Here’s where I see things go sideways most often—especially in men who were prescribed an aromatase inhibitor (AI), like anastrozole, as part of their TRT plan.
If your estrogen gets too low, you can feel:
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Achy or stiff, like you aged overnight
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Flat emotionally or unusually irritable
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Low libido despite great testosterone numbers
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Dry skin, poor sleep, and zero morning erections
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Disconnected from your usual mental drive
One guy I just saw (and what prompted me to write this blog topic) had a total testosterone of 1100 and still felt like garbage. His estradiol was 9. We backed off the AI, let it climb into the 25–30 range, and two weeks later felt like a different person.
This happens all the time.
But What About High Estrogen?
Let’s clear this up too.
Yes, high estrogen can cause problems. If your estradiol creeps too high, you might notice:
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Water retention
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Breast tenderness
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Irritability
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Dull erections or decreased performance
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A general “off” feeling, even if T is strong
But here’s the important thing: it’s not just about the number.
I’ve seen guys with estradiol levels in the 50s who felt amazing—and others in the 30s who felt bloated and moody. The key is to treat the patient, not just the lab result.
If you’re asymptomatic, I don’t touch it. If you’re symptomatic, I’ll use a range of strategies: lowering T dose slightly, adjusting injection frequency (like splitting the weekly dose into x2 or x3 injections), supporting liver detoxification, or occasionally bringing in a low dose of an aromatase inhibitor (short-term), with labs and symptoms guiding the plan.
The Sweet Spot
In most men on TRT, I like to see estradiol levels around 20–40 pg/mL, depending on symptoms. There’s no magic number—it’s about how you feel. That range is usually where men report peak function: great libido, clear mood, solid joints, and zero side effects.
The minute someone tells me their libido vanished, joints are stiff, or they feel “off,” I check estradiol. If it’s been tanked by over-suppression, we back off the AI and let the body rebalance. It works almost every time.
I don’t blanket-prescribe aromatase inhibitors. In fact, most of my patients don’t need one. The ones that do? We keep it minimal, monitored, and short-term—because the goal is balance, not elimination.
Final Thoughts
If you’re a man considering TRT—or already on it and wondering why you’re not feeling 100%—it might be time to look at your estrogen.
Not to fear it. Not to crush it. But to understand it and make sure it’s supporting your body the way it’s supposed to.
This hormone plays a role in how you think, move, perform, and feel. Ignore it, and you might miss out on some of the most powerful benefits of hormone optimization.
Estrogen isn’t the villain. Mismanaging it is.
If you want to get your levels right—or finally feel the full benefits of TRT—reach out. I’ll walk you through it step by step.
-Clay
