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Many people with obesity have trouble with hormonal issues because excess body weight can affect hormone levels. This can have an impact on energy and mood and trigger other physical changes.
Estradiol, a type of estrogen, is one hormone that can be high in people with obesity. Cleveland Clinic notes that although people of all genders need estrogen, high estrogen levels can lead to a variety of problems in males. Below are five facts that explain how this happens, what signs to look for, and how to treat it.
Having high amounts of body fat can change the levels of many hormones in your body. According to the Journal of Clinical Endocrinology & Metabolism, in overweight men, one major reason for high levels of estradiol is an enzyme called aromatase. Aromatase is found in fat tissue and turns testosterone (the main male sex hormone) into estrogen. If you have a lot of fat, especially belly fat, your body makes more aromatase.
More aromatase can lead to more testosterone being converted into estradiol. This lowers testosterone and raises estrogen levels. Testosterone is an androgen, which is a type of sex hormone that helps with body development and reproductive health.
Higher estrogen and lower testosterone can make your body store more fat. This starts a cycle that makes it even harder to lose weight. Estrogen can also disrupt other hormones, which makes the problem more pronounced.
Obesity can cause or worsen hypogonadism. This condition lowers the total amount of testosterone in the body. It also sometimes raises the amount of free testosterone, which isn’t attached to proteins and can be used by the body. But more free testosterone means more of it gets converted into estradiol, which makes the body store more fat. This starts a cycle of high estrogen, low testosterone, and more body fat.
To help raise testosterone in people with obesity whose testosterone levels have fallen too low, healthcare providers sometimes use testosterone replacement therapy (TRT). However, TRT can raise estrogen levels. This shows that keeping hormones balanced isn’t easy, and problems can arise if hormones get out of balance.
You might notice changes that indicate high estradiol. Some estrogen is required for normal body function in males. However, there are a few symptoms that indicate estradiol is too high. These signs may have other causes, so it’s important to bring them up with your healthcare provider to get a better understanding of what’s going on.
Higher levels of estradiol can lead to infertility. Infertility refers to the inability to conceive a child after having frequent, unprotected sex over the course of a year. Elevated estradiol can cause infertility by lowering sperm count and reducing semen quality.
Erectile dysfunction (inability to get and maintain an erection) is another symptom that can be caused by higher estrogen levels. When hormonal imbalance causes ED, it’s sometimes called hormonal erectile dysfunction.
The balance between estradiol and testosterone plays an important role in maintaining blood flow to the penis, which controls erectile function. Erectile dysfunction from high estradiol has also been linked to mental health symptoms, including psychological distress.
Estrogen has also been linked to changes in libido, or sexual desire. Hormone imbalances and erectile dysfunction are two factors associated with obesity that can lower your sex drive.
You might notice enlargement of the breast (chest) tissue, called gynecomastia. This happens when there’s extra glandular tissue on the chest. The chest can also develop excess fat tissue due to obesity. Gynecomastia often occurs when your body is producing too much estrogen and not enough testosterone.
The hormone imbalance from high estradiol can affect your metabolism. Metabolism is the process that converts food into energy. Many hormones — like estrogen and testosterone — play a part in its regulation.
Metabolism changes can cause fatigue (a feeling of extreme tiredness that doesn’t go away with rest). Fatigue can make you want to sleep more than normal.
If you have any of the above symptoms, talk to your healthcare provider. The first step is usually to get tested. A simple blood test can measure total and free testosterone, estradiol, and progesterone. Doctors often add other lab tests like sex hormone-binding globulin (SHBG), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) to get a better picture of what’s going on in your body.
Your doctor might also look at your body mass index (BMI). BMI is a calculation based on height and weight that helps healthcare professionals assess how your body size relates to your health. Although it is a useful metric, BMI is an imperfect measurement and only one of many factors that doctors consider when assessing your health. An endocrinologist (a doctor who specializes in hormones) can interpret your BMI — along with hormone levels and other factors — to recommend appropriate treatment options.
Reducing your body weight may help lower the production of estrogen in fat cells. Some methods to reduce your body weight include getting daily exercise and eating a healthy diet. Eating a diet that’s high in fiber but low in fats and sugars can also help your liver process estrogen more efficiently.
Drinking less alcohol can also improve your liver function. This lets your body break down estrogen more efficiently, which reduces estradiol levels.
Reducing stress can lower your levels of stress hormones. When you have less of these hormones, your estrogen and progesterone can stay more balanced.
Some medications can help lower your estradiol levels.
Aromatase inhibitors are one type of drug that can help reduce the amount of estradiol in your body. They’re often used to lower estrogen levels in people with a type of breast cancer that uses hormones to grow. Some common aromatase inhibitors are anastrozole, exemestane, and letrozole. These are approved by the U.S. Food and Drug Administration (FDA) for other conditions, but they’re used without formal approval (off-label) to reduce estrogen levels.
According to Cleveland Clinic, aromatase inhibitors can help treat infertility in men with obesity who have high aromatase levels. They can also increase testosterone levels. When combined with weight loss, aromatase inhibitors help reduce estradiol levels in men with obesity. This can also reverse hypogonadism.
Selective estrogen receptor modulators (SERMs) are another type of medication that can reduce the effects of estrogen. They don’t limit estrogen production like aromatase inhibitors. Instead, they stop estrogen from binding to its receptor. This reduces its activity, which helps prevent the unwanted side effects of high estrogen.
There are many SERMs, but clomiphene citrate and tamoxifen are the two most commonly prescribed to males, according to the journal Pharmaceuticals. Some men with high estrogen levels who take clomiphene citrate show increased fertility. Clomiphene can also improve testosterone levels, erectile function, and libido. Studies using tamoxifen in men with high estradiol levels have also shown an improvement in fertility and testosterone levels.
On MyObesityTeam, people share their experiences with obesity, get advice, and find support from others who understand.
If you had high estradiol levels, what lifestyle changes or medications have helped you to lower them? Let others know in the comments below.
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