Low T What about High E

By David Groneck, DC, FASA

There has been a large advertising campaign recently by the pharmaceutical companies about "low T" or low testosterone.  Symptoms of low testosterone in men can be:

  • Depression       
  • Loss of muscle mass
  • Fatigue
  • Prostate problems
  • Decreased motivation or drive
  • Decreased sex drive and function
  • Heart problems
  • Osteoporosis
  • Increased body fat
  • Irritability

 Measuring testosterone levels is as easy as a blood draw.  If it is determined that low testosterone is the culprit, the majority of the treatment if not the only treatment will involve supplementing with a testosterone source whether by a cream, pill, or injection.  It's that easy....or is it?  While there are numerous causes of the above symptoms the focus of this article will look at high "E" or high estrogen levels.  More specifically the focus will be on the testosterone to estrogen ratio, or T/E ratio.  Note that for men it is important to have a high T/E ratio.  While the average 20 year old might have a T/E ratio of 30 to 50, the average 50 year old usually has a ratio of around 4 to 5.  Since testosterone starts to naturally fall after the age of 25, a good ratio for a male that is 40 or older should be 8 to 10.  In other words 8 to 10 times more testosterone than estrogen.
Symptoms of a low T/E ratio can be:

  • Depression
  • Loss of muscle mass
  • Fatigue
  • Prostate problems
  • Decreased motivation or drive 
  • Decreased sex drive and function
  • Heart problems
  • Osteoporosis
  • Increased body fat
  • Irritabilty
  • Gynecomastia 

 With the exception of gynecomastia, the symptoms are the same.  Therefore it is important to have testosterone and estrogen levels measured.  It is also advised to have other markers measured as well such as free testosterone and LH but those will not be discussed here.  If it is determined that estrogen levels are high giving testosterone may make matters worse.  Why? Aromatase, that's why. 
Aromatase is an enzyme that converts androgens (male hormones) into estrogens.  While males need some aromatase activity too much is definitely not a good thing.  Some of the causes of increased aromatase activity include: increased age, obesity, elevated insulin, alcohol, and zinc deficiency.
The aromatase enzyme can be found all over the body such as the brain, fat tissue, prostate, blood vessels, and bone.  However, the majority of the activity is in fat.  The more fat cells one has the more aromatase activity so the more conversion of testosterone to estrogen.  This enzyme has also been found in breast cancer tissue, endometriosis tissue, and prostate cancer tissue.  This makes sense because one of estrogens functions is to encourage cell growth, whether it be the normal breast development in an adolescent girl or the abnormal cell growth that occurs in cancers. 

So if a man has a low T/E ratio of, say 4, how do we increase it?  There are two approaches that need to be used to be most effective.  They should be pretty obvious by now: increase testosterone and decrease estrogen.

One of the most effective ways to increase testosterone is to lift weights intensely with a larger work volume.  "Intensely" means lifting to almost failure. "Work volume" is the amount of repetitions and sets within a workout.  For instance, doing 5 sets of 8 reps may be better than doing 10 sets of 4 reps to elicit a greater testosterone response.  The bottom line is to work hard in the gym.  Another very effective way to increase testosterone is to decrease aromatase activity.  By decreasing the conversion of testosterone to estrogen, testosterone goes up.  As mentioned above increasing zinc status if it is low, decreasing fat, treating blood sugar problems, and cutting back substantially on alcohol will all effectively decrease aromatase activity.  There are also a number of nutritional compounds besides zinc that have been shown to decrease aromatase activity such as resveratrol, green tea extract, white button mushrooms, and selenium.

In addition to decreasing aromatase activity another way to decrease estrogen load is to enhance its elimination.  Cruciferous vegetables like broccoli, cauliflower, asparagus, Brussels' sprouts, and kale can facilitate the removal of estrogens.  Supplementing with extracts from these vegetables such as DIM, indole-3-carbinol, and sulforophane glucosinolate enhances this process as well. In fact, sulforophane glucosinolate has been shown to be one of the most powerful inducers of certain liver detoxification pathways.  

Limiting exposure to certain estrogen mimics, called xenoestrogens, in the environment can lower estrogen load.  Avoid eating or drinking out of plastic containers whenever possible, limit exposure to non-organic food sources as pesticides contain xenoestrogens, switch from commercial cleaning and body care products to natural ones, and avoid exposure to bisphenol A (BPA) which has estrogenic properties.  BPA is in many products including receipt paper, canned food and drinks, plastics, dental sealants, and more.  In one study researchers showed that eating fresh foods instead of canned and packaged foods for just three days decreased urinary BPA by 50%-70%!

Unfortunately, having a healthy T/E ratio is not easily obtained but it can be done with the right steps.  Men should have their T/E ratio evaluated every year making corrections as need be.  This is one of the most important ratios to monitor as having a low ratio contributes to some of the most common problems men face today.


Cleland WH, Mendelson CR, Simpson ER. Effects of Aging and Obesity on Aromatase Activity of Human Adipose Cells. JCEM.January 1, 1985 vol. 60 no. 1 174-177

Cohen PG. Aromatase, adiposity, aging and disease. The hypogonadal-metabolic-atherogenic-disease and aging connection. Med Hypotheses. Volume 56, Issue 6, June 2001, Pages 702–708

Namey, T. C. (2005). The Effects of Aging, Hypogonadism, and Nutrition on Endurance and Strength. Aging men's health: a case-based approach, 61.

Cicero TJ. Neuroendocrinological effects of alcohol. Annu Rev Med. 1981;32:123-42.

Randolph JF Jr, Kipersztok S, Ayers JW. The effect of insulin on aromatase activity in isolated human endometrial glands and stroma. Am J Obstet Gynecol. 1987 Dec;157(6):1534-9.

Williams G. Aromatase up-regulation, insulin and raised intracellular oestrogens in men, induce adiposity, metabolic syndrome and prostate disease, via aberrant ER-α and GPER signalling. Mol Cell Endocrinol. 2012 Apr 4;351(2):269-78.

Pitteloud N, Hardin M, Dwyer AA. Increasing insulin resistance is associated with a decrease in Leydig cell testosterone secretion in men. J Clin Endocrinol Metab. 2005 May;90(5):2636-4

Caronia LM, Dwyer AA, Hayden D. Abrupt decrease in serum testosterone levels after an oral glucose load in men: implications for screening for hypogonadism. Clin Endocrinol (Oxf). 2013 Feb;78(2):291-6.

Ellem SJ, Risbridger GP. Aromatase and prostate cancer. Minerva Endocrinol. 2006 Mar;31(1):1-12.

Chen S. Aromatase and breast cancer. Front Biosci. 1998 Aug 6;3:d922-33.

Bulun SE, Fang Z, Imir G. Aromatase and endometriosis. Semin Reprod Med. 2004 Feb;22(1):45-50.

McCaulley GO, McBride JM, Cormie P. Acute hormonal and neuromuscular responses to hypertrophy, strength and power type resistance exercise. Eur J Appl Physiol. 2009 Mar;105(5):695-704.

Vingren JL, Kraemer WJ, Ratamess NA. Testosterone physiology in resistance exercise and training: the up-stream regulatory elements. Sports Med. 2010 Dec 1;40(12):1037-53.

Wang Y, Lee KW, Chan FL. The red wine polyphenol resveratrol displays bilevel inhibition on aromatase in breast cancer cells. Toxicol Sci. 2006 Jul;92(1):71-7.

Satoh K, Sakamoto Y, Ogata A. Inhibition of aromatase activity by green tea extract catechins and their endocrinological effects of oral administration in rats. Food Chem Toxicol. 2002 Jul;40(7):925-33.

Chen S, Oh SR, Phung S. Anti-aromatase activity of phytochemicals in white button mushrooms (Agaricus bisporus). Cancer Res. 2006 Dec 15;66(24):12026-34.

Gao R, Zhao L, Liu X. Methylseleninic acid is a novel suppressor of aromatase expression. J Endocrinol. 2012 Feb;212(2):199-205.

Zhang Y, Talayay P, Cho CG. A major inducer of anticarcinogenic protective enzymes from broccoli: isolation and elucidation of structure. Proc Natl Acad Sci 1992;89:2399-2403.


Schecter A, Malik N, Haffner D. Bisphenol A (BPA) in U.S. food. Environ Sci Technol. 2010 Dec 15;44(24):9425-30.

Rudel RA, Gray JM, Engel CL. Food packaging and bisphenol A and bis(2-ethyhexyl) phthalate exposure: findings from a dietary intervention. Environ Health Perspect. 2011 Jul;119(7):914-20.