Male reproductive health depends on the level and ratio of sex hormones. These steroids are produced in Leydig cells (in the testicle) and in the reticular layer of the adrenal glands. The representatives of the stronger sex normally have a significant prevalence of "male" hormones (androgens) over "female" (estrogens). This ratio provides:
- the development and functioning of male reproductive organs;
- the formation of secondary sexual characteristics in men ;
- normal spermatogenesis;
- sexual desire and potency;
- maintaining muscle mass;
- propensity for logical thinking;
- certain behavioral responses (eg, aggression);
- stable psychological state, etc.
Hyperestrogenia is relative and absolute . The first of these reflects a decrease in the level of androgens . Due to the pronounced lack of male steroids, the effect of a normal amount of estrogen becomes excessive. Absolute hyperestrogenism occurs when pathologically high level of female sex steroids in the blood of men. While testosterone and other androgens can also be produced in sufficient quantities.
Estrogen function in the male body
The female sex steroids include estradiol , estrone, estriol. The first of them is the main and most potent. In a healthy man, up to 40 micrograms of estradiol is synthesized every day in the body. A quarter of this amount is formed in Leydig cells. The remaining 75% is synthesized in other tissues (mainly in adipose tissue). Estradiol is derived from the male testosterone steroid. Androgen is converted to estrogen by the enzyme aromatase (see Fig. 1).
Fig. 1 - Effect of increased activity of the aromatase enzyme on testosterone levels in men.
The normal amount of estrogen provides:
- increased bone mineral density;
- a decrease in the concentration of atherogenic lipids contributing to atherosclerosis;
- production of blood transport proteins;
- increased blood clotting;
- sufficient tissue turgor (retains sodium and water);
- normal functioning of the nervous system.
The reference values for hormones depend on the reagents, the method of determination, laboratory equipment.
Table 1 - Normal levels of estradiol for males.
|Age||Estradiol level, pmol / l|
|Up to a year||<86|
|14-18 years old||<182|
|From 18 years old||40-161|
Causes of hyperestrogenism in men
Hyperestrogenism is the cause of 0.5-3% of cases of male reproductive health disorders. Elevated estradiol is most common in adolescents and young people, as well as in elderly people. Currently, this problem is often faced by men of young and middle age.
- functional (more than 55% of all cases);
- pathological (less than 45% of all cases).
Functional impairments are not associated with any serious illness or injury. Sometimes such an imbalance of hormones occurs against the background of emotional and physical stress. Fasting, excess sports training can also trigger an increase in the level of female sex hormones. Also, functional hyperestrogenism appears in violation of the metabolism of steroid hormones. All of these conditions most often do not require treatment.
Pathological hyperestrogenism can be caused by:
- a tumor (usually malignant);
- thyrotoxicosis ;
- hyperprolactinemia ;
- obesity ;
- metabolic syndrome ;
- liver failure;
- renal failure;
- contact with toxic substances;
- taking certain drugs / drugs and phytoestrogens.
All these reasons seriously affect the balance of hormones. Patients with such disorders need to be monitored and treated.
Increasing the concentration of estrogen in men provoke:
- Leydig cell neoplasm;
- tumors from Sertoli cells;
- granule cell tumors;
- adrenal corticoestromas;
- pituitary tumors (LH-producing);
- lung and liver cancer with hCG secretion.
Thyrotoxicosis causes hyperestrogenism, as with increased thyroid function, aromatase enzymes in peripheral tissues are activated. Thyrotoxicosis increases the secretion of androstenedione in the adrenal glands. This androgen and testosterone are rapidly transformed into estrogens. In addition, thyrotoxicosis increases the concentration of sex-binding blood globulin . This protein combines with androgens and makes them inactive.
Hyperprolactinemia is always accompanied by a relative increase in the level of estradiol in the blood. This is due to the inhibition of the work of Leydig cells. Testosterone is released little and the effect of female sex steroids becomes more noticeable. Especially active in this case, the hormones act on the tissue of the mammary glands. This is facilitated by prolactin itself, which increases the number of estrogen receptors.
Obesity and metabolic syndrome lead to hyperestrogenism due to increased aromatization of androgens in the periphery. In addition, excessive hormonal activity of adipose tissue suppresses the level of pituitary gonadotropins, which leads to a decrease in testosterone production in the testicles (see Fig. 1).
Hepatic and renal failure provokes intoxication. The body accumulates harmful metabolic products. Their toxic effect suppresses the synthesis of testosterone in Leydig cells and shifts the balance towards estrogen. In addition, many liver diseases stimulate the excessive transformation of androgens into female sex steroids in her tissue.
Radioactive radiation, toxic chemicals and other substances disrupt the functioning of Leydig cells. Due to the primary hypogonadism in men, there are relatively many estrogens.
Drugs and drugs can cause hyperestrogenism:
- reducing testosterone production;
- inhibiting the action of testosterone;
- providing an estrogen-like effect;
- disrupting the pituitary and hypothalamus;
- affecting the metabolism of sex steroids (for example, the aromatase enzyme).
Have the strongest effect:
- antiandrogenic drugs;
- some diuretics (spironolactone);
- cardiac glycosides;
- marijuana and hashish (see “How does marijuana affect a man’s health” );
- herbal preparations with phytoestrogens;
Signs of excess estrogen in men
If an excess level of estrogen gets through the placenta to the male fetus from the mother, then the risk of developing anomalies of the child’s genitals increases. For example, an excess of female genital steroids during the 10-14 week of pregnancy often provoke hypospadias.
The appearance in boys of hormone-active tumors that increase the level of estrogen leads to early sexual development in a heterogeneous type. Sometimes hyperestrogenic, on the contrary, leads to a delay in sexual development.
In adult men, an excess of "female" hormones is manifested:
- decrease in sexual desire;
- gynecomastia ;
- increase the tone of voice;
- redistribution of adipose tissue on the female type;
- reduced muscle mass;
- decrease in vitality;
Fig. 2 - Gynecomastia, caused by excessive aromatization of androgens into estrogens.
Diagnosis and treatment of hyperestrogenia
To diagnose hyperestrogenia, a comprehensive examination is used. First, the most complete history is collected (heredity, previous diseases, chronic diseases, medications used, lifestyle, diet).
The patient donates blood to:
- androgens (total and free testosterone, etc.);
- estrogen (primarily estradiol);
- gonadotropins (LH and FSH) ;
- sex-binding globulin;
- inhibin B ;
- antimullers hormone.
Also recommended blood biochemistry with the definition of creatinine, urea, transaminases, cholesterol, glucose, bilirubin, etc.
In addition, a visit to a urologist or andrologist, ultrasound examination of the prostate and scrotum, spermogram is required.
Additionally, can be assigned:
- tomography of the pituitary gland;
- adrenal tomography;
- Abdominal ultrasound;
- Ultrasound of the kidneys and adrenal glands, etc.
After the diagnosis is confirmed and the causes of hyperestrogenia are identified, the doctor chooses the necessary treatment tactics.
For the treatment of hyperestrogenia can be recommended:
- conservative measures (normalization of the daily regimen, reduction of physical exertion, proper nutrition, restriction of phytoestrogens, rejection of certain drugs, rejection of bad habits);
- treatment of conditions causing hyperestrogenia (treatment of thyrotoxicosis, obesity, hyperprolactinemia, etc.);
- drug treatment (aromatase inhibitors, antiestrogens, etc.);
- radical treatment (removal of hormonally active tumors).
Endocrinologist Tsvetkova I.G.