Dr. Rob(Dr. Rob )

Q. I am a male in my 60s and was recently evaluated for enlarged breasts. Blood tests came back indicating unusually high levels of estrogen. What does that mean?

A. The results may indicate your levels of estrogen are higher than what is considered "normal" due to a variety of factors that include obesity, alcoholism and liver disease. Or, they may point to an imbalance of the male hormones known as androgens (testosterone, androstenedione, etc.) relative to the amount of estrogen in your body. Unusually low levels of androgens (from pituitary gland disease, testicular tumor, older age, a genetic abnormality known as Klinefelter's syndrome, or other reasons) amplify the effects of estrogen in your body. Either way, it's best to follow up with your primary care doctor or endocrinologist.

Not just your mother's hormone

Many men are surprised to hear their bodies produce and circulate small amounts of estrogen that help to provide hormonal balance and healthy body function. However, it's important to note that estrogen represents a group of hormones composed of three main types:

  • Estrone (E1)–This is found in women and men (in small amounts). It's obtained from the adrenal gland and is also made, as well as stored, in fatty (adipose) tissue.
  • Estradiol (E2)–The most active form of estrogen, it's mainly produced by the ovaries in women and by the testes and adrenal glands in men.
  • Estriol (E3)–This is the major type of estrogen during pregnancy with large amounts produced in the placenta. The level of this hormone continues to rise until just before delivery.

While your question didn't mention why your estrogen levels were elevated, a key clue may be linked to the increasing size of your breasts. Once physicians note these female-like physical characteristics in men, laboratory tests to check your levels of thyroid-stimulating hormone (or TSH), luteinizing hormone (LH), testosterone, dehydroepiandrosterone sulfate, sex hormone-binding globulin (SHBG), as well as estrone and estradiol would be recommended as part of a complete evaluation.

Estrogen rising

Abnormal results are only part of the puzzle. It's also important to know the reason for your "estrogen" excess, so as to correct the cause (if possible) and minimize its potential effects (higher voice, loss of body hair, decrease in muscle mass, increase in fatty tissue, prostate enlargement, change in sex drive, difficulty in losing weight, etc.) on your body systems. That said, factors with the potential to temporarily (or chronically) elevate these levels include, but aren't limited to the following:

  • Older age–Aging can lead to decreased levels of testosterone and increase in estrogen levels, especially if you're obese.
  • Medications–This includes estrogen-containing drugs, steroids, ulcer medications such as cimetidine, some antibiotics (tetracycline, ampicillin, etc.), anti-fungal medications and antidepressants. Since there are more medications that can cause this effect, it's best to check with your pharmacist.
  • Obesity–Fat cells, especially those in the abdominal region, have the ability to produce an enzyme known as aromatase. This plays a role in converting testosterone into estrogen, thus changing the hormonal balance.
  • Illness–Certain tumors of the testes, adrenal and pituitary glands, liver and lung, cirrhosis (liver disease), kidney and thyroid disease may elevate estrogen levels.
  • Drugs–The use of anabolic steroids, marijuana, cocaine and other drugs can affect hormone levels.
  • Alcohol–Drinking excessively can increase the body's conversion of testosterone into estrogen, especially in fat cells. It can also block the liver from effectively eliminating excess estrogen.
  • Environmental exposure–The breakdown products from certain pesticides, chemicals and herbicides have the potential to cause estrogen-like effects in the body. There is even some concern regarding hormone-enhanced food products; people with elevated estrogen levels may be wise to choose hormone-free foods. 

Lastly, it's important you see a physician experienced in breast health. I say this not to alarm you, but because you are a male in your 60s with high estrogen levels and changes in your breasts. (The condition of enlarged breasts in males is known as gynecomastia.) Those factors alone put you at an increased risk for male breast cancer. While rare, it's best for you to be on the safe side and be checked rather than ignore the possibility.

For further information, please speak with your physician. Visit the American Association of Clinical Endocrinologists, the Hormone Foundation, or Breastcancer.org for more information.

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