From beer bellies to low libido, how ...

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Believe it or not, women's bodies depend on testosterone - and men can't get by without oestrogen. But when things get out of balance, the health consequences can be serious.

You're a middle-aged man with an expanding waistline and cholesterol levels just edging into the danger zone. Your muscles are a little flabby and so is your sex drive. You probably blame it all on lack of exercise and a little too much wine.



We tend to think of hormones such as oestrogen and testosterone as exclusively female or male.

And it's true - oestrogen is very important for a woman's menstrual cycle, as well as giving her soft skin and glossy hair. Testosterone, meanwhile, is viewed as all male, vital for muscle maintenance, virility and helping to make sperm. At least, that's the popular idea.

Yet what will surprise many people is that women and men produce both hormones. Men need female hormones for bone strength; women also need male hormones for their bones, as well as muscles and sex drive. But what's really important is having the right balance of male and female hormones.

As Professor Richard Sharpe, a senior scientist with the Medial Research Council Human Reproductive Science Unit, explains: 'Both sexes need to keep their levels of oestrogen and testosterone in balance for good health. There is no absolute level of either for men and women - it is the relative levels that are important.'

The problem is that the balance between our male and female hormones can change. And it seems that men are particularly affected - indeed, over his lifetime a man will have more oestrogen circulating in his body than a woman.

And too much oestrogen is not good - it raises men's risk of blood clots, encourages middle-aged spread (bad for heart health and diabetes) and possibly even affects their prostates.



'Too much oestrogen does not agree with men,' explains Professor Mary Ann Lumsden, a gynaecologist from Glasgow University and a hormone expert.

In women, oestrogen has a protective effect on their heart - but on men it seems to do the opposite.

'A study a few years ago that involved giving men large doses of oestrogen to try and reduce their risk of heart disease had to be stopped because some men developed blood clots,' says Professor Lumsden.



Animal studies show that too much oestrogen can push up the male risk of diabetes and cardiovascular problems, says Ian Banks, professor of European Men's Health at Leeds Metropolitan University.

Meanwhile, too much testosterone in women is linked to infertility, excessive hair growth and other problems.

Despite the fact that they have such different effects, oestrogen and testosterone are closely connected; indeed, oestrogen is actually made from testosterone.



The balance between oestrogen and testosterone doesn't usually cause problems in men until middle age. That's when their testosterone levels go into a downward spiral.

'First, you produce less because of general ageing, but to make things worse, more of what you do make is turned into oestrogen,' explains Professor Ashley Grossman, an endocrinologist at Bart's Hospital, London.



it's not just age-related changes in the testosteroneoestrogen balance that affect men - they might also be getting more oestrogen from the environment, suggest some experts.

'We know that pesticides and other chemicals have oestrogen-like effects,' says Professor Banks. 'When you add it all up, it's clear that men are being increasingly feminised.'



However, while women are given HRT and sometimes additional testosterone to tackle their hormonal imbalances, the idea of hormone imbalance in men is new and controversial.

At the moment, few doctors will check oestrogen levels in older men, let alone offer them treatment with testosterone - partly because of the fear it might trigger prostate cancer.

'We're not really clear what's going on with oestrogen in men,' says Professor Sharpe.

'I suspect that what's important is not so much the action of either testosterone or oestrogen, but something we don't yet understand about the balance between the two.'

There are, however, some private GPs who specialise in hormones and who will recommend a combination of hormone replacement drugs, dietary changes and supplements to tackle any imbalance.

Many of their clients report they are delighted with the results, but none of the treatments has been tested in large trials. Exercise can also help boost testosterone.

Here, we look at the emerging evidence for the adverse effects oestrogen and testosterone have on both sexes.


CHOLESTEROL: Too much oestrogen can raise the levels of cholesterol. A study from Leicester University found young men with slightly raised levels of oestrogen in their blood had the highest levels of cholesterol.

The higher oestrogen levels seemed to encourage the production of 'bad' LDL cholesterol (which is linked to heart disease), while reducing levels of 'good' HDL cholesterol (the protective form that can help prevent clogged arteries).

WEIGHT GAIN: Rising levels of oestrogen encourage the development of male beer bellies.'Oestrogen encourages fat to accumulate around the central part of the body,' explains Professor Grossman. 'The problem is that the fat cells, in turn, produce an enzyme that encourages testosterone to be converted into oestrogen.'

So you end up with even more oestrogen and lower testosterone levels than normal - as well as weight gain, this can lead to tiredness, flabby muscles and reduced libido.

OSTEOPOROSIS: Oestrogen is important for men's bone health, enabling them to retain calcium. Men who have too little of the hormone tend to develop osteoporosis, or brittle bone disease.

Oestrogen also explains why men tend to be taller than women.

During puberty, oestrogen helps the bones fuse - so preventing men and women from becoming giants. In order to do this, oestrogen levels climb. But in girls this happens when they are about 12, whereas in boys it happens about two years later.



ENLARGED PROSTATE: It's thought too much oestrogen might contribute to an enlarged prostate, an agerelated condition where the gland surrounding the man's urethra grows, affecting urine flow and causing the need to use the lavatory more often at night.

Meanwhile, too little oestrogen might be linked to prostate cancer. A study published in the Journal of Endocrinology has suggested that boosting men's levels of the hormone might prevent the development of prostate cancer.

MALE BREASTS: Male breasts are common in puberty, explains Professor Stafford Lightman, an endocrinologist and professor of medicine at Bristol University.

'At this time, young boys start to produce sex hormones in large quantities for the first time.

'Normally, the body recovers from this and the breasts vanish without the need for treatment.' However, in older men the change in hormone balance causes fatty deposits to settle in the breast area, creating 'man boobs' or 'moobs'.

HEART FAILURE: Earlier this year, a study found that men with heart failure who have very high or low levels of oestrogen are at a higher risk of dying early.

Researchers from Poland noted the level of estradiol, a form of oestrogen, in the men's blood and monitored it for three years. Those in the lowestradiol group had an early death rate four times higher, while men in the high-estradiol group were twice as likely to die young.

Additional information:

Iranian Journal of Endocrinology and Metabolism-
Journal of endocrinology Journal Info
International Journal of Endocrinology An Open Access Journal
Turkish Journal of Endocrinology and Metabolism
HighWire Press About "European Journal of Endocrinology "
Internet Journal of Endocrinology
Journal of Endocrinology Wikipedia, the free encyclopedia
Society for Endocrinology Journals
Lista Maestra de Revistas
International Journal of Endocrinology and Metabolism

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