How can men lower high estrogen?

The most effective way for a man to lower high oestrogen is to lose excess body fat, especially around the waist. Fat tissue contains aromatase, the enzyme that turns testosterone into oestrogen. Drinking less, eating more fibre and checking your medicines come next. Medical treatment is for a confirmed cause, not a hunch, and "oestrogen blocker" supplements have little evidence behind them.

Men need some oestrogen: it protects bone, supports libido and helps mood and joints. The aim is a healthy balance with testosterone, never as low as possible.

Do you actually have high oestrogen?

The signs overlap with low testosterone, so guessing is unreliable. The ones that point to oestrogen:

• Tenderness or a firm disc under one or both nipples. The most specific sign.
• Fat settling on the chest and hips rather than the belly.
• Low libido or erection problems despite normal testosterone.
• Water retention and puffiness.

To find out, ask for a morning blood test of oestradiol, total testosterone, SHBG and LH. Two details matter. Standard oestradiol tests are unreliable at the low levels found in men, so ask for a sensitive (mass spectrometry) test if a result looks odd. And oestradiol means little on its own: it has to be read against your testosterone. See how to read your blood test results.

How to lower oestrogen in men naturally

1. Lose fat, especially visceral fat. This is the biggest lever by a wide margin. More fat means more aromatase, more testosterone converted to oestrogen, lower testosterone and easier fat gain: a loop. Your waist says more than the scales. NICE advises keeping your waist below half your height, so under 88 cm for a man who is 175 cm tall. See why belly fat will not budge.

2. Drink less, particularly regular drinking. Alcohol lowers testosterone and slows the liver, which is where oestrogen is broken down. Beer adds a small dose of phytoestrogen from hops. See the alcohol and testosterone truth.

3. Eat more fibre. The liver sends used oestrogen into the gut to be removed. Some gut bacteria can reactivate it so it is reabsorbed instead; fibre binds it and carries it out. Regular cruciferous vegetables such as broccoli, cabbage and broccoli sprouts are a sensible part of this. See gut health and testosterone.

4. Lift weights twice a week. Muscle improves insulin sensitivity and protects lean tissue while fat comes off.

5. Sleep properly. Short sleep lowers testosterone and drives fat gain, pushing the balance the wrong way.

Medicines and conditions that raise oestrogen

If symptoms began within months of a new prescription, that is a lead worth following. Medicines linked to breast tissue growth in men include spironolactone, cimetidine and ketoconazole, and breast tissue often settles within about three months of stopping the medicine responsible. Never stop a prescribed medicine without talking to your doctor. See medications that lower libido.

Other causes include testosterone therapy converting heavily to oestrogen, anabolic steroids, liver disease and, rarely, an overactive thyroid or a testicular tumour. That is why unexplained breast changes deserve a proper check.

Treatment for high oestrogen in men

Medical treatment depends on the cause rather than the oestrogen number alone:

• Treating the underlying cause, such as weight, liver disease or a thyroid problem.
• Changing a medicine that is responsible, where there is a suitable alternative.
• Adjusting TRT: a lower dose or more frequent, smaller doses usually solve over-conversion. See TRT side effects.
• Tamoxifen, prescribed by a specialist, is sometimes used for recent, painful breast tissue growth. It works best early; established tissue responds poorly.
• Surgery for long-standing gynaecomastia that has not responded. It is often not available on the NHS.

Aromatase inhibitors such as anastrozole are real drugs, and trials for gynaecomastia have given mixed results. Bought online and taken without blood tests, they easily push oestrogen too low, which causes joint pain, low libido, flat mood and bone loss. That is worse than the problem they were meant to fix.

What does not work

"Oestrogen blocker" supplements. DIM and calcium D-glucarate are the most marketed. DIM changes how oestrogen is broken down on a lab report, but there is almost no evidence that it improves symptoms in men. See DIM and calcium D-glucarate.

Detox protocols. Your liver and gut clear oestrogen continuously. Less alcohol, more fibre and less body fat are the useful version of "detox".

Chest fat or gynaecomastia?

Gynaecomastia is a firm, rubbery disc of gland tissue directly under the nipple. It does not go away with weight loss alone. Chest fat is soft, spread across the chest, and shrinks as you lose fat. See gynaecomastia explained.

When to see a GP

• A lump, or tenderness that does not settle.
• Swelling on one side only, or growth over a few weeks.
• Nipple discharge or bleeding, or dimpling or a rash on the skin.
• Symptoms that began after starting a new medicine.

The full guide: How to lower oestrogen in men covers why men need oestrogen, what raises it, the plastics question and what you will be sold, in depth. Related: symptoms of high testosterone · does alcohol lower testosterone? · the testosterone blood test guide

Sources: NHS: gynaecomastia · NICE: keep your waist to less than half your height · American Family Physician 2012: gynaecomastia