When people talk about hormone imbalances, they often tend to focus on women mostly. This is because hormonal imbalances are much more prevalent in the female body, especially since menopause is a particular aspect that cannot be avoided and naturally occurs as a woman ages. But here’s the thing most people overlook: men deal with their own version of hormonal disruption, and it can be just as debilitating.
Just like in women, hormonal imbalances in men are often associated with age, as the balance between estrogen levels and testosterone levels in men often becomes disturbed when they age. There are other problems, apart from age, that may also cause hormonal imbalances in men. Many of the causes and symptoms we will discuss here will be similar to those in women, but it is important to note that the particular hormones that become out of balance in men usually differ from those in women.
According to research published in the Journal of Clinical Endocrinology & Metabolism, testosterone levels in American men have been declining at a population level since the 1980s — independent of aging. This means that today’s 40-year-old man likely has lower testosterone than a 40-year-old man in 1990 would have had. Environmental factors, lifestyle changes, and rising rates of obesity are all believed to play a role in this generational shift.
Causes of Hormone Imbalance in Men
Similar to how we discussed hormone imbalances in women, we will also start by looking at the causes of a hormone imbalance in men. There are quite a large number of potential causes for an imbalance in hormones in the male body. The most common cause in men comes with age, similar to that in women. This condition is called hypogonadism, but also sometimes referred to as andropause or male menopause. Hypogonadism occurs when the testes are unable to produce an adequate supply of testosterone in the male body; thus leading to a testosterone deficiency and an increase in estrogen levels. In some publications, this condition may be called low testosterone or “low-T.”
In addition to andropause, or male menopause, many other factors have also been identified to contribute towards a deficiency of certain hormones or an excess of some hormones in the male body. Since there are different possible hormone imbalances in men, we should look at the particular causes of each separately.
Low Testosterone
Low testosterone is relatively common amongst men. Research indicates that approximately 481,000 new men are diagnosed with testosterone deficiency every year in the United States, and the condition is most commonly diagnosed in men aged between 40 and 49. It affects over 39% of men who are aged above 45. By the time a man reaches 70, his testosterone levels may be as much as 30% lower than they were during his peak years.
Low testosterone levels may be caused by a chronic disease of the liver or kidneys, as well as various types of autoimmune diseases. Men may also experience low testosterone levels when they have been diagnosed with a metabolic disorder, such as type 2 diabetes. Obesity also has an adverse effect on testosterone levels in men — excess body fat increases aromatase activity, which converts more testosterone into estrogen and creates a feedback loop that suppresses further testosterone production. Furthermore, testicular cancer also causes levels of testosterone to drop significantly.
Other medical contributors to low testosterone that are often overlooked include pituitary gland disorders, certain medications (especially opioids and corticosteroids), obstructive sleep apnea, and prior anabolic steroid use. Men who have undergone chemotherapy or radiation therapy may also develop secondary hypogonadism as a result of damage to the hypothalamic-pituitary-gonadal (HPG) axis.
High Estrogen
The most common cause for high estrogen levels in the male body is an abundance of aromatase being present. Aromatase is an enzyme that converts testosterone hormones into estrogen hormones. When there is a high level of aromatase present in the male body, too much testosterone will be converted to estrogen. Certain metabolic disorders, like diabetes and also obesity, may also lead to a higher level of estrogen.
Furthermore, it has also been found that men who have been treated with synthetic testosterone replacement therapy may develop high levels of estrogen if their protocol is not properly monitored. This is precisely why working with a clinic that specializes in hormone optimization — rather than a general practitioner who may prescribe testosterone without monitoring estradiol levels — makes a significant difference in treatment outcomes.
Additional Risk Factors
In addition to the potential causes we have discussed above, certain risk factors have also been identified that increase the likelihood for men to develop a hormone imbalance. Chronic stress is one of the most significant contributing factors that may lead to a low testosterone concentration. When the body is under prolonged stress, cortisol levels remain elevated. Cortisol and testosterone share a precursor hormone (pregnenolone), and when the body is channeling its resources toward cortisol production, testosterone production takes a hit. This phenomenon is sometimes called the “pregnenolone steal.”
Adrenal fatigue, which is a disorder that affects the adrenal glands, may also cause the level of aromatase in the body to increase, thus leading to high estrogen levels and low testosterone levels. Furthermore, it is also possible to experience a reduction in testosterone when consuming too many alcoholic beverages. Alcohol has been shown to directly suppress testicular function and accelerate the conversion of testosterone to estrogen.
Certain environmental chemicals, such as xenoestrogens, may also lead to an imbalance in hormones in the male body. Xenoestrogens are synthetic compounds found in plastics (particularly BPA), pesticides, personal care products, and even some food packaging. These chemicals mimic estrogen in the body and can disrupt the delicate hormonal balance over time, even at low levels of exposure.
Symptoms of Hormone Imbalance in Men
Similar to how we have divided the potential causes of hormone imbalances in men into two different parts, we need to do so with the symptoms as well, due to the fact that the symptoms differ depending on the particular hormone or hormones that are out of balance. Many men live with these symptoms for years before seeking medical attention, often attributing them to normal aging or stress.
Symptoms of Low Testosterone
Low testosterone levels are quite common amongst older men and can result in the development of numerous symptoms. Men will experience reduced sexual function if their testosterone levels are significantly low. This may include a low libido, as well as symptoms that are associated with erectile dysfunction. Infertility is another symptom that may be caused by low testosterone, as adequate testosterone is essential for healthy sperm production.
Certain physical changes may also occur, such as an increase in body fat, with the abdominal area being especially prone to accumulating excess fat. A loss of muscle mass, reduced strength, weaker bones, and a reduction in body hair are also relatively common amongst men who suffer from low testosterone levels. In addition to these symptoms, men may also experience hot flashes and chronic fatigue that persists regardless of how much sleep they get.
What many men don’t realize is that low testosterone can also significantly affect cognitive function and mental health. Brain fog, difficulty concentrating, memory lapses, and a general decline in mental sharpness are frequently reported by men with testosterone deficiency. Depression and irritability are also closely linked to low testosterone — a connection that has been well-documented in clinical literature yet remains underdiagnosed because these symptoms are often treated with antidepressants rather than hormone evaluation.
Symptoms of High Estrogen
The symptoms of high estrogen levels in men are similar to the symptoms they may experience when testosterone levels become deficient, but some additional symptoms may also develop. Sexual dysfunction may develop in men with high estrogen levels, as well as fatigue. Furthermore, muscle mass may be reduced, and they may also develop symptoms of depression.
Men with high estrogen are also prone to developing gynecomastia (enlarged breast tissue), as well as problems with their lower urinary tract. An increase in abdominal fat is another common symptom that men experience when they have too high levels of estrogen. Water retention and bloating, which many men wouldn’t normally associate with a hormonal issue, are also hallmarks of estrogen dominance in the male body.
How Is Hormone Imbalance Diagnosed in Men?
Accurately diagnosing a hormone imbalance requires more than a single blood test. A comprehensive male hormone panel should measure total testosterone, free testosterone, estradiol (E2), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, cortisol, DHEA-S, and thyroid hormones (TSH, free T3, and free T4). Because testosterone fluctuates throughout the day — peaking in the morning and declining as the day progresses — blood draws are typically performed before 10 a.m. for the most accurate baseline.
Lab results alone, however, do not tell the full story. A thorough evaluation also includes a detailed medical history, symptom assessment, and physical examination. What falls within the “normal” reference range on a lab report may not represent what is optimal for a given individual. A man with a total testosterone of 350 ng/dL may technically be within normal limits, but if he was at 800 ng/dL five years ago, that decline is clinically significant and worth addressing.
Treatment Options for Hormone Imbalance in Men
Once a hormonal imbalance has been properly identified, several treatment avenues are available depending on the specific imbalance and the patient’s goals.
Testosterone Replacement Therapy (TRT)
For men with clinically low testosterone, testosterone replacement therapy remains the most effective and well-studied treatment option. TRT can be administered through intramuscular injections (typically cypionate or enanthate), transdermal gels or creams, subcutaneous pellets, or nasal preparations. Each delivery method has its own advantages and considerations, and the right choice depends on patient preference, lifestyle, and how their body responds.
It is worth noting that TRT should always be supervised by a physician who specializes in hormone optimization. Improper dosing or lack of monitoring can lead to side effects including elevated estrogen (from excess aromatization), increased hematocrit levels, and suppression of natural testosterone production. Regular follow-up blood work — typically at 6-week and 12-week intervals after starting therapy, then every 6 months — is essential for safe and effective treatment.
Estrogen Management
For men dealing with elevated estrogen, aromatase inhibitors such as anastrozole may be prescribed to block the conversion of testosterone to estradiol. However, estrogen management requires a careful, measured approach. Estrogen plays important roles in the male body as well — it supports bone density, cardiovascular health, libido, and cognitive function. The goal is never to eliminate estrogen entirely, but rather to bring it into a healthy ratio with testosterone.
Clomiphene Citrate and hCG
For younger men or those who wish to preserve fertility, clomiphene citrate (Clomid) or human chorionic gonadotropin (hCG) may be used as alternatives to direct testosterone replacement. Clomiphene works by stimulating the pituitary gland to produce more LH and FSH, which in turn signals the testes to produce more testosterone. hCG mimics the action of LH directly, maintaining testicular function and sperm production while supporting testosterone levels.
Natural Ways to Support Hormonal Balance
While medical intervention is sometimes necessary, there are also several evidence-based lifestyle modifications that can help support healthy hormone levels in men.
Resistance training and high-intensity exercise have been consistently shown to increase testosterone levels acutely and improve hormonal profiles over time. Compound movements like squats, deadlifts, and bench presses produce the most significant hormonal response.
Dietary improvements play a critical role. Diets rich in healthy fats (avocados, olive oil, nuts, and fatty fish), adequate protein, and plenty of cruciferous vegetables (broccoli, cauliflower, Brussels sprouts) support testosterone production and help the body metabolize excess estrogen. Zinc, magnesium, and vitamin D are particularly important micronutrients for male hormonal health, and deficiencies in any of these are linked to lower testosterone levels.
Sleep optimization is another non-negotiable factor. Testosterone production is closely tied to sleep quality, with the majority of daily testosterone release occurring during REM sleep. Men who consistently sleep fewer than 5–6 hours per night have been shown to have testosterone levels comparable to men 10–15 years older.
Stress management through practices such as meditation, deep breathing, or simply reducing unnecessary obligations can help keep cortisol levels in check and prevent the hormonal cascade that leads to testosterone suppression.
Reducing exposure to endocrine disruptors — switching to glass or stainless steel containers, choosing personal care products free of parabens and phthalates, and opting for organic produce when possible — can also reduce the xenoestrogen burden on the body over time.
When Should You See a Doctor?
If you are experiencing persistent fatigue, unexplained weight gain (especially around the midsection), a noticeable decline in sexual desire or function, mood changes, difficulty concentrating, or any combination of the symptoms described above, it may be time to have your hormone levels evaluated. These symptoms do not have to be a permanent part of aging.
A clinic that specializes in hormone optimization for men can provide the comprehensive testing and individualized treatment plans that general practitioners often lack the time or expertise to offer. The difference between feeling “normal for your age” and feeling genuinely optimized can be profound.
References
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2. Harman, S.M., et al. (2001). “Longitudinal Effects of Aging on Serum Total and Free Testosterone Levels in Healthy Men.” The Journal of Clinical Endocrinology & Metabolism, 86(2), 724–731. https://doi.org/10.1210/jcem.86.2.7219
3. Bhasin, S., et al. (2018). “Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline.” The Journal of Clinical Endocrinology & Metabolism, 103(5), 1715–1744. https://doi.org/10.1210/jc.2018-00229
4. Leproult, R. & Van Cauter, E. (2011). “Effect of 1 Week of Sleep Restriction on Testosterone Levels in Young Healthy Men.” JAMA, 305(21), 2173–2174. https://doi.org/10.1001/jama.2011.710
5. Grossmann, M. (2014). “Testosterone and Glucose Metabolism in Men: Current Concepts and Controversies.” Journal of Endocrinology, 220(3), R37–R55. https://doi.org/10.1530/JOE-13-0393
6. Corona, G., et al. (2020). “Testosterone Supplementation and Body Composition: Results from a Meta-Analysis of Observational Studies.” Journal of Endocrinological Investigation, 39(9), 967–981. https://doi.org/10.1007/s40618-016-0480-2
7. Schulster, M., et al. (2016). “The Role of Estradiol in Male Reproductive Function.” Asian Journal of Andrology, 18(3), 435–440. https://doi.org/10.4103/1008-682X.173932
8. Gore, A.C., et al. (2015). “EDC-2: The Endocrine Society’s Second Scientific Statement on Endocrine-Disrupting Chemicals.” Endocrine Reviews, 36(6), E1–E150. https://doi.org/10.1210/er.2015-1010
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before making decisions about hormone therapy or treatment. Individual results may vary.
To schedule a comprehensive hormone evaluation, visit androgenixsolutions.com or call our clinic in North Palm Beach, Florida.
