When we think about sex hormones, testosterone, estrogen, and progesterone—come to mind. What we often don't think about are the enzymes that drive hormone pathways. Especially when considering testosterone therapy for both men and women, aromatase and 5 alpha-reductase activity should be considered first.
What is Aromatase? What happens when Aromatase activity is high?
Aromatase is the enzyme that is responsible for converting the androgens, androstenedione, and testosterone (T) into estrone and estradiol, respectively. Estrone (E1) and estradiol (E2) are both estrogens.
When aromatase activity is high, androgens will convert to estrogens at a higher rate, creating an androgen deficiency and an excess of estrogens. Although men and women need adequate amounts of estrogen, we do not need excess. In women, excess estrogen increases the risk for some breast cancers as well as overall dysregulation of steroid pathways. In both men and women, excess estrogens result in feminine fat deposits, which may include gynecomastia in men and extreme pear shape in women.
Unfortunately, stress or high cortisol states and inflammation cause aromatase to upregulate. Inflammation can be from any source, such as an infection and autoimmune conditions, but for most people, it will be due to obesity, insulin resistance, and leptin resistance. Concerning excessive body fat, abdominal fat, in particular, will drive an excess of aromatosis. Further, excess alcohol, zinc deficiency, aging, and plastics can upregulate aromatase. Plastics such as BPA, BPE, BPS, and others are all estrogenic.
Often, men and women may want to supplement testosterone to balance hormones. If stress and inflammation are not first under control, unfortunately, too much T can be converted to estradiol.
Concerning essential oils and home fragrances, some are estrogenic and antiandrogenic; however, it is not known if the effects are directly or indirectly occurring on enzymatic pathways as well as some molecules mimicking the chemical structure of estrogen. Consider fragrances possible or probable endocrine modulators.
What is 5 alpha-reductase? What happens when 5 alpha-reductase activity is high?
5 alpha-reductase is the enzyme that is responsible for converting testosterone (T) into dihydrotestosterone (DHT). DHT cannot be further converted into other hormones or be reversed to become T. There are 3 forms of this enzyme, with one form in the liver, skin, and sebaceous glands, where it contributes to acne and skin oil. Another form is in the prostate, hair follicles, and reproductive tissues, where it has a role in male sexual development. A third form is not well understood and is found in various tissues.
When 5 alpha-reductase activity is high, T will be metabolized too fast to DHT. DHT is very androgenic to all tissues except muscles, meaning that high levels of DHT will not result in bigger muscles, unlike T. DHT also causes hair loss and acne, while T does not. On the flip side, DHT promotes facial and body hair, which is welcome in men but not women. An excess of DHT also acts at the prostate by inhibiting normal cell apoptosis (cell death) and by stimulating cell growth, which can result in enlargement of the prostate. The goal is to have higher levels of T and lower levels of DHT.
When it comes to 5 alpha-reductase activity being elevated, just like aromatase, stress and inflammation are drivers. Again, obesity and insulin resistance are sources of inflammation. Both 5 alpha-reductase and aromatase activity tend to be elevated at the same time, resulting in a T deficiency. When there is an excess of E2 from high aromatase activity, the E2 will also inhibit the breakdown of DHT in the liver, where detoxification occurs, resulting in elevated levels of DHT.
Depending on the mode of testosterone therapy (intramuscular injections, topicals, or pellets) more or less aromatization may occur.
Controlling these Enzymes Naturally
As you can guess from the review above, the best natural way to control these enzymes and prevent them from being excessively upregulated is to control stress and inflammation. All forms of stress and inflammation should be addressed, but most importantly, any metabolic conditions related to excessive body weight, insulin resistance, and leptin resistance should be addressed. Remember that it is not always a good idea to reach for testosterone therapy when testosterone levels are low, as replaced testosterone will have the ability to convert to estrogens and DHT.
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