Low testosterone, high oestrogen, thyroid disorders & adrenal dysfunction in men.
Hormonal imbalances in men are more varied and more treatable than most people realise. The most discussed is low testosterone (hypogonadism), but in practice many men present with multiple overlapping imbalances — often involving testosterone, oestrogen, cortisol and thyroid hormones simultaneously. Understanding the type of imbalance is critical for selecting the right treatment.
Causes, blood test patterns and distinguishing features of each imbalance type
The testes fail to produce adequate testosterone despite normal or elevated LH/FSH. Causes include Klinefelter syndrome, orchitis, trauma, chemotherapy and radiation. Blood test: low T + high LH/FSH. - Testicular failure - border-amber-500/30
The pituitary fails to send adequate LH signal to the testes. Causes: obesity, hyperprolactinaemia, pituitary tumours, opioid use, anabolic steroid history. Blood test: low T + low/normal LH/FSH. - Pituitary/hypothalamic - border-orange-500/30
Elevated oestradiol relative to testosterone — most common in overweight men with high aromatase activity in adipose tissue. Symptoms: gynaecomastia, fatigue, low libido, emotional lability and difficulty losing weight. - High E2 relative to T - border-rose-500/30
Chronic cortisol elevation suppresses the HPG axis, impairs sleep, drives abdominal fat and increases insulin resistance. Driven by chronic stress, overtraining, poor sleep and nutritional deficiencies. - Cortisol excess - border-purple-500/30
Hypothyroidism closely mimics low testosterone — fatigue, weight gain, cold intolerance, low mood and poor libido. TSH alone is often insufficient; free T3/T4 and thyroid antibodies give the full picture. - Hypothyroidism - border-teal-500/30
Strongly linked to lower testosterone, higher oestrogen and increased cardiovascular risk. Common in South African men with sedentary lifestyles and high-glycaemic diets. Bidirectional — low T worsens insulin resistance. - Metabolic - border-green-500/30
