Estrogen management for men on testosterone replacement is absolutely critical to long term health. Research is showing that estrogen levels are extremely correlated to heart disease. This study shows that both high and low estrogen levels are almost equally dangerous when it comes to heart disease. High estrogen levels are also associated with increased blood clot and strokes and increased mortality. Not to mention, all of the other obvious estrogen dominant side effects like weight gain, gynecomastia, sexual dysfunction, poor moods, and more. Low estrogen also causes more than just cardiovascular disease. Osteoporosis is a very serious issue in men with lower than normal estrogen levels. So much so that this study proves a 650% increase in broken hips in research groups of men with the lowest estrogen levels as compared to men with healthy levels of testosterone. The mortality rates for men with broken hips and severe osteoporosis is also much higher than men with who do not suffer from these conditions. Quality of life is also extremely improved when men have better bone health in their later years. Another vital aspect of managing estrogen involves keeping estrogen optimal in order to avoid the decrease in androgen receptors due to estrogen dominance. This has been proven in several studies and will decrease the body's ability to bind to DHT and testosterone adequately. Higher levels of estrogen have also been shown to increase SHBG which will in turn drastically reduce free testosterone levels. This is just one more reason that your doctor must understand that keeping you in the optimal range of 20-30 pg/ml has a profound impact on your long term cardiovascular health, your bone health, your testosterone levels (and androgen receptor count) as well as moods and emotional state of being. The importance of managing estrogen cannot be overstated.