If you’ve been told you need an aromatase inhibitor on TRT, it’s time to take a closer look. Many men start testosterone therapy thinking they need to “control” estrogen, but that’s misinformed.  In fact, trying to block it can backfire and make you feel worse. 

At Victory Men’s Health, we see it all the time: men chasing numbers on a lab chart. The truth? Optimizing your hormones is about balance—not suppression. That’s why we’re here to clear up the confusion and explain what’s really going on.

On an episode of the Women Want Strong Men podcast, we were joined by hormone optimization expert Dave Lee to discuss common TRT mistakes. Save the episode below for a deeper dive into why chasing estrogen with an aromatase inhibitor is almost always a mistake. In the meantime, here’s what to know about estrogen and how to get the most out of TRT.

What Does an Aromatase Inhibitor Do on TRT?

Aromatase inhibitors (AIs) block the enzyme aromatase, which converts testosterone into estrogen. Originally created to help treat estrogen-driven breast cancers, drugs like anastrozole (Arimidex), letrozole, and exemestane have found their way into men’s health protocols as a “preventive” for estrogen spikes.

Here’s the problem: estrogen isn’t the villain it’s made out to be. 

Men often think symptoms like water retention, mood changes, and erection problems must be coming from excessive estrogen while taking testosterone. Taking a pill to block estrogen is easy, but also missing the point entirely. 

They’re often given AIs by default, creating a new set of problems: low mood, joint pain, low libido, and fatigue. AIs suppress a hormone your body needs to function well. That’s like putting the brakes on the very system you’re trying to optimize, which won’t benefit you in the long run. 

Why Men Need Estrogen on Testosterone Therapy

Estrogen plays an essential role in male health—just in smaller amounts than in women. It helps regulate libido, cognition, vascular function, and bone density. When you suppress estrogen too low, you’re not fine-tuning your hormones—you’re cutting off critical support systems your body relies on.

Healthy estrogen levels support nitric oxide production, which improves blood flow and erections. Estrogen also helps protect the cardiovascular system, stabilizes mood, and keeps joints lubricated. When men overuse AIs, they often feel anxious, fatigued, and disconnected.

Instead of aiming for zero estrogen, the real goal should be balance: enough to keep your heart, brain, and sexual health performing at their peak.

High Estrogen Symptoms on TRT: What’s Really Going On

If you’ve started TRT and notice bloating, irritability, or fatigue, your first instinct might be to blame high estrogen, but that’s rarely the real cause. According to Dave Lee, who has worked with thousands of men worldwide, these symptoms almost always point to lifestyle factors, not estrogen levels.

“Every man who swore he needed an aromatase inhibitor was either drinking alcohol excessively or overweight,” Dave explained on the podcast.

Here’s why that matters: excess body fat increases aromatase activity, which means your body naturally converts more testosterone into estrogen. Factors like alcohol compound the problem by affecting liver metabolism and impairing how your body processes hormones. 

The result? An artificial hormone imbalance caused by habits, not biology.

Dave calls it “the gap” — the distance between how your body should be functioning naturally and the levels you’re forcing it to reach with TRT. The bigger that gap (caused by poor sleep, diet, alcohol, or inactivity), the more side effects you’ll experience. 

Why Blocking Estrogen Can Make TRT Side Effects Worse

Aromatase inhibitors may temporarily flatten out estrogen, but they often leave men feeling worse than before. Low estrogen is just as problematic as high testosterone is helpful. When estrogen dips too far, men frequently experience:

• Fatigue and brain fog
• Joint pain and stiffness
• Low libido and erectile issues
• Anxiety, irritability, or mood swings

Estrogen is key for vasodilation (the widening of blood vessels) so lowering it too much can raise cardiovascular risk. And because estrogen also supports serotonin and dopamine regulation, over-suppression can tank your motivation, drive, and overall wellbeing.

TRT should make you feel balanced, confident, and sharp. If you’re constantly adjusting doses, chasing numbers, or adding more drugs to fix side effects, you’re missing the bigger picture.

How to Naturally Manage Estrogen on TRT Without an AI

The good news? You can keep your estrogen levels in a healthy range naturally without an aromatase inhibitor. Estrogen balance in men starts with the same habits that support optimal testosterone production in the first place.

Here’s what we recommend focusing on:

• Keep body fat in a healthy range. Lowering excess fat decreases aromatase activity and stabilizes hormone conversion.
• Limit alcohol. Even moderate drinking interferes with testosterone metabolism and increases estrogen production.
• Train consistently. Resistance training boosts testosterone and improves how your body uses both androgens and estrogens.
• Prioritize sleep. Deep sleep is when your hormones reset. Missing it disrupts testosterone and cortisol balance.
• Work with experts. At Victory Men’s Health, we design protocols around your individual labs, symptoms, and goals—not cookie-cutter dosing or unnecessary medications.

When your lifestyle supports your hormones, your hormones will support you. It’s that simple.

When Is An Aromatase Inhibitor Needed on TRT?

If a man is experiencing side effects with TRT, the best adjustment is to take smaller and more frequent dosing. This levels out all hormone spikes: both testosterone and estradiol. When you take large doses of testosterone all at once, you’ll get highs and lows of all hormones, which can lead to increased side effects perceived as an estrogen problem. 

Estrogen might be part of the issue, but it’s a result of a poor protocol. The key is data-driven treatment, not guesswork. Comprehensive lab testing helps determine if your symptoms are truly caused by elevated estrogen or something else. If you use an AI, it should be a bridge, not a lifelong prescription.

Common Questions About Aromatase Inhibitors on TRT

Do Most Men Need an Aromatase Inhibitor on TRT?

No. With proper dosing, frequency, and healthy habits, most men naturally maintain balanced estrogen levels without an AI. You should never need an aromatase inhibitor on TRT. Instead, take the dosing and frequency of testosterone that gives you benefits without side effects and eliminates the need for other medications to cover up those side effects.

What Happens If Estrogen Gets Too Low?

You’ll probably feel it. Low estrogen can cause fatigue, low libido, brain fog, and achy joints—basically the opposite of what TRT is meant to do.

Can Lifestyle Changes Help Balance Estrogen?

Absolutely! Dropping excess body fat, cutting back on alcohol, eating clean, and exercising regularly are powerful tools for hormone balance and all help keep your estrogen where it should be.

How Long Does It Take to Balance Hormones on TRT?

Give it some time. Most men start feeling more consistent results after a few months once testosterone and estrogen stabilize and your body adjusts. If needed, we can adjust your dosage and/or dosing frequency. 

Take Control of Your Hormones — The Right Way

Estrogen plays a critical role in how you feel, perform, and recover. When your hormones are balanced, everything works better: your energy, confidence, sleep, mood, and drive. The goal is synergy, not suppression.

At Victory Men’s Health, we look beyond the numbers to uncover what’s really impacting your hormones. Our team helps men optimize everything from sexual health and energy to weight management and longevity through advanced diagnostics and personalized care.

If you’re ready to feel your best and stop guessing at what your body needs, we can help. Book a consultation today and start building a stronger, more balanced version of yourself.