Increased Estrogen Production in Obese Men*

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Abstract
Serum estrone (E,) and 17β-estradiol (E2) were noted to be 2-fold elevated in a group of morbidly obese men. Urinary E1 and E2 production rates were elevated in proportion to the degree of obesity, with values as high as 127 and 157 μg/day, respectively. Although serum testosterone (T) concentrations were reduced in obese men, averaging 348 ± 35 vs. 519 ± 42 ng/dl in lean controls, the dialyzable T fractions were elevated and, hence, the calculated free T concentrations were normal in obese men. Further, the obese men exhibited normal serum LH, FSH, and T responses to clomiphene citrate, indicating intact hypothalamic-pituitary-Leydig cell axes. MCRs of T and peripheral conversion of T to E2 and androstenedione (Δ) to E1 were all increased in obese men in proportion to the percentage above ideal weight. Although the obese men exhibited increased blood levels and production rates of estrogens, there were no signs of feminization, increased T-estrogen-binding globulin levels, or suppressed basal gonadotropin levels, suggesting a lack of biological effect. We postulate that obese men exhibit defective estrogen receptors, leading to decreased T-estrogen-binding globulin, increased clearance of androgenic hormones, and elevated estrogen production rates. (J Clin Endocrinol Metab48: 633, 1979)