Hormonal
In healthy men, estrogen deficiency (caused by aromatase inhibition) is the primary driver of increased body fat, whereas testosterone deficiency is the primary driver of decreased lean mass, muscle size, and strength.
If you are a man experiencing fat gain or loss of muscle/strength, do not assume it is solely due to low testosterone. This study shows that low estrogen (estradiol) is a primary driver of fat gain, while low testosterone drives muscle loss. Treatment strategies should consider both hormones, not just testosterone replacement.
Androgen deficiency accounted for decreases in lean mass, muscle size, and strength; estrogen deficiency primarily accounted for increases in body fat; and both contributed to the decline in sexual function.
Why this rating
Randomized, double-blind, placebo-controlled trial with rigorous hormonal manipulation (goserelin + testosterone +/- anastrozole) in healthy men.
Source
Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men
Joel S. Finkelstein et al. · New England Journal of Medicine · 2013
DOI 10.1056/nejmoa1206168
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