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Elevated estrogen can cause: Gynecomastia (breast tissue growth and tenderness) Fluid retention and bloating Emotional changes or irritability In some cases, clinicians add aromatase inhibitors alongside TRT to limit estrogen conversion, but this adds complexity and potential side effects

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Bezin J, Gouverneur A, Penichon M, Mathieu C, Garrel R, Hillaire-Buys D, et al

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