Estrogens

An oestrogen is any of a group of steroid hormones which promote the development and maintenance of the female body.
Estrogens are produced by both men and women: they are essential to maintenance of bones, skin, female organs, sperm and egg manufacture, pregnancy, and many other processes in both sexes, including nervous system maturation, cognition and libido. The body makes 3 Oestrogens: Oestrone (E1), Oestradiol (E2) and Oestriol (E3).
All three perform essentially the same actions, but there are some important differences.

E2 is the main actor; it is produced primarily in both ovaries and testes by “aromatization” of testosterone (small amounts are produced in the adrenal glands and peripheral tissues, notably the fat cells). Of the three, it is dominant.**
It is responsible for development and care of the female organs, bone building and repair, support of the libido and maturation of the ova (eggs) in the ovaries.
E1 has the same functional properties as E2, but is 1/5 as potent and its blood level is usually 1/5 of the E2 level. It is produced mainly by the fat cells and tends to be higher with overweight. When the ovaries shut down at menopause, E1 becomes the dominant Oestrogen because E2 and E3 production approach zero.

E3 is 1/5 as “strong” as E2 and only 1/5th as much is produced, excepting during pregnancy (it is the main estrogen of pregnancy and hardly does anything else).
In contrast to E1, some types of which promote breast cancer, E3 has a reputation as the “anti-breast-cancer Oestrogen”.(A) Many chemicals (XENO-OESTROGENS) and some plant products (PHYTO-OESTROGENS) can mimic the action of Oestrogens in the body (more on this, later).

• Many chemicals (XENO-OESTROGENS) and some plant products (PHYTO-OESTROGENS) can mimic the action of Oestrogens in the body (more on this, later).
• Animal origin and Synthetic Oestrogens were produced and prescribed to women in the second half of the 20^th century, for contraception and hormone replacement. This practice fell into disrepute when the results of a mega-study of American nurses became known.
• Most of the time, doctors test for Oestradiol only: Oestriol is only of interest during pregnancy and Oestrone is regarded as unimportant except when breast cancer is suspected.
• Progesterone, the “pregnancy hormone”, while regarded as a “female” hormone, is not an Oestrogen: its actions are different and in fact it is in some ways an “anti-oestrogen”. It has a bearing on Oestrogen function however because the balance (ratio) between the Progesterone level and the Oestradiol level can be important. Note that Progesterone is reported in nanomoles per litre, while Oestradiol is reported in picomoles per litre …. one nmol = 1000 pmol, so we multiply the Progesterone “number” by 1,000, then divide the result by the Oestradiol “number”, to derive the ratio. (Normal is 100-500), optimal being closer to 500.

FEMALE OESTRADIOL LEVELS:

Age 7	Undetectable : < 29 Pg/ml
Age 10	10-33 Pg/ml
Age 11	15-43 Pg/ml
Age 12	16-77 Pg/ml
Age 14	17-200 Pg/ml

MALE OESTRADIOL LEVELS:

Age 7	Undetectable : < 16 Pg/ml
Age 11	< 22 Pg/ml
Age 13	10-25 Pg/ml
Age 15	10-46 Pg/ml

RHYTHMIC OESTRADIOL SECRETION, IN THE MENSTRUAL CYCLE (from Wikipedia).

OESTRADIOL DEFICIENCY:

Low Estradiol (E2) levels in young females is rare: it may be due either to failure of the ovaries, or failure of the Pituitary to send “LH” and “FSH” hormones to stimulate them. If the stimulatory hormones, LH and FSH, are high, the fault lies with the ovaries and the cause is usually genetic (Turner syndrome, ovarian failure), or toxic, usually from cancer treatment. If LH and FSH are low, the Pituitary is at fault: this can have functional causes, such as starvation, overexercise, severe physical or emotional stress, and heavy drug and/or alcohol use, or it may be caused by organic disease of the hypothalamus or pituitary. Low Oestradiol is normal in menopausal women and is a fairly common problem in older men. Postmenopausal women and older men with very low E2 levels are at increased risk of osteoporotic fractures, which can be lethal.

MENOPAUSE: Menopause begins immediately if the ovaries are surgically removed or radiated, or more slowly, due to ovarian shutdown at menopause.
The menopause begins with irregular menstrual periods and soon (within 6-12 months) a constellation of symptoms begins, with slight variations between people: these comprise Vaginal dryness, hot flashes, cold chills, night sweats, insommnia, mood swings, weight gain, slowed metabolism and occasionally, cognitive loss.

ANDROPAUSE: Some men suffer identical, though usually less severe, “Andropausal” symptoms, with the same list of discomforts, because their testosterone level is reduced as DHEA production falls due to aging.

DURATION OF SYMPTOMS: in both sexes, oestrogen deficiency symptoms usually settle down within 1-2 years, but recurrences may occur from time to time.

ASSOCIATION WITH OTHER CONDITIONS: Any and all other medical conditions may co-exist with Menopause/Andropause, but the affected individual should be checked carefully for Hypothyroidism (either true hypothyroidism due to thyroid gland malfunction, or functional hypothyroidism due to stress), in particular.
Adequate management of coexisting hypothyroidism can improve the experience of “the pause” and render the patient’s situation much more bearable.

OESTRADIOL EXCESS:

MALE: Over-medication with Testosterone or DHEA can result in high levels of Oestradiol, with breast enlargement, water retention and weight gain, because the Testosterone is “aromatised” (changed) into Oestradiol in the tissues. This can happen either before, or after, andropause. However the commonest cause of high Oestrogens in the male is obesity; fat cells produce Oestrone and the bigger they get, the more they make.

FEMALE: Some young women produce more Oestradiol than others: these females tend to have large breasts and hips and to become overweight, which can be problematic, since the “Lipocytes” produce Oestrone.
The menopausal female has discontinued production of the hormone, so excess Oestradiol is not possible. Oestrogen excess, with the problems attendant on Oestrogen dominance, will occur if the Oestrogen replacement prescription is too strong, or the Progesterone prescription is too weak.

COMPLICATIONS OF OESTROGEN EXCESS:

OESTROGEN DOMINANCE: Progesterone opposes Oestroen’s tendency to fat production and if the Progesterone level is low relative to the Oestradiol level, the person is said to be “Oestrogen dominant”. This is easily assessed by checking the blood level of each hormone and dividing the Progesterone “number” by that of Oestradiol: low Progesterone and high Oestradiol produce the same result.
As previously said in this paper, Progesterone is reported in nanomoles per litre, while Oestradiol is reported in picomoles per litre (One nmol = 1000 pmol), so we multiply the Progesterone “number” by 1,000 and then divide the result by the Oestradiol “number”, to derive the ratio. The Normal result is 100-500; optimally, closer to 500. NOTE that Oestrogen dominance can be a problem for younger women, too, either because of high Oestradiol production or because of Progesterone deficiency.

COMMON SYMPTOMS OF ESTROGEN DOMINANCE:
Fat deposition in the Oestrogen-responsive areas; hips and upper thighs, buttocks, lower abdomen and breasts, increased PMS, irregular periods, depression, mood swings, headaches, bloating,hot flashes, poor sleep.

TREATMENT OF OESTROGEN DOMINANCE:
Correction of Oestrogen dominance is easily achieved by prescribing Progesterone or by reducing the strength of any prescribed Oestrogen preparation.
However hormone therapy should only be prescribed by a physician who is certified competent to supervise the course of the patient and no hormone restoration therapy, including Progesterone, should be prescribed unless pregnancy and other pre-existing conditions have been excluded by blood, urine or saliva tests, ultrasounds, x-rays or other investigations, as necessary.
In persons who are still “cycling”, it is possible to reduce the amount of oestradiol by prescribing an antiestrogen medication; but this usually results in complete elimination of the libido ***. For premenopausal women, cyclic administration of progesterone, from the 15^th to 20^th day of the menstrual cycle, is preferred; but taking progesterone every night will eliminate insomnia and may be better for some women.
For the menopausal, it is a better idea to prescribe oral or transdermal progesterone on an ongoing, regular basis.

NOTE: ***
(1) You can reduce Oestradiol with medication, but this destroys the libido, in women and men.
(2) If Progesterone is to be prescribed, it must be bioidentical Progesterone: Progestin” medications are not bioidentical and may be dangerous to health.

PLEASE SEE THE NOTES ON PROGESTERONE, elsewhere in this website.