Estrogens

Estrogens are essential to bones, skin, female organs and libido.
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.
E1 tends to be higher in women with breast cancer.
It is produced mainly by the fat cells and tends to be higher in overweight people.
When the ovaries shut down at menopause, E1 becomes the dominant Oestrogen, since E2 and E3 production approach zero.

E3 is 1/5 as “strong” as E2. Only 1/5th as much is produced, excepting during pregnancy (it is the main estrogen of pregnancy and hardly does anything else).
E3 has a reputation as the “anti-breast-cancer Oestrogen”.

The principal Oestrogen cream offered by functional medicine practitioners, “BIEST”, contains Oestriol (E3) and Oestradiol (E2), in an “80% – 20% ratio,with no Oestrone (E1).
The dose is adjusted so as to control menopause symptoms without weight gain.
Progesterone is usually prescribed with it, to counteract any tendency to weight gain.

XENO-OESTROGENS, the “UN-natural female hormones”

• 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 a mega-study of American nurses was reported, showing that the synthetic hormones were causing cancer, blood clots, heart attacks and strokes.

Blood Tests for Estrogens

• Most of the time, doctors test for Oestradiol only.
• Oestriol is only of interest during pregnancy.
• Oestrone rises in obesity, because it is produced by the fat cells (it also encourages fat cells to grow). It is regarded as unimportant except when breast cancer is suspected. However some practitioners do a yearly check of the estrone level, with analysis of the proportion of “flavours”, which may provide an “early warning sign” of developing breast cancer.
• Progesterone, the “pregnancy hormone”, while regarded as a female hormone, is not an Oestrogen.
  Its actions are different and in fact in some ways it is an “anti-oestrogen”.
  It has a bearing on Oestrogen function however because Oestradiol tends to make women gain weight and Progesterone couteracts that side effect.
  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 “P/O ratio”. (Normal is 100-500), optimal being closer to 500.
  
  * The easy definition of a “MOLE” is the molecular weight of a substance, in grams. The mole, or “Mol”, is widely used in chemistry as a convenient way to express amounts of reactants and products of chemical reactions.
  ** A Gram = 1000 Milligrams, a Milligram = 1000 Micrograms, a Microgram = 1000 Nanograms & Nanogram = 1000 Picograms.

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 (graphic from Wikipedia): Note the wide production range.

OESTRADIOL EXCESS (DOMINANCE)

FEMALE:
As said, Estrogens are essential to bones, skin, female organs and libido: as such, it is imperative that there be enough; but what is “enough”, and how much is too much?
Some young women make more Oestradiol than others. Oestradiol causes an increase in the female traits and these females tend to have large breasts and hips and become overweight, which can be problematic, since “Lipocytes” produce Oestrone and as strong encourages lipocytes to grow.
The menopausal female has discontinued production of the hormone, so in menopause, excess Oestradiol is not possible.
However Oestrogen excess, with the problems attendant on Oestrogen dominance, will occur if the Oestrogen replacement prescription is too strong, or if the Progesterone prescription is too weak.
High producers increase enlargement of the breasts and fat deposition in the buttocks, hips and thighs.
Progesterone tends to prevent Oestrogenic weight gain.
MALE:
in the male too, Estrogens are essential to bones, skin and libido, however, an oversupply can present a problem! 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 liver and other tissues.
Estrogen oversupply can begin either before, or after, andropause: Estrogen excess in men does the same as it does in women: fat increases on the breasts, hips and thighs.
It is a vicious circle: fat cells produce Oestrone: the bigger they get, the more they make and the more they make, the bigger they get!

However estrogen does not cause reduction of the libido.
In fact, Oestrogen is necessary to the male, as well as the female, libido and total oestrogen blockade causes complete loss of libido in both sexes.

OESTRADIOL DEFICIENCY

Low Estradiol (E2) levels in young females is rare, but the cause can usually be identified by means of blood tests.
It may be due to failure of the ovaries, or failure of the Pituitary to send stimulating “LH” and “FSH” hormones to them.
If the stimulatory hormones, LH and FSH, are high, the fault lies with the ovaries and the cause is usually either genetic (Turner’s syndrome, ovarian failure), or toxic, as in 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 or alcohol use, or organic disease of the hypothalamus or pituitary.
Low Oestradiol is normal in menopausal women and is fairly common in older men.
Postmenopausal women and older men with low E2 levels are at increased risk of osteoporotic fractures, which can be lethal.

MENOPAUSE

Menopause begins immediately if the ovaries are removed or radiated, or slowly, due to ovarian shutdown.
The menopause starts with irregular menstrual periods and soon (within 6-12 months) a constellation of symptoms begins, with slight variations between people.
These symptoms are variable, with some combination of vaginal dryness, hot flashes, cold chills, night sweats, insommnia, mood swings, weight gain, reduced libido, slowed metabolism and occasionally, cognitive loss.
The symptoms usually increase slowly, but can start suddenly and can present with any mixture of low oestradiol, low progesterone and low Allopregnanolone symptoms, sometimes with added low thyroid symptoms as well.
Menopausal symptoms are easily treated with an Oestrogen cream (called “BIEST”, which contains Oestriol* and Oestradiol, in an “80% – 20% ratio **).
The dose is adjusted so as to control menopause symptoms without causing weight gain: usually, cream containing between 1.0 and 2.5 mg of estradiol is prescribed.

Progesterone is routinely added to the prescription, either because it is deficient, as a hedge against weight gain or as a treatment for insomnia.

DHEA is prescribed also, because it is naturally deficient by the time of menopause (DHEA production falls by 1 – 2% per annum, from the age of 26, in both sexes).
DHEA may be taken by mouth, but is very effective as a vaginal cream, for treatment of vaginal dryness and urine loss.

* E3 is added because of its anti-cancer effect and E1 is not, because it is pro-cancer.
**80/20 is the usual ratio of E3-to-E2 in humans. Also, in terms of strength, E2 = E3x5.

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.
Some men also develop low thyroid symptoms, which usually respond well to DHEA.

DURATION OF SYMPTOMS

In both sexes, oestrogen deficiency symptoms usually settle down within 1-2 years without treatment.
However recurrences may occur from time to time and the lack of Oestrogen causes osteoporosis.

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 (including intracellular (functional) hypothyroidism due to stress), high cholesterol and diabetes, in particular.
Adequate treatment of coexisting true hypothyroidism with T4, or of intracellular hypothyroidism with T3, will eliminate hypothyroid symptoms like fatigue, fuzzy thinking and anxiety.
On the one hand, this will improve wellbeing and render the patient’s situation much more bearable. On the other, it will normalise body temperature, improve cholesterol and glucose management and help to reverse weight gain.

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 PROBLEMS 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.
Increased liability to cancers of the breast, colon and (in the male) prostate.
High Cholesterol, with increased liability to blood clots in the legs, heart attacks, strokes etc.

TREATMENT OF OESTROGEN DOMINANCE:
Correction of Oestrogen dominance is easily achieved by prescribing Progesterone or by reducing the strength of any prescribed Oestrogen preparation, so that the blood Progesterone/Oestrogen ratio is between 100 and 500.
Hormone therapy should only be prescribed by a physician who is certified competent to supervise the course of the patient.
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 anti-estrogen medication; but this usually results in complete elimination of the libido ***.
For premenopausal women, cyclic administration of progesterone, from the 15^th to 24^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 in men.
(2) If Progesterone is prescribed, it MUST be BIOIDENTICAL Progesterone, not “Premarin” (pregnant mare’s urine) or any other synthetic.
“Progestin” medications are not bioidentical and are dangerous to health: do access this URL and read the abstract of the paper: you will see how many conditions used to be treated with poisonous synthetic “progestin” drugs!

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