Chapter 5. Estrogen, Progesterone, and Testosterone

Estrogen defines women.  When you hear the word estrogen, the human female comes to mind.  Estrogens have been shown to be responsible for over 400 different functions in the body.  Estrogens are responsible for the growth, development, maintenance, and function of the female sex organs.  They protect against bone loss and heart disease.  Estrogens regulate other hormone and help certain cells grow and multiply in the body.

Conventional medicine assumes that once a woman goes through menopause, she is estrogen deficient.  The doctor will then prescribe a synthetic estrogen to ease the menopausal symptoms.  It is absolutely untrue to assume that a post-menopausal woman is estrogen deficient.  Over two-thirds of women have adequate estrogen levels after menopause.  The issue is an imbalance of her hormones, not necessarily a deficiency.

There is technically no such thing as “estrogen.”  The word estrogen is used to describe the three main human estrogenic hormones.  These are estrone (E1), estradiol (E2), and estriol (E3).

Both men and women make estrogen in our stored fat.  Enzymes convert the hormone, androstenedione, into estrone.  Estrone can then be converted to either estradiol or estriol, whichever we need.  If you have a higher level of body fat, you are producing more estrogens than someone with a low level of body fat.

We’ll begin our estrogen discussion with estrone.  Estrone is the main estrogen in post-menopausal women.  I refer to it as “old lady estrogen.”  It comprises just 5% to 10% of all estrogen when balanced.  The ratio of estrone to estradiol and estriol is at its highest after a woman has gone through menopause.  The body converts estradiol to estrone and also produces estrone in fat cells, in the liver, and in the skin.

Women in the United States generally have an excess of estrone because of their high fat diet and lack of exercise.  Generally, only women who have had hysterectomies have a deficiency in estrone.  Excess estrone will cause estrogen dominance symptoms.  We will discuss estrogen dominance later.  You can reduce your estrone level with the supplement DIM (diindolylmethane), exercise, reducing saturated fats in the diet, losing weight, and lowering your alcohol consumption.

Estradiol is the most powerful estrogen hormone in the female body.  It makes up about 5% to 10% of the total estrogen but is twelve times as powerful as estrone and eighty times a powerful as estriol.  Estradiol is produced in the ovaries and is highest during a woman’s fertile years and drops at menopause.  This estrogen can be elevated for the same reasons as estrone and can be lowered using the same methods.

Estriol is a very weak estrogen.  Estriol comprises 85% to 90% of human estrogen and is the safest and most beneficial of the estrogens.  It is highest during pregnancy and is made from the conversion of estrone.  Studies show that estriol has a breast cancer protective effect by regulating the actions of estrone and estradiol.  Estriol cannot be converted into the other two, more powerful estrogens; estrone and estradiol.  Therefore, if you supplement with estriol, your body cannot convert it into estradiol or estrone.  Also, estriol should not be taken orally as it does not get absorbed and is broken down into harmful metabolites.

Estrogen dominance

The term “estrogen dominance” was first used by John R. Lee, M.D. in his book Natural Progesterone-The Multiple Roles of a Remarkable Hormone.  Estrogen dominance occurs when one or more of the estrogen hormones is out of balance with the other hormones.  This can occur because your body is producing too much estrogen, throwing the balance off, or your body is not producing enough progesterone and testosterone, again throwing off the balance.

It can also be caused by giving too much estrogen, being exposed to excessive xenoestrogens, a problem with your body’s elimination of estrogen, or not enough progesterone to regulate and balance the estrogens.  Estrogen dominant symptoms can even occur if you have low estrogen but not enough progesterone to balance its effects.

Xenoestrogens, in case you are wondering, are estrogen-like chemicals that are found virtually everywhere in our current society.  They get into the body and act like estrogen, but are not estrogens.  It is virtually impossible to avoid them with our current lifestyle.

Xenoestrogens are man-made products that have been introduced into our environment beginning about 70 years ago but their impact has only been studied since 1991.  They act as estrogens but do not have the beneficial effects of estrogen.  They also accumulate in the body and, over time, can cause symptoms of estrogen dominance.

The short list of estrogen dominance symptoms include:

Depression
A craving for sweets
Breast tenderness
Fatigue
Mood swings
Fluid retention
Headaches
Decreased libido
Weight gain
Poor sleep
Heavy menstruation
Irregular menstruation
Panic attacks

I know, I can hear your thoughts, ‘I have those.’  Don’t be alarmed.  With the fluctuation of female hormones, you can get brief episodes of estrogen dominance.  This does not necessarily mean you are totally estrogen dominant.  It means at certain times, you have too much estrogen and are feeling the over-dosing effects.

Estrogen is good

Let’s just make this simple and say that the right amount of estrogen is good for you.  But if I left it at that, you’d feel disappointed.

First and foremost, estrogen relieves the symptoms of menopause.  This is why women come to me every day complaining of menopausal symptoms.  The proper level of estrogens in the body lowers your risk of heart disease and improves your cholesterol.  Studies show that LDL or the “bad” cholesterol is lowered 10-20% and the HDL or “good” cholesterol is increased 10-20% with a return to proper estrogen levels.  It is interesting to note that the same cholesterol effects are seen with the synthetic estrogens.  Estrogens also lower blood pressure by decreasing the amount of calcium inside the cells of your blood vessels.  This causes them to relax and allows blood to flow more easily.

Estrogens prevent osteoporosis by reducing the amount of bone loss.  The hormone maintains or improves memory function by increasing certain brain chemicals like serotonin, norepinephrine, and dopamine and promotes the growth of nerve connections in the brain.  Estrogens act as antioxidants in the central nervous system and allow the brain to use glucose for energy more easily.

Estrogen is crucial in keeping healthy looking skin, mouth, and eyes.  It helps regulate the amount of water in the skin, builds collagen, increases skin thickness, and improves skin firmness and elasticity.  This regulation of your skin’s water content smoothes out those fine wrinkles that begin around age 40.

It also prevents vaginal atrophy by increasing the number of blood vessels.  This in turn thickens the lining of the vagina, decreases vaginal discharge, and increases elasticity and moisture.  The lining of the vagina has the highest number of estrogen receptors in the body.

Hormones do not belong in the stomach

 When you take a pill, that medication is carried to your liver where it is broken down and metabolized.  This process is known as the first-pass effect.  When developing oral medications, manufacturers must consider not only what the liver does to the medication but what the medication does to the liver.  Synthetic estrogens like Premarin® are swallowed in a tablet and must go through this first-pass metabolism.

The liver destroys approximately 90% of oral estrogen before it has the chance to enter the bloodstream and do its job.  Many assume that since only 10% is usable, only 10% is absorbed through the stomach.  This is not true.  The estrogen is fully absorbed but the liver only allows about 10% to return to the bloodstream.  The remaining 90% is altered into estrogen metabolites before returning to the bloodstream.  The effect that these metabolites have on the body is not fully understood.  When progesterone gets to the stomach, it is digested and goes to the liver where 90% to 95% is broken down into metabolites.  These metabolites are known to increase one’s chances of getting blood clots.

When our bodies secrete hormones, they go directly into the blood stream.  When applying a bio-identical hormone cream, the hormones are going directly into the blood stream.  They then flow to the heart and are pumped throughout the entire body; just like the ones we produce naturally.

Taking a pill to supplement your hormones bombards the liver with a highly concentrated dose.  On average, a 35-year old woman will produce 0.1mg to 0.2mg of estradiol per day, total.  The most popular dose of the conjugated estrogen drug, Premarin® is 0.625mg in one dose.  So the woman is receiving approximately three to six times the total daily production in one concentrated dose.  When this dose hits the liver, it alters its production of vital substances.  More clotting factors are released, C-reactive protein increases, sex-hormone binding globulin is changed, your thyroid globulin is altered, and many other adjustments in liver function are observed.

When using transdermal estrogens, there are no effects on the liver.  The absence of these effects has all been proven in clinical trials.

No hormones belong in the stomach.  All female hormones should be administered in a cream form, formulated specifically for her requirements.  The cream penetrates the skin, pulling the hormones along and entering the bloodstream.

Progesterone

Starting around the age of 35, most women’s hormone levels begin to change.  Beginning at this age and continuing through age 40 is the steepest decline is in progesterone.  This creates an estrogen dominant situation.  When a woman is having mood swings, depression, irregular periods, hot flashes, weight gain, sleep disturbance, heavy menstrual flow, and loss of libido, it’s time to balance out the progesterone.  Of course a test, preferably saliva, is required to determine just how much progesterone is needed.

Most practitioners in the medical field use the terms progesterone and progestin interchangeably.  Because of this, a portion of the population believes that taking hormone replacement therapy in the form of natural progesterone will have the same negative side effects that the synthetic progestins are infamous for.

Many doctors have been taught that progesterone affects only the uterus.  They are told that if a woman has had a hysterectomy, there is no need for progesterone.  It’s not their fault; the drug companies have been telling them that for years.  I was taught this in school and believed the doctor who told me this.  It was not until I educated myself on the subject that I realized how wrong this assumption is.

Progesterone is not medroxy-progesterone

Drug companies cannot patent progesterone and therefore cannot make money from it.  So they changed the structure to medroxyprogesterone, patented it, and turned a profit.  Medroxyprogesterone, a progestin, affects only the uterus and has a harmful affect on the body, unlike progesterone.

The synthetic medroxyprogesterone can actually block the action of progesterone in the body.  So, if you are taking medroxyprogesterone, your own progesterone that your body is producing may not be working.  Drugs and hormones are “captured” by cells at receptor sites.  Your receptor sites for progesterone are being taken up by medroxyprogesterone; your own hormones cannot work.  Your body will also “think” that there is plenty of progesterone in your blood and will not produce as much as is needed.

Also, by blocking these receptor sites, your risk of cancer goes up.  And there are side effects with synthetic medroxyprogesterone like acne, fluid retention, headache, breast tenderness, depression, blood clots, insomnia, anxiety, and more.  For natural progesterone, the side effects include…none.  That’s right, I’ve said it before and I’ll say it again; with bio-identical hormones, there are no side effects.  There are only under dosing effects and over dosing effects.  Before you get supplemental bio-identical hormones, you are experiencing under dosing effects.

Real progesterone

The progesterone in a woman’s body is produced by the corpus luteum of the ovary during ovulation as well as by the adrenal glands.  It is also manufactured in the body from cholesterol.  Cholesterol is converted to pregnenolone, which is then converted to progesterone.  Progesterone can then be made into the other hormones our bodies use like estrogen and testosterone.

Progesterone affects the entire body.  There are receptor sites all throughout your body waiting for progesterone to come floating by.  Your body also uses progesterone to make other hormones.  For example, your adrenal glands take progesterone and change it to adrenaline and noradrenalin.  These give us our “flight or fight” reactions.  Thousands of years ago when we were chased by a tiger, adrenalin kicked in and gave us that short, tremendous boost of energy to get away.  This is explained later in the section concerning stress.

From progesterone, your body also forms hormones that regulate blood pressure, inflammation, and glucose metabolism.  In the synthetic, medroxyprogesterone, there is no such conversion.  The chemistry cannot and does not happen.

One thing that has to be considered when discussing these conversions; some people do not convert at a proper rate.  In other words, some people’s bodies can make plenty of estrogen from progesterone, while others cannot.  So a woman who is experiencing estrogen deficiency symptoms may get no relief at all from supplemental progesterone.  Her body may lack the required amount of specific enzymes needed to convert the progesterone over.

Some doctors simply give their patients a prescription for bio-identical progesterone with the understanding that her body will produce the required sex hormones when needed.  That is not the answer.  The answer is to balance the progesterone with the estrogen and testosterone.  What if you are enzyme deficient?  You then return to the doctor with the same symptoms and are given a higher dose with the same result.  After a couple months, the patient gives up now believing that this bio-identical stuff doesn’t work.

So what does progesterone actually do?

Estrogens in the body cause the uterus and breast tissue to grow.  Progesterone counteracts this growth, “telling” the cells what to do.  Without it, you have an overgrowth of cells, possibly leading to cancer.  It also works on the nucleus, or “brain,” of the cell.  Progesterone maintains the proper balance of estrogen receptors on the nucleus of the cell and moderates the metabolism of estrogen.  When the female egg is fertilized, progesterone prepares the uterus for the implantation of this new life and prepares the breasts for lactation.

Progesterone is a natural diuretic that maintains the proper amount of water in the body.  Without the proper amount of progesterone, a woman will not urinate enough water and feel bloated.  It acts as a mild antidepressant by regulating certain chemicals in the brain.  Progesterone boosts the cells that produce new bone, therefore increasing bone density.  The hormone signals to breast cells to grow, reproduce, and die at the proper speed.  This regulation protects the breasts against cancer.  It is also vital in signaling your body to use fat as an energy source.

Your circulatory system relies heavily of progesterone for proper function.  We already know the estrogens protect the heart and blood vessels.  Progesterone increases this effect.  When there is an injury with bleeding, progesterone allows for normal blood clotting.  It also lowers LDL cholesterol and increases HDL cholesterol.  Progesterone regulates the thyroid, decreases uterine cramping, and increases libido.

I call progesterone the regulator.  Envision this hormone sitting in the background, telling everyone else what to do.  She’s kind of like the boss.  If one of the other hormones cannot do what they are supposed to do, she can change herself into that hormone and perform many functions.  She also helps and guides the other hormones, moderating the entire system and making sure you are functioning properly.  Like a business without a boss, without progesterone, there is chaos.

Another way to envision progesterone is to think of an old balance scale.  On one side, you have estrogen, on the other, testosterone.  Progesterone is the balance in the middle that can move right or left to keep that balance.  If there is too much estrogen at a certain time of the feminine cycle, progesterone can adjust the balance.  Too much testosterone results in the same balancing act.  Without the appropriate amount of progesterone in the body, this balancing act cannot occur properly.

The estrogen-progesterone combo

 These two go hand in hand.  By giving estrogen without progesterone, you will most likely lead to estrogen dominant symptoms.  By giving only progesterone when estrogen is low, you could end up with continued symptoms of low estrogen, symptoms of high estrogen, or a combination of the two.  The different effects depend on the individual woman and how her body is uniquely made.  It’s the story of the conversion of progesterone into different hormones.  If your body is lacking in certain enzymes, all the progesterone in the world is not going to help.

You shouldn’t use estrogen without progesterone.  These two need each other to balance your body.  At the cellular level, these two actually counteract each other.  Believe it or not, this is what we want.  Progesterone “tells” the cell to grab some estrogen.  But estrogen “tells” the cell to block excess estrogen.  So, too much progesterone causes your cells to grab too much estrogen.  There is not enough estrogen to stop this uptake and you get estrogen dominant symptoms.  It seems illogical to give estrogen to counteract estrogen dominant symptoms but this is what needs to be done in this scenario.  It has to do with balance, not your body’s level of hormones.

Once the supplemental estrogen counteracts the high progesterone, all is normal again.  But what if there is too much estrogen?  Too much and your cells grow too rapidly.  There is not enough progesterone to slow the process down.  This can lead to cancer if unchecked by progesterone.  You may also get, of course, estrogen dominance.

When the female body is given natural progesterone, she will convert a small portion to estradiol, an estrogen.  Therefore, using progesterone along with estrogen in a cream, allows for a lower dose of estrogen.

As a point of interest, breast cancer cells hoard large amount of estrone inside the tumor cells.  The estrone is then converted into estradiol and used to further grow more unregulated cancer cells.  Progesterone blocks this conversion of estrone to estradiol inside tumor cells limiting their growth rate.

PROGESTERONE                       VS                       ESTROGEN

limits endometrial growth                               stimulated endometrial growth
matures breast cells                                           stimulates breast cell growth
normalizes blood pressure                               increases blood pressure
removes excess fluid                                          retains fluid
normalizes blood clotting                                 increases blood clotting
resists cancer                                                       promotes cancer
strengthens immunity                                       weakens immunity
decreases inflammation                                    increases inflammation
decreases PMS symptoms                                increases PMS symptoms
slows aging                                                          quickens aging
protects the prostate in men                            stimulates prostate cell growth in men

As you can see, progesterone is very beneficial to our body.  Too much estrogen has some pretty serious effects on the body when not balanced by progesterone.

Testosterone

Testosterone is a significant hormone for both men and women but conventional doctors overlook the importance of keeping testosterone levels up.  Low testosterone causes issues like a decreased libido, loss of sexual satisfaction, infertility, poor concentration, lowered sense of well being, less stamina, decrease in muscle mass, increase in fat percentage, and diabetes.

Men generate 6 to 8 milligrams of testosterone daily while women produce about 0.3 milligrams.  Testosterone is produced in the testicles of men, in the ovaries of women, and in the adrenals of both sexes.  Yes ladies, you have testosterone.  When a woman gets in her middle thirties, the testosterone level begins to drop.  It is a slow decline but a decline none the less.  The decline in levels is gradual but the symptoms begin abruptly.  This is because the lowering of the testosterone throws off the balance of hormones.

The decline in male testosterone begins around age 35 and is slow and gradual.  Women can have either a decrease or increase in testosterone at any age past puberty.  An abundance of testosterone in females can lead to conditions such as polycystic ovaries and excessive hair growth.

Getting supplemental testosterone

When supplemental testosterone is given to women who are low, the first noticeable effects are libido and sleep quality.  The improvement of these two features usually occurs after just one day of testosterone supplementation.

The benefits of testosterone to women are varied.  This hormone increases muscle tone and strength, increases lean body weight percentage, increases bone density, improves memory, and gives an overall sense of well-being.  Along with improving the quality of life, testosterone also protects the heart by relaxing blood vessels.  It increases the body’s response to insulin and maintains the healthy glow in the skin and hair.

Testosterone, like the other hormones, should not be taken orally.  It can be given sublingually, injected, in a cream, a female suppository, or in an implantable pellet.

Hormones are very powerful and only a skilled medical practitioner should be involved in the balancing of hormones.  Many patients want extra testosterone to enhance libido, increase well being, increase lean muscle tissue, etc.  This practice should be avoided.  In women, the extra testosterone can eventually lead to enhanced male characteristics like hair growth, a deepening of the voice, and shrinking breast tissue among other issues.

In men, bringing testosterone back to optimal levels will change a man’s life.  The best way for a man to regain his vitality is through testosterone injections.  The difference is dramatic.  An increase in muscle mass, a decrease in body fat, increased energy, increased competitive drive, and a remarkable raise in libido are just a few of the benefits a man will experience.  Be advised though, excessive long term testosterone can increase the estrogen levels due to aromatization leading to breast enlargement, prostate enlargement, and an increase in cancer risk.

Balancing of all hormones to the levels of a 30-35 year old is what we are after here.  This can only be done correctly through a little trial an error based upon each individual patient.  Everyone is different; everyone’s body reacts differently to the same dose of hormones.  It takes time and cooperation between patient and practitioner to get the levels properly balanced.

Why saliva for hormones?

Testing hormones in the blood is virtually useless, saliva must be used.  A blood test will measure your total hormone level.  While this sounds correct, 90% to 95% of our hormones are bound to proteins in our blood.  This means that they cannot pass through the blood vessels, get into the tissue, and perform their duties.  The protein bound hormones eventually make their way to the liver where they are destroyed.

The five to ten percent that are active make their way into tissues and cause the body to react to their signals.  One of the tissues that the hormones enter is the saliva.  By testing saliva at the correct, specific time, the laboratory can get an accurate measure of your overall hormones.  Getting blood drawn at a doctor’s office will give you varying hormone levels based on your female cycle as well as the time of day.

Saliva testing is done in the morning, shortly after arising.  This gives the lab an accurate level because the time that the specimen is taken is uniform.  When giving blood at a doctor’s office, the appointment could be at any time during the day.  Hormones fluctuate throughout the day and these results are not as accurate as a morning saliva sample.

Testosterone and prostate health

Many men and doctors are conditioned to think that a higher testosterone level can lead to an enlarged prostate and possibly prostate cancer.  This is absolutely, 100% untrue.  In fact, the opposite is true.  A men age, testosterone declines and the ratio of testosterone to estrogen now favors estrogen.  This “changing of the guard” corresponds almost exactly to the rise in prostate disease.  Younger men with a higher testosterone level do not have prostate issues.

Two factors are in play here with regard to prostate health.  When the body was just a group of stem cells, the same cell either becomes the prostate for men or the uterus for women.  Therefore, the prostate has a large percentage of estrogen receptors located on it.  As estrogen rises, the amount of estrogen entering the prostate increase causing cells to grow.  As the cells grow more and more, faster and faster, the prostate grows causing an enlarged prostate.  Also, a metabolite of testosterone, dihydrotestosterone (DHT) binds strongly to the prostate.  As men age, their body gets more and more proficient at converting testosterone to DHT.  DHT also causes an enlarged prostate.

There has yet to be a conclusive study showing that testosterone has any significant impact on the prostate.

Excessive testosterone

The term “roid rage” has been used to describe the irrational aggressive behavior demonstrated by men taking excessive amounts of synthetic testosterone.  This is a controversial subject as natural testosterone given in the correct doses has never been shown to cause aggression, or any other side effects for that matter.  Even when men were given large doses of natural testosterone in a controlled laboratory study, their level of aggressiveness did not increase.  Increases in aggression are occasionally seen when large doses of synthetic testosterone are given.  This is why it is important to use only natural testosterone in the right doses.

Balancing your hormones with the help of a trained professional is vital to age management.  Hormone fluctuations not only make you feel bad, but wreak havoc on your body.  The process of aging causes these hormone fluctuations.  By balancing the big three; estrogen, progesterone, and testosterone, you will hold on to your youth much longer.  The quality of your life will greatly improve once these levels have returned to the youthful levels.

Chapter 4. Getting to Know Your Hormones

Chapter 3. Real Age

Chapter 2. Achieving Your Optimal Health

Chapter 1. Your Introduction to Age Management