The common misperception promulgated by the mainstream media, big pharma and organized medicine is that estrogen will cause heart attacks, strokes, and cancer. The data clearly shows that that is hyperbole and only applies to the synthetic version of estrogen called Premarin which is derived from horse urine. It contains ten equine versions of estrogen that do not occur in the human body. I do not find it surprising that those compounds would cause problems in humans.
There are three forms of estrogen that God designed for humans (yes that includes females and males): estrone, estriol and estradiol. Estradiol is the form most people associate with treating the symptoms of menopause in women. Estradiol has been shown to be effective in treating the symptoms of menopause, which include hot flashes, anxiety, insomnia, vaginal dryness, brain fog and bladder issues. The data also shows that estradiol is effective at improving the health and well-being of women. It reduces the risk of heart disease, strokes, Alzheimer’s disease and other memory issues, and breast cancer.
Estriol is a weaker form of estrogen that has more specific effects on the bladder issues and vaginal atrophy seen during menopause, when the natural production of all sources of estrogen plummet. Estriol does not exhibit the same beneficial effects on the heart or brain as seen with estradiol.
Estrone is a form of estrogen produced during the production and breakdown of estrogen as it is an intermediary form. It also has a more inflammatory effect and plays a role in the symptoms of estrogen dominance. It is also much weaker than estradiol.
Estrogen Dominance occurs in women when estrogen is higher than progesterone (see last week’s article for the scoop on natural progesterone). This occurs at the time of women’s menstrual cycles as the progesterone drops to initial the sloughing of the uterine lining and is responsible for all of the adverse symptoms during the cycle. The levels of progesterone rise after the cycle and the symptoms abate under normal progesterone levels.
Unfortunately, when women enter perimenopause (also known as the Valley of the Shadow of Death), progesterone and testosterone levels drop. The problem with estrogen production during perimenopause is that one day the production may be 30 to 50 times higher than normal and the very next day it is barely measurable. Replacement of progesterone and testosterone during perimenopause helps to alleviate some of the issues associated with these wild fluctuations in estrogen production. Tragically, perimenopause may last up to 5-10 years in some women. Estrogen replacement cannot begin in earnest until the ovaries are retired.
Estrogen may be given by multiple routes, including oral tablets or capsules, sublingual or vaginal troches (dissolving tablets), topical gel or patches and creams, or by pellets or injections. The advantage to injections (given every 1-4 weeks) or pellets (implanted in your buttocks every 4-6 months) is convenience as the other choices require more frequent treatment, usually daily or twice a day. The natural topical, oral, or vaginal therapies may either be compounded at a compounding pharmacy or generic formulations produced by generic manufacturers. The compounded versions are usually sourced with countries other than China. The largest supplier of generic drugs in the world is China and I cannot trust the CCP, so I prefer the compounding pharmacies.
The process of estrogen replacement begins with interviewing the patient and then obtaining a medical history, social history, family history and their current symptoms. Risks and benefits as well as alternatives to treatment are then discussed. Bloodwork is obtained and sent to the lab for baseline levels to establish which therapies might be indicated. Therapies are discussed and if treatment is appropriate for the patient, it is initiated. Follow-up labs and visits are usually scheduled in 6-8 weeks to evaluate the therapy. It is especially important for women to continue their monitoring for breast cancer and cervical/uterine cancer while they are using natural hormone therapy.
The accepted perception by most people as well as some doctors is that estrogen is the female hormone and for women only. This is not true. The male brain and heart respond to estrogen the same as women. It reduces the risk of heart disease, stroke, and Alzheimer’s disease the same as women.
The best evidence of this is how estrogen plays a role in prostate cancer. This explanation involves a short diversion into testosterone therapy. Prostate cancer in men has been thought to be worsened by testosterone for many years. The evidence proves that the prostate gland has a certain number of receptors for testosterone and that all of those are fully stimulated at an incredibly low level. This means it does not matter if the level is extremely high because the maximal effect of testosterone on the prostate occurs at the low level. What this means is if you want to prevent any effect of testosterone on the prostate you would need to stop all testosterone production. When you castrate males to stop the effects of testosterone it causes profound symptoms similar to menopause symptoms in women. This is called andropause and the symptoms are depression, anxiety, impotence, increased risks of heart disease and strokes. Castrated males also do not have any significant source of estrogen because the main source is from conversion of testosterone to estradiol. When you castrate males with metastatic prostate cancer, it slows the cancer but does not stop it.
A revealing study was conducted to look at treatment of metastatic prostate cancer in castrated males. The first group was castrated and given a placebo. The second group was castrated and given oral estradiol. The first group had the expected response with the symptoms of andropause and low quality of life as well as slowing of the cancer progression. The second group had total resolution of the symptoms of andropause, including resolution of impotence and lowering of the risk of heart disease, stroke, and Alzheimer’s disease. The prostate cancer did not slow, it regressed in the presence of estrogen treatment. This shows that the bulk of the benefit in treating males is from the concomitant rise in estradiol. The difference is men also need a higher testosterone level than women. If males have a satisfactory level of testosterone but not a good estradiol level, they are candidates for estradiol supplementation and they will not feminize. If males only have high estradiol levels with low or no testosterone, they will feminize.
Quite a few male patients come to me on estrogen-blocking agents that other doctors have prescribed. I do not agree with that as it is canceling out the benefits of estrogen. It is obvious to me that estrogen is vital to men and women, with the difference being the level of testosterone needed. Men and women were created by God and although we differ in some respects, we are still created in His image. I know replacing the same hormones that God designed as they decrease will improve our time here on earth.
Edited by Ann Jayne
– David Jayne M.D.