What is Estrogen Dominance?
The following article will discuss what estrogen dominance is, the role of estrogen in the male and female body, signs and symptoms of both low and high estrogen in men and women, sources of xenoestrogens (including phytoestrogens), and the importance of liver health in maintaining healthy sex-hormone levels.
The term estrogen dominance was first coined by Dr. John Lee, MD, to describe a condition of either high, normal, or low estrogen, but with low to no progesterone. Progesterone has a balancing effect on estrogen, where even when levels of estrogen are low, with no progesterone those low levels of estrogen can assert an effect of estrogen dominance.
Since first coining the term, estrogen dominance has reached the public lexicon and is now used to describe the condition—or symptoms of—high estrogen (usually high estradiol). Estrogen dominance can occur in men and women. Estrogen dominance is also referred to as hyperestrogenism. Today, use of the term denotes the prevalence of estrogen, not of progesterone.
The (Many) Roles of Estrogen In Men and Women
All men and women produce estrogen (as they do testosterone) throughout the lifespan, and maintaining healthy levels of estrogen are important for both groups. Research has shown that estrogen plays an important role in promoting and regulating—in women and men—skin, cholesterol, bone health, and brain health. In women, estrogen has a profound impact in sexual maturation, maintenance, and reproduction.
It is possible to highlight the importance of estrogen though looking at the symptoms of low levels of it in men and women.
Low levels of estrogen in women may produce the following symptoms:
- Dry skin;
- Emotional disturbances;
- Hot flashes;
- Insomnia / disturbed sleep;
- Irregular or cessation of menses;
- Low libido;
- Vaginal drying and thinning of the vaginal wall.
Low levels of estrogen in men may produce the following symptoms:
- Decreased bone strength;
- Emotional disturbances;
- Erectile dysfunction;
- Excess abdominal fat;
- Low libido.
High Estrogen (Estrogen Dominance)
Because of the wide prevalence of estrogenic compounds (xeno-estrogens) in the environment (including food), most people are more concerned with high levels of estrogen (not with low estrogen levels).
High levels of estrogen (estrogen dominance) also produce a wide array of symptoms—many similar to low levels. This not only supports the seemingly confusing nature of the endocrine system, but also emphasizes the importance of working with a practitioner in establishing the root cause of illness or complaint.
In women, high estrogen can result in:
- Depression and/or anxiety;
- Exacerbation of premenstrual syndrome (PMS);
- Fibrocystic breast (benign breast lumps);
- Increased weight gain, particularly in waist, hips, and thighs;
- Irregularity, including heavy or light bleeding, in the menses;
- Loss of sexual desire/low libido;
- Uterine fibroids (benign tumors).
In men, high estrogen can result in a similar array of complaints:
- Diabetes (Type 2);
- Emotional disturbances, including depression and/or anxiety;
- Enlarged breast (gynecomastia);
- Erectile dysfunction;
- Increased abdominal fat;
- Loss of fertility;
- Loss of muscle mass (sarcopenia);
- Loss of sexual desire/low libido;
- Lower urinary tract issues, as associated with benign prostatic hyperplasia (BPH).
Low Progesterone and Estrogen Dominance
Dr. Lee, MD, who first coined the term “estrogen dominance,” wrote that the following symptoms and conditions are associated with estrogen dominance:
- Acceleration of the aging process;
- Allergies, including asthma, hives, rashes, sinus congestion;
- Autoimmune disorders such as lupus erythematosus and thyroiditis, and possibly;
- Sjoegren's disease;
- Breast cancer;
- Breast tenderness;
- Cervical dysplasia;
- Cold hands and feet as a symptom of thyroid dysfunction;
- Copper excess;
- Decreased sex drive;
- Depression with anxiety or agitation;
- Dry eyes;
- Early onset of menstruation;
- Endometrial (uterine) cancer;
- Fat gain, especially around the abdomen, hips and thighs;
- Fibrocystic breasts;
- Foggy thinking;
- Gallbladder disease;
- Hair Loss;
- Increased blood clotting (increasing risk of strokes);
- Irregular menstrual periods;
- Magnesium deficiency;
- Memory loss;
- Mood swings;
- Polycystic ovaries;
- Premenopausal bone loss;
- Prostate cancer;
- Sluggish metabolism;
- Thyroid dysfunction mimicking hypothyroidism;
- Uterine cancer;
- Uterine fibroids;
- Water retention, bloating;
- Zinc deficiency.
It is important to note that Dr Lee was describing a condition of estrogen dominance marked not for the levels of estrogen present, but for the absence (or the scarcity) of progesterone—a hormone present in men and women ( source).
By definition, the preface xeno dictates something “ relating to a foreigner or foreigners ,” or simply the “other.” The preface derives from the Greek xenos, “stranger” or “foreigner.”
The word xenoestrogen is used to refer to a group of chemicals (either synthetic or naturally occurring) which exert estrogenic effects—they imitate estrogen. Xenoestrogen is part of a larger group of xenohormones. Xenohormones are also referred to as endocrine-disrupting chemicals (EDCs).
Endogenous and Exogenous Estrogen
In biology, the terms endogenous and exogenous are used to define whether a compound is produced within the body or outside of the body. Here, endogenous means that something occurs from within the body and exogenous from outside of the body.
The terms xenoestrogen and exogenous estrogen can be used interchangeably (synonymously) to reference any outside chemical that has an estrogenic effect within the body. For instance, the popular plastics containing PCBs, BPA, and phthalates are all xenoestrogens. Similarly, the phyto-estrogens present in soy or hops are also xenoestrogens.
There is growing concern over the impact that xenoestrogens have on both human health and on environmental health. The highly respected Endocrine Society states that the prevalence of xenoestrogens pose a serious environmental hazard due to their endocrine disruptive effects in humans and wildlife. In the journal Endocrinology (Oxford Press), researchers state that exposure to endocrine-disrupting chemicals can result in (but are not limited to) the following.
Increased prevalence of cryptorchidism and hypospadias; testicular, breast, and prostate cancer; endometriosis; polycystic ovarian syndrome; and declines in semen quality…developmental abnormalities of the male reproductive tract, leading to the proposal of the testicular dysgenesis syndrome.
In wildlife, the researchers go on to state that it is widely accepted that exposure to EDCs cause the feminization of fish—that is, male fish becoming female fish.
Common Sources of Synthetic Xenoestrogens
Researchers at Balanced Concepts compiled the following list of common exposures to xenoestrogen:
- Organochlorines. These are a primary source of xeno-estrogen, and care used in pesticides, dry cleaning chemicals, bleach, and the production of plastics. Choose organic foods to avoid exposure to pesticides in the diet.
- BPA (Bisphenol-A). BPA is produced when polycarbonate is broken down. Polycarbonate is present in many food containers, including plastic bottles, the lining of canned foods, beverage containers, and soda and beer cans. Heat causes a rapid breakdown of polycarbonate and the subsequent production of BPA.
- Animal products (meat, dairy, and eggs). These can accumulate xenoestrogens used in their production.
- Butylated hydroxyanisole (BHS). A food preservative that is also a xenoestrogen.
- Body care products can contain the following xenoestrogens: stearal konium chloride, phthalates, parabens, phenoxyethanol, and benzophenone-3, homosalate, 4-methyl-benzylidene camphor, octyl-methoxycinnamate, octyl-dimethyl-PABA (found in sunscreens).
- Detergents, fabric softeners, and dryer sheets may be manufactured from petrochemicals, a potential source of xenoestrogens.
Common Sources of Xenoestrogen (Phytoestrogens) in the Diet
In the diet, xenoestrogens (present as phyto-estrogen) can be found in the following foods, herbs, and beverages ( source):
- Barley (present in almost all beer);
- Flax seeds;
- Hops (present in almost all beer);
- Red clover;
- Sesame seed;
- Soy (soymilk, tofu, soy infant formula, et cetera);
- Wheat germ;
It is important to highlight that phyto-estrogens do not always work in a similar way as synthetic xenoestrogens do in the body, where some estrogens from foods are agonist of the estrogen receptors, some neutral, and yet others are estrogen receptor antagonists.
Agonists are substances that fully activate the receptor it binds to, while antagonists bind to the receptor but do not activate it—effectively shutting the door to that receptor so that it is not activated. So while a food may have phyto-estrogens present within it, not all phyto-estrogens produce an estrogen-like effect in the body.
Liver Health and Estrogen Dominance
The liver is the main organ responsible for detoxification—including excess hormones. The liver filters blood for these hormones and excretes them into the colon, where they pass through during elimination (the kidneys similarly filter blood for excretion in the urine, but sex-hormones are filtered in the liver).
With liver disease, whether caused by a pathogen (such as Hepatitis C), through alcohol abuse, or through diet (non-alcoholic fatty liver disease), normal cells are replaced with fat cells and scar tissue. Over time, enough normal cells are replaced that the functioning of the liver is diminished. Left untreated, liver disease can result in death.
As the filtering capacity of the liver is impaired, excesses of hormones—including estrogen—can arise. Like a dam, they are unable to pass through to the colon for elimination because of the impaired health of the liver.
The prevalence of non-alcoholic fatty liver disease in the US is astounding. This is liver disease as the result of diet—not alcohol or pathogens. It is estimated that between 12 and 25% of all adults have non-alcoholic fatty liver disease (but some estimate much higher rates due to the difficulties in testing for the disease). Left untreated, the disease will progress into NASH (Non-alcoholic steatohepatitis) and eventually cirrhosis.
Elevated levels of estradiol have been found in biopsies of fatty-livers, indicating the rise in estrogen from the disease ( source). Furthermore, other research has shown the co-occurrence of "hypogonadism, hypothyroidism, [and] GH deficiency” (source) with non-alcoholic fatty liver disease. This shows both how a diseased liver can both elevate estradiol (estrogen) levels and cause lowered testosterone production (hypogonadism).
In writing about estrogen (specifically estradiol), it quickly becomes evident just how important healthy ranges of hormones are. Simply speaking of high or low does a disservice both in the understanding of the biology behind a symptom or complaint, but it does a disservice to those figuring out the sources of their symptoms and/or complaints.
Low estrogen and high estrogen can mimic each other in symptoms. While the environment is increasingly becoming exposed to synthetic xenoestrogens, still low estrogen does occur—a blood test is needed to correctly identify.
Phytoestrogens are present in many of the foods commonly consumed. But simply cutting out all phytoestrogen containing foods is not the answer. As explained above, phytoestrogens can present as agonists and antagonists, where antagonists actually block estrogen receptors from becoming activated—great for those suffering high estrogen and seeking to detoxify estrogen from the body. Antagonists help keep estrogen circulating in the blood, where it can become bound to sex-hormone binding globulin (SHBG), and eventually eliminated through the liver and colon.
Conservative estimates state that between 12 and 25 percent of American adults have non-alcoholic fatty liver disease. This disease, caused by diet and effectively treated if caught early on, can result in elevated estrogen (estradiol) levels due to the impaired functioning of it, and it can result in hypogonadism (low testosterone production).
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- Characterization of Estrogen and Androgen Activity of Food;
- Hypogonadism (Low Testosterone) In Men;
- Symptoms of High Estrogen in Men;
- Estrogen (Healthywomen.org;
- Estrogen (Hormone.org);
- Estrogen Dominance: Elevated Estradiol to Progesterone Ratio;
- Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement;
- High estrogen in men after injectable testosterone therapy: the low T experience.