Brittany:

Hello, good afternoon Thrive Lab. This is Brittany, Nurse Practitioner. We are going to be covering the causes of estrogen dominance. We're really gonna dive into all the things. I again have the lovely Katie Jo, Nurse Practitioner, senior provider as well here joining me. Absolute pleasure to kind of cover these areas, especially with how popular it is. We'll cover different medical conditions. Katie Jo, welcome. How's everything going on your end?

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Katie Jo, NP:

Oh, it's so good to be here. I want to point out that we're recording this in the summertime. So many of my clients today are saying, Katie Jo, I don't know if my hormones are changing or if it's because it's summertime and I'm hot. And that's one reason that we do want to reach out to someone like Thrive Lab. We have experts. I say experts, we have time underneath our belt that gives us a level of perspective that lets you know it might be your hormones or it might be the summer heat. So reaching out to providers at Thrivelab, we can help distinguish between the two and help you feel your best during the summertime and know maybe it's a hot flash or maybe it's because it's 107 degrees outside. So speaking of hot flashes, Brittany, I understand today we are talking about estrogen dominance. With that said, usually hot flashes are not necessarily related to dominance, but today we're gonna be focusing on the hormone estrogen and how it can affect women when it is overpowering our other hormones.

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Brittany:

Absolutely.

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Katie Jo, NP:

Go ahead.

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Brittany:

No, absolutely. I think that there's a lot of dominating effects with estrogen. I do like to kind of touch base on estrogen within itself. It's essential for women. There's receptors throughout the whole entire body. For estrogen, it plays over 400 different roles in our body. It has receptors in brain, bones, breasts, uterus, right? Muscles. And so it is a beautiful hormone, but with the dominating effect of it, it can cause... lots of symptoms and the goal is to review those with our patients and be sure that we can address that to make a better balance.

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Katie Jo, NP:

I love the way you describe that, creating a better balance. Because at certain times of a woman's cycle, and I say cycle to define that, that's from one bleed to another bleed, that full month cycle. We call that a lunar cycle. But there's also cycles, the seasons, summer, spring, fall, winter, where our cycles can change. And also cycles such as you're in your age of your life, where you're prime for reproduction for producing babies. And you might be on the other side of that where you are no longer in the baby reproduction mode and you'd rather sleep than think about making a baby. But we can change that for you if you'd like to get back into that prime vigor of baby fever. And estrogen is one of the hormones that actually causes the baby fever. I remember when I was younger and I had baby fever and I didn't know it was because of my estrogen but that's one of the hormones that makes you feel more flirtatious, more outgoing, more willing to try new things. And so with estrogen dominance, it actually is beneficial to have your estrogen dominating the first half of that monthly lunar cycle from when you menstruate until about midpoint of your cycle, which is normally where you ovulate. And ovulate is when the egg is released and we want estrogen to be dominant. That's what is a driving force for you to want to procreate, one of the driving forces, not the only one. So there's times that estrogen dominance is a beneficial thing. However, that term has been marketed and used in a way that we think that estrogen dominance is a bad thing. So at certain times in your life, for example, a patient said, Katie Jo, I had my labs checked and they're so excited to look at their labs. And they said, I checked them on day seven of my cycle. And I said, your estrogen should be dominant right now. It should be the most dominant hormone. If it's not, that's a clear sign of hormone deficiency. But we are expecting at certain times to be estrogen dominant. Another example I use, Brittany, is when I give the example when a young girl is starting to enter puberty, those changes. Well, estrogen is what causes the breast to grow and become full. So during perimenopause, if you notice your breasts are becoming deflated, I've had women tell me, it's gravity. Well, we are working with gravity, but it also can be a physical sign that your estrogen stores are being depleted. That's estrogen depletion, not dominance. But estrogen dominance in the first part of your life will be causing those breasts to grow, causing hips to widen, causing that baby fever to happen. And we say estrogen, that's actually an umbrella term. And so there's three primary types of estrogen in the body. There's estriol, which is what we check in the labs. You may see that when we assess labs. There's estrone. And there's, what's the last one, Brittany, help me out. Estriol, estone..

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Brittany:

So it's E3, I just say E3, but combination of E2 and E3, which really is the corporate of bias estrogen that we make for our formulary for those who are deficient in estrogen. But I say E3.

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Katie Jo, NP:

Thank you. You helped me spark. So it is 3 E3. So each of the estrogens in this umbrella family of estrone, they have the number in the name. So estrone, O-N-E, that's E1. Then we have estradiol, D-I, di is for two. I think of dice, there's two dice. And then we have estriol, and it has a T-R-I, triol, which would be three. So E1, E2, and E3. Those are all under the umbrella of estrogens. And so we know that 80% of the estrogen from the ovaries is estradiol, which is one reason why we assess that. 10% is the estriol, that's the E3, and the other 10% is the estrone. So when our females come to us and they say, 'Katie Jo, I think I'm having estrogen dominance.’ And women will use those terms because it's so prevalent in our culture that if you go and look at your symptoms online, it will diagnose you by Dr. Google and say that you have estrogen dominance. And so we know that the different types of estrogens that at different times in their life, they're more dominant. And that estrone, the E1, is the estrogen that is more likely associated with the development such as breast cancers. And you mentioned our bias, which is by estrogen, by bicycle, two wheels, two types of estrogen. And we use E2, the estriol, and then E3, the estriol. I said this correctly. And... those ones are actually known to be protective against cancers. So estrogen dominance, my whole point is that it's not always a bad thing. There's certain points of your life that you want to be estrogen dominant, but then we want to see if estrogen is overpowering. I give the example of going out on the dance floor for people that like to dance, maybe you like to tango. Well, you know there has to be a good lead and there has to be a good follow. And our hormone cascade in our body, the lead is often estrogen and then the follow, the partner, is progesterone. But if the lead is not directing the follow hormone very well, or if the follow hormone progesterone is not following the lead estrogen very well, that's when you have dancing partners that are stepping on each other's feet and you're no longer having fun on the dance floor. So I do have a question for you, Brittany. Speaking about estrogen dominance, I talked about estrogen dominance that would be a part of the normal life cycle. What are times that you see estrogen dominance where it's no longer normal? We might call that abnormal. I often say hormone dysregulation. So it's not regular anymore. What are times or examples that you might see estrogen dominance and hormone dysregulation?

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Brittany:

You know, it's interesting in a world where labs have such a voice, I get it with the clinical presentation of what my patients may appear as far as their medical history, their symptoms, and also sometimes appearance. So to explain what I'm meaning by that PCOS, Polycystic Ovarian Syndrome. A 24-year-old female who may have been diagnosed or be told before that she is obese, right? So she has excess adipose tissue throughout her body. Her face appears to be a little bit more swollen. That is common for PCOS. But then also she developed some black facial hair on her chin. That is estrogen dominance. And she says, Britney, I haven't had a cycle in seven months. I'm not sure what's going on, but I have a partner. I would like to get pregnant. So many flags are going off with that. That is not common for someone in their 20s to not have monthly cycles. The goal is to reverse that, which is happening with estrogen dominance. Or I have had a patient who says, I have my cycle monthly, but when I do have it, I have it for about 10 to 14 days. I will at times pass clots and they'll be the size of golf balls. And I'm actually anemic too. Well, I'm thinking fibroids, I'm thinking endometriosis, and I'm also concerned about fertility because with heavy long cycles that are presented that way, we are worried then about ovulation reproduction, especially when this patient is in their 20s. So those are the two major ones that come to mind. Labs again help kind of guide that even better, but with those big symptoms and clinical presentations, on what they're explaining their cycle to be, or even sometimes visually descriptive appearances of what they're seeing monthly for their cycles, or given their BMI with physical symptoms, like facial hair on the chin, things like that. That's kind of the clinical presentation of those two dominating effects of estrogen that are very, very popular.

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Katie Jo, NP:

Thank you so much for sharing those stories. And I've had clients as well, those heart wrenching stories where they're in their reproductive prime, their estrogen is dominant, but it's dominating to the point where they're having excess estrogen exposure and those heavy long periods. And so I do wanna distinguish with that because you can have high estrogen and also have normal progesterone. So progesterone, I mentioned that's the partner with our estrogen, that's the hormone that I call our relaxation hormone. It helps calm us down physiologically for women as estrogen during the first two weeks of a monthly cycle is increasing. Remember I said that's when you're more flirtatious. That's also when the lining of the uterus is thickening. So estrogen helps to build that lining and the lining is preparing for a possibly egg to come and be fertilized and implanted. Well, once ovulation occurs and that egg is released, then estrogen starts to take the backseat and then our progesterone starts to increase. And as progesterone increases, it starts to nourish that uterus lining. It starts to give it nourish it, help it, help it to be thickened, help it to be ready for that implantation of the egg. And for women who's had the polycystic ovarian syndrome, they might not be having that ovulation happen every month. That egg might not be releasing. And that egg release is what's signaling the progesterone to increase. It's telling our brain, okay, it's time to produce estrogen. So if that's not occurring monthly, you're gonna have excessive estrogen exposure. And so for some of my female clients, you may have high estrogen and normal progesterone. I often see that in women who are experiencing obesity. And I don't like to use that term because it's not always obese by the terms of what media says it is. But if you have excess fat cells, if you look at your midsection, not you Brittany, because you're pregnant, don't look at your midsection, you're growing a baby. But if you look at your midsection and you have belly fat that you don't want there, that's usually a clear sign of hormone dysregulation. If you look back, you know, 50 years, 60 years, 70 years, our ancestors didn't have belly fat like we do nowadays. And there's a whole cascade of reasons that might be happening, which can be some of the factors that impact estrogen dominance, such as outside sources of estrogens. We call those xenoestrogens. Xeno is from the Greek and that means foreign. So foreign estrogens, well, what are things that cause foreign estrogens? They can be in our food, such as plastics that enter food from food containers. Also certain foods are higher in estrogen. Think about soy. That's one of the common sources. So if someone's estrogen dominant, maybe avoiding soy, no soy milk, no tofu. And then also, unfortunately ladies, a lot of the beauty products. So wearing makeup, if it's not good quality, some of those products have chemicals in them that can be cause these xenoestrogens. So being very mindful of sources of estrogens. Now some people will say, hey Joe, what does it matter the lipstick I put on if it has a xenoestrogen? Well, our health is like a bucket. And every little drop, we're either adding something good, like water, or we're adding trash. And over time, that bucket's eventually going to fill up and then spill over. For some people, it might be when you're 24 and you're diagnosed with polycystic ovarian syndrome and you're trying to get pregnant. For other people, it might not be till later on in life when you're in your 50s and 60s. Our goal is to help you thrive so those challenges don't happen and we can cut them off beforehand.

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Brittany:

Absolutely.

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Katie Jo, NP:

So that could be one reason that you might be estrogen dominant is from the xenoestrogens in our environment. Go ahead, Brittany.

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Brittany:

No, I think that's a great point, Katie Jo, because if we think about the detoxification process of what our liver does to help metabolize those things, it's not horrible to ingest them, right? We're human, we are an environment where there are plastics and all these things, but it's also a way to be aware. But then what about your liver process? What about your detoxification process? as this builds up and you have this poor metabolism or poor detox process with your liver, it only gets worse. So then it becomes, well, what can I do to help rid this in my body? And there's a lot of great foods and things that you can do to help rid that excess as well, if it is digested in excess or even having those baseline issues with estrogen dominance like PCOS.

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Katie Jo, NP:

I love that you brought up the liver because one of my mantras, this is from Dr. Justin Lustig. He wrote the book, Metabolical, and he said, one of the first things is to always protect the liver. Protecting the liver is huge for our estrogen metabolism. Our liver is responsible for our metabolism of our estrogen. There's two phases. There's the first phase of liver detoxification called hydroxylation. And there's a second phase which is called conjugation. I think of conjugation as being brought together. I think of the hydroxylation as when it's breaking it apart to break it down. And so the liver has to have these two steps and it does this with all our hormones, but for women, especially our estrogen, because it's our most dominant hormone out of all of the hormones. And so if our livers are sluggish, if we have maybe consumed a little bit more alcohol than we should over the course of our life, we need to help detoxify those livers so our estrogen can metabolize more. And that is a very important aspect of bioidentical hormone replacement therapy. We are not going to slather with hormones and say, okay, here you go, here's your hormones. No, we wanna make sure that things like your liver are working well, because if you're adding bioidentical hormones such as estrogen and your liver is sluggish and you have a buildup of old estrogen in your liver that's not being taken out, then you could have signs of estrogen dominance that aren't treated properly. And we often see that when I have clients come, maybe they had, and I'm saying this with all love and respect, but maybe they had a pellet inserted and they had a pellet and had testosterone and estrogen. It sounds so great. Let's have this pellet inserted once every three months and I'll have all the hormones I need. Well, what happens is you have this buildup of estrogen. And if your liver is not detoxifying properly, then you're not gonna have your symptoms resolved. So that can be what we call an iatrogenic, which means we, as your healthcare provider, actually cause the healthcare issue for you. So being very mindful of protecting the liver when you're using hormone replacement therapy. 

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Brittany:

Absolutely.

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Katie Jo, NP:

Another source of estrogen I wanted to speak about, and Brittany, I know that part of your background is in weight management for individuals, is weight and fat cells. Can you speak a little bit about how our fat cells could contribute to an unhealthy estrogen dominance?

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Brittany:

Absolutely. So if I am seeing a patient who is in menopause who has not had a cycle in over a year, but her BMI, which is body mass index is ideally greater than 28, which shows to be overweight. They have more adipose tissue or adipose excess. And so estrogen, although it is a beautiful hormone, it is stored. It is stored there for several years. So even though women are not having these cycles and they go, I'm in menopause, Brittany. I was told I need estrogen, and I was taking this pellet of estrogen, all the things, but I'm having hot flashes and night sweats with this estrogen. It's already because she's having more than what she needs. And so on a weight loss perspective, when it comes to even the opposite, patients who have had gastric bypass, which is really kind of rerouting the intestines to keep your stomach as big as almost a tablespoon. And what happens with them is they're rapidly losing weight and they start to have this heavy, long bleeding for weeks and weeks and weeks. And they are told, you know what, let's go ahead and do a uterine ablation or let's do a partial hysterectomy. These are women in their twenties. Time out. This is all the excess estrogen shedding from the adipose tissue because of the rapid weight loss. So all the clinical presentations are different, but when it comes to the adipose tissue and their storage there, we wanna be mindful of past medical history and diagnoses because we can't just say, you haven't had your period or you've been bleeding forever, hysterectomy, or oh, you have a little bit of excess weight. Well, yeah, you haven't had a period, let's give you estrogen. So there's an overall treatment approach for each patient individually, but Katie Jo, to answer your question, when it comes to excess adipose tissue or excess fat, which is not a pleasant term to the ears, but just excess weight, estrogen can be stored there. And so we have to be mindful of that when it comes to our treatment approach, absolutely.

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Katie Jo, NP:

And that is one of the big drivers of seeking healthcare. It's pain or vanity. And when you have excess fat, you often are in pain. Your joints are aching. You maybe don't wanna go out with your family and interact with your community because you don't like the way you look. It's a psychological pain. It can be a physical pain. And we know that fat cells, when they have the estrogen stored in them, they also work as their own endocrine gland. So many people are familiar with the pancreas because that's what produces insulin. Many people know insulin, but our fat cells actually act like an endocrine gland. And when there's an excess amount, they produce an inflammatory protein. We call that a cytokine. And some people may be familiar with cytokines because that word was introduced in popularity during the height of the pandemic. But essentially those fat cells then end up giving off inflammatory markers. So you do feel inflamed. And one thing that I see in my female clients, if they are having estrogen dominance related to relative fat is that you may notice changes in your blood vessels. So a new onset where you're noticing, wow, my cheeks are more rosy. Maybe I'm more sense sensitive or maybe you have a workup for lupus. You're concerned that it's an autoimmune condition because lupus can often cause what's called a butterfly rash where you have a rash on your face or maybe you're noticing the changes in other parts of your body such as you're starting to have spider veins on your legs. Well, those can all be related to the hormone estrogen. And we know when estrogen is in the right place, not stored in excess fat cells, that it actually can help your blood vessels, your veins and arteries to be soft and supple, and then also to prevent that deterioration of the veins, which you might see in the skin. So that skin assessment is huge. And we meet by telehealth, but I will tell you, I am looking at your skin through the camera and checking to see if I notice any changes in your skin that could be related to estrogen dominance. So we were speaking about in this situation with the excess adipose tissue, you could have high levels of estrogen and your progesterone could still be normal. And I call this a relative estrogen dominance. So the estrogen is relatively dominant compared to your progesterone. When we're looking in your blood work, I often like this to be a 10 to 1 or 21 to 1 ratio. And that's a good wiggle room. If you're in that range, it's a good balance. But if it starts to get too high, estrogen dominance, too low progesterone dominance. However, if you're looking at the saliva, we don't offer much saliva testing, but some of my clients will come in and they say, Katie Jo, I have a needle phobia, I checked my saliva. We usually see that ratio 200 or 300 to one in the saliva for the estrogen progesterone ratio. So looking at those two hormones as they scuttle across the dance floor together. Now, when

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Brittany:

It's interesting.

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Katie Jo, NP:

you’re a- Go ahead, Brittany.

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Brittany:

No, it's interesting because labs, I mean, you have saliva, you have blood, you have those different things, but there's clinically no gold standard rule on which test trumps the other, right? So it's interesting from a clinical diagnostics side of things on, we have saliva, we have the blood, all those things, but there's no perfect gold standard on which one's the most or best accurate. Ideally, serum is based around that time of the month. but there's so many different tests that they're all helpful, but sometimes they all can kind of reflect differently.

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Katie Jo, NP:

That's correct. And what's the most accurate? What tells me what's happening in the DNA of your cells is how you feel. So when you come back to me and say, Katie Jo, I've lost five pounds. Wow. Katie Jo, my mood's better. I'm not as grumpy anymore. Katie Jo, I'm not bloated. I can put my wedding ring back on now. Well, those are all signs that your estrogen dominance is decreasing. One of the other characteristics of estrogen is it actually helps us to retain water and salt. And that can be beneficial during that part of your reproductive cycle where your body's priming to make a baby, you wanna have more water on board or 70% water. And many of us are chronically dehydrated. And then when estrogen dominance, estrogen, or I'm sorry, when progesterone starts to dominate the second half of the cycle, that's when we start to lose some of that water weight. Progesterone is a natural diuretic, and so we see some urination happening. Some people notice an increase in urination. Other people might not be aware of that as a part of the balancing of your hormones. I wanted to ask you about Brittany. So we talked about this relative estrogen dominance. We have a normal progesterone, a high estrogen, often related to xenoestrogens and excess body fat. What about in the menopause, when we check a woman's lab or even symptom wise, they say, 'Katie Jo, I'm having hot flashes. My vagina feels like the Sahara Desert and I can't find my keys to save my life.' But we check their labs and we see both their estrogen is low and the progesterone is low. Can you tell me more about the science behind that?

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Brittany:

I mean, ideally, clinically, if they're in menopause and based off body weight and things like that, estrogen deficiency does look like, I mean, that's one of the tell tale signs for me is vaginal dryness. You know, estrogen helps to lubricate the vaginal area. And so if I'm having a Sahara Desert comment made about the vaginal area and brain fog, that is all due to estrogen deficiency. And given menopause age, clinically, if she's, you know, healthy and there's not a lot of comorbidities, I would approach that as a menopausal state, but it's also different on when the last menstrual was and kind of how her BMI is and what other symptoms are correlated with that. But I would say that both of those, I mean, labs look low, that we would wanna approach it with that and symptoms to have our treatment be addressed.

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Katie Jo, NP:

And I will say with some of our female clients, when they're in that menopause state and both of the hormones are low, they're both below the bar of normal, but your estrogen might still be higher compared to your progesterone. And those situations we normally see signs of what you mentioned would be the estrogen deficiency. The last situation which is not very common and I'm so thankful I have not seen this in clinical practice is when a woman has high estrogen and high progesterone at the same time. This is not very common and this is usually related to a tumorous cell. It's called a granulosa and this excretes a lot of hormones. It sometimes can be in breast cancer situations so there's an excessive amount of hormones at both progesterone and estrogen. And lab-wise, we could look for that. Some of us would check prolactin to see if that was a causative factor because that can tell us about some tumor growth. It's very rare. I don't see it often, but that's why you need to have a skilled practitioner to be able to assess that. And that's one of our goals in Thrivelab is we have a whole host of practitioners that are trained in bioidentical hormone replacement therapy. And that's one of our distinctions. With all love and respect, we have such a huge array of specialties in medicine. And when our clients have found Thrivelab, and I've said this in other podcasts, they've gone to their general practice, they've gone to their OBGYN, and they're crawling to our door saying, I haven't been able to find the answers. And so coming to Thrivelab, we can help dig in deeper as we're demonstrating today on some of the answers of what you might be feeling and why. And the diagnostic tools, I've had so many of my clients tell me, Katie Jo, I was told I was normal and you were able to compare my estrogen and progesterone and tell me, actually you're not normal, you're estrogen dominant. This is not a normal ratio. So that's huge for the outcomes of our patients. One of the other hormones that we didn't speak about because we're focusing on estrogen dominance is testosterone. And testosterone is one of my favorite hormones. Can you tell me more Brittany about how testosterone may impact with a situation with estrogen dominance, how are these two hormones interconnected?

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Brittany:

You know, when I talk to my patients, I kind of have a see-saw demonstration. Estrogen and testosterone are siblings. They really work hand in hand together, and they're both energizer hormones. So if I'm treating with estrogen, ideally it can convert into testosterone, it goes hand in hand. So it's very important to be mindful of the dosing of those because they work together. If we go back to our patient with PCOS, Ideally high estrogen and testosterone. That's why we have the facial hair and the acne and just kind of more of a higher weight as well because of those two. But when you have estrogen dominance, ideally sometimes clinically, they will have higher testosterone as well, depending on the diagnosis. Younger patients in their 20s, they ideally have both of those high but estrogen and testosterone go hand in hand. They are siblings and they are energizers. They are phenomenal for the body, but in excess it can really be an issue because it's really then on the other side of that seesaw, you have progesterone, right? And so then progesterone you ideally will see a deficiency or an imbalance and that can really cause high estrogen symptoms, which we want to avoid at all costs.

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Katie Jo, NP:

Except during the first half of your cycle when you want to be flirtatious and sexy and make a baby.

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Brittany:

Exactly. Right. That is exactly right.

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Katie Jo, NP:

I'm so glad that you brought up the polycystic ovarian syndrome again because that is one of the situations and I will give a shout out to Dr. Mark Hyman. If any of you follow him, he's a functional medicine doctor who's very popular. He actually wrote the foreword to our book to our chief scientist Dr. Nayan Patel. He has a book called The Glutathione Revolution and Dr. Hyman wrote his forward note. So I do recommend that book for liver support. Glutathione is one of the major oxidative antioxidants for the liver, speaking back to the phase one and phase two liver detoxification. But going back to the testosterone and PCOS, in this article by Dr. Hyman, he was speaking about how when a woman's experiencing PCOS, one of the first symptoms is actually insulin resistance. So you have high levels of insulin. Insulin, we don't want it to be hanging out in the bloodstream. We want it to shuttle the nutrients in the bloodstream and then to dissolve. But when it's there for a long period of time, it actually ends up bathing our ovaries in insulin. So our ovaries are in an insulin bath and the ovaries are saying, this is not fun. This is not a fun bath. Maybe it's tepid and the water's dirty. And what happens when the ovaries are bathed in this insulin for a long period of time, then you start producing high levels of testosterone. So there's a masculinizing effect. You mentioned the hair growth in the chin, but for some women it may be acne on your face. You can start having thin hair. It affects your self-esteem. And you may, ironically, I see many women that are having these high masculine symptoms also will have their libido in the toilet. So you're more masculine, but you don't get the benefit of having a high libido, which is often associated with males, your libido's in the toilet. And so with these high testosterone levels, your body actually makes your estrogen based on the amount of testosterone you have. And so that's why with our male clients, when we are replacing with testosterone replacement therapy, we are mindful that your body's gonna convert that testosterone to estrogen. We wanna make sure that's happening at a balanced level because if you're a man and your estrogen becomes too high, that's not beneficial, it becomes more feminizing. But for our female clients with PCOS, that high estrogen then can cause what you mentioned, those long cycles where you're bleeding for two weeks at a time, you're becoming anemic, you're fatigued, you can't go to work like you used to, you can't think clearly because you have low oxygen from all the blood loss. So in bioidentical hormone replacement therapy, there's so many interconnected pieces with all the body systems. It's not just the ovaries, it's not just the uterus, it's all interconnected. So I wanted to bring that part about testosterone because there's a huge connection there. And if you are testosterone dominant, if you're a woman who's having excessive acne, if you're having that chin, having fertility issues, we're not a fertility specialist, that's who you would best be served by. But we do wanna know that we are holding you in our hearts and we know that hormone replacement therapy later on down the road may be a good benefit for you. So we spoke about- go ahead.

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Brittany:

And you know, speaking on the point of having the dominating effects of testosterone, there are two medications that come to mind like PCOS. Ideally with PCOS, you will have your primary care provider possibly prescribe Metformin. Metformin is a first line medication that can help with weight loss clinically because it increases Lipton, which makes you feel fuller longer and it is an approach for medical weight loss. But on the treatment of PCOS, they will give it to patients at first line for insulin resistance. What's one of the side effects that can happen with Metformin? Decreasing your testosterone. So patients' libido will be plummeted. On top of that, Metformin decreases your vitamin B12 level. We test for that. We don't want your B12 level to be deficient. So those two things are actually kind of causing two other issues that could possibly go on. Or even clinically if I have a patient who has cystic acne, my dermatologist put me on Spironolactone. Wonderful, but that completely inhibits you to be able to have normal testosterone levels. And so they find that their libido is completely zero. So it's kind of like you said, Katie Jo, it's very important to kind of review all of the overall same clinical pictures on what their primary care is also doing as well and working alongside them, just because the medications that are prescribed may be helping for certain things, but it's also taking away with vitamins and hormones as well.

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Katie Jo, NP:

So beautifully said, Brittany. I wanna add on as a hormone specialist, I am a member and a mentor. I have sampled almost all of our hormones, tried them because I wanna know what my patients feel. And I also reap some of the benefits of hormone replacement therapy. And so when you were speaking about the Metformin, it made me remember the podcast that you and Dr. Bimisa did on weight loss. And I watched those because I'm a member of hormone replacement therapy. I wanna hear what the experts are saying. And on that video, you talked about Berberine. And Berberine is often used for weight loss. And Berberine is considered to be the herbal alternative to Metformin. And so I'll often use that for my clients if they're showing signs of insulin resistance. Let's add some Berberine. It can help with weight loss. It can help with insulin resistance. And actually an added benefit of it is it also helps with your microbiome. If there's any type of, not any, but specific types of bacteria that could be in balance, it can help balance your microbiome. And so Berberine is a great Metformin alternative. And then you don't have that side effect. I'm almost 99% sure you wouldn't have the side effect of the high androgens that you have when you use Spironolactone. So Spironolactone, which many of our viewers may be familiar with because they've been using it for the cystic acne, actually blocks the receptors. So your testosterone levels might show up as normal or high, but the cells can't get that testosterone because it's blocking those receptors. And so it creates this symptom of the low testosterone. And so the cells then no longer produce the acne, which is associated with a higher testosterone. Medicine is so interesting. I really, as you probably can tell, I love everything that we get to learn and get to share with our clients here today. So in closing remarks, we went over a lot of issues of estrogen dominance. We talked about weight, we talked about low sex drive, we talked about the irregular cycles. I mentioned not being able to find your keys, talked about PCOS. A few topics that we still have yet to cover. One would be fatigue and sleep issues. So in your cases with estrogen dominance, Brittany, how does that show up for you with fatigue and insomnia? What do your clients tell you?

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Brittany:

Honestly, they can't sleep at night and they have no energy. And ideally it can be related to their heavy menstruation where they're possibly anemic. But also too, it's interesting when you have women in their 20s and early 30s saying, I'm having hot flashes and night sweats and my periods irregular. I think I'm in menopause. Those are their clinical findings from Google. And I'm thinking, well, not at all. Let's kind of back up here a little bit. It can also reflect the side effects of estrogen deficiency. And so when you're hormonally not well-balanced, the first red flag is how are you sleeping? And it's, I can't sleep at all. I have insomnia. I'm just so tired. Well, it's a domino effect. If you're not sleeping well, you're gonna feel tired because you're not really rested. And like I've mentioned before in previous webinars, at night is when those dumpster trucks come and they take what we don’t need and rid our bodies of it and that’s the beautiful aspect of sleep. So it's really a domino effect in what it does. But those two go hand in hand and it's really important that we address that because then the rest of it kind of sets the foundation for treatment.

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Katie Jo, NP:

I like that you use that analogy at night is when the dump trucks come to take out the trash. And so, so many of my female clients will tell me, Katie Jo, I wake up every night from two and four in the morning, I can't go back to sleep, I have to get up at six, so I finally fall back asleep at five, and then I wake up at 6.30 after I've snoozed my alarm clock five times, I'm exhausted. First thing is because you're waking up in between a complete sleep cycle, so you're gonna be exhausted, but those dump trucks between two and four a.m. is when your liver is wanting to detoxify. So going back to the estrogen dominance and the excess amount of estrogens in the liver. So if you're having this nighttime waking, if you're not yet a part of Thrivelab, protecting the liver, and these are not popular topics, but decreasing alcohol or stopping it, and then caffeine as well. Caffeine can be one of the liver activators. Switching to a decaf, maybe a half-caf, can be helpful for some women. And so many of my clients will tell me, Katie Jo, on the days I drink alcohol, I'm up from two and four in the morning. So for when you go on your vacation and you're engaging in your alcohol, know that you might not sleep as well, but the goal is when you come back from your vacation then to be more mindful of that. So those trash trucks at night are so essential. I also use the example, and this was provided to me by a chiropractor named Dr. Nick of, our body is like a fish in a fish bowl. And so we're swimming in water and we need that filter on the fish tank to be working effectively to clean the water. Because if we're feeding the fish and the fish is pooping in that fish bowl and that filter is not working good, if the liver is not detoxifying our estrogens properly, eventually it's going to back up and that water is going to become murky. And then that's when we see things like chronic disease, like lupus, like inflammation, those skin changes I mentioned, the feeling of heaviness, fullness. And so again, the hormones are all interconnected. We're not treating autoimmune here, we're treating bioidentical hormones, but we do know that many women and men have less inflammation, they have less joint pain, they have better thinking process, less brain fog with the use of bioidentical hormones when estrogen is no longer dominating inappropriately but instead is dancing a tango with all the other hormones in the body. That's my closing remark, Brittany. Any closing remarks from you?

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Brittany:

You know, I wanted to kind of pull up some literature when it came to kind of our overview message of estrogen dominance. And after doing some research, I found one that was published in 2019 with the International Journal of Molecular Science. And they had a study that really showed that endometriosis goes hand in hand. And ideally, the goal is the dysregulation of the pathways of this really can affect fertility and these receptors and modulators are being interrupted. So it really has to do with keeping that endometrium, the dysregulation can cause endometriosis, which then reverts and estrogen dominance, which then can cause infertility. So I thought it was really fascinating that really in 2019, they kind of dug into the endometrium, the lining of the uterus and seeing the pathways and all of those things go hand in hand when it came to now the causation of what this is leading to, which is estrogen dominance. So just kind of more like a medical journal aspect of some things I found, I was like, that's really interesting that they dug into the receptors and the pathways and all of that and how they said, yeah, this is actually what it's caused by. And so I thought that was quite fascinating. Just like you mentioned with medicine, there's so much research out there. It's constantly evolving, right? And just like we focus on hormones and things like that, there is also our awareness of the liver and autoimmune and things like that we are familiar with. But ideally, I thought that was quite interesting, that research.

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Katie Jo, NP:

Brittany, thank you so much for sharing that. And I looked at one research article, and it was based on a fact that all vertebrates, so all mammals with a backbone, produce estrogen. And this research study was based on insects that produce estrogen. The theory was that estrogen is a very ancient hormone, and there's several insects that produce estrogen, one of them being a silkworm. And I just recently was told about... how the silk worms were smuggled out of what would be modern day China in the hollow part of a staff. We wanted to know how silk was produced. And they couldn't imagine that it was produced by a worm exiting out of their body until they saw it. And when they saw it, they hid some in their staff and smuggled it out of the area and took it back and then spread the silk road on. So know that we as women and men that have estrogen, we also have some...

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Brittany:

Right.

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Katie Jo, NP:

associated with silkworms that also are one of the insects that produce estrogen. And I love to wear silk and so it's a beautiful connection there.

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Brittany:

It's awesome, awesome. We covered a lot, my goodness. This is a really, really great and popular discussion. And I forgot to mention too, if y'all have any questions, please feel free to put them in the comment box. We will get back to you. This is a fascinating topic. If you find that you have any questions or want like a part two to this, we can really dive in deeper, but this is kind of an overlaying view of estrogen dominance, but it can go further. And so if this is interesting to you, let us know. We would love to hop on again and dive in even deeper. So let us know your questions and thank you so much for tuning in. If there's any friends, loved ones, family, please share this, get the word out that we are all on the same team and the goal is to feel great in this life. And that is our goal here at Thrive. So thank you so much for logging on and until next time. Katie Jo, always amazing to be with you here.

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Katie Jo, NP:

Take good care.

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