Progesterone and Oestrogen Dominance

[judithlynn]

In the last month, my doctor has added Progesterone (Prometrium ) to my HRT regime. Over the last 5 years (nearly) I have been on Oestrogen  (1 Progynova tablet twice a day) but no Anti Androgen. The main reason being that I started with such a low level of Testosterone and in the last 6 months have seen it drop dramatically to less than 0.9.

Anyway one thing that I have found since my doctor effectively doubled my dosage of Oestrogen about 9 months ago is that I have been putting on weight (fatty tissue), admittedly in the good places which have been my thighs, buttocks, breasts , but also my lower abdomen. My breasts have grown so much so now that I am a small 44C, but until the addition of Prometrium were very tubular.

Anyway I have now completed my first month on Prometrium (with my doctor and pharmacist recommending to be on a continuos cycle them moving after 3 months to a 14-28 day cycle).

Anyway I have already noticed a bunch of things since starting Prometrium. I am sleeping more soundly. My breasts have developed a more rounded shape especially on the upper pole. my fingernails are stronger and growing again, my areolae are wider and more feminine and my skin is really a lot less oily and super soft.

The most surprising thing though is a complete loss of appetite and I am losing weight, with my waist slowly re-appearing. Anyway all this seems quite surprising, until I read this very interesting article  last night which talked about Oestrogen dominance and why Micronised Progesterone i.e. Prometrium was really essential to get the best overall benefits to women that have a high Oestrogen dependency (and that of course is most MtoF transgender women. Basically this is what was stated:(it explains a lot)

Estrogen Dominance

Maintaining your ideal body weight can be a frustrating and difficult task. You may have heard or suspected that your hormones have something to do with your inability to lose weight. Well, that can absolutely be the case for many women, especially if you have had children, been on birth control pills or are approaching mid-life or indeed are trans-women with a major estrogen dominant HRT program. These things and more can lead to a condition called Estrogen Dominance, which simply means your levels of Progesterone are too low to balance out the Estrogen you have.

The 6 Big Reasons Why Estrogen Dominance (Low Progesterone) can greatly inhibit your ability to lose weight & keep it off:

Excessive Estrogen Turns More Calories Into Fat.
You can see the dramatic effects of this in the dairy industry. They give excess amounts of estrogen to the cows because it fattens them up. Which is also why it is a good idea to eat and drink organic dairy and meat products. To make matters worse, your fat cells actually make more estrogen, and your estrogen causes more fatty tissue growth. This excess fat usually accumulates around the lower abdomen when you are estrogen dominant because estrogen levels also impact where the body distributes fat. This is a vicious cycle that can be greatly mitigated by balancing your oestrogen out with proper levels of natural progesterone.

Progesterone Helps Your Thyroid Hormones Function More Efficiently.
When you have low levels of progesterone your liver produces excess amounts of a protein called Thyroid Binding Globulin (TBG). This TBG binds to the thyroid hormones your body makes. This basically means it blocks, or ties up the hormone so that it is not able to be utilized properly by your body. The net effect of this is a form of Hypothyroidism that some refer to as Type 2 Hypothyroidism, which does not show up on blood tests since the problem is within your cells rather than in your blood.

Progesterone Lowers Insulin Levels.
Insulin is affected by hormone imbalance, and estrogen dominance can lead to the release of excess insulin. Increases in insulin can lead to sugar cravings that can be hard to control. This is why many women crave chocolate or other sweets during PMS. It's all making sense now isn't it?

Progesterone is a Natural Anti-Inflammatory.
Reducing inflammation also helps your brain to receive another hormone called Leptin, which helps to regulate your appetite. Balanced hormones make it easier to eat in moderation and lose weight.

Progesterone is a Natural Sleep Aid.
This is because progesterone has a calming effect on the brain. Estrogen on the other hand has an excitatory effect on the brain. Because of this, women with estrogen dominance typically sleep very restlessly. Sleep deprivation is also associated with disrupting the hormone that regulates your appetite (Leptin). Lack of sleep has been linked to both increased calorie consumption and reduced energy expenditure (more calories in and fewer calories out).

Progesterone Reduces Fluid Retention.
When Estrogen levels are not balanced out by adequate levels of progesterone, women tend to retain more fluid than usual. Progesterone is a natural diuretic and can greatly reduce bloating and swelling.  Estrogen dominance can be safely and effectively treated with the use of bio-identical progesterone such as prometrium. Lab testing, preferably saliva testing, allows us to see the levels and balance of estrogen and progesterone in your body and develop a treatment plan to supplement the progesterone you have with enough to adequately balance out your estrogen. By simply replacing the missing progesterone in your body with bio-identical progesterone such as Prometrium, you can get your hormones back into balance. The benefits of hormonal balance can include better sleep, improved moods, increased energy, better mental function, improved libido, and even weight loss.

[KayXo]

Excessive Estrogen Turns More Calories Into Fat.
You can see the dramatic effects of this in the dairy industry. They give excess amounts of estrogen to the cows because it fattens them up. Which is also why it is a good idea to eat and drink organic dairy and meat products. To make matters worse, your fat cells actually make more estrogen, and your estrogen causes more fatty tissue growth. This excess fat usually accumulates around the lower abdomen when you are estrogen dominant because estrogen levels also impact where the body distributes fat. This is a vicious cycle that can be greatly mitigated by balancing your oestrogen out with proper levels of natural progesterone.

And yet (based on actual studies)...

Maturitas. 2012 Mar;71(3):248-56.

"Ovariectomy of rats increases food intake and, concomitantly, body weight [11] and these effects can be reversed by restoring physiological levels of estradiol [11]"

"estradiol potentiates the effect of the satiating CCK peptide released from the small intestine in response to food intake [14,15], while attenuating the appetite-stimulating potency of the gastric hormone ghrelin [16]. Furthermore, estradiol stimulates anorexigenic POMC/CART activity and inhibits orexigenic NPY/AgRP neurons in the ARC [17,18]."

"In contrast to estrogen, progesterone itself does not significantly influence feeding behaviour in ovariectomized rats, except when administered in non-physiological, pharmacological doses [11]. However, in the presence of estrogen, progesterone does stimulate appetite and promote weight gain [19]."

"Similarly in the case of women, food intake during the different phases of the menstrual cycle varies (Fig. 3). Thus, a meta-analysis revealed that mean food intake is lowest during the periovulatory phase of the menstrual cycle, when estradiol levels are high [23]. In contrast, a peak in food intake occurs during the premenstrual period, when progesterone levels are high [23–28]."

"Estradiol stimulates the activity of lipoprotein lipase (LPL) in femoral adipocytes and lipolysis in abdominal adipocytes
[35], thereby promoting accumulation of gluteo-femoral fat. On the other hand, estrogen deficiency is associated with enhanced accumulation of abdominal fat [35]."

"treatment of postmenopausal women with estrogen enhances LPL activity in the femoral region and at the same time lipolysis in the abdominal region, which might promote fat accumulation in the former region and fat loss from the abdomen [84]."

Menopause. 2014 Jan 6.

"Women in all treatment groups gained weight; the largest weight gain occurred in the placebo group, followed by the CEE/MPA groups and the CEE/MP group. The smallest weight gain occurred in the CEE-alone group (P = 0.03 vs placebo).11,13,14*"

CEE =  conjugated equine estrogen
MPA = medroxyprogesterone acetate
MP = micronized progesterone

With many more studies confirming the above like:

Horm Behav. 2017 Apr;90:8-14.

"In many nonhuman mammals, estradiol causes drops in feeding and foraging, progesterone reverses this effect, and the two hormones in combination produce cycle phase shifts characterized by lower food intake near ovulation when sexual receptivity is at its peak. Hormonal predictors of within-cycle shifts in women's total food intake have not been previously tested. Here, in a study with both daily hormone measures and self-reported food intake, we found that within-cycle fluctuations in estradiol negatively predicted shifts in food intake, progesterone fluctuations positively predicted them, and the two hormones together statistically mediated a significant peri-ovulatory drop in eating. These patterns are precisely opposite to those previously reported for sexual desire from this same sample (i.e. positive and negative effects of estradiol and progesterone, respectively, on desire)."

AND

Physiology & Behavior, Volume 22, Issue 3, March 1979, Pages 583-593

"Estradiol and testosterone decrease adiposity, while progesterone increases carcass fat content. These hormone-induced changes in body weight and composition are accompanied by changes in food intake and voluntary exercise"

My appetite is significantly reduced on estrogen (and on testosterone) all the while increasing when I am on progesterone.

Progesterone Helps Your Thyroid Hormones Function More Efficiently.
When you have low levels of progesterone your liver produces excess amounts of a protein called Thyroid Binding Globulin (TBG). This TBG binds to the thyroid hormones your body makes. This basically means it blocks, or ties up the hormone so that it is not able to be utilized properly by your body. The net effect of this is a form of Hypothyroidism that some refer to as Type 2 Hypothyroidism, which does not show up on blood tests since the problem is within your cells rather than in your blood.

As far as I know, estrogen tends to increase TBG and as a result, more thyroid hormones are bound and inactive BUT the thyroid gland increases its production of thyroid hormone due to less negative feedback inhibition so that the free concentration of thyroid hormones remains constant.

Progesterone Lowers Insulin Levels.
Insulin is affected by hormone imbalance, and estrogen dominance can lead to the release of excess insulin. Increases in insulin can lead to sugar cravings that can be hard to control. This is why many women crave chocolate or other sweets during PMS. It's all making sense now isn't it?

Studies have practically found no benefit of progesterone on PMS and cravings, even in very high doses. Here are two such studies:

JAMA. 1995 Jul 5;274(1):51-7.

"Oral micronized progesterone is ineffective for PMS."

Physiol Behav. 1999 Sep;67(3):417-20.

"Neither progesterone nor alprazolam decreased chocolate or sweets craving."

Regarding Insulin,

Pathol Oncol Res. 2012 Apr;18(2):123-33.

"Insulin resistance and estrogen deficiency are concomitant disorders with mutual interrelationship."

"a moderate or severe decrease in serum estrogen levels enhances the prevalence of insulin resistant states both in men and women. Healthy premenopausal women enjoy the defensive effect of estrogens against metabolic and hormonal disorders. However, even a slight decrease in their circulatory estrogen levels associated with insulin resistance may increase the risk for cancers, particularly in the organs having high estrogen demand (breast, endometrium and ovary). On the other hand, postmenopausal state with profound estrogen deficiency confers high risk for cancers in different organs with either high or moderate estrogen demand. After menopause, hormone replacement therapy improves insulin sensitivity and decreases the enhanced inclination to malignancies in postmenopausal women."

Hum Reprod. 2002 Mar;17(3):825-9.

"We examined metabolic parameters in cohorts of women with and without subcutaneous estrogen therapy with concomitant supra-normal concentrations of estradiol (SE)."

"Women with SE have similar triglyceride and HDL cholesterol levels but lower LDL cholesterol concentrations compared with post-menopausal women not taking ERT. The observations that the SE group showed reduced fasting insulin and WHR suggest that supra-normal circulating concentrations of estradiol, delivered subcutaneously, may beneficially influence insulin metabolism."

Int J Oncol. 2011 Dec;39(6):1443-53.

"Estrogen treatment triggered the loss of body fat, induced insulin sensitivity, suppressed tumor growth, reduced growth factors and improved hepatic steatosis."

Int J Pharm Compd. 2015 Jul-Aug;19(4):289-93.

"A major function of estradiol involves obesity, insulin resistance, and cardiovascular disease; studies have shown the beneficial effects of estradiol in these areas, and this is somewhat at variance with traditional belief. In recent years, many researchers have studied its protective, beneficial effect, and have arrived at convincing evidence. In females, and, to some extent in males, estradiol is very important in protecting against obesity and lessening the likelihood of insulin resistance and cardiovascular disease."

Acta Physiol Scand. 1993 Sep;149(1):91-7.

"It was concluded that particularly E2 plays an important role in the maintenance of normal insulin sensitivity while P alone seems to be followed by insulin resistance, both effects apparently mainly by regulation of glucose uptake in muscle."

Estrogen on the other hand has an excitatory effect on the brain. Because of this, women with estrogen dominance typically sleep very restlessly.

American Journal of Obstetrics and Gynecology, Volume 178, Issue 5, May 1998, Pages 1002-1009

"Estrogen replacement therapy improved sleep quality, facilitated falling asleep, and decreased nocturnal restlessness and awakenings (p < 0.001). The subjects were less tired in the mornings and in the daytime (p < 0.001) when taking estrogen replacement therapy. "

"the more the subjects experienced insomnia, the better the estrogen replacement therapy facilitated falling asleep (r = 0.26, p = 0.040). Estrogen-induced sleep improvement was also reported by the 15 climacterically asymptomatic subjects. In these subjects initial insomnia scores strongly predicted estrogen-induced sleep improvement (r range 0.50 to 0.75)."

"Estrogen replacement therapy significantly diminished sleep complaints among postmenopausal women."

Fertility and Sterility, Volume 71, Issue 5, May 1999, Pages 873-880

"Estrogen effectively alleviated hot flashes, sweating, sleep complaints, and headaches."

"Estrogen replacement therapy improves objective sleep quality by alleviating the frequency of nocturnal movement arousals."

Personally, while I was taking progesterone, I would often wake up in the middle of the night and have trouble falling back asleep whereas now, on just estrogen, I tend to sleep right through the night and wake up more rested.

Progesterone Reduces Fluid Retention.
When Estrogen levels are not balanced out by adequate levels of progesterone, women tend to retain more fluid than usual. Progesterone is a natural diuretic and can greatly reduce bloating and swelling.  Estrogen dominance can be safely and effectively treated with the use of bio-identical progesterone such as prometrium.

While it is true that progesterone exerts anti-mineralocorticoid effects, similar to spironolactone, I personally find I am less bloated and swollen on just estrogen vs estrogen + progesterone. Some studies have found similar findings in women given high dose progesterone vaginally while other studies have actually found that estradiol may reduce these symptoms and relieve PMS.

Gynecol Endocrinol. 1990 Jun;4(2):99-107.

"Fifty patients receiving estradiol implants for long-term treatment of premenstrual syndrome were studied over 5.6 years (range 2-8 years). There was a continued beneficial response to treatment in all symptoms, varying between 74% for bloating and 96% for depression. Menstrual cycle control improved in 31 patients and periods were less painful in 30 patients."

Climacteric. 2013 Apr;16(2):265-73.

"Estradiol decreased systolic blood pressure, plasma aldosterone levels, and the expression of renal sodium transporters."

Am J Physiol Renal Physiol. 2015 Aug 15;309(4):F305-17.

"These findings suggest that changes in estradiol levels, such as during menopause or following reproductive surgeries, may contribute to dysregulation of water homeostasis in women."

Am J Physiol. 1995 Apr;268(4 Pt 2):R951-7.

"Progesterone had no effect, whereas estradiol attenuated and restored the antidiuretic response to vasopressin to a level similar to that in intact nonestrous female rats."

Eur J Endocrinol. 2003 May;148(5):571-7.

"Women without a history of PMS had more physical symptoms on progesterone treatment compared with placebo."

"In women without prior PMS natural progesterone caused negative mood effects similar to those induced by synthetic progestogens."

Lab testing, preferably saliva testing, allows us to see the levels and balance of estrogen and progesterone in your body and develop a treatment plan to supplement the progesterone you have with enough to adequately balance out your estrogen.

Maturitas. 2002 Jan 30;41(1):1-6.

"The absorption of progesterone from transdermal creams is low and we caution against the use of saliva measurements to monitor progesterone absorption."

Climacteric. 2000 Sep;3(3):155-60.

"Salivary progesterone levels were not of value in managing the therapy of postmenopausal women."

"Levels of salivary progesterone were so variable as to be considered completely unreliable in determining the potential influence on biological activity."

Saliva test results don't reflect blood (what goes to tissues everywhere in the body) levels and as such, appear to be inaccurate and unreliable. Levels in saliva may be normal-high but low in blood.

**I am not a doctor and only wish to share these findings in hopes of showing that assertions need to be weighed against scientific findings, critically assessed, that there is controversy and that things may not be as clear as they seem to be**