Estrogen dominance? Progesterone deficiency? Low T?: Hormone experts answer your biggest questions

Content By: Ari Whitten

In this episode of The Energy Blueprint, we’re looking back on conversations with three hormone experts: Dr. Shawn Tassone, Dr. Stephanie Gray, and nutritionist Magdalena Wszelaki, the author of the bestselling cookbook Cooking for Hormone Balance.

Whether you’re male or female, this podcast will answer your most pressing hormone questions—we cover everything, including some really fascinating connections between hormones and organs you don’t expect, like the gallbladder.

Table of Contents

In this podcast, you’ll learn:

  • The 12 hormone “archetypes” identified by a gynecologist who’s seen over 40,000 patients in his 20 years of practice
  • The unexpected hormone imbalance most women are unaware of that leaves them feeling isolated, fatigued, and uninterested in life
  • 6 distinct ways to address hormone issues, including one strategy you’ve probably never heard of before 
  • The rarely discussed hormone-disrupting effect of excess belly fat—it’s not just about aesthetics 
  • Multiple patterns of estrogen dominance and symptoms that most doctors don’t recognize
  • The link between estrogen and your thyroid and a very common reason why women feel run down when dealing with estrogen dominance
  • Symptoms of andropause in men; guys, this is a must-listen for you!
  • How cholesterol-lowering medications might create a deadly loop of hormone imbalance and increased risk of cardiovascular disease 
  • One surprising reason for hormone imbalance and infertility that you should be aware of if you’re struggling to get pregnant
  • The difference between bio-identical and synthetic hormone replacement and why this distinction is crucial for your health
  • The safety of testosterone replacement therapy, even in men who have had prostate cancer…plus, the best way to increase testosterone naturally
  • The shocking number of women who experience estrogen dominance and the many body systems it can negatively impact
  • The fascinating connection between your gallbladder and estrogen…if you’ve had your gallbladder removed, you have to hear this!
  • The importance of progesterone for female health and the major role it can play in estrogen dominance

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Dr. Shawn Tassone -Transcript

The 12 types of hormonal balance

Ari: Very cool. I like it. You mentioned hormonal balances. Let’s talk about what these 12 types are. We don’t have to go through all 12, but maybe you can give an overview of some of the key principles that differentiate these 12 different types.

Dr. Tassone: What happened for that was I was realizing over the last few years that I was repeating myself over and over and over again, and that’s because I was hearing the same story. These archetypes are just stories. Hormone imbalances, tell a story. Most of these and that’s what I distill down into those 12 archetypes. Far and away the number one hormone imbalance in women is testosterone deficiency. I see it all the time.

Ari: More than estrogen dominance.

Dr. Tassone: I thought it was going to be estrogen dominance. I reviewed this with my patient population. I’ve got about 20,000 women that have taken my quiz online, and it’s about 36 questions. I thought for sure estrogen dominance would be number one, and it’s not even close. Testosterone deficiency is by far and away in all age groups. Testosterone deficiency, I call the nun jokingly because the good nuns don’t have sex and you ain’t getting none really. All the archetypes they’re not negative, so there’s benevolent queen, there’s off your head queen. While nuns are great because the only nun that maybe wouldn’t be great would be a cloistered nun, so a nun that’s secluded. A nun that doesn’t want to go out and do anything, because testosterone is a hormone of feeling good. It’s a quality of life hormone for women. Women that have testosterone deficiency sometimes will cloister themselves because they don’t feel like doing the things that they used to do. They don’t want to go out with their friends, because they don’t feel good and they’re run down, and they’re tired in the afternoon. I would hear this story over and over and over again. Then decrease libido, obviously and we know libido isn’t necessarily testosterone-driven. If you don’t feel good because you’re run down and your body image, whatever, you aren’t going to be interested in sex. I’d hear these stories over and over again. When I talk about these archetypes, it’s not just like a negative thing. There are definitely positive. Nuns they’re very loyal, they’re very knowledgeable. They are very serious, they have a lot of positives to bring, but you don’t necessarily want to live there your entire life. When I say these imbalances are a problem is when they interfere with the way that you want to live your life. A lot of these women will come in and they’ll say, “I don’t want to have sex, I don’t feel like having sex.” I say, “Well, first of all, who’s asking you to come in? Is it your husband or is it you and she’ll usually say him? I’m like, “Well, if I made you make a list of 10 things today that you had to get done would sex be on the list?” I will tell you 100% of the time, it’s no. It’s not on the top 10. For guys, it’s probably in the top three somewhere, so there’s that mismatch. It’s just more of a relationship thing at that point. Far and away testosterone deficiency. All of the archetypes have a storyline, but then there’s also a six-step correction. One being a spiritual practice, two being hormone balancing, which I can do with the actual hormones if we need it. Something I call infoceuticals which is Allah Harry Massey. Infoceutical is more the energetic information that’s transferred to the body. That can be through acupuncture, essential oils, things that convey more of an energetic, that’s Reiki, healing touch. Nutrition obviously, is hugely an important exercise and then finally supplementation. I combine all six of those things for each of those storylines and have a plan for everybody.

How testosterone imbalance affects women

Ari: I want to go back to there’s actually like five questions that I want to ask after everything you just said, but I want to go back to testosterone. It’s interesting, I’ve interviewed at least two, if not three, no, at least three other women’s hormones experts, and I don’t think testosterone deficiency has ever come up once. This seems to be a-

Dr. Tassone: We all specialize, I think in different things. Most of the people that I know that you probably talked to either deal with PCOS or obesity. It’s probably a populational bias that they see. I tend to see a probably a wider range of people. I just see different things, I think. It’s like I tell, the lady we did an interview with, [unintelligible] she sees women that all day long that hate their IUDs, they hate them. She hates IUDs. I’m like, “I have put in thousands of IUDs, and I hardly ever had people that want them out. Because of her population, and I think it’s the same thing with me. maybe I see women that are older, like maybe in their 40s and 50s. They probably have more of a testosterone deficiency. Women in their 20s and 30s probably have more PCOs and estrogen dominant. It is probably more of an age group thing.

Ari: What do you see as the main causes of testosterone deficiency in women? Is it some of the same causes as testosterone deficiency in men or does that differ?

Dr. Tassone: I think it’s obesity is a big one, I think it’s lack of moving your body. I think a lot of–

Ari: Need to be obesity per se or excess body fat.

Dr. Tassone: A little abdominal fat yes, abdominal fat is the killer. Same thing for men. It increases estrogen levels, estrogen then increases sex hormone-binding globulin and drop in your testosterone levels down a little bit. I think the ovaries are just overwhelmed with environmental toxins, pollution, the stuff that even EMFs. We don’t even know the tip of that iceberg. You probably know that better than I do. I think women nowadays are so toxic with birth control pills. I don’t know if that really ever– There’s a big argument right now, there’s another physician out there who has a book out and she really pushes birth control pills in girls that are 12 to 14, and how they don’t need to have periods because the periods annoying. It’s like yes, but do we really know what birth control pill is doing to the brain of, not even just a teenager but a woman in general? Sarah Hills, I think her name just came out with a book on oral contraceptives and what it does to your brain.

Ari: Jolene Brighton also.

Dr. Tassone: In Jolene’s book the post on birth control, Beyond the Pill is a great book and I recommend that to a lot of people.

Ari: I had her on the podcast recently.

Dr. Tassone: Jolene sees all the bad stuff with birth control, just like Fiona Macola does PCOs and there’s a lot of great information out there. It’s just getting the diagnosis, and actually getting the labs whereas that’s what Jolene does, and some of these people guess. Sometimes it’s hard to guess. You really need the lab work.

Ari: List off those main causes. Obesity, or excess body fat, stress.

Dr. Tassone: Diet, I also think that we’re just– I think that the ovaries make about 50% of the female’s testosterone levels, and the adrenals make the other 50. I think with overwork, not sleeping, the adrenals are getting a little bit squashed. I think adrenal, I don’t like to call it fatigue or insufficiency because it sounds, I don’t know if that’s a real thing or not. It’s just one of those things that I think does add to it, because it just doesn’t put out the same amount that it could. Then I think a lack of sleep is probably a huge factor. You can see my dog in the corner there. He needs to go outside. I think those would be the main things

The role of estrogen dominance in women

Ari: Got you. So, next thing I want to go to is estrogen dominance. Talk to me about what that is, first of all. What does it mean for people listening? What does it mean to be estrogen dominant? What are the main causes of that? What are the main symptoms and then let’s talk about the causes?

Dr. Tassone: Estrogen dominance is basically either your estrogen is just too high. Usually it’s, I look at it more as too high compared to your progesterone. You could have normal progesterone and a super high estrogen. You could have a normal estrogen and a very low progesterone. Which would be two things, it would be not just estrogen dominance, but also progesterone deficiency. Symptoms of estrogen dominance, breast tenderness, mood swings, irritability, irregular periods, weight gain, headaches, just water retention. I call it jokingly choke a bitch syndrome, because think of estrogen as a very stimulatory hormone. Then progesterone comes in and calms everything back down the second half of the cycle. What happens is they’re constantly being stimulated by this estrogen and they just feel wired all the time. Then they don’t have the calming effect of the progesterone and Gabba and things like that that come in to help them sleep and recover, and so they’re constantly just being barraged by estrogen. They just feel like they want to– these are the women that come in and say, “I’m yelling at my kids, I don’t know why? I’m not like this usually. I’ve gained 20 pounds in the last year. My periods are all messed up.” Then it can throw your thyroid off. It’s a lot of just that irritability, mood swings, weight gain. Roughly, probably most of the women that come to my office complain of stuff like this. Hair thinning, headaches, things like that.

Ari: These are the two most common hormonal imbalances, testosterone deficiency, estrogen dominance. Is there any other one that is remotely close to this?

Dr. Tassone: I would say subclinical hypothyroidism, or what I call the underdog is super common nowadays. It’s one of those things that’s like, it’s really making a big rise right now. I would say it’s a really close second to estrogen dominance. Again, that’s interpretation of labs and symptoms. It’s not just normal abnormal. It’s like how are you feeling, weight gain, hair thinning, can’t get up in the morning, can’t stay awake during the afternoon, and a free T3 which is 2.4 to 4.4 and you’re 2.4. The doctor looks at that and says it’s normal, but you don’t feel very well, and I can bump that up to 3.3, which is still abnormal, but you might feel a hell of a lot better. It’s just one of those. It’s symptoms, so it’s like do the patients feel better with a little bit of thyroid. It’s hard because the medical boards they’re really starting to crack down on people that are prescribing thyroid meds if the labs aren’t abnormal. There’s doctors all around that are getting nabbed for this now, and it makes me a little nervous. Because I have so many people that feel better in the 50th percentile versus the fifth percentile for a lab value. I can defend myself, but it’s sad.

Ari: That doctors are getting in trouble for it.

Dr. Tassone: Yes.

Ari: I think there’s also this issue of the lab ranges of what’s normal getting narrower and narrower. People rightfully I think, at least in some cases, asking the question, how much evidence is there to support that this particular range is better than this range? I think in many cases there’s just a lack of evidence, it just hasn’t been tested very well. To some extent it is this speculative jump to say, somebody will feel better if they’re in the 80th percentile as opposed to the 20th percentile.

Dr. Tassone: I think it give heedance to this possibility of bio individuality or whatever word we want to make up. Somebody like you who’s super active, work out a lot, you got muscle mass, you got kids, you got to do all this stuff. You might need more thyroid hormone than somebody that sits on the couch. For you, you might not feel good at a 2.4 where somebody else is probably like, “Yes, I’m fine. I don’t feel anything different.” I do think that that, but that going along with it because of the way that you live your life, your thyroid probably isn’t an issue. There are people genetically I just think that, and that’s another thing is that we better can talk about just the genetic possibility of the way that your body is shaped, the way that you gain weight. Trying to live past your genes. 

Dr. Stephanie Gray -Transcript

Who can be affected by hormone imbalance?

So, men and women both have hormone imbalances. This is not just about women, even though I have kept mentioning hot flashes and night sweats, what-not. So, women go through menopause, but there’s actually a term for men going through this transitional period which is called andropause. Sometimes we joke around calling it manopause but really the term is called andropause. So, why do these years even matter? Well, we’re living longer than we have before and we want to increase the quality of life amongst those years, right. 

So, if women are going to go through menopause in there, I see women in their 30s and 40s, but the average age is 52 and they live to be 90, right, we want to make sure we’re optimizing those years of their life. That’s 40 years. We want to make sure they’re feeling well. If you haven’t experienced menopause or andropause yet, you’re in luck, because there’s still time to improve your hormones before you go through that transitional period. Which for women we call perimenopause. 

So, I see women going through perimenopause every week in my office. And so, these women can be very tired. They can be depressed. They can have acne, migraines, low libido, mood changes, thinning hair, sleep disturbances, and then the hot flashes, night sweats, weight gain, irregular cycles and infertility can set in. 

Now men many times come in to see me because they feel like they’ve lost their edge, maybe previously they were really confident, they did public speaking or maybe they were a CEO of a company, or a pastor. They used to be able to get up in front of people and speak and now they’ve lost their edge, they’ve lost their confidence, and their having depression, and anxiety, and weight gain, especially around the middle. 

Maybe they’re having low libido or erectile dysfunction, or even bone density issues and they’re tired. So, men and women both experience this age-related change. But again, we want to optimize the years after that change, so they’re still feeling well through those years of life. 

So, let’s talk about what hormones are. So, hormones are chemical messengers. They are made by our glands that act to control certain actions of cells and organs and they fit like a key into a keyhole. They’re gender specific. They send billions of messages and they’re made from cholesterol. 

So, again, I want to emphasize this point, all hormones come from cholesterol. And one of my pet peeves is when men come into my office with low testosterone and that’s because of the cholesterol-lowering medications they’ve been put on. So, one of the first things I check in these men is always a cholesterol panel, because I want to make sure their cholesterol is not too low because many times it is and we actually need to lessen that medication, hopefully get them off it but lessen the medication so they can actually make some testosterone. 

So, it’s really important to have cholesterol. This doesn’t just apply to men. So, if women have eating disorders, they’re really lacking healthy fats and nutrition that they need, their body’s not going to make hormones and they’re not going to cycle. So, it’s really important to have adequate cholesterol for hormone production.

Ari: Quick question for you. Are you sometimes engaged in battles with people’s doctors over statins?

Dr. Gray: Yeah. So, luckily there are other tests which we may not get to today, in chapter 7 of my book where I talk more about the cardiovascular system. I mention the importance of running an advanced lipid panel because we know just putting someone on a statin medication, just lowering cholesterol doesn’t necessarily translate into lowering risk. 

Some doctors are so fixated on those numbers, but what I try to educate them on is, hey, we need to look beyond just the regular old lipid panel and assess an advanced lipid panel, looking at particle size, and inflammation, their oxidative stress to see really, how high is the risk? Do they really need the statin medication or not? Or is there something safer we could put them on? Because having for instance low testosterone is going to put them at greater cardiovascular risk. Then the statin isn’t going to be helping in the first place, so.

Ari: What alternatives would you suggest? Let’s say there are people listening right now who are on statins and maybe they start to, they have symptoms of low testosterone and they don’t necessarily feel equipped to go to their doctor and say, “Hey, I don’t want to take this anymore because I heard someone say that maybe the statins could be contributing to my low testosterone levels and so on.” And the doctor might argue. So, what alternatives might somebody examine in that scenario?

Dr. Gray: Yeah. So, first I would say depending on that individual’s risk will determine if the right decision is to really take them off that Statin medication. So, I don’t want to blanket, make a blanket statement that everyone should get off their statin medications. Because if you’ve had a triple bypass and you’re a smoker and you’re really higher risk, we need to always evaluate that. For patients who have to remain on those medications, we can put them on testosterone replacement therapy, and we can boost their levels. So, that’s one option.

If they’re looking for an alternative to the statin medication, I use a lot of plant sterols in my practice. I use a lot of, B vitamins can help, fish oil can help, citrus bergamot can be very effective. So, I will use that if needed. If I have to use a medication, the benefit of an advanced lipid test is that it will tell us if the problem with cholesterol is in the production, if it’s boiling down to the liver, if the patient’s producing too much cholesterol, or if we have more of a gut issue. If the cholesterol isn’t getting bound, if it’s getting reabsorbed because maybe the patient just needs fiber to bind the cholesterol so they can poop it out. 

So, the benefit of the testing which you could, you should be able to receive through a functional medicine provider is that it’s going to help guide what that best decision is. What sort of supplement or medication the patient needs to truly reduce their risk. So, I wish there was an easy answer, but it’s a little more, it can be more complex than that. 

Ari: Got it.

The role of sex hormones in health

Dr. Gray: So, if we talk about sex hormones, so sex hormones are primarily made by the ovaries in women, and the ovaries are shown in this picture here. So, they’re small glandular organs about the size and shape of an almond, and they’re located on the opposite side of the uterus. They’re the most important organs of the female reproductive system and as glands they secrete the hormones. So, the estrogen, progesterone, testosterone and they’re lit up pink in this picture. 

So, estrogen is one of the primary female sex hormones. It helps women maintain that youthful appearance, maintains memory and cognition, balances the body temperatures, and regulates the cycles. It ensures healthy development of female sex characteristics like breast development, and fat distribution on the hips and legs during puberty. And it also ensures fertility because of helping with egg quality and egg production. So, lack of estrogen can lead to hot flashes, night sweats, insomnia, which can lead to fatigue if you’re not sleeping, poor concentration, wrinkling skin, and dull hair and dull nails. 

And during puberty, estrogen controls the development of the mammary glands and the uterus. So, this helps to stimulate the development of the uterine lining which then the body is going to shed and cause that woman to have a menstrual cycle. 

You may have heard of the term estrogen dominance and I have a lot of patients who come to my office who, this is what we find, we find their estrogen is actually too high initially and that their progesterone can be too low, which can set them up for weight gain, and fibroids, and cysts, and irregular bleeding, and potential risk of cancer. 

Now progesterone is my favorite hormone. It’s the most soothing, calming hormone, great for sleep and anxiety and it works to balance the effects of estrogen. So, estrogen is a proliferative hormone. It causes the growth of the uterine lining like I mentioned, and then the body’s natural response is to bleed or to shed. Progesterone keeps that growth in check, its antiproliferative or anti-growth. So, you want to make sure you have decent levels of both estrogen and progesterone which can be tested, which we’re going to talk about here. 

So, low progesterone can lead to PMS, amenorrhea, heavy bleeding, painful cycles, and anxiety, and depression, and insomnia as I alluded to.

Progesterone levels start to decline in the 30s. Low progesterone was part of my problem with my infertility struggle. 

So, I believe, unfortunately, many women are heavily medicated with sleeping pills, and anxiety and depression pills, when many of those times their progesterone levels just were never checked, never optimized. So, this is the first hormone I see go in many of my patients, it’s the first hormone that needs to be replaced. 

Testosterone is also important. It’s also secreted by the ovaries. It helps with mood, motivation, drive, libido, energy, and muscle mass. Low testosterone can lead to fatigue, and depression, and muscle loss, poor energy performance and stamina, lower libido, thinning hair, even bone density challenges. 

I’ve had even men come to see me who have had to take steroids for various reasons and the steroids then lead to bone density issues because the steroids knocked out testosterone production, and now they need testosterone to improve their bone density. So, testosterone is extremely important in both men and women. 

Men aged 30 to 70 will lose one to five percent of their total testosterone production per year, and women aged 20 to 40, 20 to 40 will lose fifty percent of their total testosterone production per year. So, that’s me, right. 

Ari: Yeah, that’s amazing. I’ve never heard that stat. So, is that saying from the age of 20 to 40 you lose about…

Dr. Gray: Yep.

Ari: Women lose about 50 percent? 

Dr. Gray: Yep.

Ari: Okay. 

Dr. Gray: So then on, we only have 50 percent left and that’s going to continue to decline.

Ari: After the age of 40.

Dr. Gray: Yes. 

Ari: Got it. 

Dr. Gray: But we’ll talk about ways to boost that today. 

Ari: Wow.

Dr. Gray: But women and men both need testosterone and I don’t know the average person watching this, but chances are they’re over 20 maybe a good chance they’re over 20. So, if you’re watching this your hormone levels are declining, and thus you need to have them tested. If you haven’t had them tested, I highly, highly advise for that. 

And so, that’s my first point, something that I really want you to have a take home today from, is that you need to know if you have low hormone levels. So, how do you know that? You test. You got to know your numbers. Your labs serve as your health data. The reason we’re going to talk about this is that labs can show you where potential problems lie. So, if a light on your car is flashing, it’s telling you that something has gone awry, right.

So, symptoms are telling you something has gone awry and we can confirm that with labs. When something’s wrong with your car you take it to the mechanic, they run a test and they tell you, they give you a quote on here’s what we need to do to fix X, Y, and Z. So, my heart racing was a sign of an underlying problem, and my infertility was a sign of an underlying problem. Even fatigue can be a sign of an underlying problem. Testing helps us determine where that underlying problem is caused by.

And in my book, I mention a lot about human fingerprints. That fingerprint is actually on the cover of my book because I feel like our fingerprints are our unique detailed marker of our human identity, and so are our test results. Everyone’s test results can be different, right. A woman can think she has low estrogen but maybe she has low progesterone. The test results can help your provider personalize a plan to really rebuild your health. 

And I know what you might be thinking. You might be thinking, I’ve gone to my doctor, Dr. Gray I’ve been told that all my labs are normal. But I’m here to tell you today if that’s what you’ve been told, those doctors could be wrong. They may not have run the right tests. They may not have interpreted your test appropriately. So, don’t get me wrong, we need conventional medicine, but I want to discuss a little analogy here today to share a little bit about why I got into functional medicine and why I think this is different. 

So, I see conventional medicine as more of the fire department. They’re here to put out big, bad, ugly fires and their two tools are drugs and surgery. And we need those! Thank God we have those tools. But upon putting that fire out, prescribing that drug, whatnot, for the cholesterol or back to the bypass surgery, whatnot for the patient, conventional medicine doesn’t always tell patients how to get to the root cause of the problem. It doesn’t tell them, or explain to them, or always dig for the faulty circuitry that may be led to that fire in the first place. 

And that’s where functional medicine really comes. So, in my book analogy that’s where I mention the importance of having a carpenter or a contractor. We need a fire department, we need the fireman, but we also need carpenters or contractors to help us repair and rebuild the body. And your audience may be very familiar with functional medicine.

Ari: Yeah. Absolutely. Yeah, we have lots and lots of functional medicine practitioners and doctors in this summit. 

Dr. Gray:  Wonderful. So, I don’t have to dive in too deep here, but with functional medicine we look at how and why illness occurs, and we try to restore natural balance to the body. And one huge piece of that, I mean we look at nutrition, and genetics, and toxins, we look at the foods patients are eating but one important piece of that is hormones, which we’re talking about today. 

So, when I had symptoms that conventional medicine couldn’t find a root cause for this only really fueled my desire to, again, kind of find a better road to healing, and that’s where I furthered my knowledge with functional medicine. So, regardless of your symptoms, whether it’s irritable bowel syndrome, or fatigue, or fast heart rate, I truly believe functional medicine and a blueprint like this can help.

Why hormones play an important role in health

Ari: One quick thing to interject. I just want to emphasize and point out; there are a lot of people out there who kind of think of hormones as like a separate thing. So, what I mean is they might go get a blood test and let’s say a hormone panel, and there are certain abnormalities that come back on that test.  

Let’s say cortisol is out of whack, and estrogen, and progesterone, and testosterone, and and DHEA, and whatever else, thyroid hormones and so on. And they immediately think okay, what are the specific, I need to take this hormone, or I need to take a supplement specific to this hormone.

And there’s a disconnect for a lot of people where they don’t realize that those hormones are intimately tied with their nutrition and their lifestyle. Their sleep, their stress levels, their circadian rhythm, their exposure to different toxins in the environment, to environmental disrupting chemicals, BPA, and fragrances, and phthalates, and things like that. Nutritional deficiencies, nutritional toxicities, all of these things tie directly into hormones. 

And I just feel it’s worth emphasizing that point, which is everything that you were just talking about there. But I really just think that a lot of people when they see that their hormones are out of whack they immediately jump to some hormone specific thing or replacement therapy, without really addressing what’s often times the root cause is, at the nutrition and lifestyle level.

Dr. Gray: Totally. I think some patients like men, or not just men, well for an example men, a man with low testosterone could say, “Oh, all I need to do is take tribulus, horny goat weed. I just need to take this herb and that’s going to fix all my problems.” But while the herb can help with internal production, in a way the supplement is still a Band-Aid right. It’s not getting at the root cause of the problem. If you have a toxicity, you still need to correct that to help your body produce more hormones naturally. So, that’s a good point. And you pretty much covered this whole next slide on detoxing the body. 

So, it is important to make safe swaps with our personal care products to remove the fragrances, parabens, phthalates like you mentioned. Choose safe home cleaning products, quit drinking out of plastic and out of aluminum. I keep saying eat organic, eat organic. Assure that your air is clean that you’re breathing in. I live in Iowa and we’ve had several major floods here, and I have so many patients who struggle with mold toxicity. And I have young women my age who have unfortunately been exposed to mold and now they have infertility because they have no hormone levels, but no one ever tied the mold exposure to the reason why they now can’t get pregnant, right.

And we’re finding this out and we’re able to help them identify their toxic environment, clean it up, and eventually get their body to produce more hormone levels. So, you’re right, this is, hormone levels as I said with my own example at the beginning, hormone levels or having hormone imbalances are a sign that something’s wrong within our body. So, it’s not as easy as just taking the replacement. If you had a hysterectomy though, you do need for sure, you need the replacement. 

So, that’s really the third point and that section of this presentation. And now I actually want to get into hormone replacement therapy, because there is a time and a place for that. And in my case I did while I was correcting to get to the root cause of my low hormones and correct my stress, I did need to take some progesterone and I took that through part of my pregnancy as well. 

So, the most common hormone that I prescribe, I mentioned earlier to women is progesterone. That can be prescribed in a capsule form. So, one option is to take compounded progesterone in a capsule form. There are also sublingual lozenges you can put under your tongue. So, for progesterone, estrogen, testosterone, thyroid even, some compounding pharmacies can make liquids that you can take under your tongue. But I use a lot of sublingual lozenges in my practice, primarily because you can also titrate your dose. 

So, for cycling women, they may take half a troche for a couple weeks and then they might work up to a whole troche and then reduce back down. So, sublingual lozenges or troches can be very effective. And topical gels or creams exist as well. I don’t use a lot of those because they’re pretty weak. If we think of potency, I think topical gels or creams are the weakest, then we’ll get into like the capsules and the sublinguals, and then the hormone pellets are by far the most effective in my patients. 

So, I’ll spend a little bit of time on the pellets. So, hormone pellets look like almost little grains of rice or little skinny Tic-Tacs, and they can be inserted under the subcutaneous or the fatty tissue in the upper bottom, lower back area. Sounds weird, it sounds foreign, but actually the pellets have been the most widely studied form of hormone replacement therapy dating back to the 1930s in Europe. So, they have been studied for a very long time and the dose is very refined. 

So, for all of our patients in need of hormones, we put their height, their weight, their age, their labs, everything into the computer into an algorithm that personalizes a dose for them. The benefit of the pellets is that if we do have patients who have blood clotting disorders who couldn’t take oral hormones, they actually can take the pellets, can use the pellets. 

And not that I advocate for smoking, but even patients who smoke can use pellets, because pellets are cleared through the kidneys, they’re released on cardiac output. So, they’re not going through the gut and the liver like taking something by mouth would. So, there is a time and place for pellets, and I’ve seen all forms of hormone replacement therapy significantly improve the quality of life of my patients. 

Ari: And which specific hormones are given through pellets? Is it just estrogen and progesterone, or anything else?

Dr. Gray: So, thank you for asking that, I didn’t mention that. So, actually estrogen and testosterone are delivered via pellets. And that’s where BioTe gets its name. T for testosterone, E for estrogen. Progesterone is not given in pellet form. So, progesterone separately would need to be used as a topical gel or cream, a sublingual lozenge, or a capsule. 

The benefit of the capsule is that we can compound a sustained release version also. So, for patients who can’t sleep through the night, who are waking up multiple times a night, which could be for various reasons that also needs to be discussed, we can give them a sustained release progesterone capsule. It can be very effective. 

Ari: And then, for the troches, for the sublingual’s, is that estrogen, and progesterone, can you do testosterone as well via that.

Dr. Gray: Yep, yep. You bet. 

Ari: Interesting. 

Dr. Gray: And the benefit of the troche’s is we can easily change the dose, right. With the pellets, once they’re in they’re in. We can’t take them out. We can change the dose next round, but we, once they’re in they’re in. They’re not coming out. If we’re going to talk about hormones though the c word, the cancer word always comes up. So, I do want to differentiate synthetic hormones from natural hormones, I think that are a really important point to kind of wrap up with here. 

So, what was used in the Women’s Health Initiative study was Prempro, which was Premarin which I alluded to earlier, and medroxyprogesterone acetate. So, a synthetic estrogen, synthetic progestin taken by mouth. So, that study showed 41 percent increased risk in strokes, increased risk in heart attacks, blood clots, Alzheimer’s, and cancer risk. 

So, naturally, I don’t want to replicate any of that in my practice. So, guess what? I don’t use any of that in my practice. I don’t use synthetics. I don’t use estrogen by mouth in a capsule form. Progesterone is okay, if it’s natural but not estrogen in a capsule form. 

However, many providers who see my patients who are taking hormones, they just assume the patients are on the synthetic hormones and that the risks of the Women’s Health Initiative study can be translated to what I’m giving my patients and that’s just not, that’s not the case. They are comparing apples to oranges. So, I have a little slide here to kind of show you maybe a trick, I’ll say a trick quiz here. But what’s the difference between what your body makes on the left and what bioidentical hormones are on the right? Nothing. 

Ari: Nothing. 

Dr. Gray: I answered that prematurely there, I should have let you answer that, but literally nothing. And so, patients sometimes ask me, “Well, is it risky for me to take this hormone?” And I say, “No because this is what your body used to be making more of, it’s now just making less of.” A quote in my book that I use a lot is, if hormones cause cancer then we’d have a bunch of 20 year olds with higher hormone levels walking around with cancer, and a bunch of 90-year olds very cancer-free. 

And that’s not the case. The 90-year olds have the lower hormone levels and they’re at increased risk for cancer. So, hormones don’t cause cancer. I just want to make a clear point there. 

Ari: But do you think that non-bioidentical hormones, which my understanding is most conventional medical doctors who are in the realm of hormone replacement therapy might deal with non-bioidenticals, or has that changed? 

Dr. Gray: Most of the time, yeah. I would say most of the time. There are some bioidentical patches, estradiol patches that have become a little more popular. Sometimes progesterone not a progestin gets prescribed. So, there are some doctors who are learning more and are prescribing some bioidenticals, but the large majority are still prescribing the synthetics. 

Ari: Okay, so not to digress too much, but I think it’s worth mentioning, someone might be thinking “Well if that’s what they’re prescribing maybe that’s what has the most scientific evidence to support it.” And there’s a confounding variable here which is pharmaceutical interests, which my understanding is they can’t really make money off of bioidentical hormones because they can’t patent them. So, they have to… 

Dr. Gray: You can’t patent an apple.

Ari: Right.

Dr. Gray: You can’t patent a naturally existing, molecular structure per se so that’s… 

Ari: So, they have to, they have to chemically modify it. So, there’s a huge financial incentive in the realm of hormone replacement therapy for the conventional medical industry, which is often times unfortunately, very heavily influenced by the pharmaceutical industry to push the synthetic nonbioidentical hormones. Is that correct?

Dr. Gray: Correct. Over the bioidentical, more natural hormones, what our body’s already making that would pose much less risk, some believe no risk, and actually more protective benefit, right. That’s what I believe for my patients. 

Ari: It’s like don’t trust what your body’s making, what we’ve made in a lab that’s different is better, trust us.  

Dr. Gray: So, and that also, so my doctorate was on estrogen metabolism. And so, what I studied was more or less hormone levels aside, what we think is more problematic is not even the hormones but it’s the metabolism. It’s the way, what does our body do with what it’s been given. Everything we consume has to be excreted. Air we breathe, the water we drink, everything that we consume has to be metabolized or eliminated. Our body uses some of it and we have to get rid of the rest. 

And so, we think the problem lies with getting rid of the rest, of the estrogen per se. And so, with synthetics when there’s an extra molecule there. Well here let me go to my next slide. So, on the next slide here, you can actually see the difference and I have this in chapter 6 in my book, between natural testosterone on the left and synthetic on the right, or natural progesterone on top here and the medroxyprogesterone acetate on the bottom. 

You don’t have to have a chemistry background to understand these molecules look different and when they do look different, they don’t bind like a key fitting in a keyhole. They don’t bind exactly they bind partially and then our body has to, it’s just more difficult for a body to eliminate the rest. And so, that’s why synthetics can cause more harm. 

Ari: Got it. Excellent. 

Dr. Gray: Almost wrapping up here. I want to mention a few things pertaining to males because I mentioned the Women’s Health Initiative study, and kind of talked a little bit about breast cancer, estrogen related cancers, but we need to include the males here. So, there was an exciting study. I remember when this came through my email actually in 2016 authored by Dr. Abraham Morgentaler who’s a Harvard urologist who taught in my fellowship program. 

This paper came through talking about prostate cancer and testosterone, because there has been such kind of a controversy there. Do you give it, do you not give it? And he said there’s no scientific basis for any age specific recommendations against the use of testosterone in men. This paper showed, there was no increased cardiovascular risk, no increased prostate cancer risk, and there have been several studies that have followed that. 

So, for men testosterone is safe. You need testosterone. We won’t get into the details of that, but I just wanted to kind of reference that. I also want to make one more point for men. So, one of the best ways that men can raise their testosterone levels, aside from everything we’ve mentioned above, is to lose weight. 

So, when you have fat around your middle that fat secretes an enzyme called aromatase. And aromatase converts testosterone to estrogen. So, if you’re a man, you don’t want to have high estrogen, right. You want your estrogens to be lower, your testosterone higher.

So, losing weight will help get rid of the fat, but also there’s a supplement called DIM, and this is more or less what I studied in my doctorate. DIM is an extract from cruciferous vegetables like broccoli, kale, cauliflower, bok choy, brussels sprouts. DIM will help block testosterones conversion to estrogen. So, you should eat a lot of those foods, but you can also take the supplement DIM to help you lose weight, to help lower estrogen and keep your testosterone levels higher.

Ari: Is that also true for women? I know you mentioned low testosterone is a big thing for women as well. Is it true that carrying excess body fat will decrease testosterone levels in women as well? 

Dr. Gray: Absolutely. So, a lot of my women, my women, my female patients, who have higher estrogen or who have that estrogen dominance, if they’re making cysts and fibroids, if they have heavy bleeding, I’m going to put them on DIM. Absolutely. DIM will help lower the estrogen and in their case also help keep their free testosterone, but their testosterone higher for sure. So, I used DIM in men and women, all the time.

Ari: Excellent. Excellent. 

Dr. Gray: Yep. So, one of the most common questions that I get in my practice is, Dr. Gray, can you help me rebuild my health? Am I someone that would be a good candidate to see you? And the short answer is more than likely, yes. I sit down with patients every weekend. I walk them through The Longevity Blueprint and some patients need help with chapter 6, right, with the hormone system. Some don’t, some need helps in other departments. But like you mentioned they are all related. 

So, every day you struggle with nasty symptoms, whether it’s fatigue, or hot flashes, or weight gain, brain fog, IBS, or maybe you have autoimmune disease or a cancer that’s really time spent away from your family, time away spent from your precious life. 

So, we could take Gina for example, she spent years without having her hormones properly assessed, which is terrible. So, maybe had she come to see me sooner we could have prevented her hysterectomy and her gallbladder from being removed, but we can’t go back in time. We can only move forward, right. Focus on the present like I mentioned. 

So, we were able to get her off her oral Premarin, like I mentioned we got her onto natural hormones, natural progesterone and testosterone, estrogen, and thyroid and her health has dramatically improved. So, picture yourself having a day where you wake up and feel younger with vibrant energy, and mental clarity, at an optimal weight, you have a lovely mood and everyone wants to know what you’ve done to turn your health around. Picture a day when your friend or family member says to you, “You’re like the Energizer bunny, you look amazing. What are you doing?” Picture a day when health isn’t holding you back from the life that you want to live. We can help get you there. 

So, whether you’re someone who never thinks about your health, has just started paying attention to your health, or someone who’s extremely in tune to your health, working with a functional medicine provider, like myself can help you get to the root cause of your problems and allow you to live your life to the fullest. 

So, the best is yet to come whether you’re 32 or 92. It can always start with filling out paperwork, like on my website, if you’re interested to become a new patient. Our website is, one of our websites is, ihhclinic.com and I want you to really imagine what life would be like at your best health ever. 

So, I want to leave you with this. So, remember when I told you there was a better way. There is a better way, that doesn’t rely on pills and medications.

There is a better way that uses data to personalize a plan to build your health. There is a better way to get you feeling the way that you deserve to feel. 

And I know this to be true, because the better way gave me my health back, the better way normalized my heart rate, and on February 27th, 2019 the better way gave me my beautiful healthy baby boy.  So, join me and we can find you a better way.

Ari: Beautiful. Congratulations on your what, one month and, sorry 14-month old.

Magdalena Wszelaki -Transcript

Root causes of estrogen dominance

Magdalena: Okay. So maybe why don’t we just start off with just some facts about estrogen dominance and to set the stage a little bit here? Obviously this is, Ari, you know, this is a very personal topic to me because I am hugely; I have a predisposition to be very estrogenic. That’s my genetics, and always had a history of a lot of problems with lumpy breasts and terrible PMS and thyroid nodules. And, as you’ll find out all of that is a result, direct result of estrogen dominance. 

So the interesting thing is that 70% of women experience estrogen dominance at some point in their lives. And 90% of us do not realize that they have it. And I’m going to be talking about the specific symptoms in just a second.

You know, one in seven women in United States will develop breast cancer, and 80% of breast cancers in developed countries are estrogenic. What we call the estrogen receptor positive breast cancers, and therefore, preventable. Then you’re talking about 250,000 gallbladders are being removed every year in the United States, most of them are the result of estrogen dominance in women. Or women develop estrogen dominance a few months after the surgery. 75% of women experienced PMS. You show me a woman who doesn’t experience PMS, right? 

Again, this is something that is completely preventable, and, from today onwards, I really hope that our listeners will realize that having PMS is not part of being a woman. It is completely unacceptable, and it’s totally reversible. You know, you’re talking about 40% of women experience hormonal insomnia. Most of the time, it is mostly women who have a problem sleeping, right? I’m not saying men don’t, but it is more of a female problem. And guess what? Most of it is hormonally connected, and we’re going to talk a lot more about progesterone later, and that’s typically low progesterone causes that. 

We have 600,000 hysterectomies, so removal of the uterus, performed annually in the United States. And this is, again, a lot of them are very preventable. And most of the hysterectomies happen because of fibroids, endometriosis, and both of these conditions are estrogen dominance driven. Most American women develop fibroids at some point in their lives. One study found that at age 50, by age 50, 70% of white women and 80% of African American women have fibroids. Similarly, they are completely preventable and manageable because fibroids growth happens because of estrogen.

85% of women suffer from some degree of hormonal imbalances, at least once in their lifetime. So as you can see, this is like pretty much everyone you know, whether it’s your neighbor or your friend, your colleague, your sister, your mom. It’s like, who doesn’t have that, some of those issues that I’ve mentioned. 

And so, I know we are talking about estrogen dominance today, but I just want to make sure that we don’t demonize estrogen because the truth is that we need it to be a woman. We need it in order to be in the right balance. And the question is about how we breaking down those estrogens and the balance of estrogen versus progesterone that we have that really can make a big difference in how we feel.

So Ari, why don’t we start off with some of the symptoms of estrogen dominance so that our listeners can connect with the message? 

Ari: Yeah. It sounds like it’s a majority of the female population. So I’m sure you’ll address this later on, but I’m curious. If it’s a majority of the female population, how do we know if it’s truly an abnormal thing of something that’s gone wrong versus, “Hey, maybe this is just the normal balance of hormones for women”?

Magdalena: Yup. That’s a really good and a really important question. And I can tell you, and I can speak of it firsthand that having lived, for example, in Asia. I grew up in Asia, spent 22 years of my life there. Conditions like fibroids, endometriosis, thyroid nodules, lumpy breasts, breast cancers, for example, in Japan and China were pretty much unknown until a Western way style with living and diet has come in.

And so it’s not like it was completely unknown. It was obviously, there’s always somebody who has that, there’s always some abnormality. But as the majority of women, we didn’t experience that at all. There was a belief for a long time that in Japanese, there’s no word for menopause, actually there is, but that word only started existing 20 years ago. So, that’s kind of interesting and we know today that with the change in diet, with the amount of chemicals that we are using, a lot of them as you know, estrogens that come from whether our skincare stuff, whether it’s from the food we’re eating, all of that contribute towards estrogen dominance. So it’s definitely something that is amplified by our modern life for sure. 

So, if we’re talking about symptoms, it’s everything from PMS, heavy bleeding or postmenopausal bleeding, spider or varicose veins, cellulite like the woman just cannot get rid of no matter what she does. Heavy periods, breast cysts and ovarian fibroids, irritability, mood swings, and anxiety, especially around your ovulation or just before your period or on the first day of your period. Headaches or migraines, particularly before your period. Fat around your hips. 

So again, it’s like that woman who goes to the gym three times a week and works on her butt and her legs. And yet she carries all that fat there, can’t get rid of it. Thyroid nodules, history of thyroid cancer, history of lung cancers in non-smokers, history of estrogen receptor positive, but also interestingly, progesterone receptor positive breast cancer.

I just came back from a conference when they were showing studies that prove that women who are progesterone receptor positive breast cancer, which many of them are, the progesterone receptors get amplified because of the presence of estrogen dominance. Bloating, puffiness, water retention, lumpy and fibrocystic breasts. And so how many women here do not have lumpy breasts or didn’t have a lumpy breast at one point in their lives then.

This is one of the most painful and scary situations when a woman finds a lump on her breast. Endometriosis, fibroids, like I mentioned before, gallbladder issues or your gallbladder was removed, and often times that then leads to estrogen dominance. When you have brown facial discoloration called melasma, whether it’s on top of your lips, on the side of your cheeks. Having a lot of allergies can also be a sign of estrogen dominance.

That’s in the women, in men it’s not as common, but it’s becoming more common. Things like prostate issues and men boobs, or both of them can be due to estrogen dominance. On the other hand what’s also interesting is that a lot of times women will say to me, “You know, I’m in menopause, right? Oh, I’m going through perimenopause. And I know my estrogen is tanking, is lower than before. I know it. I had it tested. My gynae told me, my doctor told me, and why am I experiencing a lot of the things you talked about here, Magdalena? You were talking about estrogen dominance. I’m low on estrogen. Why am I experiencing this?” 

And so I want to assure you that are completely possible. And so in order to explain that, I want to just explain that the three different types, if you will, of estrogen dominance. And I kind of compiled it to three different scenarios just to make it easy to explain to our audience. The first one is what I call too much of the bad guy. 

The second one is what I call a dirty breakup. That’s when you have too many of the dirty estrogens. Scenario three is when you’re talking about having unbalanced partners. Think of it as like that imbalanced partners, like you meet this couple and this guy is talking all the time, talking over the woman and a woman that’s like very timid. And you can see it’s not a healthy relationship. With hormones it’s actually no different than that. 

So if you’re looking at scenario one. What happens is we have three different types of estrogens. Estrone. We have estradiol, also known as E2. It goes by E2, just for simplicity. And estriol also known as E3.

So when there is an overall dominance of E2, estradiol, that’s when we call it the aggressive estrogen, its highest in the premenopausal women, that’s the one that’s linked to breast cancer. There’s also estrodiol what’s found in, I mentioned skincare products, like if you’re using the commercial skincare products, the one that smells really nice has got the fragrances and the phthalates and the BPA’s in it. 

The drinking water from plastic bottles that’s been out in the heat for a long time. You microwave your food in plastic foods and eat that stuff. That’s estradiol that’s entering your body. And so having too much of that is what can cause estrogen dominance in the first scenario.

Ari: So just to clarify the BPA, the phthalates are not estrodiol themselves, but they’re raising your levels of estrodiol or they’re influencing the balance of these three types of estrogens in a way that shifts things more towards estrodiol.

Magdalena: Absolutely. That’s correct. In the second scenario what happens is that in our slides, the one that I sent over to you is where I show a snippet of an example of a test from Dutch. And one of the reasons why I like the test very much is because it shows you how one of the hormones, estrone, that’s your E1, gets broken down to metabolites. 

So think of it this way. Think of it like a river that’s going and you have this bank in the middle of the river bed, and this bank clears out the water and some of the water then flows through the bank and it’s dirty and the other side is clean. And so that’s what the dirty estrogens, if you will, are the ones that you can see is right on top there, 16-OH-E1. 

So this hydroxy estrone and then the four is problematic. And then the two right at the bottom, there, that’s the one that it’s a protective one. So this is an example of someone who, these are actually my results. As you can see, like right at the bottom there, the two, the protective one, I’m very high on that. And I’m very low on both the four and the 16, which is a good thing; because those are the metabolites that are causing a lot of the symptoms that we talked about. 

Ari: I see, so you’re just showing off, huh?

Magdalena: I am saying that I’m living proof that is possible for someone who is genetically very inclined towards being super estrogenic. And I have family members on both sides. I know you’re joking, but…

Ari: I mean, it’s super important. It’s important also to know that if somebody is teaching something that they’re walking the walk and that their methods actually work. 

Magdalena: You know, I have family members of both sides of family and my mom’s side, my dad’s side, my aunts who passed away from ovarian cancers, uterine cancer, breast cancers. So I’ve inherited both snips on both sides of my parents. And I’m super high risk on having breast cancer. So I’ll do anything obviously, within reasonable causes, to prevent that. 

And so that’s the second scenario and that’s what I was calling originally the dirty breakup. You think about it, you break up in a bad way. And so that feels very negative and that’s what it is.

The third scenario is what we call the unbalanced partners. And so, in the slides that I sent over to you, there was a really cool slide that shows how, when you’re, for example, 35 years old, take a look at the axis when you’ve got the age. And you look at someone who is 35 years old this shows you how much of a balance there is between estrogen and progesterone. And in a healthy woman there’s a healthy balance between those two.

And then scroll more to the right and take a look. And then now the woman who is 55 years old. And first thing, you will see that both her estrogen and progesterone have dropped and that’s perfectly normal. That’s the way it’s supposed to be, it’s part of nature. But take a look at how much more estrogen she has versus progesterone. And so even though both of her hormones dropped, there is an excess of that estrogen as compared to progesterone. And so this explains what I was saying earlier, where women say to me, “I’m in menopause, it’s impossible that I should be having estrogen dominance symptoms”, yet it’s possible because you have that imbalance of progesterone versus estrogen, even though you’re low on both hormones. 

So and, just to add to this, a lot of women would relate to this about symptoms of low progesterone. So let’s not forget about that. They’re very similar to everything that I talked about, all the symptoms on their estrogen dominance. But you also have to look at a few other ones which are pretty specific to low progesterone such as insomnia. Women who never had a problem sleeping before and then suddenly she’s like, “I just can’t sleep anymore” or “I wake up at three o’clock in the morning and I cannot go back to sleep”. So midnight waking and then inability to go back to sleep. 

Then you have, of course, infertility, miscarriages, and especially in the first trimester, mid cycle spotting. When you’re spotting when you’re still menstruating and spotting, that’s most likely low progesterone. Feeling really anxious. And the sense of restlessness that goes with that, a lot of mood swings and hot flashes. All of them can be due to low progesterone. So do you want me to talk about what causes estrogen dominance?

Ari: Please. Yeah, that’s important and kind of goes back to the question that I asked you earlier. Since its majority of women, how do we really know that this isn’t just a normal hormone balance for women? That the introduction of the Western lifestyle and the fact that how it correlates to that is obviously a huge way we can know, but even more specifically, there’s probably research around the specific causes and the likelihood specific factors and the likelihood to have estrogen dominance. So yes, I would absolutely love to hear about that.

Magdalena: So I have divided them into internal factors and external factors. So internal factors is what is related to your body and how your body produces and metabolizes estrogens that can contribute to that. So the first one is body fat cells. So your body fat actually is an endocrine organ, believe it or not. A lot of people think like, “Oh, your ovaries and the thyroid are part of the endocrine system”. Actually, a lot of the fat, especially around your abdomen becomes an organ as well. And that can produce excessive estrogen. 

As now as a woman, you’re producing estrogen in your ovaries. For some women it’s the adrenals, especially after hysterectomy, but then you have your body fat also over producing estrogen. So adding fuel to the fire. Women who have lost their gallbladders, or have insufficient bile to bind and evacuate metabolized estrogens can experience that as well.

Ari, let me give you an example. This actually happened to me probably seven years ago when I met this woman and she says, “You know? I lost my gallbladder. And then six months later, I started having really lumpy breasts”. And two years later she was diagnosed with breast cancer. And so that was the first thing and she was like, “You know, I was always wondering what is the connection?” And at that time I didn’t really connect the dots. 

And then I started doing more research on it. And it was really fascinating that the gallbladder stores bile and a lot of people think that bile, if you ask anybody in our space or most people, many people don’t even know what bile is for. But even in our space as practitioners, everybody will tell you that bile is there to emulsify fats, to help you digest fats.

Not many people talk about the fact that the bile also, one of its roles, is to bind up those estrogens, those metabolites, the 4 and the 16 that I was talking about, and evacuate it through poop. Because you’re pooping out your hormones, especially the metabolized ones. So when a woman loses her gallbladder, she still produces bile, but in very small amounts and it’s like on demand, it’s not in storage when it’s like available when you eat something fatty. And then it’s kind of like dripping a little at a time from the liver. And so then the body prioritizes and says, “I’m going to deploy that bile for fat production”, because you need that fat in order to produce cholesterol.  

From cholesterol you have all these other hormones that are produced, all your steroid hormones, your testosterone, estrogen, your cortisol, progesterone, DHEA. All of that comes from that. So you need that, but I’m going to then compromise and not metabolize your estrogen so well, because I just don’t have enough bandwidth. And so this is consistently, I posted once on our group saying “Who here lost gallbladder?” and “Have you had any estrogen problems after that?” And I cannot tell you how many women have come on and say, “I never thought about that. Why hasn’t my doctor told me this?” It was overwhelming.

Ari: And with gallbladder surgeries, I think every time…

Magdalena: 250,000 in the country, every year? 

Ari: Wow. I had no idea it was that common, but I know that they will prescribe digestive enzymes in most cases or tell people to take digestive enzymes with meals.

Magdalena: But it doesn’t replace the bile. So I mean, taking ox bile is a good replacement for that. Yes.

Ari: Yeah. That’s what I was going to say is like, yes, you’ll digest the food and emulsify fats, but maybe the digestive enzymes don’t take care of this other role relating to estrogens.

Magdalena: Exactly. So ox bile does, but guess what? Most people are not even made aware that that is an option. And so that’s, I think, part of the reason why we so liberally remove women’s gallbladders. A man’s as well, but I think as women, we suffer more from that hormonally, that could be one of the contributing factors. The fact that so many of us have a sluggish liver, like one of the biggest shockers that I remember I had was that when I started researching this is that your liver has different pathways, like the sulfation pathway, methylation pathway. 

And every one of these pathways is responsible for metabolizing different hormones, bacteria, viruses; different drugs go through different pathways. And estrogen gets metabolized by three of them. And so you need those compounds and you need basically the liver to function properly to break down, remember the chart I was showing you? The ugly breakup, that 2, 4 and 16?

We need a healthy liver. That’s when the metabolized gets broken down. There is a genetic component to that. But the majority of that is going to depend on your liver. So when you said, “Is this like a given or is it acquired?” Well, guess what? Most of us have compromised livers. Because of all that, whether it’s caffeine, whether it’s alcohol, whether it’s stress, whether it’s the diets that we eat.   

Ari: There’s an epidemic now of nonalcoholic fatty liver disease. I mean, it’s skyrocketed in the last couple of decades. 

Magdalena: Absolutely. So then, you have a diet full of sugar and little fiber, that’s another big factor here. And that causes constipation. Well, guess what, I kind of alluded to this when I was talking about a gallbladder, is that you need to poop your hormones out. When you’re not pooping often enough, meaning at least once or twice a day, feeling completely empty, having a really nice, healthy bowel movement. All of those hormones re-enter and get reabsorbed into the body. And then your endocrine system shuts down because it thinks it has got enough hormones, but actually it doesn’t. So that’s another contributor here and I don’t need to convince you that back in the day, we have no constipation problems. Now you go into CVS, you walk into the aisle, what do you see? On constipation, you probably have like 40 different products for helping people move their bowels. 

Ari: I take all 40, just to be clear. 

Magdalena: Right I’m sure you do. That, in fact it could be poor gut microflora. There is something called estrobolome. Estrobolome is a subset of bacteria that codes for enzymes that break down those estrogens. Again, remember that ugly breakout? The 2, 4, and 16? Estrobolome are these little bugs, those little subset of bacteria that will help you to break down those hormones or not. 

Stress can be a huge contributor and something we call pregnenolone steal. The stress basically steals your progesterone in order to produce more cortisol for you to survive through stress. And when that happens, then you’re depleted of progesterone. And that’s a scenario number three, when I talked about the unbalanced partners, when you have too much of estrogen and too little progesterone, and that’s because of stress. 

Again, to your point, we did not have as much stress in our lives as we do now. And there’s a small element of genetic predispositions, like the COMT and the MAO genes that people, who have like double mutations of those, and definitely that predisposes us a lot more to having those metabolites to be taken care of properly.

So those are the internal factors. Then you have the external ones, like phytoestrogens when you have excessive amounts of extragenic foods that are unhealthy, such as soy, processed soy here, and meat. And I’m not talking here about meat that comes from farm animals out there that are grass fed. I’m talking here about animals that are fed antibiotics that are put on hormones. And most of the time you eat meat that comes from females. And so that contributes to the problem. Dairy because of all the hormones that cow has been given. Xenoestrogens. 

So things like phthalates, parabens, BPA, plastics, all mess up our endocrine system in a huge way. Birth control pills, no brainer there, hormone replacement therapy. So taking synthetic hormones can be a contributing factor here. But I think it’s like the smallest of them all. I think a lot of the other ones, things that we don’t even realize that we do. Like I said, that bottle, you just go to the supermarket; you buy a bottle of water. What’s the big deal? And you don’t realize that the bottle was probably sitting there for six months in the storage facility somewhere and out in the sun. It’s not covered because why cover it? And all of that plastic gets into the water and that’s what gets to us.

Is soy healthy or unhealthy?

Ari: Yeah. I have a quick question for you on soy. I grew up, since the time I was a teenager, when I started studying nutrition over 20 years ago, especially in the fitness community and the bodybuilding community. Soy was very feared among men as well. Women, because it’s like, it’s phytoestrogens, it’s going to cause breast cancer and ovarian cancer and those kinds of things. But for men, it was like, “Oh, you know, it increases estrogen levels. You’re going to get man boobs. You’re going to build less muscle. You’re going to put on fat”, all these types of things. So it was very feared. 

And for, I would say much of the last 20 years, that’s the case. But then in the last, I think last five years especially, there’s been a whole bunch of research that’s come out. That’s pretty much vindicated soy, that’s basically said, “Women in particular, women have lower rates of breast cancer and lower rates of breast cancer recurrence, the more soy that they consume”. And I think that doesn’t even take into account whether you’re consuming organic tempeh, fermented soy, or GMO, typical soy, milk, tofu, and stuff like that. 

Magdalena: Yeah. So I would love to talk to you about that. So there are studies actually that shows both. One of the problems with the studies is that they don’t tell you exactly what form of soy that was. And that is one of the detrimental things about that kind of research, because you don’t know whether they were given soy milk or given a nice fermented tempeh that in Indonesia. 

As I said, I grew up in Asia and half of the population in Indonesia can only afford fermented soy as the source of protein. So is it that, or is it that horribly processed stuff and the fake meats and stuff like that? What have they been feeding them?

Ari, there was research that shows both sides and because of the flavonoids in soy, yes, there is. I have met a number of women who have said that their hot flashes have stopped after taking soy. 

The thing is that I feel like there are so many other foods and that’s the second part of the presentation today I prepared for you, is to talk about foods that you can really safely incorporate into your life without fearing what it is. So let me just clarify this. When I talk about soy here, I’m talking about the highly processed form. So that would include things like tofu. That’s going to be all the fake meats. So you want to stay away from that stuff as far as possible. Soy milk. And then the good form of soy will be things in a natural form, what they are doing in a Japanese restaurant, I’m forgetting…  

Ari: Miso?

Magdalena: Miso is wonderful. Yes, absolutely. And then you’re doing tempeh, all of that stuff is really great. That one I have no issues with. It’s just that most people don’t. And so the first thing they do is run off and get soy milk. 

Ari: I eat a lot of tempeh myself.

Magdalena: Right. That’s a really great food. So since we’re here to talk about specifically estrogen dominance and energy, I will say that there is a direct and indirect link between estrogen dominance and energy. So let’s just explore this a little bit.

Exercising in accordance with your cycle

The first thing I’ll say is that if you look at the menstrual cycle of a woman. We all know as women that in the first part of the cycle, meaning from after your period, from when your period starts and when it’s kind of over. That’s when you enter like a good time. That’s when you are full of energy and optimism and you’re feeling like the world is yours.  

And if you look at the chart, how our hormones fluctuate in our cycle, this is only of course for cycling women who still have a period. This is the time when estrogen is at its highest. And that’s when we have really good energy. The second part of the cycle, which is called the luteal phase. This is where the estrogen starts dropping and it comes up a little bit again, and then it drops really low before the period.

So the luteal phase typically, that’s what we always say a lot of times after ovulation, this kind of becomes more of a quiet time, more like introvert time, like a time of reflection. But your energy is also not the same. And then of course, before your period, this is when it’s like a lot of women just want to stay in bed the whole day. 

Why? If you track it back to estrogen, this is when it’s completely at its lowest before it comes back up again. So what’s one thing as a woman and is also really important for us to recognize is that you don’t expect, especially if you’re menstruating, to be like “Go, go, go, full of energy the whole time”. Honor your cycle and know what are the times that you want to be energetic and engaged and honor the time when you feel introverted, it could be something to do with your hormones. And that’s perfectly okay.

Ari: Yeah. That’s great. I’ve even seen some fitness training programs that have come out in the last few years that are specifically for women and how to train, how to periodize their training. Organize their difficult days, their intense days and their lighter days according to their monthly cycle. And there’s actually some research that has shown greater improvements in women training on those kinds of programs compared to conventional non periodized training programs. So I think this is really important. Great advice.

Magdalena: Yeah. Whether its exercise or whether it’s anything you do in your life. Whether you have to make certain decisions or you’re doing presentations, you need to talk to your investors or whatever. Just try to pick a time when it’s not before your period. That’s just fine. I mean it really impacts us in every way. 

And I’m not just talking about energy here, but it’s just a whole demeanor too. So the other thing that I think is important to talk about is that estrogen and inflammation, on one hand, remember how I said at the beginning of the presentation that estrogen, let’s not demonize estrogen? When I talk about estrogen dominance, it’s gained this reputation of estrogen’s bad.

One of the most common emails that we get is “You’re suggesting flaxseed, you’re crazy.  Flaxseed, it’s full of estrogen. You’re going to kill women”. That’s going to be one of the foods that I do want to talk about so let’s not demonize it. And this is like one study that I cited here. The name of the study is, “Estrogen is a modulator of vascular inflammation”. And it was a really fascinating long study and it shows that a right amount of estrogen can actually be anti-inflammatory and anti-oxidative; it can help us with anti-aging. It can help with pain. 

It controls our blood sugar levels; it increases reception for sensitivity to leptin so you’re not hungry all the time after eating. It has really important functions. But on the other hand, this is where the nuance is, that it’s the excess of estrogen or the dirty metabolites that are there and they are highly inflammatory. And so you are the mitochondrial expert and you can tell, can you just share, maybe? Have you seen anybody who has got a lot of inflammation, who’s got a healthy mitochondria?

Ari: Well actually there’s research showing specifically elevated inflammatory cytokines directly shut down mitochondrial respiration. So yeah, those two things are pretty mutually exclusive to have very high end chronic inflammation and lots of energy.

Magdalena: So I thought that I’m not going to be going into research, showing you how inflammation is going to shut down mitochondria, because that’s not my expertise area. Ari can tell you more about that. But if you could just take it for a fact. Remember one of the symptoms I talked about is allergies? And you’d be like, “Estrogen dominance, allergies. What is she talking about?”  

Well, it has the inflammatory response. It’s the estrogen dominance that causes the inflammation. You were so inflamed. Your immune system is reacting to everything. Whether it’s dust, whether it’s an animal, whether it’s food, whether there’s pollen that you never had an allergy to before, suddenly all of those things develop. And so that’s something really important to remember is, again, is the inflammation.

And when you have an inflammation, it shuts down your mitochondria, your energy is down. The other thing how we can look at estrogen dominance and energy is a direct link on estrogen onto the thyroid. And think of the thyroid like a speed pedal in your car, gas pedal, sorry. You have gas pedal in a car. So it gives you great energy. It gives you super sharp mind. It gives you healthy hair. It gives you the ability to express yourself. And all of that is related to the thyroid and a lot more. 

So let’s explore the connection between estrogen dominance and thyroid. Interestingly, estrogen dominance causes the liver to produce high levels of this protein called thyroid binding globulin. And you can actually get this tested on the blood work.

And the interesting thing is that elevated numbers of thyroid binding globulin binds up T4 hormone. T4 is what the thyroid produces. But T4 is also for those women who are on Synthroid, for example. Synthroid is also a T4 hormone. 

And so these are the women who go, “You know? I feel so tired. I’ve put on so much weight.” They go and see the doctor. And a doc goes, “Well, let’s just increase the doses.” So then she goes up from 125 ML to 150 ML. Okay. Milligrams. Okay, great. And then she comes back. She’s like, “Doc, I just feel so off. It’s not helping at all.” And they go, “Well, it’s in your mind. I put you on antidepressants.” The one looks into estrogen dominance, nobody looks at her thyroid binding globulin to see, is there something that’s binding up all that T4 hormone, that’s why she’s not enjoying the benefit of that additional energy which she should be getting.

So this is really important. And then again, it goes back to what I was saying just now, is that estrogen in excess and too many of those metabolites can be inflammatory, that can weaken your intestinal lining, that can create an immune response and guess what? And that can then worsen your autoimmune condition. And most people who have thyroid condition have that because of Hashimoto’s disease. 90% of low thyroid cases are because of Hashimoto’s. Hashimoto’s is an autoimmune disease. So there you have it, the inflammation then directly feeds it into Hashimoto’s. 

And so it’s kind of killing me when I hear people write to us and say, “You know, I read and love your blog and everything you’re doing. But some things you were saying makes no sense to me at all. You asking everybody to start eating kale and collard greens and all the cruciferous vegetables, all the goiters are going to kill my thyroid”. And I always say to people, “You know, I have never, ever met a person who has gotten off all the cruciferous vegetables that are supposedly killing your thyroid and then feeling fantastic”.

Ari: I think of that as reported improvement. 

Magdalena: Never.

Ari: It’s my understanding of that, I’m curious if you agree, but my understanding is it’s only something that interferes with thyroid production and, you know, iodine transport in the thyroid in the context of an iodine deficiency or an iodine deficient diet. And then you have to worry about goitrogenic effects from cruciferous vegetables, but almost nobody’s on an iodine deficient diet. So removing these cruciferous vegetables with so many amazing benefits just doesn’t make any sense.

Magdalena: Yes, that is correct. I mean many are people low on iodine. That is the fact in the country. However, you’ve got to have huge amounts of like, amounts that you never eat in terms, of course, of eating them in a raw form in order to, and I have met people before who would juice and eat bunches of kale a day, like two, three of them in a smoothie because they go on a healthy trip and then they develop a thyroid problem after three months. But you know, I’m not asking anybody to eat three bunches of kale every day. That’s not what it’s about. And especially not in raw form. So anyway, this is one thing. 

And then the other thing I think is also important, the way we talk about estrogen dominance and this role on energy is that let’s not forget that the third form of estrogen dominance, the unbalanced partner said that we have low progesterone and progesterone can impact us indirectly in terms of energy.

Why? Because when you are low on progesterone, which so many women are, especially after 45, it’s pretty much a pandemic. You don’t sleep and you’re having a lot of insomnia problems. And so you tell me how many people here feel fantastic after not sleeping at night. 

And then mood swings, anxiety and nervousness, which is hugely energetically zapping. I know you’re not a woman, but any woman will tell you when you have a lot of fits and the kind of mood swings, you don’t feel good, and it’s hugely energetically zapping as well, and you feel bad about it. So I know many people ask, or always ask about, “So how do I test? How do I know if I’m estrogen dominant?” And definitely go by the symptoms, that’s very telling, but if you want something on paper, there’s a couple of options.

 

Blood is the least reliable way of doing it, but you can do a couple of things. One is, well, actually the one thing I recommend is the 2:16 hydroxyestrone is something you can do by blood. Those are the two metabolites that I was talking about. Unfortunately, when it comes to seeing estrogen and progesterone in your blood is highly inaccurate and I do not recommend it. I cannot tell you how many women I have seen having screaming symptoms of estrogen dominance, and then showing me the blood work. And the doctor says everything is perfectly fine, but then when we test it through saliva or urine, it’s a different story altogether and then the truth comes out. 

So saliva is a pretty decent way of doing it. The only thing I think that’s missing in saliva is that they cannot test those metabolites, the dirty breakup ones that I was telling you about. It doesn’t show up. The best right now, the state of the art is urine testing. And the lab that I personally love a lot, and I know a lot of practitioners use is called Dutch. D-U-T-C-H. And that will show you a whole bunch of different things about what’s going on with your hormones, not just estrogen, progesterone, but a lot more. 

So, to sum up this section here, I just want to say really estrogen is super needed for us to be healthy in terms of healthy weight, good energy, brain function, reproductive health, cardiovascular, bone health, you name it. But estrogen metabolites can either be protective or they can be highly antagonistic. And they are the ones that are causing all the gain weight and energy loss and cancers. The cool thing is that we can control how we break down those estrogens. And I think that’s one of the most redeeming and inspiring thing about doing this work is that we can really shift that around and guess what? Food and supplements are the most natural way to do that. 

Show Notes

00:00 – Intro
02:22 – Dr. Shawn Tassone intro
03:00 – The 12 types of hormonal balance
06:44 – How testosterone imbalance affects women
10:59 – The role of estrogen dominance in women
16:08  – Stephanie Gray Intro
16:28 – Who can be affected by hormone imbalance?
21:56 – The role of sex hormones in health
28:53 – Why hormones play an important role in health
43:05 – Magdalena Wszelaki
43:14 – Root causes of estrogen dominance
1:06:23 – Is soy healthy or unhealthy?
1:09:49 – Exercising in accordance with your cycle

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