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

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.

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.