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True Root Causes of Dis-Ease in the Body: Estrogen Dominance


Oh, great questions are coming in!  Please keep them coming.  In response, I am sharing some additional tips and specifics below which might be helpful.

These dynamics are core tenets that you want to be not just aware of but savvy about catching early.  Then you can help your clients and patients to resolve them fully using functional medicine know-how.  Wildly satisfied clients build wildly successful practices!

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  • An excellent resource for helping clients to choose non-toxic personal hygiene products is from the Environmental Working Group (EWG).  In particular, they offer a database called Skin Deep which includes thousands of products and some targeted best-choice lists as well.
  • If you want to learn more about xenoestrogens (aka “estrogen mimickers” or “endocrine disruptors”) in our environment,  you might enjoy this clinical statement from the The Endocrine Society.
  • Here is a good, high-level article you could use with your clients about the most common and most potent endocrine disruptors .
  • Body fat makes estrogen.  This means an obese woman, even post-menopausal, is highly unlikely to have truly low estrogen levels.  She may still have hot flashes due to rapid fluctuations in estrogen – which can still happen even when the overall baseline level of estrogen is moderately high.  Many other lifestyles can contribute to hot flashes e.g. alcohol, caffeine, low cortisol (due to sustained stress).    It’s important to remember, however, that even very thin women can struggle with estrogen dominance, usually due to poor detoxification or hormone imbalance (usually due to very low progesterone).
  • Here is the hormone cascade diagram I promised you.  I share this with clients very often and use it to help them to understand clearly the downstream hormonal effects of prolonged (especially unrelenting) stress.  It is an excellent prelude to helping a client understand the empowerment and opportunity they have in choosing their reactions to their life situations.
  • One of my favorite brands of chastetree berry is Gaia Vitex Berry.   You may learn more about what clinical research has shown regarding vitex here.  About 1000mg/day is a typical dose, ideally divided.
  • Yes, it would be quite common for people with MTHFR genetic variants (called “SNPs”) to struggle with estrogen detoxification.  The addition of COMT SNPs compounds this challenge greatly and makes estrogen dominance more likely.
  • Here is a simple handout about cruciferous vegetables – which you are welcome to use with your own clients .
  • A couple of you are looking for a more clinical article about how the body naturally detoxifies estrogens (more clinical one here).  As I shared in the video, promoting in particular the Phase 2 liver detoxification processes called sulfation and glucuronidation is key.  Yes, other detoxification processes are involved in processing downstream metabolites of hormones.
  • You may find a wealth of information about DIM here.  200mg/day is a typical dose, ideally divided.  Sometimes DIM is paired in a supplement with calcium d-glucarate, a substance which deactivates an enzyme in the GI tract called beta glucuronidase (BG).  Certain bacteria in the gut produce large amounts of BG, and this enzyme prevents excess estrogen from being fully removed from the body in the detoxification process.  We need small amounts of BG to fully digest many phytonutrients in plant foods.  Too much, however, can cause estrogen to be cleaved from its detoxification escort, marooned in the gut, and then reabsorbed back into the blood supply – effectively rendering the body unable to fully get rid of excess estrogen.  Another great example of how disease usually does indeed begin in the gut.
  • Here is a great summary article on the estrogen-balancing benefits of flaxseed.  This one references many clinical studies but is also written in a way that should be quite accessible to your clients.

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18 Questions for “True Root Causes of Dis-Ease in the Body: Estrogen Dominance”

  1. 8
    Angela Smith says:

    Do you happen to have the link for part 3 of this series?

  2. 7
    Andrea Reynolds says:

    I read a lot about Estrogen dominance but in this case I’m not 100% sure if this would be considered that.
    50 yr old, newly post-menopausal.
    Dutch Hormone test levels:
    b-Pregnanediol 82 (low end)
    a-Pregnanedial 17 (low end)
    Estrone E1 2.4 (below range)
    Estradiol E2 (low end)
    Estriol E3 (low end) (all other estrogen metabolites are low end or below range)
    DHEA-S 45 (low end)
    Androsterone 868 (mid-range)
    Etiocholanolone 795 (mid-range)
    Testosterone .8 (below range)
    5a-DHT .3 (below range)
    5a-Androstanediol 9.5 (below range)
    5b-Androstanediol 11.1 (below range)
    Epi-Testosterone 1.2 (below range)
    Phase 1 Estrogen Metobolism ratios are good. (4-OH 7.5%)

    Eats fairly well, exercises regularly, Little alcohol, no medications, decent supplementation, likes to keep things natural. Has a small frame, fit and trim body but has gained 10 to 13 lbs for no good reason and can’t get it off. Some hot flashes but not bad. Mood swings and low libido are evident. Need help on this one! Can’t find examples of these kinds of ranges all at once.
    Thank you!

    • 7.1
      SAFM Team says:

      Alas, we don’t have the capacity to respond in detail to the myriad specific cases that our hundreds of practitioners support, but I am happy to offer a few general comments. Across the board, this woman’s hormones are mid-range or low which may indicate some overall suppression or sex hormones in the HPATG axis – which is often in response to stress. I would put more focus on what the DUTCH cortisol data is telling you and how that might be affecting sex hormones and also thyroid function. Remember that post-menopause, especially for a thin woman, the adrenals are the primary source of sex hormones. It’s also importance to remember that a state of “estrogen dominance” should be something that you look for primarily in the person’s symptoms and experiences, with the data giving your pointers on the *type* of estrogen dominance at play (a topic we cover in detail in the Demystifying Hormones clinical course). Two women can have identical hormone results and dramatically different, downstream life experiences. Hormone data (even awesome data as with DUTCH) is still only a portion of what is at play. Hormone receptors and receptor sensitivity and the rich interplay of all these hormones together is something that will always be beyond the numbers and will vary individually. A major, major contributor to estrogen dominance in women these days are xenoestrogens, and they are not going to show up on


      hormone test data, including DUTCH. From a root cause perspective, I would focus on the effects of stress (keeping mind that stress is not about the events of our lives but rather how we respond to them – especially in the quiet recesses of our minds). For rapid relief, I would also use maca root to boost androgen and estrogen effects. If you are an active Semester or Practitioner Incubator student, you may wish to seek a Custom Consultation in order to get some 1:1 support with specific lab interpretation and overall pearls where you will have time and dedicated support to dive into the details.

  3. 6
    Gayle Arnold says:

    Hi Tracy:

    I love this topic! I’m also a big fan of Dr. Gottfried. I’m post-menopausal and do exhibit some symptoms of estrogen dominance and maybe even the inability to detox excess estrogens. I’m hypothyroid and when I was periomenopausal, I had large fibroids, very tender breasts, and when I did have my period I passed clots, with excessive bleeding. Since then, I’ve used progesterone cream but discontinued using it about 4 years ago. My fibroids went away, and of course I no longer have a period. I do have some hot flashes, but not a lot and not very strong, I also experience headaches and have extra belly fat that doesn’t seem to go away. I will try the Vitex to boost my progesterone. I would like to incorporate a B complex, but whenever I take them, I experience shakiness and a very hyper feeling. I’m thinking I might have low stomach acid which is not allowing the B complex to be assimilated in my digestive track. Could that be the issue? Thanks! I love your work and so appreciate the access through the membership program. I look forward to enrolling in the next Semester program.

    • 6.1
      SAFM says:

      How wonderful that you are so self-aware of your own body! You might consider doing some testing to see where your postmenopausal hormone balance lies. Given the history of hypothyroidism and fibroids, you may have a need for more iodine as well. Beyond Vitex, daily ground flaxseed plus the vitex may do wonders for your hot flashes. I would boost your magnesium to help with both hormone balance and headaches. Sex hormone balance also affects how thyroid hormone is absorbed into our cells, so make sure your thyroid numbers are really optimal (not just “barely in the range”). Depending on the doses included in your B complex, it’s likely that either B6 or B9 (folate) is causing the feelings you describe. I recommend you try a B-complex that has only a small amount of B6 and only in the P5P form to ensure absorption – specifically Thorne’s “Basic B Complex”. Begin by emptying out half the capsule and reassembling it tightly before taking. Always take in the middle of a meal or near the end, so it’s with active food in your stomach. You can always check your B12 levels to ensure those are adequate specifically. As you clearly know, we do indeed tend to struggle with optimal stomach acid levels as we age. Be well!

  4. 5
    Kathy Connell says:

    LOVE LOVE LOVE this video Tracy!! ( Who doesn’t have clients with estrogen dominance – or for that matter who of us isn’t or hasn’t been estrogen dominant at one time or another??) One key question I have here is about a 45-plus year old female who exhibits most symptoms of estrogen dominance but who is already working with physician and has been prescribed bio-identical hormones. Would it be best not to use DIM or chaste berry because of the aforementioned situation?? I’m passionate about DIM AND Vitex but am feeling very cautious recommending their use in this case. Additionally her lab work shows a slightly elevated testosterone level. THANK YOU!!

    • 5.1
      SAFM says:

      Good thinking! And indeed DIM and Vitex are two supplements I recommend often to my clients. First of all, ask the client specifically what hormones are being used. If it’s only progesterone, then DIM might be very appropriate to help encourage further balance. If it’s only estrogen, then Vitex can help to boost progesterone to find balance. In this case, I would highly encourage the client to speak with their physician about their symptoms of estrogen dominance. Wherever possible, help to create a bridge! But if there is no resolution, then having the client to a salivary sex hormone panel could be quite helpful in order to see what levels of free hormone are having cellular effects. With strong receptor sensitivity, some individuals can suffer from estrogen dominance symptoms even with mid-normal levels of estrogen. With the higher testosterone, I would think about a diet that is provoking too much insulin secretion; in women, this promotes higher testosterone levels. Fasting insulin labwork could help to determine if this is a driver, but generally most people benefit from reducing refined carbohydrates in their diet.

  5. 4
    SAFM says:

    A question was sent to me about clinical evidence that boosting progesterone improves hot flashes. This is a good one: . Keep in mind, however, that this is only going to be true for those who actually need more progesterone. As with most things in the body (but especially hormones!), more is not necessary better. Balance is critical, and I always encourage my clients to seek both blood and saliva hormone data before they consider supplementing with hormones of any form (e.g. transdermal progesterone cream).

  6. 3
    james says:

    Just today I started reading Dr. Sara Gottfried’s book about diet and hormones. She has a seven-stage dietary program for rebalancing hormones and the first one has to with estrogen dominance.
    Her two main dietary recommendations are to stop eating conventionally raised and processed
    meats which she says are full of estrogenic hormones and alcohol in all forms including
    red wine. Would you agree?

    • 3.1
      SAFM says:

      Thanks for joining in the conversation, James! Oh, I really appreciate Dr. Gottfried’s work – especially because she helps to make the very complex topic of hormones highly accessible to the public. I absolutely agree with eliminating conventionally raised meats, and I recommend that to every one of my clients regardless. For the same reason, I recommend avoiding all dairy foods for those who have estrogen dominance. I do find that many people who have estrogen dominance find relief in limiting or fully eliminating alcohol. And yes, I have noticed a trend in women having more intense symptoms when they choose to imbibe wine in general (vs. a distilled spirit like vodka). I personally do not always recommend full elimination of all alcohol, though certainly there is no harm in doing so. It depends on the person and the full balance of how much lifestyle change is needed. On the practical side, a coach always has to balance in one-on-one work (vs. the general education a book provides) what a client is willing and able to do and how much change they can implement sustainably. I personally would actually prioritize overall reduction of refined carbohydrates (in addition to the removal of hormone-laden foods above) in order to reduce estrogen dominance (by reducing insulin-mediated body fat – which produces estrogen).

  7. 2
    Nan says:

    I am a health coach certified by IIN. All of your videos are very informative. In this video on estrogen dominance you tackle lots of material very clearly. You mention the relationship between estrogen and hypothyroid. Can you tell me if estrogen dominance can be responsible for Hashimoto’s Thyroiditis? I have an autoimmune condition that I’ve resolved by being gluten free and eating very well. I have the TPO antibodies, but normal thyroid hormone levels. I’ve been on bioidentical estradiol and progesterone replacement for 10 years. I think it’s time to get off them. Meanwhile, I discovered the Hashimoto’s during that 10 year period.

    Thank you for your response, your time and your great info.

    • 2.1
      SAFM says:

      Thanks for joining the conversation, Nan! I am glad you enjoyed the video. The answer to your questions is Yes. Autoimmune disease in general usually has multi-factorial causes (usually including intestinal permeability which, as you pointed out, is commonly triggered by gluten). And each person’s set of triggers and imbalances is unique (which is what makes it so satisfying and – dare I say – Fun to investigate; I know, I’m a geek!). Estrogen dominance generates inflammation which is a major component of autoimmune activation in general and also influences thyroid autoimmunity gene expression. Hashimoto’s activation is more common during/near-post pregnancy and in perimenopause, times when estrogen surges are quite common. If you still have clinically high TPO antibodies, then something is still triggering the immune system to be overwrought in your body. Of course, this could be many different things such as unrecognized food sensitivities, toxic burden, or gut microbial imbalances. I would gently recommend you consider getting salivary hormone testing to see the amount of free hormone your body is choosing to keep in circulation. In blood, 95%+ of estrogen is bound to proteins which is tells you little about what is available to have cellular effects. I beileve the combination of blood and saliva testing for hormones is most accurate. Urinary hormone/metabolite testing is excellent, but is a much more esoteric, thus hard to find, and expensive test.

  8. 1
    Kathleen Mitchell says:

    Hi Tracy,

    I have two questions on the Hormone Cascade Diagram.

    Can chastetree berry help raise progesterone levels even after menopause? Or can you really only try to lower estrogens to help the ratio?

    Also, what can you do if you have low cholesterol level, which is the backbone of all hormones?

    Thanks so much!

    • 1.1
      SAFM says:

      Yes, chastetree helps with progesterone postmenopausally (PM). This may be of interest: . Its action is at the level of the pituitary, not the ovaries, so it is effective even after the ovaries have stopped producing progesterone. For my clients with low cholesterol (esp. LDL below 70 mg/dl), I recommend intake of organic butter, organic free-range eggs, and crustaceans. Vitamin B5 (pantothenic acid) helps available LDL to be pulled into the hormone cascade, but this needs quite high doses (~500mg/day).

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