What Are the Clinical Effects of High E (As Opposed to High E2)?

[DavidZ]

Why should we worry about high total estrogens (E)?

I know what the negative effects of high E2 are, namely, ED, loss of libido, loss of energy, and basically a lot of the same negative effects as low T.

But I don't know what the negative effects of high total E are? Are there any? If not, why should we worry about high E?

 

[mranak]

There are contrasting opinions on this. SWALE doesn't seem to concern himself much with total estrogens.

 

[DavidZ]

There are contrasting opinions on this.

Actually, a lot of times people say high E, they really mean high E2. So, I'm not sure if it's contrasting opinions or if it's a matter of knowledge versus ignorance. That's why I'm posing the question.

Assuming that it's a real difference of (knowledgable) opinions, what are the (supposed) clinical effects of high E?

SWALE doesn't seem to concern himself much with total estrogens.

Actually, I think I recall Swale discussing some concern with high E, but it may have been more in the realm of exploring a theory rather than describing an adopted part of his recommeded regimen.

 

[pmgamer18]

Nick O' talk to Dr. Shippen and he feels there is something to it.
Here is a cut & paste on it.
Phil
To: hypogonadism@...
CC: hypogonadism2@yahoogroups.com
From: "Nick O'Hara Smith" <nick@...> Add to Address Book
Date: Fri, 25 Feb 2005 22:25:20 -0000
Subject: [Hypogonadism] Conference day two



Hi guys,

Today was another excellent day at the Conference. It started with a
chat to
Eugene Shippen just before he spoke on Estrogens. What a nice guy he
is! As
someone who hasn't had an E2 problem, hearing it from him in depth
was
amazing!
He states very clearly that the balance of Testosterone and Estrogen
in
the
body at the right level for the individual is the way to go. We all
know
that of course, but it was good to hear it confirmed. He also told
us
he is
now testing for the ration between Estrone and E2, suggesting it is
important to get the whole picture because there is an enzyme H17 in
the
brain that facilitates E2 and also can cause inflammatory conditions
to
result if it is screwed. Estrone is the other component of the
process.

 

[DavidZ]

Nick O' talk to Dr. Shippen and he feels there is something to it. Here is a cut & paste on it.

Nonetheless, the mystery remains...what are the (supposedly negative) effects of high E?

 

[robertin75]

Two things that I know for sure, is that high estrogen levels will bind both thyroid and cortisol. By increasing thyroxine binding globulin and cortisol binding globulin, you will have less thyroid and cortisol available for your tissues. Not a good thing as you can see !

Have you had your total estrogen levels measured Davidz?

Roberto

 

[HeadDoc]

I've seen several testing protocols for HRT/TRT in which only E2 is checked. I continue to test total E and E2. The E2 has to come from somewhere. I also want to make sure that I am not driving the E's too low. I'm sure some would consider this redundant. Estrogen is neuroprotective and necessary for the bones.

 

[robertin75]

HeadDoc or anyone:

Any chance you could post your total E results along with the reference ranges?

Thanks,
Roberto

 

[peewee327]

swale seemed concerned about my high total E's (170). even though my E2 was 24. i do recall sometime ago swale stating on this board that it is very hard or maybe not even able to lower total E's without pushing E2 too low. i may be wrong but i do recall that. it may be correct because i have not seen anyone state how to lower total E's without also effecting you E2 levels.

 

[robertin75]

peewee327:

Any chance you know the reference ranges for your total E?

Thanks,
Roberto

 

[peewee327]

i believe it was <135

 

[pmgamer18]

I have both tested my Dr. has been doing both from the first Day I got him looking into E2.
My E2 is 21 range <20 - 56 pg/mL and my Total E is 196 range <200 pg/mL
When I was just doing Arimidex just my E2 changed but Total E stayed over the range. Now that I am doing Indolplex/DIM my Total E has come down a lot on Arimidex my Total E was over the top 539,312,436 and so on. I think Arimidex blocks E2 and Indolplex/DIM changes it to good E that is easy for the liver to get rid of.
Phil

 

[SWALE]

I have evolved my thinking to where I think Total E's are very important. This is because I sometimes see mid-range E2, but the patinet is still experiencing E-like symptoms. Now that I have been doing this, many times E2 is midrange, but Total E's are well above the top of range.

The difference between E2 and Total E is basically Estrone. There are several types of estrone whihc are quite bad for you. So when I see elevated Total E's, I now run a 24 hour urinary panel for estrogen metabolites. From there I can use mixtures of OTC products to control them.

I used to tell everyone that E2 is the major player, and that was all we had to worry about. Now I know that was wrong.

However, if we can at least get docs to test E2, it will be a vast improvement.

 

[robertin75]

SWALE:

Which lab do you recommend to measure 24 urinary estrogen metabolites?

Thanks,
Roberto

 

[Matt Muscle]

Two things that I know for sure, is that high estrogen levels will bind both thyroid and cortisol. By increasing thyroxine binding globulin and cortisol binding globulin, you will have less thyroid and cortisol available for your tissues. Not a good thing as you can see !

Have you had your total estrogen levels measured Davidz?

Roberto

Roberto, where did you find this information regarding high estrogen and its effects on thyriod and cortisol?
Could this give you symptoms of hypothyriod?

 

[robertin75]

Hi Matt:

The following is information from labcorp, but you can also find similar information in the Quest Diagnostic's webpage (www.questdiagnostics.com)

Thyroxine binding globulin

Distinguish between high T4 levels due to hyperthyroidism and due to increased binding by TBG in euthyroid individuals who have normal levels of free hormones; document cases of hereditary deficiency or increase of TBG; work-up of thyroid disease. In patients with low T4, high T3 (uptake) or the reverse, who clinically seem eumetabolic and have normal FTI, measurement of TBG is only occasionally needed. Some such patients may have hereditary anomalies of TBG. TBG is increased by estrogens, tamoxifen, pregnancy, perphenazine, and in some cases of liver disease, including hepatitis. Decreased TBG is found with some instances of chronic liver disease, nephrosis and systemic disease and with large amounts of glucocorticoids, androgens/anabolic steroids, and acromegaly. Although alterations of TBG are usually resolved by the thyroid profile, TBG must occasionally be directly measured.

Cortisol Binding Globulin

From "The Diagnosis and Differential Diagnosis of Cushings Syndrome and Pseudo-Cushings States", The Endocrine Society 1998

Estrogens increase the cortisol-binding globulin concentration in the circulation; since RIAs measure total cortisol, false positive rates are seen in 50% of women on the oral contraceptive pill (75). It is our routine practice, where possible, and particularly in mild cases, to stop such estrogen-containing drugs and delay investigation for 6 weeks to allow the cortisol-binding globulin to return to baseline. However, this may not be necessary in the case of transdermal estrogens.

75. Tiller JW, Maguire KP, Schweitzer I, Biddle N, Campbell DG, Outch K, Davies BM 1988 The dexamethasone suppression test: a study in a normal population. Psychoneuroendocrinology 13:377384

There are lots of references but these are just some.

The greater this transporter proteins are (TBG and CBG), the less available cortisol and thyroid hormones will be for your tissues.

That's why it is important to measure both free levels of thyroid and cortisol, since the total measurements of these hormones can be altered by estrogens and other things.

Regards,
Roberto

 

[SWALE]

In the intact system, with feedback mechanisms in place, it does not matter. The free level of the hormone remains the same, only total hormone changes.

This information is useful for describing how to interpret labwork.

Drawing free levels is obviously the answer.

 

[robertin75]

SWALE:

Which lab do you recommend to measure 24 urinary estrogen metabolites?

Maybe AAL labs? Any particular panel?

Thanks,
Roberto