Estradiol the Queen of the Steroid Hormone Family

17 ß estradiol is the name of human estrogen and a bioidentical synthetic derived from soybeans is available for use in humans. It is one of the two prime sex steroid hormones, the other being testosterone. The steroid hormones are a family of molecules derived from cholesterol that are the most important hormone group for higher life forms on our planet. What distinguishes this family from others is the control they all exert over us from the cradle to grave. They exert this control by virtue of their being granted privileged access to our cells nucleus and within the nucleus, each has its own receptor located on the DNA where the sit and exert their control over us. An excess or absence of any member of this distinguished family results in a serve disease or disabling chronic condition. Synthetic bioidentical steroid hormones are extremely potent in small quantities and can be effectively administered by multiple routes. When used properly is a boon but when used irresponsibly can be deadly.

Estradiol was one of the first steroid hormones to be synthesized and commercialized. It was also used widely because it relieved hot flushes but due to ignorance on the proper use of this hormone it was used incorrectly and many women suffered. The dose prescribed was too high and it was given to women with a uterus. We did not know then that giving high dose estrogen caused blood clots, heart attacks, and strokes or that giving even moderate dose estrogen to women with a uterus caused cancer.

The estrogen controversy grew when studies from Europe showed estrogen combined with progesterone caused breast cancer. I remember having a hard time accepting that data. It was published when evidence-based medicine was in its ascendancy but had not yet displaced empiricism. There were great debates surrounding estrogen during these times and I was pleased to have been right in the thick of it as a supporter of estrogen.

Estradiol had many supporters. A number of well-designed studies showed that use of estrogen after menopause resulted in a significantly longer better quality life. Many clinicians and scientists thought estrogen prevented heart disease because it has a positive effect on cholesterol. These data remain valid today.

The Women’s Health Initiative was a 150,000 strong study funded by the NIH to settle these issues finally and it did not. It did many things though, some good and some bad. I am glad we have the data from the WHI but the way the data was managed and the way the results were announced could have been handled better.

The WHI changed everything and has cast a long dark shadow on the use of the Queen of the sex steroids, estradiol by those who need it most, postmenopausal women. Estradiol is not for everyone but it is something that can significantly enhance the quality of life and longevity of many women. It must be used properly, started as early after menopause as possible, balanced with an androgen, with progesterone in women with a uterus, and monitored regularly. Using estradiol this way works well is safe and can be continued for life as intended. Menopause is an unfortunate compromise Mother Nature had to enforce on its daughter for the good of all Her children but She did it with regret. Menopause is a serious sex steroid hormone deficiency condition that causes a multitude of diseases. It is easily treated, treatment is inexpensive, is safe, is readily available, and effectively prevents the problems caused by the hormone deficiencies caused by menopause.

The forgotten sex steroid is testosterone. Testosterone is the King of the steroid hormone family and sits on his throne next to his Queen. It is a mystery why the Queen has gotten all the attention while the King has been abandoned by most clinicians but not all. To obtain hormonal balance and return herself to a simulated early 40s woman requires the addition of an androgen. Testosterone is necessary for women to maintain their muscle and bone mass. The loss of testosterone begins after the peak, which occurs at age 30 in both genders. From that age on it falls in both on average 1.5% annually for as long as one lives. In men, the lucky dogs, their testosterone just slowly drifts down without any drastic change until death do us part. In women, Oh No! Menopause. Yes, menopause again. What causes menopause is the failure of the ovary. The two ovaries stop making eggs and producing the three sex hormones estradiol, testosterone, and progesterone. Nada, zilch, no way, Gonzo. This does not happen in one day as you know, it is a slow torturous process that stretches out over years with fits and starts of hot flushes and periods that come and go and come and won’t go and so on. Both ovaries have to give it up before it is over and that does not happen contemporaneously. One goes bye-bye first while the other hangs on and on and on and then…nope another period, but finally it is over. The average age of this happy day is 51.75 years. Girls mark your calendar and chill the Champaign.

This happens all over the body, everywhere. It happens gradually and it happens to just about everyone so it is considered normal. Natural. Oh, Harriet, she is getting older, isn’t she? My preference is for synthetic

Menopause itself is one of the compromises nature selected that was for the best for our ancestors a few hundred thousand years ago. Today it is no longer necessary nor is there anything noble or good about it. We can provide women with balanced hormones safely that studies provide them with a significantly greater quality of life, prevents the development of frailty, and extends their life expectancy. It seems that a large portion of the medical profession has drawn the wrong conclusions about this subject based mainly upon one study, the Women’s Health Initiative. This study created a huge dust-up. It rattled academic and clinical medicine and the regulatory authorities. It resulted in the major Women’s health specialty societies issue strict guidelines on the use of estrogen after menopause that instructs physicians to use the lowest dose for the shortest time to control vasomotor symptoms then stop them. Since 2002 WHI study announcement, there has been no mention of the good science supporting the use of hormones after menopause.

It is time for the pendulum to return to a less extreme point of view. Women need both testosterone and estrogen after menopause. If they have a uterus, they need progesterone. I have an approach to the prescription of hormones that my patients find very satisfactory. What I have found is that other doctors who specialize in Women’s Health and prescribe these hormones too use different approaches than I do and they work very well. There are many ways to prescribe these.

They can be given by mouth, in a skin cream, by a patch, in a combination of a patch, oral and topical cream, or gel, and they can be given vaginally. There are many effective ways to do this and there is no best way. Every doctor has his or her favorite way that depends on a variety of factors. Some use ready-made prescription drugs while others order their prescriptions through compounding pharmacies. The important thing is that they use estrogen and testosterone and that you feel well because of being on them. The dose of the hormones should not be too high or too low. There is a Goldilocks zone. One problem I see with doctors who administer estrogen and testosterone by pellet is that the dose they give is often well above what is natural even for young healthy women. I find that troubling and advise my patients to avoid those treatments.