Category Archives: Estradiol & Estrogen

Middle Aged Men, Too, Can Blame Estrogen for That Waistline

It is the scourge of many a middle-aged man: he starts getting a pot belly, using lighter weights at the gym and somehow just doesn’t have the sexual desire of his younger years.

The obvious culprit is testosterone, since men gradually make less of the male sex hormone as years go by. But a surprising new answer is emerging, one that doctors say could reinvigorate the study of how men’s bodies age. Estrogen, the female sex hormone, turns out to play a much bigger role in men’s bodies than previously thought, and falling levels contribute to their expanding waistlines just as they do in women’s.

The discovery of the role of estrogen in men is “a major advance,” said Dr. Peter J. Snyder, a professor of medicine at the University of Pennsylvania, who is leading a big new research project on hormone therapy for men 65 and over. Until recently, testosterone deficiency was considered nearly the sole reason that men undergo the familiar physical complaints of midlife.

The new frontier of research involves figuring out which hormone does what in men, and how body functions are affected at different hormone levels. While dwindling testosterone levels are to blame for middle-aged men’s smaller muscles, falling levels of estrogen regulate fat accumulation, according to a study published Wednesday in The New England Journal of Medicine, which provided the most conclusive evidence to date that estrogen is a major factor in male midlife woes. And both hormones are needed for libido.

“Some of the symptoms routinely attributed to testosterone deficiency are actually partially or almost exclusively caused by the decline in estrogens,” said Dr. Joel Finkelstein, an endocrinologist at Harvard Medical School and the study’s lead author, in a news release on Wednesday.

His study is only the start of what many hope will be a new understanding of testosterone and estrogen in men. Dr. Snyder is leading another study, the Testosterone Trial, which measures levels of both hormones and asks whether testosterone treatment can make older men with low testosterone levels more youthful — by letting them walk more quickly, feel more vigorous, improve their sexual functioning and their memories, and strengthen their bones. Smaller studies have been promising but unreliable, and estrogen has not been factored in.

“We had ignored this hormone in men, but we are studying it now,” said Dr. Alvin M. Matsumoto, a testosterone and geriatrics researcher at the University of Washington School of Medicine and the V.A. Puget Sound Health Care System, who is a Testosterone Trial researcher. “We are just starting out on this road.”

Both men and women make estrogen out of testosterone, and men make so much that they end up with at least twice as much estrogen as postmenopausal women. As levels of both hormones decline with age, the body changes. But until now, researchers have focused almost exclusively on how estrogen affects women and how testosterone affects men.

Dr. Finkelstein’s study provides a new road map of the function of each hormone and its behavior at various levels. It suggests that different symptoms kick in at different levels of testosterone deficiency. Testosterone, he found, is the chief regulator of muscle tone and lean body mass, but it takes less than was thought to maintain muscle. For a young man, 550 nanograms of testosterone per deciliter of blood serum is the average level, and doctors have generally considered levels below 300 nanograms so low they might require treatment, typically with testosterone gels.

But Dr. Finkelstein’s study found that muscle strength and size turn out to be unaffected until testosterone levels drop very low, below 200 nanograms. Fat accumulation, however, kicks in at higher testosterone levels: at 300 to 350 nanograms of testosterone, estrogen levels sink low enough that middle-aged spread begins.

As for sexual desire and performance, both require estrogen and testosterone, and they increase steadily as those hormone levels rise. Researchers say it is too early to make many specific recommendations, but no one is suggesting that men take estrogen, because high doses cause feminine features like enlarged breasts.

Although doctors prescribe testosterone gels for men whose levels fall below 300 nanograms per deciliter, that cutoff point is arbitrary, and there is no clinical rationale for it, Dr. Finkelstein said. Often men take the hormone to treat complaints like fatigue, depression or loss of sexual desire, which may or may not be from low levels of testosterone. The data suggest that men with levels around 300 nanograms who complain of sexual problems may want to try testosterone, but those who complain of flagging muscle strength should not blame testosterone deficiency, Dr. Finkelstein said. But, he added, “symptoms of low testosterone tend to be quite vague.”

Today, millions of men are using testosterone gels, fueling a nearly $2 billion market.

For their study, Dr. Finkelstein and his colleagues recruited 400 men aged 20 to 50 who agreed to have their testosterone production turned off for 16 weeks. Half then received varying amounts of

It turned out to be surprisingly easy to recruit subjects, Dr. Finkelstein said. One, Ben Iverson, joined in part for the $1,000 subjects were paid. “That, to me, was enticing,” he said. He was a 28-year-old Harvard graduate student at the time and is now an assistant professor of finance at Northwestern University.

Although Mr. Iverson’s wife looked askance at the injections to block testosterone production, Mr. Iverson ended up getting enough testosterone in the gel he was assigned to use. The worst were the testosterone-suppressing injections, which required him to use a huge needle in his abdomen once a month, he said.

He found out when the study ended that he was in a group that got enough testosterone to keep his levels in a normal range. “I literally did not notice any difference at all,” Mr. Iverson recalled.

The worst symptoms were in men whose estrogen production was shut down — they got intense hot flashes.

Now Dr. Finkelstein is repeating the study with older men. The Testosterone Trial is looking at them too.

For that study, Dr. Snyder and his colleagues recruited nearly 800 men aged 65 and older who have low testosterone levels. The men take either a placebo or enough testosterone to bring their level to between 400 and 800. Investigators are assessing walking speed, sexual functioning, vitality, memory, red-blood-cell count, bones and coronary arteries. The yearlong study will be completed next year.

Next, researchers said, they want to do a large study like one conducted with thousands of women in 2002 that asked about long-term risks and benefits of hormone therapy. Does testosterone therapy lead, for example, to more prostate cancer? Does it prevent heart attacks?

“We still don’t know the answers to the clinical questions,” Dr. Matsumoto said. “Does it prevent things that are really important?”

By GINA KOLATA, Published: September 11, 2013, source:

Estrogen and Breast Cancer: Women suffer estrogen deprivation due to a medical community that disregards a safe alternative.

In September 2012, a jury in Salt Lake City, Utah awarded a breast cancer survivor $5.1 million in a court case against the pharmaceutical company, Wyeth (also known as Pfizer), alleging that the use of Premarin-Provera (Prempro) was responsible for the development of her breast cancer.1 This is one of many lawsuits against Wyeth, since the Women’s Health Initiative trial (WHI) was published in 2002. The general matter for this case is whether Wyeth withheld data and failed to inform the public concerning the risk of breast cancer with the use of the synthetic hormones, Prempro. There have been over 10,000 cases filed against Wyeth, which has paid $896 million to resolve over 6,000 lawsuits. Furthermore, they have set aside an additional $330 million to resolve the remaining lawsuits.
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Metabolic syndrome after menopause and the role of hormones.

Lobo RA.

Department of Obstetrics & Gynecology, Columbia University College of Physicians & Surgeons, New York, NY 10032, United States.

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Low Estradiol Levels and Progression of Heart Disease

The Journal of Clinical Endocrinology & Metabolism Vol. 93, No. 1 131-138
Copyright © 2008 by The Endocrine Society
Relationship between Serum Levels of Sex Hormones and Progression of Subclinical Atherosclerosis in Postmenopausal Women
Roksana Karim, Howard N. Hodis, Frank Z. Stanczyk, Rogerio A. Lobo and Wendy J. Mack

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Estrogen treatments may sharpen mental performance in women with certain medical conditions

Estrogen treatments may sharpen mental performance in women with certain medical conditions, but University of Florida researchers suggest that recharging a naturally occurring estrogen receptor in the brain may also clear cognitive cobwebs.

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Estriol acts as a GPR30 antagonist in estrogen receptor-negative breast cancer cells

Mol Cell Endocrinol. 2010 May 14;320(1-2):162-70. Epub 2010 Feb 6.
Lappano R, Rosano C, De Marco P, De Francesco EM, Pezzi V, Maggiolini M.
Dipartimento Farmaco-Biologico, Università della Calabria, Rende (CS), Italy.
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Timing of Estrogen Therapy Determines Anti-Stroke Benefit

Information from Industry

NEW YORK (Reuters Health) Mar 26 – The timing of estrogen therapy after menopause appears to play a key role in determining whether this intervention will protect against or facilitate damage from a stroke, findings from an animal study suggest. This may help explain seemingly discordant findings from previous studies.

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Different Effects of Oral and Transdermal Estrogen Replacement Therapy on Matrix Metalloproteinase and Their Inhibitor in Postmenopausal Women

Akihiko Wakatsuki; Nobuo Ikenoue; Koichi Shinohara; Kazushi Watanabe; Takao Fukaya

Department of Obstetrics and Gynecology Kochi Medical School, Kochi, Japan

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Bone Mineral Density and the Risk of Alzheimer Disease

Zaldy Sy Tan, MD, MPH; Sudha Seshadri, MD; Alexa Beiser, PhD; Yuqing Zhang, DSc; David Felson, MD; Marian T. Hannan, DSc; Rhoda Au, PhD; Philip A. Wolf, MD; Douglas P. Kiel, MD, MPH

Arch Neurol. 2005;62:107-111.

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