Total Estrogen

Why do Estrogen levels increase?

- Overweight/obesity

- Peri-menopause = surges of estrogen

- Diabetes

- PCOS

- Estrogen supplementation

- Steroid medications

- Poor liver clearance so estrogens build-up

- Dysbiosis/Estrobolome problems

- Over aromatization from testosterone

- Environmental estrogens (difficult to test, however)

- Alcohol (2 or more glasses/day shown to increase estrogen)

- Ovarian cysts

- Having elevated testosterone levels – testosterone gets converted to estrogen through the aromatase enzyme. Therefore, having Polycystic Ovarian Syndrome (PCOS), over supplementing with testosterone or DHEA, or generally having a high production of this hormone, can lead to more estrogen being produced as a byproduct.

In men – over aromatization from testosterone to estrogen due to inflammation and blood sugar/insulin issues, environmental/xenoestrogen exposure (this does not show up on DUTCH testing, but they can cause symptoms), moderate alcohol use, and obesity

Common symptoms of elevated estrogen:

- In women – mood swings, weight gain, breast tenderness, fibrocystic breasts, heavy menses, fibroid/polyp development.

- In men – breast development, weight gain, and mood swings.

Common ways to lower estrogen:

Please consult with your health care provider about advice/treatment/diagnosis. The following statements are general informational statements.

- In women - address the cause, avoid alcohol, avoid environmental/xenoestrogens, DIM/I3C supplementation, calcium-d-glucurate, increased fiber (especially ground flax seeds), increased detoxification support, and weight loss

- In men – address the cause, avoid alcohol, avoid environmental/xenoestrogens, DIM/I3C supplementation, calcium-d-glucurate, increased fiber, decrease blood sugar and insulin, increased detoxification support, weight loss, and things that block aromatase (Chrysin, Damiana, Zinc and pharmaceutical aromatase inhibitors)

Other general interventions to keep in mind that can be beneficial for everyone if you don’t know the status of your hormones includes:

- Avoiding xenoestrogen exposure. Here is a great link to the top endocrine disruptors to avoid your environment [L]:

- Eat more cruciferous vegetables from the Brassica family- broccoli, kale, Brussels sprouts, cauliflower, cabbage, kale, etc.  

- Support your liver on-going – from the basic lemon water to increasing consumption of dandelion or dandelion tea, doing a liver cleanse twice a year, and reducing consumption of sugar and alcohol.

- Make sure your bowels are going – lots of fluids and high fiber in your diet will help regulate your bowel movements and make sure your hormones are properly detoxified rather than sitting in your body and recirculating back in the system.

Low Total Estrogen on a DUTCH Test: What Does It Mean?

What is Total Estrogen on a DUTCH Test?

Total Estrogen on a DUTCH (Dried Urine Test for Comprehensive Hormones) test represents the combined levels of the three primary estrogens:

• Estrone (E1) – A weaker estrogen that serves as a precursor to both estradiol (E2) and estriol (E3).
• Estradiol (E2) – The most biologically active estrogen, critical for reproductive function, bone health, mood, and skin integrity.
• Estriol (E3) – The weakest estrogen, important for vaginal and urinary tract health, particularly in pregnancy and postmenopausal women.

Low Total Estrogen suggests that overall estrogen production is insufficient, potentially affecting menstrual cycles, fertility, bone density, mood, and metabolic function.

Potential Causes of Low Total Estrogen

1. Perimenopause or Menopause

• Estrogen levels naturally decline with age, especially during perimenopause and menopause, leading to symptoms like hot flashes, vaginal dryness, mood swings, and bone loss.
• If estrogen is low and the person is over 40-50 years old, menopause may be a key factor.

2. Hypothalamic-Pituitary-Ovarian (HPO) Axis Dysfunction

• The HPO axis regulates estrogen production. If the brain is not signaling the ovaries properly, estrogen production may be reduced.
• Causes include:
  • Chronic stress and high cortisol levels
  • Over-exercise (especially excessive endurance training)
  • Low-calorie or restrictive diets
  • Significant weight loss or underweight status (low body fat can reduce estrogen synthesis)

3. Primary Ovarian Insufficiency (POI) or PCOS

• Primary ovarian insufficiency (early menopause) can cause low estrogen production before the expected age of menopause.
• Some forms of Polycystic Ovary Syndrome (PCOS) may also present with low estrogen if ovarian function is suppressed.

4. Postpartum or Breastfeeding

• Estrogen levels are naturally low during postpartum and lactation due to high prolactin levels, which suppress ovarian function.

5. Hypothyroidism

• Low thyroid function can disrupt estrogen metabolism and lower total estrogen levels.
• If symptoms of fatigue, weight gain, dry skin, and hair thinning are present, check thyroid markers (TSH, Free T3, Free T4).

6. Nutrient Deficiencies and Poor Cholesterol Levels

• Estrogen is synthesized from cholesterol, so very low cholesterol levels (often due to extreme dieting or malabsorption issues) can result in lower estrogen production.
• Nutrient deficiencies, particularly zinc, magnesium, vitamin D, and B vitamins, can impair hormone synthesis.

7. Excessive Estrogen Detoxification or Poor Absorption

• If Total Estrogen is low, but estrogen metabolites (2-OH-E1, 4-OH-E1, 16-OH-E1) are also low, it may indicate low estrogen production rather than excessive detoxification.
• If estrogen metabolism markers are high despite low total estrogen, the body may be over-detoxifying estrogen due to excessive liver clearance or gut imbalances.

Symptoms of Low Total Estrogen

Since estrogen plays a key role in many physiological functions, low total estrogen levels can contribute to:

• Irregular or missing periods (amenorrhea or oligomenorrhea)
• Hot flashes, night sweats, and temperature dysregulation
• Vaginal dryness, painful intercourse, or urinary discomfort
• Low libido and sexual dysfunction
• Mood imbalances (depression, anxiety, irritability)
• Fatigue and brain fog
• Weaker bones and increased risk of osteoporosis
• Skin aging, dry skin, and thinning hair

Next Steps: How to Support Estrogen Levels

1. Address Underlying Causes

• If menopause or perimenopause is the cause, hormone replacement therapy (HRT) or bioidentical estrogen may be considered under medical supervision.
• If HPO axis dysfunction (stress, over-exercise, undernutrition) is the cause, focus on restoring hormonal balance through diet, stress management, and adequate calorie intake.
• If thyroid dysfunction is present, correcting thyroid imbalances can help restore estrogen levels.

2. Optimize Diet for Estrogen Support

• Healthy fats (avocados, nuts, seeds, and olive oil) support hormone synthesis.
• Protein sources rich in amino acids (chicken, fish, eggs, legumes) help regulate hormone production.
• Phytoestrogens (flaxseeds, soy, chickpeas, lentils) can provide mild estrogenic effects and support balance.

3. Support Adrenal Function

• If stress or high cortisol is suppressing estrogen production, prioritize stress management techniques, including:
  • Meditation or deep breathing exercises
  • Limiting high-intensity workouts and replacing with moderate exercise
  • Getting 7-9 hours of quality sleep

4. Consider Hormone-Supportive Nutrients and Herbs

• Zinc and magnesium support ovarian function and hormone balance.
• B vitamins (B6, B12, folate) are crucial for estrogen metabolism and neurotransmitter support.
• Adaptogenic herbs (ashwagandha, rhodiola, maca) may help regulate the HPA axis and support hormonal balance.
• If in perimenopause or menopause, bioidentical estradiol or estriol (under medical guidance) may help restore estrogen function.

Final Thoughts

Low Total Estrogen on a DUTCH test can indicate declining ovarian function, stress-related hormone suppression, nutrient deficiencies, or excessive estrogen clearance. Symptoms like irregular periods, vaginal dryness, mood changes, and low energy suggest that low estrogen may be impacting overall well-being.

By identifying the root cause, optimizing nutrition, stress management, and hormone metabolism, and considering medical support when needed, it’s possible to restore estrogen balance and improve overall health.

Total Estrogen measures the combined levels of estradiol (E2), estrone (E1), and estriol (E3). These hormones support reproductive function, bone strength, brain health, and cardiovascular protection. Abnormal levels may indicate menopause, pregnancy, or hormone imbalances. While levels are lower in men, estrogen balance remains important for overall health.