Total Estrogen

Optimal Result: 5.42 - 16.13 mcg/g.

Estrogen is the primary female sex hormone. It is responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three major endogenous estrogens in females that have estrogenic hormonal activity: estrone, estradiol, and estriol. The estrane steroid estradiol is the most potent and prevalent of these. In addition to their role as natural hormones, estrogens are used as medications, for instance in menopausal hormone therapy and hormonal birth control.

Where is estrogen made?

Estrogen is made primarily in the ovaries of cycling women, while smaller amounts can be converted from testosterone through aromatization. In menopause, estrogen production shifts almost completely to aromatization. The enzyme responsible for aromatization is found in fat tissue, the brain, gonads, blood vessels, skin, and bone.

In Men: 

Men need far less estrogen than women, and it is aromatized primarily from testosterone. Women who are still cycling have much greater estradiol quantities than men, but it is important to note that men do make estrogen. In fact, the level of estrogen in men is actually higher than the level in a post-menopausal woman!  

What does estrogen do?

- Growth and development of female secondary sex characteristics

- Thickens the uterus for implantation, increases vaginal acidity to protect against infection, important for vaginal lubrication (particularly E3) 

- Necessary for bone health 

- In the brain helps maintain body temperature, protects against memory loss, increases serotonin and serotonin receptors

- Important for collagen production, skin thickness, and getting blood supply to the skin

- Helps protect against atherosclerosis

Normal Ranges for Total Estrogen in pg/mL:

Adult Female (depends on the menstrual phase)


   Follicular Phase (1-12 days)  90-590 pg/mL

   Luteal Phase                         130-460 pg/mL

   Postmenopausal                    50-170 pg/mL

   Adult Male                              60-190 pg/mL


Critical Range: anything outside the limits mentioned above.

The three primary estrogens:

Estrone (E1):

- Weaker compared to Estradiol

- Research says the estrogenic activity is about 4% of estradiol’s activity 

- Most abundant in menopause

- Made via aromatization in several tissues like fat and muscle

- Converts into estradiol (E2)

Estrone (E1) is also made by the ovary but in fat tissue in lesser quantities. While not as abundant in circulation as estradiol, estrone excess can still increase the risk for estrogen dominant cancers and estrogen dominant symptoms such as breast tenderness, heavy menstrual cycles, headaches, and erectile dysfunction and breast development in men just like estradiol. Estrone is commonly thought to be more abundant during menopause. 

Estradiol and estrone can interconvert into each other. 

Estradiol (E2):

- Most potent

- Made primarily in the ovaries

The main and most potent estrogen is known as Estradiol (E2). It is made primarily in the ovaries or testes and in the fat, liver, and neural tissue. 

Expected values for E2:

- 1.8 - 4.5 Premenopausal (days 19-22), not on birth control

- 1.0 - 2.0 Collecting right after menstruation

- 4.0 - 12.0 Collecting close to ovulation

- 0.2 - 0.7 Postmenopausal (and not supplementing) or on birth control

Estriol (E3):

- The ‘end product’ of estradiol/estrone metabolism

- 16-OH-E1 can convert into estriol

- Not made in the ovaries

- Very weak estrogen

- Elevated in pregnancy due to placental production 

The third estrogen is known as Estriol (E3) and is produced in significant amounts during pregnancy. In men and women, Estriol is irreversibly produced by estradiol (estriol cannot make estradiol) or from estrone through 16-OH-Estrone, which makes it the largest circulating estrogen because both Estrone and Estradiol can make it. Despite this, estriol is not nearly as potent as estradiol (Estradiol is 80x more potent!).

What does it mean if your Total Estrogen result is too low?

Why does estrogen decrease?

- Age (peri-menopause and menopause)

- Irregular cycles/skipped cycles/anovulation

- Hysterectomy with ovaries removed

- Anorexia

- Low cholesterol (backbone to hormones)

- Extreme exercise or training

- Extreme stress resulting in skipped menses

- Under appropriate body weight percentage for height/age (Mixed research: suggested <15% body fat = amenorrhea)

- Hypogonadism (ovaries fail)

- Hypopituitarism (pituitary not communicating)

- Decreased blood flow to the ovaries (Ex. Surgery or smokers)

- Breastfeeding

- Hypothyroidism


- Fertility medications

- Opioid pain medications (in last 6 months)

- Hormonal birth control – pill, patch, ring, implant, injection

Common symptoms of low estrogen:

- In women - fatigue, depression, hot flashes, night sweats, vaginal dryness, pain with intercourse, low libido, joint pain, brain fog, migraines/headaches, fertility issues, dry skin

- In men - not generally considered symptomatic, but in very extreme cases, men may have similar symptoms as in the list above for women

Common ways to raise estrogen:

In women - address the cause, phytoestrogens such as Red Clover, Dong Quai, Kudzu, soy, diosgenin, genistein, fennel, and Black Cohosh (although studies are mixed on whether it acts as a phytoestrogen or not), Maca, and bioidentical estrogen replacement.

What does it mean if your Total Estrogen result is too high?

Why do Estrogen levels increase?

- Overweight/obesity

- Peri-menopause = surges of estrogen

- Diabetes


- 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.

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