Should I take estrogen?

Our read is that estrogen therapy is well-supported for its potential to diminish the risk of significant heart conditions, offer neuroprotection, and alleviate menopausal symptoms.

However, it is crucial to acknowledge potential risks such as increased risk of endometrial cancer in women with an intact uterus taking estrogen alone, and a small but non-zero risk of hypercoagulability with oral bioidentical estradiol.

Lifestyle interventions are often sufficient for estrogen control in many individuals, and the decision to take estrogen should be approached with caution, considering both its powerful effects and potential drawbacks.

Optimal estradiol levels for men are generally in the range of 30-50 nanograms per deciliter, according to Andrew Huberman. Peter Attia notes that oral estrogen is inexpensive and offers a wide range of doses, potentially allowing for lower effective doses due to the first-pass effect. Vaginal estrogen preparations can alleviate genital and urinary symptoms in breast cancer patients without significant systemic absorption, as stated by Peter Attia. Hormone therapies like estrogen or testosterone cream/injection are prescribed for perimenopause or menopause symptoms, leading to subjective improvements, according to Andrew Huberman.

• 01Peter Attia (2x) states that estrogen helps diminish the risk for significant heart conditions.
• 02Andrew Huberman (1x) notes that optimal estradiol levels for men are generally in the range of 30-50 nanograms per deciliter.
• 03Peter Attia (1x) indicates that estrogen has been used to treat breast cancer, showing a 25% response rate.
• 04Andrew Huberman (1x) claims that estrogen is generally neuroprotective, and its decline is correlated with neurodegeneration.
• 05Andrew Huberman (1x) states that restoring estradiol levels is a primary solution for many menopausal symptoms in women.
• 06Rhonda Patrick (1x) observes that women, particularly around menopause, experience a loss of muscle mass due to decreased estrogen-mediated stimulation of protein synthesis.
• 07Peter Attia (1x) mentions that vaginal estrogen preparations can alleviate genital and urinary symptoms in breast cancer patients without significant systemic absorption.
• 08Peter Attia (1x) points out that oral estrogen is inexpensive and offers a wide range of doses, potentially allowing for lower effective doses due to the first-pass effect.
• 09Andrew Huberman (1x) suggests that symptom relief from hormone therapies like estrogen can indirectly support adherence to diet and exercise, leading to improved well-being.
• 10Peter Attia (2x) reports that women who used estrogen in the Women's Health Initiative had a decreased risk of developing and dying from breast cancer.
• 11Peter Attia (1x) explains that birth control pills are a high-dose form of hormone therapy that suppresses ovarian function and adds synthetic estrogen and progestin, but not testosterone.
• 12Peter Attia (3x) states that systemic estrogen therapy can lower LDL and increase HDL, and may be cardio-protective by dilating blood vessels via a nitric oxide effect.
• 13Peter Attia (1x) notes that estrogen plays a protective role against neurotoxicity, with lower neurotoxicity observed when estrogen is present compared to when aromatase is inhibited.

Our read is that lifestyle interventions are often sufficient for estrogen control in most individuals, as noted by Andrew Huberman. Inhibiting estrogen with aromatase inhibitors can disrupt brain function, cause connective tissue issues, and reduce libido, according to Andrew Huberman. Rhonda Patrick warns that stopping estrogen therapy 10-15 years after initiation, particularly after age 60, may lead to decreased bone density. Peter Attia suggests that estradiol is a less potent tool for cardiovascular disease risk reduction compared to other available interventions. Andrew Huberman states that severe liver disease is a contraindication for estrogen therapy due to potential for abnormal metabolism. Rhonda Patrick indicates that oral bioidentical estradiol is not preferred due to a small but non-zero risk of hypercoagulability. Peter Attia notes that estrogen can increase CRP levels and is pro-thrombotic, potentially increasing the risk of venous thromboembolism. Peter Attia and Andrew Huberman (6x) highlight that women with an intact uterus taking estrogen alone have a high risk of endometrial cancer and increased vaginal bleeding. Peter Attia and Andrew Huberman (2x) also point out that the Women's Health Initiative showed an increased risk of stroke with both estrogen alone and estrogen plus progestin. Andrew Huberman (1x) mentions that exogenous estrogen may increase breast cancer risk by 25%. Peter Attia (1x) notes that high estrogen levels can have variable effects on physique, recovery, sleep, sex drive, water retention, mood, and sleep. Andrew Huberman (1x) states that crashing estrogen levels can paradoxically lead to reduced libido. Peter Attia (1x) and Andrew Huberman (2x) clarify that the Women's Health Initiative (WHI) study used synthetic estrogen and progestin, not bioidentical hormones.

Our read is that starting estrogen in early menopause may translate into a slightly lower risk of heart disease, but the magnitude of risk reduction seen in observational studies is unlikely to hold up in randomized trials, as Peter Attia suggests. Further robust randomized trials demonstrating significant risk reduction for heart disease would strengthen the recommendation. Additionally, more definitive data differentiating the efficacy between estrogen suppositories and DHEA suppositories for treating menopausal symptoms would be beneficial, as Peter Attia notes.