To Estriol Or Not To Estriol - This is One Clinical Debatable Question!

Here is me (years ago at Tulane) with Dr. Jan-Ake Gustafsson PhD, the discoverer of the second estrogen receptor, ER Beta, that he calls “the anti-cancer receptor”.

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I was recently on one of our member’s podcasts. She is simply amazing. Karen Martel is a hormone expert with a huge following. Doing great work in the world.

I had a blast on her show.

She is spreading essential information in an expertise manner.

Then we got to estriol.

Estriol is one of our parent estrogens. When a ligand (a hormone like estradiol or estriol) signals this receptor, the responding actions are that protective anti-proliferative, anti-cancer and anti-inflammatory signals are sent to cells with this receptor on them.

Estrogen receptor or ER was the second estrogen receptor found, thus it’s name: ER beta. Beta = second.

• Estradiol signals ER alpha 50% of the time.

• Estradiol signals ER beta 50% of the time (we think, hope & cross fingers, ha.).

• Estriol is a weaker estrogen. This means estriol has 1/7th to 1/8th the potency of estradiol. It’s weaker as it signals ER alpha (growth receptor) less, and ER beta more.

Thus, ER beta signals protect.

Estriol, a weaker estrogen, signals ER beta most of the time. Theorized to be 75 to 90% of the time.

Many opinions abound about estriol, especially in “hormone-land”.

Karen is a student of the amazing OBGYN hormone expert, Felish Gersh MD.

Dr. Felish teaches at many of the similar platforms I do. Just saw her at A4M in Vegas. We even roomed together at a MindShare event.

Dr. Gersh teaches that estriol is a pregnancy hormone. It’s job, she says, during pregnancy, is to be “immuno-suppressive”. So the mom’s body won’t reject the baby’s body.

Thus, Dr. Gersh teaches that we should not take extra estriol as it would act to tamp down our immune system.

There are a few that think this way.

And many that don’t.

I don’t. I have lots to back my views. I am sure she has such to back hers.

It’s very similar to the T3 deal. Many endocrinologists recommend T4. They feel our own bodies will convert T4 to T3, the active signal.

The opponents against replacing with estriol say that taking E2, estradiol, will convert to estriol. So we don’t need to add it to the replacement mix.

To add estriol to estradiol (called biest as this makes two estrogens) is one of the big questions and differences between hormonal experts.

To prescribe biest when you prescribe. Or to just take estradiol without biest?

To depend on converting, Or not?

When I wrote Safe Hormones, Smart Women, Dr. Tori Hudson, a respected colleague and dear friend, who ran the OBGYN department at National (where I both went to school and taught) teaches NOT to prescribe estriol.

When I asked Dr. Tori to write one of the testimonials for my book, she said “no” as I promoted prescribing estriol. BTW we still are great friends. We can disagree and still adore each other! That’s one of these points!

I learned and hung with Dr. Jan-Ake Gustafsson PhD at Tulane.

Dr. G’s lab first discovered ER beta. (Ken Korach’s lab discovered it next and I got to lecture with him at A4M ‘s Endocrinology 2 Symposium, but I digress).

ER beta is the second estrogen receptor.

Estriol mainly signals ER beta.

Before disease, when ER Beta is signaled, these signals protect against disease. Especially against breast cancer.

Dr. Jan-Ake Gustafsson PhD himself has written in a 20-year “birthday update” of ER beta, a peer review article about the importance of ER beta agonists (compounds that signal this receptor) and the “emotionality” surrounding ER beta.

Dr. G wrote:

ERbeta (ERβ) celebrated its 20th birthday in 2016 and although the overwhelming data in the literature indicate a role for this receptor in the control of epithelial proliferation, neurodegeneration and immune function, no ERβ agonists have yet made it to the clinics. (I have just written Dr. G about estriol, a main ERB signaling protective estrogen).

This is the situation, despite the fact that very good safe ERβ agonists have been synthesized and at least one has been donated to the NIH for distribution to researchers, who want to study its possible clinical use.

Although these are scientific issues, scientists are sometimes ruled by “emotion” and the acceptance of ERβ as an important endocrine receptor is a very emotional issue.

After many years of thinking that there was only one estrogen receptor, the discovery of a second estrogen receptor was too big a change to be acceptable.

This was a WOW.

This birthed Karen and I getting the idea to invite both sides of the estriol story for a panel or round table of respectful Q & A and debate on her show.

I hope we get to do it. We are trying!

Dr. Gersh responded right away with a “yes”. Grateful!

I invited the most amazing and hard-working hormonal medical expert, Dr. Daved Rosensweet. Dr. R. is just getting back from a well needed vacation and we await his yay or nay.

While writing this, Dr. Rosensweet wrote back YES! Yeah. Grateful.

We also invited Tori Hudson ND. Another anti-estriol doc.

We also invited Dr. Jan-Ake Gustafsson PhD himself.

This is what we need.

Great round table discussions.

Both sides.

Respect.

Kindness.

Let’s hear why we all think what we think and you get in on these conversations.

Similar to the Let’s Talk Iodine tonight. Don’t miss out on Dr. Brownstein and my round table discussion of iodine.

This video discussion will also be sent out once edited for FREE to all that sign up.

It’s like the Steven Wright line:

“For my birthday I got a humidifier and a de-humidifier... I put them in the same room and let them fight it out.”

Won’t be a battle.

But we’ll share why we each think and practice and teach the way we do.

Also on the table with estriol is the concept of the “timing hypothesis”. Another rabbit-hole of the “hormone space”.

Recently Dr. Northrup had a huge well-done presentation saying estrogen deficiency does not drive heart disease. I dove into her science and boy do I disagree with what she had to say.

Let’s get a round table with her if we can? Anyone got her email?

Let’s Talk to get in the grasses and hear why we each think the way we think.

Thank you Karen Martel for the genesis of all this.

Knowledge is power. Let’s hear all sides.

Dr. B.

References:

Update on ERbeta. J Steroid Biochem Mol Biol. 2019 Jul;191:105312

Estrogen receptor alpha negative breast cancer patients: estrogen receptor beta as a therapeutic target. J Steroid Biochem Mol Biol. 2008 Mar;109(1-2):1-10.