Does Estrogen Make You Gain Weight?

Does estrogen make you gain weightPostmenopausal women suffering from hot flashes, may hesitate to take estrogen because they’ve heard it can cause weight gain. Who needs any extra help to gain weight? Is there any truth to all this?

What are Bioidentical Hormones?

When you’re replacing deficient estrogen, it’s important to respect the wisdom of the body. No drug we give can approach the amazing complexity of the endocrine system. However, you can start by giving a hormone that is identical to the hormone that’s missing. We call these bioidentical hormones.

Another important factor is the route of administration. Estrogen is most commonly given as a pill that’s taken orally. It’s convenient and easy to pop a pill. But easy isn’t always the best. If we’re wanting to mimic the body, how does the ovary deliver estrogen to your tissues? I assure you the ovary doesn’t dump a big load of estrogen in your stomach once a day!! A more natural way to take estrogen is by applying it to the skin as a patch or cream. Estrogen taken in a pill form overloads your liver with excessive amounts of estrogen that increase harmful proteins, clotting factors and proinflammatory substances leading to various problems. Let me explain how oral estrogen leads to weight gain.

Weight Gain & Oral Estrogen

Weight gain from oral estrogen causes visceral obesity, the medical term for increased fat around your middle from fat that gets deposited in vital organs like the heart, kidneys and liver. This increased fat mass leads to increases in leptin produced by the fat cells. Topical, but not oral, estradiol prevents this increase in body fat and leptin. An interesting fact about visceral obesity is that women who take NO estrogen can also get weight gain around their middle because they develop insulin resistance. This is a frequent complaint from older women who are not on estrogen!

Oral, but not topical, estrogen increases the production of thyroxine-binding globulin (TBG) the carrier for thyroid hormone. Higher levels of TBG lower the amount of available thyroid hormone thereby lowering your metabolism. Oral, but not topical, estrogen also suppresses IGF-1, a marker for growth hormone. Growth hormone is needed to build muscle and burn fat. All this explains a common complaint I hear from women who’ve been on oral estrogen. “After starting oral estrogen, I gained 15 pounds in the first month and I didn’t increase my calories or lower my exercise. Now I’m eating less and exercising more and I just keep gaining!” Estrogen from injections or pellets can also lead to weight gain because the blood levels produced are much too high.

Weight gain from oral or injectable estrogen occurs because these preparations violate the natural physiology of the body. The ovary is amazing…it releases tiny bits of estradiol throughout the day directly into the blood stream. Even topical estradiol preparations can’t reproduce this same elegant effect, but it’s the closest delivery system we have. That’s why your chances of maintaining a healthy metabolism and weight are best when you choose topical estradiol preparations.

O’Sullivan, AJ, Crampton LJ, Freund, et al, “The route of estrogen replacement therapy confers divergent effects on substrate oxidation and body composition in postmenopausal women,” The Journal of Clinical Investigation, vol 102, (1998): pp 1035-1040.
Lwin R., Darnell B. Oster R, et al, Effect of oral estrogen on substrate utilization in postmenopausal women,” Fertility and Sterility, vol. 90, no 4, (2008): pp 1275-1278
DeCarlo C, Tommaselli G, et al, “Serum leptin levels and body composition in postmenopausal women: effects of hormone therapy,” Menopause, vol 11, no 4 (2004): pp 466-473
Nachtigall LE, Raju U, Banerjee S, et al, “Serum estradiol binding profiles in postmenopausal women undergoing three common estrogen replacement therapies: association with sex hormone binding globulin, estradiol and estrone levels,” Menopause, vol 7, (2000): pp 243-250.
Slater CC, Hodis HN, Mack WJ, et al, “Markedly elevated levels of estrone sulfate after long-term oral, but not transdermal, administration of estradiol in postmenopausal women,” Menopause, vol 8, (2001): pp 200-203

Safer Options Exist—Top Eight Natural Birth Control Methods

Safer Options Exist—Top Eight Natural Birth Control Methods







Young women are often not given options for natural birth control. They opt for BCPs because they’re easily available and convenient and they’re not aware of the the health risks.Here are some effective options for natural family planning that prevent pregnancy without damaging your health.

Barrier Methods:

Male condoms: Condoms have a 98 percent effectiveness rate when used correctly. A water-based lubricant will increase the effectiveness; do not use an oil-based lubricant, however, as they break the latex.
• Female condoms: These thin, soft polyurethane pouches fitted inside the vagina before sex are 95 percent effective. Female condoms are less likely to tear than male condoms.
Diaphragm: A diaphragm is a soft latex or silicone dome that’s inserted into the vagina before sex. It must be initially fitted by a doctor. When used correctly with spermicidal jellies, it’s 92 to 98 percent effective.
Cervical cap: This heavy rubber cap fits tightly against the cervix and can be left in place for 48 hours. Like the diaphragm, a doctor must fit the cap. Proper fitting enhances the effectiveness above 91 percent.
• Cervical sponges: The sponge, made of polyurethane foam, is moistened with water and inserted into the vagina prior to sex. It works as a barrier between sperm and the cervix, both trapping and absorbing sperm and releasing a spermicide to kill them. It can be left in for up to 24 hours at a time. When used correctly, the sponge is about 89-91 percent effective.

Tracking Ovulation:

• Calendar Method:
The woman avoids sex during the week the she is ovulating. This technique works best when a woman’s menstrual cycle is very regular. However, it may not work very well for couples who use it as the sole means of contraception, as its success rate is only around 75 percent. You can boost its effectiveness by combining it with the temperature and mucus methods described below.
• The Basal Body Temperature Method: This is a way to pinpoint the day of ovulation so that sex can be avoided for a few days before and after. It involves taking your basal body temperature (your temperature upon first waking) each morning with an accurate “basal” thermometer, and noting the rise in temperature that occurs after ovulation. This method works best in women who have regular monthly cycles.

Following your basal body temperatures enables you to become so aware of ovulation that when you’re ready to have your family you can better plan your pregnancy. I used this method myself when
I was in medical school and I was able to later choose a convenient time to have my pregnancy!

Be aware that illness or lack of sleep can change your body temperature and make this method unreliable by itself, but when it is combined with the mucus method, it can be an accurate way of assessing fertility. The two methods combined can have a success rate as high as 98 percent.

The Mucus Method: This involves tracking changes in the amount and texture of vaginal discharge, that reflect rising levels of estrogen in your body. For the first few days after your period, there is often no discharge, but there will be a cloudy, tacky mucus as estrogen starts to rise. When the discharge starts to increase in volume and becomes clear and stringy, ovulation is near. A return to the tacky, cloudy mucus or no discharge means that ovulation has passed.

I realize the convenience of birth control pills is what makes them so popular. However, my advice to women is to seriously evaluate the risks versus benefits before taking any type of birth control pills. A bit of planning on your part is well worth the health risks you’ll avoid.

Recommended Reading

1. Outliving Your Ovaries by Dr. Marina Johnson. While I initially wrote this book for menopausal women, I also included chapters for young women that included a section on natural birth control.
2. Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement and Reproductive Health by Toni Weschler
3. Honoring Our Cycles: A Natural Family Planning Workbook by Katie Singer

Testosterone Increases Heart Attacks: Fact or Fiction

Testosterone Increases Heart Attacks: Fact or Fiction

Headlines screamed in 2013 after a study in the Journal of the American Medical Association (JAMA) reported increased cardiovascular risk in men given testosterone replacement. The study compared the incidence of heart disease in 8709 low testosterone men in the Veterans Administration health system who underwent coronary angiography. Their data showed that the testosterone-treated group had a 25.7% absolute rate of stroke, heart attack and death compared to 19.9% in the untreated group. These findings received enormous media attention and were repeated in a widely quoted accompanying editorial.
However, it was later found that the statistical analysis was incorrect and instead the number of adverse evens was lower by one-half in the testosterone-treated group! In March 2014, JAMA published a second correction of additional data errors involving more than 1000 individuals. Furthermore, it was revealed that the “all-male” study population actually comprised nearly 10% women. To date, 29 medical societies have called for the retraction of the original article, arguing that the data are not credible.

In clinical practice, when giving testosterone to men with deficient levels, we routinely see improvement in sex drive, sexual function, muscle mass, bone density and reduced fat mass.

With regard to the cardiovascular system, a review article of several dozen studies, revealed:
Untreated low testosterone is associated with increased mortality, generalized hardening of the arteries and heart disease;
Mortality is reduced by one half in testosterone deficient-men treated with testosterone therapy compared with untreated men;
Exercise capacity is increased with testosterone treatment compared to placebo in men with know heart disease.
Testosterone replacement compared to placebo results in uniform improvement in cardiovascular risk factors (fat mass, waist circumference, insulin resistance).

The media tends to sensationalize the news. When you read headlines warning about risks from a hormone, you need to pause and use some common sense. Does it really make sense that a hormone that’s part of your body’s design suddenly becomes dangerous when you give it to someone who’s deficient? Each hormone plays a vital role in your body. The whole specialty of endocrinology is devoted to evaluating and treating diseases caused by hormones that are deficient or in excess.

As a board-certified endocrinologist who’s been in practice for over 25 years, I’ve learned to have a healthy respect for the body’s ability to self-heal. When I see men with low testosterone, before rushing in with testosterone replacement, I first want to determine WHY
a man is deficient in testosterone. Does he have a treatable underlying condition that’s interfering with his body’s ability to produce testosterone? For example, testosterone is primarily produced during sleep. Does he have a correctable condition like sleep apnea that’s causing his low testosterone state? If I can get his body to restore its own testosterone production, that’s better than anything I can prescribe! If testosterone levels are deficient and testosterone replacement is needed, it’s important to avoid excessive levels because those can lead to adverse events. Hormones are powerful therapies and it’s always best to respect the wisdom of the body.
Vigen R, O’Donnell CI, Barón AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310;1829-1836

Cappola AR. Testosterone therapy and risk of cardiovascular disease in men. JAMA. 2013;310:1805-1806.

Correction. Incorrect number of excluded patients reported in the text and figure. JAMA. 2014;311:967.

Traish AM, Guay AT, Morgentaler A. Death by testosterone? We think not! J Sex Med. 2014;11:624-629.

Morgentaler A, Lunenfeld B. Testosterone and cardiovascular risk: world’s experts take unprecedented action to correct misinformation. Aging Male. 2014;17:63-65

Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc. 2015;90:224-251.

Corona G, Isidori AM, Buvat J, et al. Testosterone supplementation and sexual function: a meta-analysis study. J Sex Med. 2014;11:1577-1592

Isidori AM, Giannetta E, Greco EA, et al. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clin Endocrinol (Oxf). 2005;63:280-293.

Tracz MJ, Sideras K, Boloña ER, et al. Testosterone use in men and its effects on bone health. A systematic review and meta-analysis of randomized placebo-controlled trials. J Clin Endocrinol Metab 2006;91:2011-2016

Understanding Integrative Medicine

What is Integrative Medicine?

I believe our health care system needs to be more patient- centered and engage patients in their own care. American medicine excels at crisis intervention with innovative drugs and surgical procedures. Yet chronic illness comprises the majority of problems that most physicians see in their office. Chronic health problems are adversely affected by poor diet, lack of exercise, obesity, smoking and excess alcohol. Another factor affecting chronic disease management is that insurance companies typically do not reimburse for measures to prevent disease. They instead wait until a serious disease has occurred that generally is much more costly to treat.

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Where Do We Stand Now?

Although the debate over the safety of hormone replacement still rages in the press, it appears some semblance of common sense is beginning to be heard. Yes, we need more confirming studies, but today’s women – myself included – cannot be put on hold and forced to wait another 10 to 20 years until all of the definitive studies have been completed. As with so many other issues in medicine, physicians have to use their best clinical judgment based on the information available now. Each woman needs to make these decisions with input from her own physician.

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Gina’s Journey: A Hysterectomy Story

Dr. Marina Johnson explains hysterectomies, What is a  Hysterectomy? Undergoing a hysterectomy is major surgery and when you have cancer, severe uterine prolapse or any serious condition that has failed medical therapy, it is warranted. Gina's Journey: A Hysterectomy Story

I often have women tell me – “I wish I’d never had my ovaries removed because all my problems started after I had that surgery.” Women with benign disease are sometimes told, “You’ve had all your children. You might as well take everything out so you can’t get ovarian cancer.”

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Considering Breast Cancer-Reducing Your Risk – Part 4 of 4

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Where Do We Go From Here?

Key Points About Breast Cancer & Other Hormone Related Cancers

  1. More deaths occur from heart disease than the next 16 causes of death combined including diabetes, all cancers, AIDS and accidents
  2. A first pregnancy before age 25 protects against breast cancer
  3. Dense breasts on mammography increase risk of breast cancer
  4. Small breast cancers less than 2.1 cm (2.5 cm = 1 inch) have a lower mortality than large breast cancers
  5. Positive family history occurs in only 15-20% of women with breast cancer but is an indication for closer monitoring and possible genetic testing
  6. Bad estrogen” byproducts increase risk of breast cancer, ovarian cancer and uterine cancer
  7. Good estrogen” byproducts lower risk of breast cancer, ovarian cancer, and uterine cancer and lower the risk of heart disease

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Considering Breast Cancer-Reducing Your Risk – Part 3 of 4

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Screening: The Importance of Early Detection

Tumor size greatly affects mortality. The smaller the tumor, the more likely it is to be confined to the breast and therefore more responsive to treatment. In a study of 83,686 cases of women with primary breast cancer with tumor sizes ranging from 0.3 cm to 5 cm, and no lymph node involvement, the smallest tumors were associated with a mortality of 10% while the larger tumors were associated with a mortality of 25%. In women with tumor sizes ranging from 0.3 cm to 5 cm and positive lymph nodes, those with the smallest tumors had a 20% mortality and those with the larger tumors had a 40% mortality. Studies show improved mortality when breast cancer is detected as a small lesion, especially if it’s less than 2 cm.

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Considering Breast Cancer-Reducing Your Risk – Part 2 of 4

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Risk Factors You Can Modify To Decrease Your Risk of Breast Cancer


Obesity and weight gain during adult life increases risk of postmenopausal (but not premenopausal) breast cancer because fat tissue increases estrogen levels. The adverse effect of obesity on breast cancer is strongest in women who do not use HRT. In the Nurses’ Health study, women gaining 22 pounds or more after menopause increased their risk by 18% while losing at least 22 pounds lowered their breast cancer risk by 57%.

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Considering Breast Cancer-Reducing Your Risk – Part 1 of 4

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Breast cancer is the most feared health problem for women.  In a previous blog, I’ve pointed out that women experience more deaths each year from heart disease and strokes than breast cancer. I’ve given you specific data on the absolute risk of breast cancer.

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The content of this website is for informational purposes only and is not intended to be a substitute for professional medical advice,diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. This website may discuss nutritional products and protocols that have not been evaluated by the U.S. Food and Drug Administration. These products or the information contained on this website is not intended to diagnose, treat, cure or prevent any disease.