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Progesterone and Adrenal Fatigue
By: Michael Lam, MD, MPH

Hormone Basics

Progesterone is useful in Adrenal Fatigue recovery The two main sex hormones in women are estrogen and Progesterone. Both are produced in men and women, although in different quantities. Progesterone is made from pregnenolone, which in turn comes from cholesterol.

Production of Progesterone occurs at several places. In women, it is primarily produced in the ovaries just before ovulation and increases rapidly after ovulation. It is also produced in the adrenal glands in both sexes and in the testes in males. Its level is highest during the ovulation period (days 13 to 15 of the menstrual cycle). If fertilization does not take place, the secretion of Progesterone decreases and menstruation occurs. If fertilization does occur, Progesterone is secreted during pregnancy by the placenta and acts to prevent spontaneous abortion. About 20-25 mg of Progesterone is produced per day during a woman's monthly cycle. Up to 300-400 mg are produced daily during pregnancy. During menopause, the total amount of Progesterone produced declines to less than 1% of the pre-menopausal level. This drop is extreme.

Progesterone occupies an important position in the pathway of hormone synthesis. In addition to being the precursor to estrogen, it is also the precursor of testosterone and the all-important adrenal cortical hormone cortisol. Cortisol is essential for stress response, sugar and electrolyte balance, blood pressure and general survival. In short, Progesterone serves to promote survival and development of the embryo and fetus. It acts as a precursor to many important steroid hormones and helps to regulate a broad range of biological and metabolic effects in the body. During chronic stress, Progesterone production is reduced as the body favors cortisol production to reduce stress. This is an important point, which we will look into later.

Estrogen is produced in the ovaries. It regulates the menstrual cycle, promotes cell division and is largely responsible for the development of secondary female characteristics during puberty. In non-pregnant, pre-menopausal women, only 100-200 micrograms of estrogen is secreted daily. However, during pregnancy, much more is secreted. Estrogen is produced in the ovaries, adrenal and fat tissues. During menopause, the amount of estrogen in the body declines by about fifty to sixty percent. Production, however, is augmented in the adrenals and in the fat cells.

Estrogen and Progesterone work in synchronization with each other. They oppose each other in their actions and check and balance each other to achieve hormonal harmony in both sexes.

Functions of Progesterone

Progesterone acts primarily as an antagonist (opposite) to estrogen in our body. For example, estrogen can cause breast cysts while Progesterone protects against breast cysts. Estrogen enhances salt and water retention while Progesterone is a natural diuretic. Estrogen has been associated with breast and endometrial cancer, while Progesterone has cancer preventive effects.

Some of the functions of Progesterone include:

  • breast, uterus, and ovarian cancer protection

  • a natural diuretic

  • a calming, anti-anxiety effect

  • contributing to formation of new bone tissue

Most significantly, it is shown that high amounts of estrogen can induce a host of metabolic disturbances, and the body's way of counterbalancing estrogen is Progesterone. When this balancing mechanism is dysfunctional, a multitude of health related problems can arise.

Hormone Replacement Therapy (HRT)

Menopause is often a time when the hormonal balance between estrogen and Progesterone is off.

Symptoms of such imbalance include hot flashes, vaginal dryness, water retention, weight gain, insomnia, mood swings, short-term memory loss, wrinkly skin and osteoporosis. The breakthrough in treatment of menopausal symptoms came in 1964, when Dr. Wilson first reported that the lack of estrogen causes menopause. Pharmaceutical companies introduced a synthetic estrogen hormone called Premarin. With this drug, symptoms of menopause such as hot flashes were greatly reduced. There was little doubt then that menopause was solely due to estrogen deficiency. Few doctors knew then that estrogen deficiency alone did not explain many of the symptoms of menopause.

For example, how does one explain the fact that women who are post-menopausal but cannot take HRT can experience relief from their menopausal symptoms when using Progesterone replacement alone? Clearly there is more to the menopausal picture than deficiency of estrogen.

In fact, many women on HRT with estrogen alone are unhappy with fat accumulating at their hips and abdomen, osteoporosis, loss of sex drive and often swollen breasts. The common perception is that estrogen is the primary regulator of libido, but in reality, estrogen replacement often does not restore their previous sex drive. What is needed is Progesterone and in some cases, testosterone. While the exact mechanism is not known, it is postulated that estrogen primes the brain cells but Progesterone turns on the sex drive. This has been studied and clinically observed in laboratory rats whose ovaries are removed. Supplementing with estrogen alone does not increase sex drive, but supplementing with Progesterone together with low doses of estrogen does.

During menopause, the absolute level of estrogen decreased by 50% to a level below what is needed for pregnancy and enough for other normal body functions through the golden years. This is the way nature intended it to be. Menopause is therefore a normal physiological adjustment that does not produce any undesirable symptoms. It is not a disease. The current menopausal problem is an abnormality resulting from the relentless insult on the body's hormonal system from industrialized cultures and deviation from a wholesome and healthy lifestyle. We shall examine this in more detail.

Dr. John Lee - Pioneer on Natural Progesterone

Dr. John Lee was a world-renowned authority on natural hormonal balance and author of the book Progesterone: The Multiple Roles of A Remarkable Hormone. He treated thousands of menopausal women in the 1980s and 1990s with a program that was contrary to popular medical thinking at that time. Instead of prescribing estrogen alone (the standard of medical practice then), Dr. Lee prescribed natural Progesterone alone for treatment of menopausal symptoms. In addition to relieving the menopausal symptoms, the treatment was able to reverse osteoporosis and prevent cancer. Studies had confirmed that Dr. Lee's approach using Progesterone alone had vast palliative effects.

The key to Dr. Lee's approach is to understand the balance between estrogen and Progesterone. In pre-menopausal women, estrogen is always in balance with Progesterone. When these two important hormones are out of balance, hormone related illnesses emerge. Symptoms include weight gain, fatigue, auto-immune disorders, fibrocystic diseases, loss of libido, depression, headaches, joint pain and mood swings. These are just some of the common symptoms experienced during menopause, peri-menopause and pre-menstrual periods.

According to Dr. Lee, what is commonly perceived as an absolute estrogen level deficiency during the menopausal years is in effect estrogen dominance caused by an extreme low Progesterone level. Since Progesterone's role is to balance estrogen, the extremely low level of Progesterone experienced after menopause leads to a relative dominance of estrogen, despite a 50% drop.

Dr. Lee treated menopause as an estrogen dominance syndrome. His treatment was simple - reduce the estrogen to Progesterone ratio by increasing Progesterone. When the opposing force of Progesterone is increased, the toxic effect of estrogen is decreased. Fortunately for many women who followed Dr. Lee's advice, their menopausal symptoms reduced remarkably.

Why is estrogen and Progesterone out of balance?

Our body normally functions in perfect homeostasis. With the advent of modern society and industrial state, in the past 70 years, our body has been subjected to unprecedented insult from environmental estrogen-like hormones. In less than one hundred years, we have managed to turn our diet from whole fruits and whole foods to fast and processed foods. In the past, cattle were raised on grass and natural organic feed and chickens were allowed to run free. This is in stark contrast to the commercialization of the cattle and poultry farms of today where animals are in cages most of the time. Worse yet, feeds laced with pesticides and hormones, both of which have estrogen-like activities, are routinely given to animals, which in turn is passed to humans.

Women in non-industrialized cultures, whose diets are whole food based and are untainted with modern processed foods and pesticides, seldom suffer a deficiency in Progesterone and the signs of estrogen dominance manifested as menopausal symptoms as described by Dr. Lee.

Some of the reasons for increased environmental estrogen are:

  • Commercially raised cattle and poultry fed with estrogen-like hormones.

  • Commercially grown vegetables that contain pesticide residues whose chemical structure is similar to estrogen.

  • Synthetic estrogens & synthetic Progesterones (Progestin, Progesterone Acetate and birth control pills).

  • Exposure to xenoestrogen. Petrochemical compounds found in general consumer products such as creams, lotions, soaps, shampoos, perfume, hairs spray and room deodorizers. Such compounds often have chemical structures similar to estrogen and act like estrogen. They are fat soluble and non-biodegradable.

  • Hormone replacement therapy with estrogen alone without Progesterone. This increases the level of estrogen in the body.

  • Overproduction of estrogen from ovarian cysts or tumors.

  • Stress, causing adrenal gland exhaustion and reduced Progesterone output. Stress is one of the most frequently overlooked causes of estrogen dominance.

  • Obesity Fat has an enzyme that converts adrenal steroids to estrogen. The higher the fat intake, the higher the conversion to estrogen.

  • Liver disease such as cirrhosis that reduces the breakdown of estrogen.

  • Deficiency of Vitamin B6 and Magnesium, both of which are necessary for neutralization of estrogen in the liver.

  • Increased sugar intake leading to a depletion of magnesium.

  • Intake of process and fast foods that are deficient in magnesium.

  • Increase in coffee intake. Caffeine intake, from all sources, was linked with higher estrogen levels regardless of age, body mass index (BMI), caloric intake, smoking and alcohol and cholesterol intake. Studies have shown that women who consumed at least 500 milligrams of caffeine daily, the equivalent of four or five cups of coffee, had nearly 70% more estrogen during the early follicular phase than women who consume no more than 100 mg of caffeine daily, or less than one cup of coffee.

Hormones and Lifestyle

Overeating and under-exercise is the norm in developed countries. The populations from such countries, especially in the Western hemisphere where a large part of the dietary calorie is derived from fat, have much higher incidence of menopausal symptoms. Studies have shown that estrogen and Progesterone levels fell in women who switched from a typical high fat, refined carbohydrate to a low fat, high-fiber and plant based diet even though they did not adjust their total calorie intake. Plants contain over 5000 known sterols that have progestogenic effects. People who eat more wholesome food and exercise more have a far lower incidence of menopausal symptoms because their pre and post menopause level of estrogen does not drop as significantly.

In non-industrialized societies, not subjected to environmental estrogen insults; Progesterone deficiency is rare. During menopause, their diet produces sufficient progestogenic substances to keep their sex drive unabated, strong bones and symptom-free passage through menopause.

Therefore, lifestyle is the single most important factor in causing estrogen and Progesterone imbalance.

Imbalances of estrogen and Progesterone in females:

  1. Progesterone deficiency

    Symptoms: Premenstrual Syndrome (PMS), insomnia, early miscarriage, painful or lumpy breasts, infertility, unexplained weight gain and anxiety.

    Discussion: This is the most common hormone imbalance among women of all ages.

    Solution: Estrogen free diet, discontinue birth control pill and use natural Progesterone cream to increase the Progesterone level.

  2. Estrogen deficiency

    Symptoms: night sweats, mood swings, depression, hot flashes, sagging breasts, vaginal dryness, osteoporosis, fibrocystic lumps, night sweats, painful intercourse and memory problems.

    Discussion: This hormone imbalance is most common in menopausal women; especially with petite and/or slim women.

    Solution: Progesterone is a biochemical precursor to estrogen. Progesterone cream alone is sufficient to restore estrogen balance and relief of many of the symptoms. If after three months of Progesterone cream, proper diet, nutritional supplementation of magnesium and B6 do not relieve the symptoms, then low-dose natural estrogen may be considered. 2.5 mg of natural tri-estrogen cream ( 10% estrone, 10% estradiol and 80% estriol) provides the equivalent action of 0.625 conjugated estrogen such as Premarin. Herbs like black cohash have weak estrogenic effect. Isoflavone extracts and cruciferous vegetables extracts such as DIM may be considered as well.

  3. Excessive estrogen:

    Symptoms: bloating, rapid weight gain, heavy bleeding, migraine headaches, foggy thinking, insomnia, red flushing of face and breast tenderness during the first 2 weeks of menstrual cycle.

    Discussion: This often comes about from excessive estrogen intake as part of a hormone replacement therapy program.

    Solution: Discontinue estrogen replacement therapy that uses estrogen alone.

  4. Excessive androgens (male hormones):

    Symptoms: Acne, polycystic ovary syndrome (PCOS), excessive hair on face and arms, thinning hair on the head, infertility and mid-cycle pain.

    Discussion: Excessive sugars and simple carbohydrates in the diet often cause this. Excessive sugar stimulates androgen receptors on the outside of the ovary. Androgens also block the release of eggs from the follicle, causing polycystic ovary disease.

    Solution: Dietary adjustment to reduce sugar and grains and proper exercise are important. Natural Progesterone cream can be used to maintain hormonal balance and discontinued when symptoms are resolved. If Progesterone levels rise each month during the luteal phase of the cycle, a normal synchronal pattern of estrogen and Progesterone is maintained and excessive androgen seldom occurs.

  5. Estrogen dominance:

    Common symptoms include: acceleration of the aging process, breast tenderness, depression, fatigue, foggy thinking, headaches, hypoglycemia, memory loss, osteoporosis, PMS, pre-menopausal bone loss, thyroid dysfunction, uterine cancer and fibroids, water retention, fat gain around abdomen, hips and thighs

    Discussion: This is the result of low estrogen but even lower Progesterone, resulting in a relative excess of estrogen. Up to 50% of western women, especially those who are obese between the ages of 40 and 50, suffer from estrogen dominance.

    Solution: Reduce stress, sugar and coffee from diet. Adrenal function is normally compromised in a person with estrogen dominance. Normalization of the adrenal function should be considered first, as well as relief of stressors. Follow a natural whole food diet, application of stress reduction techniques and natural Progesterone cream in physiological doses (20 mg a day).

Estrogen Dominance, Key to the Puzzle

Estrogen dominance commonly occurs during menopause when Progesterone production falls to approximately 1% of its pre-menopausal level while the production of estrogen falls to about 50% of its pre-menopausal levels. The lack of Progesterone, to oppose the toxic effect of estrogen dominance, results in a myriad of undesirable symptoms.

In the west, the prevalence of estrogen dominance syndrome approaches 50% in women over 35 years old as they enter the transitional phase of aging (ages 35 to 45). Definitive diagnosis can be made with a thorough history and physical examination, together with laboratory tests of estrogen and Progesterone levels. Yet few doctors actually do this. Synthetic estrogen is often prescribed out on the premise that symptoms presented are due to estrogen deficiency without any consideration for the Progesterone part of the equation while in reality, many are suffering from relative estrogen dominance.

What the body needs is natural Progesterone as a first line defense and not more estrogen, which it already has a relative oversupply. It is no wonder many women given estrogen for these menopausal symptoms do not get well.

Premenstrual Syndrome (PMS)

In addition to menopausal symptoms commonly blamed on estrogen deficiency instead of relative estrogen dominance, researchers noted that many women suffer a similar set of symptoms associated with estrogen dominance during the menstrual cycle of each month. Dr. Katherine Dalton published the first medical report on PMS in 1953. She observed that administration of high dose Progesterone, via rectal suppository, relieved symptoms of PMS.

These symptoms often occur during the two weeks before menstruation and are associated with unopposed estrogen and Progesterone deficiency during this time. The most common complaints are weight gain, bloating, irritability, depression, loss of sex drive, fatigue, breast swelling or tenderness, cravings for sweets, and headaches. This is called Pre-menstrual Syndrome (PMS). It is important to note that not all PMS symptoms are caused by Progesterone deficiency. Hypothyroidism can produce similar symptoms. Stress, leading to adrenal exhaustion and low adrenal reserves, commonly seen in working mothers, for example, can also cause similar symptoms. A low fiber diet can cause estrogen to be reabsorbed and recycled. Excessive intake of xenoestrogen laced beef and poultry contributes to relative estrogen dominance associated with PMS. Natural Progesterone has been used effectively to treat many PMS patients, according to Dr. Lee and Dr. Hargrove.

Elimination of coffee, sugar and alcohol, together with proper exercise, avoidance of dairy products and the usage of natural Progesterone replacement, frequently reduces the symptoms of PMS. A diet, high in phyto-estrogen or supplementation of isoflavone extract or DIM, as well as nutritional supplementation with nutrients high in fatty acids, such as evening primrose oil or fish oil, to reduce the inflammatory response, also helps. Avoidance of food high in a special kind of fatty acid called arachidonic acid, commonly found in fatty fish like salmon and mahi-mahi, should be considered, as arachidonic acid contains pro-inflammatory prostaglandin.

Pre-Menopause Syndrome

Scientists have also identified a chronic condition similar to PMS, which is called premenopausal syndrome. The symptoms are similar to that of menopause, but often occur in the mid-thirties to early forties and years ahead of menopause. In addition to primary ovulation failure and the resulting drop in ovarian progesterone output, most often this is due to stress induced adrenal gland exhaustion which leads to a reduction of adrenal Progesterone output. The reduction in Progesterone level leads to a relative increase of estrogen or estrogen dominance.

The picture that emerges is clear--what is commonly perceived as menopausal, pre-menstrual and pre-menopausal symptoms in women often reflects a state of relative estrogen dominance due to an absolute Progesterone level deficiency.

The Progesterone Solution

Once the concept of estrogen dominance is understood, the cure is simple--reduce estrogen load and/or increase Progesterone load.

The best way is first through normalization of adrenal function that is commonly compromised in most people with estrogen dominance. If this fails, one can replenish the body with physiological doses of Progesterone (approximately 20-30 mg/day) to overcome the estrogen dominance and reestablish hormonal balance. One can also raise the level of Progesterone by supplementation (orally, by injection or topically). Taking phytoestrogen rich food, such as soy products, is another alternative way of reducing estrogen as these foods contain weak estrogens that competitively take up the estrogen receptor site, making estrogen less available for use. Foods that have estrogenic activities include: oats, peanuts, cashew nuts, wheat, apples and almonds. Interestingly, ginseng also has a weak estrogenic effect. Phytoestrogens also appear in a host of herbs, including black cohash, alfalfa, pomegranate and licorice. While widely promoted as the miracle food in recent years by the soy industry, it should be noted that soy products have their own set of problems. Unfermented soy products, such as tofu, contain acid, thereby robbing the body of many valuable nutrients and should not be eaten in large quantities. Fermented soy products, such as miso, do not have this problem and are the way to go.

Benefits of natural Progesterone include:

  1. Stimulates osteoclast bone building (osteoporosis reversal)

  2. Helps use fat for energy

  3. Natural diuretic

  4. Natural antidepressant

  5. Restores sex drive (libido)

  6. Normalizes zinc and copper levels

  7. Facilitates thyroid hormone action

  8. Prevents endometrial and breast cancer

  9. Protects against fibrocystic breasts

  10. Normalizes blood sugar levels

  11. Normalizes blood clotting

  12. Restores proper oxygen cell levels

  13. Normalizes menstrual cycles

Natural vs. Synthetic Progesterone

The natural form of Progesterone is derived from wild yam. It is very different from the synthetic unnatural form made in a laboratory (the widely prescribed Provera). The synthetic version is a chemical compound called progestin. It is a prescription drug commonly used in small amounts to balance the estrogen effect in a hormone replacement program. Being a drug, progestin is far more powerful than a woman's natural Progesterone. It is metabolized in the liver into toxic metabolites which, if excessive, can severely interfere with the body's own natural Progesterone. This creates other hormone-related health problems and further exacerbate estrogen dominance.

The structural differences between natural and synthetic Progesterone are significant with direct bearing on their functionality. Whereas natural Progesterone causes a reduction in water and salt retention, synthetic Progesterone does the opposite. This is why some women taking synthetic Progesterone in their birth control pills, or estrogen pills combined with synthetic Progesterone during menopause, experience bloating and fluid retention. In fact, studies have shown that administration of synthetic Progesterone lowers the blood level of the body's natural Progesterone.

Reported side effects of synthetic Progesterone include an increased risk of cancer, increased risk of birth defects if taken during the first four months of pregnancy, fluid retention, abnormal menstrual flow, nausea, acne, hirsutism, mental depression, nausea, insomnia, masculinization, and depression. It is contraindicated in those with thrombophlebitis, liver dysfunction, known or suspected malignancy of the breasts and genital organs. One of the metabolites has an anesthetic effect on brain cells. A woman on high doses of synthetic Progesterone is often lethargic and depressed.

Natural Progesterone is obtained by extracting diosgenin from wild yams and then converting this component into natural Progesterone in the laboratory. Natural Progesterone is referred to as natural because it is the identical molecule to that which the human body manufactures. Such yam-derived natural Progesterone should not be confused with yam extracts commonly sold in health food stores. Our body easily converts natural Progesterone into the identical molecule made by the body. It cannot convert the yam extracts into Progesterone. There is no evidence that such extract is converted into Progesterone once it enters into the human body and unlike natural Progesterone, no conclusive formal studies have ever been conducted that identifies any particular benefits from wild yam extracts.

Side Effect of Natural Progesterone

No known side effects exist when using natural Progesterone in physiological amounts (20-30 mg a day for women and 6-10 mg a day for men) under normal conditions. It is therefore very safe. However, as with most substances, too much of a good thing can cause problems. Too much Progesterone is actually counterproductive, as chronically high doses of Progesterone over many months eventually causes Progesterone receptors to turn off, reducing its effectiveness and possibly leading to toxic side effects. Some possible side effects include:

  • An anesthetic and intoxicating slightly sleepy effect. Excess Progesterone down-regulates estrogen receptors, and the brain's response to estrogen is needed for serotonin production. Simply reduce the dose until the sleepiness goes away.

  • Some women report paradoxical estrogen dominance symptoms for the first week or two after starting Progesterone. It is also common for those who have been deficient in Progesterone for years, in the initial application of Progesterone, to experience some water retention, headaches, and swollen breasts. These are symptoms of estrogen dominance, but paradoxically exhibited in the initial stages of Progesterone application, as the estrogen receptors are being re-sensitized by the Progesterone and waking up. This usually goes away by itself and is not a sign of toxicity.

  • Edema (water retention). This is likely to be caused by excess conversion to deoxycortisone, a mineralcorticoid made in the adrenal glands that causes water retention.

  • Candida. Excess Progesterone can inhibit anti-Candida white blood cells, which can lead to bloating and gas. Systemic candidiasis can be treated with a grain-free diet for two weeks, followed by 40 mg of Progesterone (using 3% Progesterone cream) a day applied vaginally and to the breast. More is applied gradually elsewhere to areas such as the neck, face, brow, and inner arms. If side effects worsen, reduce Progesterone dosage.

  • Lowered libido. Excess Progesterone blocks the conversion of testosterone to DHT. This primarily happens to men.

  • Excessive Progesterone can also lead to the increase in androgen production and ultimately increase in estrogen production within the adrenal hormonal synthesis pathway as the body shunts the excessive Progesterone to these other hormones.

Excessive Progesterone is normally caused by the excessive built up of Progesterone in the body. This is more commonly seen in those who are self-administering topical Progesterone cream in the wrong area. Progesterone cream should be applied to areas of the body that have good circulation but are not high in fat. These areas include the wrist, back of the neck, and under part of the upper arm because areas such as the abdomen, buttocks and breasts are high in fat and will retain Progesterone faster than other parts of the body.

Absorption of Progesterone from topical application is about 20% to 30% for the first day. A residual amount is left behind at the site of application, and this can accumulate in the subcutaneous fat tissue over time.

Routes of Progesterone Delivery

Natural Progesterone can be administered orally, topically, sublingual or by injection. Oral administration is relatively ineffective as it is quickly metabolized in the liver. Injection is very effective, but can cause irritation to the injection site and it can be quite painful. To achieve a physiological dose (and not a higher pharmacological dose), the best method is sublingual or topical. Progesterone is easily absorbed by the skin and is 5 to 7 times more effective in reaching the blood stream than oral forms of Progesterone. In other words, 100-200 mg of oral Progesterone is needed to obtain the equivalent benefit of 20-30 mg of transdermal Progesterone. Sublingual Progesterone offers the best and most direct delivery route, as it is well absorbed directly into the blood stream. However, the required alcohol based for sublingual drops may not be tolerated by some.

Salivary levels go up in 3 to 4 hours and come back down by 8 hours while blood levels go up in a matter of a few weeks, for some

For best stabilization of Progesterone absorption and effectiveness, natural Progesterone should be taken or applied in divided doses, two to three times a day.

Delivery Systems of Topical Progesterone

To pass the skin barrier and achieve maximum absorption, natural Progesterone should be carried in an oil/water emulsion that contains the same fatty acid composition as the skin. Mineral oil will prevent the Progesterone from being absorbed into the skin if topical Progesterone is used. Oral progesterone is micronized.

There is a wide variety of dosages available. Topical cream should contain at least 400 mg to 600 mg of natural Progesterone per ounce. Each one-half teaspoon application would supply a minimum of 26 mg of Progesterone (women usually produce about 20 mg of Progesterone daily during normal circumstances). To simplify matters, the better suppliers use a pump, with one pump delivering about 20 mg of Progesterone. To get the physiologic dose, women should usually apply one full pump a day (20 mg), while men can apply one-half pump a day (10 mg). Common low dose sublingual drops usually contain about 1.2 mg per drop.

The consumer should read the label carefully. Studies have shown that many commonly used topical commercial Progesterone formulations contain less than 15 mg of Progesterone per ounce. In fact, some of these creams contain as little as 2 mg of Progesterone.

The way to make sure that Progesterone is present and not simply "wild yam extract" is to look for "U.S.P. Progesterone" on the label. U.S.P. stands for United States Pharmacopoeia, which is the international standard of purity. It confirms that the Progesterone is the identical molecule as produced by the human body.

Progesterone and Adrenal Gland Optimization

The adrenal gland has two components: the inner medulla modulates the sympathetic nervous system through secretion and regulation of two hormones called epinephrine and norepinephrine that are responsible for the fight or flight response.

The outer adrenal cortex secretes three classes of hormones - glucocorticoids, mineralcorticoids and androgens. The most important glucocorticoids are cortisol and hydrocortisone. Reduced output of these hormones often results from chronic stress of the adrenal glands or malnutrition. Symptoms include fatigue, low blood sugar, weight loss and menstrual dysfunction. Mineralcorticoids such as aldosterone modulate the delicate balance of minerals in the cell, especially sodium and potassium. Stress increases the release of aldosterone, causing sodium retention (leading to water retention and high blood pressure) and loss of potassium and magnesium. Magnesium is involved in over 300 enzymatic reactions in the body. Its deficiency is widespread and has been linked to a variety of pathological conditions, including cardiac arrhythmias, uterine fibroids and osteoporosis.

The adrenal cortex also produces all of the sex hormones, although in small amounts. One exception is DHEA, a weak androgenic hormone that is made in large amounts in both sexes. DHEA, together with testosterone and estrogen, are made from Progesterone, which in turn comes from cholesterol.

Progesterone is therefore at the top of an important hormonal metabolic pathway. Deficiency in Progesterone leads to reduction of both glucocorticosteroids and mineralcorticoids such as cortisol. Symptoms of cortisol deficiency include fatigue, immune dysfunction, hypoglycemia, allergies and arthritis. Symptoms of mineralcorticoid deficiency include high blood pressure and mineral imbalances. Progesterone supplements often effectively resolve these problems.

Chronic stress is commonly seen in the western society and career women often cause the adrenal glands into overdrive, with excessive secretion of cortisol. Excessive cortisol can block Progesterone receptors, making them less responsive to Progesterone. High cortisol levels also occur with trauma and inflammatory responses such as the flu. Inflammatory bowel disease, for example, has been shown to induce high levels of cortisol, leading to reduction of Progesterone efficacy and resulting in estrogen dominance. With chronic stress, eventually the adrenals are exhausted and production of these important hormones are drastically reduced.

Women frequently have exhausted adrenal glands by the time they reach the mid-thirties or early forties. Their adrenal glands have nothing left to give. Production of progesterone by the adrenals comes to a halt as the body focuses on producing cortisol and not Progesterone or other sex hormones. Insufficient Progesterone production leads to estrogen dominance.

The adrenal glands therefore deals with the daily stress of life. To have total body hormonal balance the first thing to do is to normalize the adrenal glands. In fact, replacement of deficient hormones alone without addressing the overall health of the adrenal gland is a band-aid approach and ineffective in the long run. The normalization process starts with stress reduction by increasing rest. A good nights sleep is a good start. Go to sleep early and make sure you sleep in a completely dark room to maximize melatonin production. It is prudent to optimize the adrenal gland function prior to or concurrently with Progesterone supplementation. Multiple hormonal supplementations such as DHEA, pregnenolone, low dose natural cortisol or cortisol enhancing agent such as licorice root extract should also be considered. An optimal and balanced intake of vitamins and minerals serves as a good foundation, including 500 mg to 3000 mg of vitamin C, 400 I.U. of vitamin E, 10,000 to 25,000 I.U. of beta-carotene and other important minerals such as selenium and magnesium as well as important amino acids such as lysine, proline and glutamine. Supplementing with natural hydrocortisone or cortisone acetate in doses of 2.5 to 5 mg two to four times a day can be a safe and effective way to replenish depleted adrenals. This should be done under the guidance of a physician.

Progesterone and Osteoporosis

For more than half of a century, estrogen was given routinely with the hope that it would prevent osteoporosis. It is now well established that estrogen replacement therapy does reduce osteoporotic fractures by 50 percent. Estrogen works by preventing increased bone resorption during menopause. Estrogen has no effect on bone formation; therefore, it does not reverse osteoporosis. Furthermore, when estrogen is discontinued, the rate of bone resorption resumes and the rate actually is accelerated. To be successful, estrogen replacement should be started early (before significant bone loss has occurred) and be maintained indefinitely.

It is important to note that a lack of estrogen does not cause osteoporosis. For example, it is proven that there is significant bone loss during the 10 to 15 years before menopause, despite an ample supply of estrogen during this period. But during that same period, there is often a shortage of Progesterone. Although estrogen inhibits the bone-destroying osteoclast cells, it cannot rebuild bone. Progesterone, on the other hand, is a bone builder. It does so by stimulating the osteoblast cells that rematerialize and restore bone mass. Supplementing with natural Progesterone has proven useful in the prevention and reversal of osteoporosis. In other words, Progesterone is the key to healthy bones, in addition to magnesium (and not calcium alone).

In the July, 1990 issue of the International Clinical Nutrition Review on the effectiveness of natural Progesterone, Dr Lee reported healthy 35 years-olds were administered natural Progesterone cream. In the first six to 12 months, subjects had a ten percent increase in bone density instead of an annual decrease of three to five percent. Reversal of osteoporosis is indeed possible through the use of natural Progesterone alone. Instead of a projected 4.5 % loss of bone density, subjects had a 10% increase in bone density after 6 to 12 months of natural Progesterone therapy alone. Some patients had up to a 20 to 25% increase within a year. Just as significant, the beneficial effect of Progesterone is not affected by age but more related to initial bone density status. Those with the lowest bone density scores showed the most improvements. It is apparent that Progesterone can help any women, no matter how far the bones have degenerated. Dr Lee's study also showed that the addition of estrogen to natural Progesterone does not make the Progesterone more effective. Dr Lee only uses estriol for relieve of menopausal symptoms and not for treatment of osteoporosis.

The effect of estrogen can be mimicked by selected foods. Compounds called phytoestrogen, contained in the food, act as weak estrogens. While consumption of phytoestrogen has been linked to reduce symptoms of menopause, it is unclear if osteoporosis is prevented.

Progesterone or Estrogen and Cancer

40% of cancer incidents in women in the United States are in the breasts, ovaries and uterus. Breast cancer is a silent epidemic, striking 1 in 9 women; up from 1 in 30 women in 1960, before estrogen replacement therapy was popularized.

FDA-approved estrogen drugs have been documented to cause cancer. Published studies have shown that women taking estrogen and a synthetic Progesterone drug had a 32% to 46% increase in their risk of breast cancer. This was based upon a large pool of data from the famous Nurses' Health Study conducted at Harvard Medical School. The study showed that the carcinogenic risk of estrogen-progestin replacement therapy became most pronounced when it was used for 10 or more years. However, recent data from the Breast Cancer Detection Demonstration Project suggests that the relative risk is increased by 20% even after four years of use compared to no hormone treatment, and that, surprisingly, there is a 40% increased risk of breast cancer using both estrogen and synthetic Progesterone (called progestin) combined, compared to only a 20% increase for estrogen alone. Clearly, the progestin that is supposed to counter-balance the estrogen is not what the body recognizes as good. The body needs natural Progesterone to counter the estrogen effect. Synthetic Progesterones are far from the natural form. Some studies show that estrogen does not cause cancer in the short-term; however, in women taking estrogen and/or a synthetic progestin for more than 10 years, there appears to be a significantly elevated risk of breast, ovarian, and uterine cancers.

In addition to breast cancer risk, long-term estrogen replacement therapy increases the risk of fatal ovarian cancer. A large 7-year study, including 240,073 pre- and post-menopausal women, focuses on this. After adjusting for other risk factors, women who used estrogen for 6 to 8 years had a 40% higher risk of deadly ovarian tumors, while women who used estrogen drugs for 11 or more years had a startling 70% higher risk of dying from cancer of the ovaries.

The risk of cancer therefore has to be considered carefully when it comes to any hormonal replacement therapy. Extensive studies have been conducted on two oncogenes, BCL2 and P53, and their effect on female-specific cancers and prostate cancer. First, it is important to understand that estrogen in our body comes in three forms - estrone (E1), estradiol (E2), and estriol (E3). Our body makes the three estrogens in the following ratio: 10% E1, 10% E2, and 80% E3. E1 and E2 are potent estrogens. They relieve symptoms of hot flashes, but also promote cancer. E3 is the weakest of the three forms. Not only is it non-carcinogenic, but it actually prevents cancer.

Laboratory studies have shown that when E1 or E2 is added to cells of the prostate and breast, the BCL2 gene is regulated, causing the cells to grow rapidly and not die (cancerous). The BCL2 gene, therefore, stimulates the growth of cancer cells and thus increases the risk of cancer. In fact, many studies now show that E2 actually causes breast and prostate cancer. When Progesterone was added to the cell cultures, cell reproduction stopped and the cells died on time (apoptosis). Progesterone counteracts the BCL2 gene by stimulating the production of the P53 gene, causing cancer cells to die. To put it simply, according to Dr. Lee, estrogen increases cancer risks while Progesterone reduces cancer risks for cancer of the ovary, uterus and small cell lung cancer.

Extensive studies have been conducted in the past 25 years on E3 and breast cancer. They show that women with breast cancer have a lower relative level of E3 in comparison to E1 and E2. In fact, some doctors use E3 as treatment for metastasized breast cancer. A dosage of 2.5 mg to 15 mg a day is used. Studies show that 37% of those receiving E3 had remission or no further progression of the metastatic cancer. For relief of menopausal symptoms, more E3 is required in comparison to E2. Dr. Jonathan Wright is a pioneer in the use of natural estrogen. He formulated a natural compound called "tri-estrogen" composed of 80% E3, 10% E2, and 10% E1. According to Dr. Wright, 2.5 mg of this tri-estrogen, a prescription item available at compounding pharmacies only, is equivalent to 0.625 mg of conjugated estrogens or estrone.

Natural Progesterone therefore has cancer prevention properties. It helps to reduce the risk of ovarian, endometrium and breast cancer, while unopposed E2 causes these same types of cancer.

Does synthetic Progesterone have a cancer prevention effect? The answer is no. Natural Progesterone stimulates activation of the anti-cancer P53 gene by attaching itself to Progesterone receptors, found in abundance in the ovaries, breasts, and endometrial cells. Synthetic Progesterone (commonly found in birth control pills) or any of its variant forms such as Progesterone acetate or medroxy-Progesterone acetate competitively occupy Progesterone receptors and prevent natural Progesterone from occupying these sites. Synthetic Progesterone therefore not only fails to stimulate the P53 gene but also prevents its activation by blocking natural Progesterone from occupying the Progesterone receptor.

How Much Topical Progesterone Cream to Use?

The goal of Progesterone replacement is to restore the normal physiological Progesterone level in the body for two to three weeks out of a month; the way it was designed by nature. An ovulating woman makes about 20 mg a day for about 12 days each month after ovulation. That works out to about 240 mg per month.

One should locate a Progesterone cream that supplies 480 mg per ounce (960 mg per 2 ounce). This means that each two-ounce jar or tube will contain 3% by volume or 1.6% by weight of U.S.P. Progesterone. Using one ounce over two or three weeks will provide about 240 mg if the absorption is 50%. This is the ideal target dose to apply. This works out to 1/8 to 1/2 teaspoon of the cream per day, or three to 10 drops of it in oil form. For creams that come in pre-set metered doses, one full pump normally contains the equivalent of 20 mg Progesterone. This is the simplest for most people to remember - one full pump a day for women and half a pump a day for men in divided doses. If sublingual drops are used, make sure that the drops are applied sublingually and washed in the mouth for best absorption. Do not take in more than 6 drops at a time as it can be swallowed easily and lose its effectiveness.

Sublingual Progesterone drops are 99% absorbed, while micronized Progesterone in a capsule is only about 40% absorbed, and some studies even report an absorption of less than 15%.

Low vs. High Dose Progesterone Cream

Progesterone cream comes in a variety of concentrations. Which is best? According to Dr. Lee, low dose cream costs a little bit more, but it is the better way to go. There are two important reasons.

First, excessive Progesterone in high dose (10%) cream is metabolized in the liver and some of the metabolites may have anesthetic properties on the brain, causing lethargy and depression. Secondly, Progesterone is rapidly absorbed from the skin and there is a danger that the release of Progesterone into the blood stream is not smooth. Since Progesterone has a half-life of only 5 minutes once in the blood, its effectiveness is limited.

Other physicians favor a higher potency cream ( up to 10%) because they have better results. Regardless of whether it is high or low dose, the key is that your progress is monitored by a qualified health care professional.

Laboratory Measurement

Salivary or serum hormonal testing will provide information on your current level of Progesterone and assess the amount of natural Progesterone that you need.

Serum level of Progesterone will rise in about three months after proper use of Progesterone cream. It measures the total available and is not the much smaller biologically active portion. The normal post-menopausal, untreated patient will show an initial serum Progesterone level of 0.03 to 0.3 mg/ml. After 3 months, this level rises by about 10 fold to 3 to 4 mg/ml. In normal pre-menopause women during midcycle (luteal phase); the Progesterone level reaches 7 to 28 mg/ml. In the treatment of osteoporosis, good results are obtained at Progesterone levels of 3 to 4 mg/ml.

Saliva testing is gaining popularity due to its ease of use, faster indication of free Progesterone level and good accuracy. It is more accurate than serum testing because it measures the amount of free Progesterone that is bio-available to the cell and active. The challenge is to obtain a good salivary sample free from contaminants. The normal range depends on the stage of the menstrual cycle. Normal physiological range is 100-500 pg/ml, there is usually no reason to exceed this range because that is how high the endogenous production usually gets.

Interpretation of laboratory results is confusing to many health professionals. To properly interpret the meaning of salivary test result, the following parameters should be followed:

  • Does the Progesterone level fall within range normal for the menstrual cycle period? For example, pre-menopausal range is from 50-400 pg/ml, post-menopausal range is from 5-95 pg/ml.

  • Does the Progesterone level stay within the normal physiological range of 100-500 pg/ml? This is especially important during hormonal replacement therapy.

  • What is the Progesterone to estradiol (E2) ratio? The minimum ratio is 22 to 1 during the follicular phase and 30 to 1 during the luteal phase. If the ratio is low, it is a sign of estrogen dominance.

  • What is the total Progesterone to total estradiol ratio? The minimum ratio should be 26 to 1.

Is there an upper limit of Progesterone to E2 ratio? Provided the total amount of Progesterone does not exceed the normal physiological range at any time, there is no limit to the Progesterone to E2 ratio.

In general, it takes about 3 to 4 months for Progesterone in the body fat to reach physiological equilibrium for those who are menopausal, and about 1 to 2 months for those who are pre-menopausal.

How to Apply Progesterone Cream

It is important to be as accurate as possible when applying Progesterone. The best low dose Progesterone cream should contain 1.7% Progesterone and yield 20 mg Progesterone per application. The simplest application method is through the use of metered pump that measures the exact amount (20 mg), each time the pump is pressed.

Progesterone is best absorbed where the skin is relatively thin and well supplied with capillary blood flow. Areas such as face, neck, upper chest, and inner arms are good areas. Spread it out to as big an area as possible for maximum absorption and allow as much time for absorption as possible. Therefore, bedtime application is best if you are applying it once a day. Twice a day application is best but it may be too troublesome for most. Rotate to different areas to avoid saturation in any one particular site.

Here is a sample rotational application protocol:

  • Day 1 morning: Apply to the right side of the back of the neck.

  • Day 1 before bed: Apply to the left side of the back of the neck.

  • Day 2 morning: Apply to the right wrist area, with palm facing up.

  • Day 2 before bed: Apply to the left wrist area, with palm facing up.

  • Day 3 morning: Apply to the underside of the right upper arm.

  • Day 3 before bed: Apply to the underside of the left upper arm.

Repeat this cycle from day 4 onward. In other words, day 4 will be the same as day 1, and day 5 will be the same as day 2, etc.

Practically speaking, the best gauge for the ideal dose should not be determined by any laboratory test alone. It is important to rely on relief of symptoms when figuring out the ideal dose. The right dose is the dose that works.

The following are general recommendations for topical Progesterone cream application that may need to be modified for specific situation:

  • Women in premenopause - still ovulating:

    • Use: Progesterone cream can be used to relieve PMS, painful cramps with periods, menstrual irregularities, prevent cancer and to protect against osteoporosis later in life.

    • Directions for those on no hormonal supplementation: Count the day the period begins as the first day. Apply 20 mg (one full pump when properly dosed) of natural Progesterone every day from day 12 to day 26. Those with longer cycles may wish to use from day 10 to day 28. Begin the cream after ovulation that usually occurs about 10 to 12 days after your period begins. If bleeding starts before day 26, stop the Progesterone and start counting up to day 12, and start again.

    • Directions for those on synthetic Progesterone (progestin) supplementation: Taper off the synthetic Progesterone gradually and replace with natural Progesterone over a 3-6 month period. Synthetic Progesterone can be reduced to every other day and then further taper off.

  • Women in peri-menopause (still menstruating with menopausal symptoms and/or PMS but not ovulating):

    • Use: Progesterone cream can be used to relieve PMS symptoms and prevent osteoporosis.

    • Directions: Count the day the period begins as the first day. Apply 20 mg of natural Progesterone (one full pump when properly dosed) from day 7 to day 27. If your period begins early, stop using Progesterone cream while you are bleeding.

  • Women in menopause (not menstruating):

    • Use: For prevention or reversal of osteoporosis and relief of menopausal symptoms.

    • Directions for those who are not on estrogen replacement therapy: Choose a calendar day, such as the first day of the month. Apply 20 mg of natural Progesterone (one full pump when properly dosed) of natural Progesterone daily from day 1 to day 25. Let the body rest the rest of the month. If a woman has not been making Progesterone for a number of years, the body-fat Progesterone is probably low. In this case, double up on the application for the first 2 months, and return to normal physiological dose thereafter.

    • Directions for those who are on estrogen replacement therapy: Reduce the dosage of estrogen supplementation to half when starting Progesterone. Those women who fail to do so will likely experience symptoms of estrogen dominance during the first one to two months of Progesterone. Every two to three months, reduce the estrogen supplement again by half. Estrogen and Progesterone can be used together during a three-week cycle each month, leaving a rest period of 7 days without either hormone. The estrogen dose should be low enough that monthly bleeding does not occur but high enough to prevent vaginal dryness or hot flashes.

    • Directions for those taking estrogen and synthetic Progesterone (such as Provera) combination: Stop the synthetic Progesterone immediately when Progesterone cream is added. Estrogen should be tapped off slowly.

    • Low dose natural estrogen (estriol) may be added for 3 weeks out of the month in cases of menopausal symptoms such as vaginal dryness and hot flashes unrelieved by Progesterone cream alone.

  • Other Special Uses

    • Osteoporosis: Apply 20 mg daily from day 1 to day 25 of the menstrual cycle. Baseline bone mineral density (BMD) test should be obtained. If after 1 year bone density increases, the amount can be reduced by half. If BMD does not increase, other factors such as exercise, diet and optimization of nutrition should be undertaken together with a full medical workup to identify other underlying causes.

    • Severe PMS or Endometriosis: Apply 20 mg from day 12 to day 26.

    • Uterine Cramps: Apply above the pubic area at onset of cramps.

    • Hormone Related Headaches: Apply creams to the sides of the neck just behind the earlobe at onset of headache. Do not use on day 28.

    • During Hot Flashes: Apply a small dab to the inside of the wrist at the onset of hot flashes.

    • Premenstrual Migraine Headaches: Apply 20 mg Progesterone cream during the 10 days before the period begins. Be alert to the aura that usually precedes these headaches. You can apply a small glob (1/4 to 1/2 teaspoon) every 3 to 4 hours until symptoms subside.

    • Polycystic Ovary Disease: Apply 20 mg of Progesterone cream during day 14 to 28 of the menstrual cycle. Adjust accordingly if for longer or shorter cycle. As the hormonal balance is regained, facial hair and acne, two commonly associated symptoms, will disappear.

    • Progesterone Cream and Pregnancy: According to Dr. Lee, one of the chief causes of early pregnancy loss is the failure of the body to increase Progesterone production sufficiently during the first several weeks after fertilization. Women who are having difficulty conceiving or who may be at risk of a miscarriage may wish to speak with their physician about natural Progesterone supplementation after ovulation.

    • Breast Cancer Prevention: Breast cancer occurs most often during estrogen dominance. Dr. Graham Colditz of Harvard postulated that unopposed estrogen is responsible for 30% of breast cancer. Preventive low-dose Progesterone supplementation (12-15 mg per day) can be used 24 to 25 days a month and should be considered, especially for those at risk.

    • Breast Cancer Patients: Progesterone supplementation should be maintained for life with all breast cancer patients, before, during and after surgery.

    • Uterine Fibroids: 20 mg of Progesterone cream can be used from day 12 to day 26. You can start as early as day 8 and go through day 30. Ultrasound tests can be obtained initially as baseline and after 3 to 6 months of use. A 10-15% reduction in size is generally expected or at least the size should not increase further. Continue this treatment until menopause if it is successful. At menopause, Progesterone application can be reduced. Fibroids normally atrophy after menopause as estrogen level reduces.

    • Breast Fibrocysts: Apply 20 mg of Progesterone cream from ovulation (day 12 to 14) until a day or two before the period starts. Normal breast tissue will return within 3 to 4 months. Also, take 400 IU of vitamin E at bedtime, 600 mg of magnesium and 50 mg of vitamin B6 a day. Do also refrain from coffee and reduce sugar and fat intake.

    • PMS: Apply 20 mg of Progesterone cream from days 10 to 12 to days 26 to 30. This is best done in two divided doses, with a small dab at night starting on days 10 to 12 and gradually increasing to two dabs per day, morning and night. Finish off the last 3 or 4 days with bigger dabs. Each day total should not exceed 20 mg.

    • Pre-Menopausal Women with Hysterectomy or Ovaries Removed: Apply 20 mg of Progesterone for 25 days of the calendar month and rest from day 26 to the end of the month.

    • Menstrual Migraine: Apply 20 mg of Progesterone cream during the 10 days before your period (days 16 to 26). Apply a small amount every 3 to 4 hours when you sense the "aura" coming until symptoms cease.

    • Increase Libido: Progesterone and testosterone are both important factors in libido. Testosterone is much more potent. Natural Progesterone is the preferred choice.

    • Hair Loss: When Progesterone level drops due to ovarian follicle failure (lack of ovulation), the body responds by increasing the synthesis of androstenedione, an adrenal cortical steroid. This has some androgenic properties, resulting in male pattern hair loss. Natural Progesterone supplementation for 6 months may be helpful to reduce the androstenedione level, at which time normal hair growth will resume.

    • Hypothyroid: Thyroid hormones and estrogen have opposing actions. Progesterone also opposes estrogen. Symptoms of hypothyroidism occurring in patients with unopposed estrogen or estrogen dominance (Progesterone deficiency) become less symptomatic when Progesterone is replaced.

Progesterone and Men

Men also produce estrogen and estradiol (E2), but in much lower amounts than women. Males also produce Progesterone, but about half the amount from that of females. It is produced in the testes and in the adrenal glands. While the level of Progesterone in males is significantly lower than in females, some womens' Progesterone levels fall below that of men of the same age during menopause.

The male hormone, testosterone, is an antagonist to estradiol (E2). Like Progesterone, testosterone can stimulate new bone formation, increase bone density, and a lack of it causes osteoporosis. It is made from Progesterone. Men normally continue to produce a relatively normal level of testosterone for their age and well into the seventies. Contrary to common perception, testosterone does not cause prostate cancer. Studies have shown that men with the highest level of testosterone have the least prostate enlargement. Conversely, men with the highest level of estrogen have enlarged prostates. Declining testosterone from aging, together with increasing levels of estrogen, is the most likely reason for prostate enlargement and cancer in men. Since Progesterone has an antagonistic effect on estrogen, application of Progesterone cream would indirectly enhance the effect of testosterone.

In addition to the use of Progesterone cream to offset the negative effect of estrogen leading to increased testosterone levels, use of zinc should be considered. Zinc inhibits the action of aromatase, an enzyme that converts testosterone to estrogen. Of all the body's organs, the prostate has the highest level of zinc. Therefore, supplementation with 50 mg of zinc one to two times a day enhances testosterone function.

Large doses of Progesterone inhibit sexual behavior but physiological doses appear to enhance sexual drive. Clearly testosterone alone is not the only driver of sexual function in males or females.

Male Hormonal Imbalances

  1. Testosterone deficiency in Men:

    Symptoms: weight loss, lower stamina, enlarged breasts, loss of muscle, lowered sex drive and fatigue.

    Discussion: These symptoms commonly occur in men over the age of fifty as part of andropause.


    • Take nutritional supplements such as zinc (50 mg twice a day until improvements are seen, then 50 mg once a day).

    • Take a pro-hormone such as androstenedione or pregnenolone to stimulate testosterone production.

    • Do regular strength training exercises.

    • Testosterone replacement therapy as indicated.

    • Reduced weight: obesity has a direct effect on increasing estrogen build up in the body.

    • Reduce alcohol consumption. Alcohol significantly inhibits the clearance of estrogen from the blood stream and decreases zinc levels. One or two drinks should be the maximum per day.

    • Increase consumption of plant proteins that contains phytoestrogens. Such phytoestrogens have only 1/500 the active effect of estradiol, the most active human estrogen. It acts competitively and blocks estrogen receptor sites in the body as well as stimulating the P450 system in the liver to metabolize estrogen more actively.

    • Avoid grapefruit that has a tendency to inhibit the liver's breakdown of estrogen.

    • Increase cruciferous vegetables such as broccoli and cauliflower that stimulate the burning-off of extra estrogen. Cruciferous extracts such as DIM can be considered as well.

    • Reduce drugs that inhibit the P450 system and result in increased estrogen levels. These include non-steroidal anti-inflammatory drugs (ibuprofen, diclofenac), aspirin, acetaminophen; certain antibiotics such as sulfas, tetracyclines, penicillins; cholesterol lowering drugs (Statins, lovastatin; heart medications such as propanolol, quinidine, methydopa and coumadin.

  2. Excess Estrogen in Men:

    Symptoms: Hair loss, prostate enlargement, irritability, headache and breast enlargement.

    Solution: Reduce estrogen in diet and male hormone replacement. Progesterone cream will act as an antagonist of estrogen in the body. Apply 10 mg a day.

Progesterone and Prostate

The prostate is the male equivalent of the female uterus. When prostate cells are exposed to estrogen, the cells proliferate and become cancerous. When Progesterone or testosterone is added, cancer cells die. During the aging process, Progesterone levels fall in men, especially after age 60. Interestingly, Progesterone is the chief inhibitor of an enzyme called 5-alpha reductase that is responsible for converting testosterone to di-hydrotestosterone (DHT), a much more potent derivative that is linked to prostate cancer. When the level of Progesterone falls in men, the amount of conversion from testosterone to DHT increases. Unfortunately, DHT is not as powerful an inhibitor of cancer cells compared to testosterone. Benign prostatic hyperplasia (BPH) and prostate cancer do not appear in men when the level of testosterone is high. Both conditions come 20 to 30 years after the onset of declining testosterone levels associated with the aging process that commences in the mid-twenties.

Testosterone is also an antagonist to estradiol. When the level of testosterone decreases, the relative level of estradiol in men increases. Estradiol, as we have seen earlier, turns on BCL2 oncogenes and increases the risk of prostate cancer if an adequate amount of Progesterone is not there to counteract its effect by stimulating the P53 cancer protection gene.

Prostate cancer is the most common cancer in men. It is slow growing, with a doubling time of 5 years. Breast cancer is much more aggressive, with a doubling time of a few months. Dr. John Lee, Dr. Jesse Hanley and many other progressive doctors now believe that excessive estrogen is a primary cause of prostate enlargement and prostate cancer. Numerous anecdotal reports of reduction of BPH and reversal of prostate cancer through use of natural Progesterone supplementation have been reported. It is apparent that Progesterone protects the prostate gland.

PSA is a widely available prostate cancer marker. Studies have shown that PSA levels return to normal upon application of natural Progesterone cream before or after prostate surgery.

Benign prostatic hyperplasia (BPH), a prostate enlargement condition, is a common condition affecting the majority of males above age 50. Progesterone cream can help to reduce prostate size. Progesterone's inhibitory effect on 5-alpha reductase is far more effective than Proscar and Saw Palmetto, which are standard agents, used in traditional and natural medicine to cure BPH. Concurrent use of Progesterone cream can reduce the amount of saw palmetto needed to achieve the same effect.

All men over age 40 should consider natural Progesterone replacement therapy, or even earlier if there is a history of prostate cancer or BPH. The amount needed is 10 mg a day, approximately half of that used in women. No rest day is needed and men should apply it on a daily basis.

One benefit is that there is a reasonable chance that natural Progesterone supplementation decreases male balding due to the corresponding rise in testosterone. More research is needed in this area.


Modern society has brought with it many external hormonal insults to our body. Such insults exhibit themselves in symptoms associated with menopause, PMS and pre-menopause. It is apparent that the common thread of these symptoms is often relative estrogen dominance rather than absolute estrogen deficiency as traditionally thought.

The vast majority of these symptoms can be avoided by lifestyle adjustments alone in many cases. These include stress reduction and a comprehensive exercise program. Good nutrition can go a long way to reduce estrogen in the body. Estrogen levels can be lowered by calorie restriction, avoidance of sugar and refined carbohydrates, maintaining a high-fiber diet and supplementing with high-fiber products such as psyllium or rice bran. Intake of an optimum amount of antioxidants is needed together with the avoidance of environmental estrogenic toxins. Since the liver is where estrogen is metabolized, protecting the liver function with herbs such as milk thistle should be considered for those with impaired liver function. Supplementation with weak estrogens such as isoflavone, DIM, and selected herbs can be useful as well. Natural Progesterone cream should be used as indicated to relieve symptoms. The risk is extremely low in physiological doses. Most menopausal symptoms normally respond well with lifestyle changes and natural Progesterone supplementation alone. If not, women may need very low dose natural estrogen supplementation for several years, which can then be gradually discontinued without recurrence of symptoms.

In men, Progesterone has health enhancement effects, from increasing sex drive to prostate cancer prevention. Any male who is in the clinical phase of aging (above 45 years old) should consider using Progesterone.

Progesterone supplementation is part of a total hormonal balance program and indeed an invaluable anti-aging tool when properly used. It is virtually free from side effects. When estrogen is required, the use of anti-carcinogenic estriol may reduce the cancer risk associated with estrogen treatment. The concurrent and judicious use of other hormones such as natural cortisol in case of adrenal stress, DHEA, pregnenolone, androstenedione, and melatonin should also be considered as part of an anti-aging total natural hormonal replacement program. Not to be forgotten are lifestyle factors that can enhance total body hormones and normalize important adrenal function.

These include:

  • Avoidance of hydrogenated oils and most vegetable oils in the diet with the use of olive and canola oil instead.

  • Eat whole, unprocessed food in accordance to the anti-aging food pyramid of 50% complex low glycemic carbohydrates, 25% proteins (preferably from plant sources) and 25% fat.

  • Optimize nutritional supplementation with vitamins, minerals, enzymes and amino acids, including 1000 to 3000 mg of vitamin C, 400 IU of vitamin E, 500 to 1000 mg of magnesium and 50 mg of vitamin B6.

  • Drink at least 10 glasses of pure filtered water a day.

  • Maintain a smooth and regular bowel movement with enzymes and probiotics as needed.

  • Reduce stress to normalize the adrenal gland.

  • Avoid cigarette smoking, coffee and alcohol.

I hope you have enjoyed reading this article. If you have areas you don't understand, feel free to write to me by clicking here.

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© 2008  Michael Lam, M.D. All Rights Reserved.
5 stars - "First let me thank you" First let me thank you so much for your most informative, excellent article about progesterone. It offers me a great deal of hope, as I recognize myself in the list of symptoms you list under estrogen dominance. I am a new comer to your site and I am looking forward to reading it more thoroughly over the next few days and becoming more acquainted with your many contributions to healthful living.

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