I want to make a few quick points. Your doc is saying something unusual.

An aromatase inhibitor will slow the conversion of testosterone to estradiol. So, the conversion will be pushed toward DHT. It does nothing for existing estradiol. DHT will exacerbate hirsutism.

Estrogen dominance does not cause melasma. Hormonally it occurs when the pituitary attempts to increase cortisol output by the adrenals (if they are strong enough) by increasing ACTH. Overproduction of ACTH (with weak adrenals) can result in melanine production by the melanocytes causing excessive pigmentation (melasma among others)..

DIM and aromatase inhibitors are very different. An aromatase inhibitor results in decreased estradiol metabolism from testosterone and increased DHT production. DIM positively changes the metabolism of estradiol and imporves the ratio of 2-hydroxy estrogens : 16 and 4-hydroxy estrogens. It's believed that 2-hydroxy estrogens are protective and the 16 and 4-hydroxy extrogens are associated with an increased risk of breast/prostate cancer.

Hmm...what you are saying makes sense, but how can I hormonally treat melasma? My mom had it and it went away when her hormones got balanced, so maybe I have a chance of it going away. Will stress reduction help at all? I read some sources online after a quick search that say I need to work on thyroid (which was checked twice, T3 and T4, and seems fine), adrenals, and also the possibility of fungal infections. So maybe my stomach issues could also contribute to it? I never did have success with the candida diet though, just the anti-histamine diet.

So, you are saying that neither myomin (aromatase inhibitor) nor DIM would work for me?

Are you saying I should check for other hormones besides the main ones associated with acne? This doctor doesn't like it when I tell her what to check for, she didn't even let me check what they are testing for so I guess I'll find out when I get the results back. I don't even think they tested cortisol.

So far, the only thing positively working is inositol, which boosts progesterone and works as an anti-androgen, and also controls glucose. But it's not helping with estrogen dominance. I would need something separate for that. But now that other factors are thrown into the equation, it complicates things. I don't want to fix one issue and make others worse. My liver and digestion are also problematic, so I can't take too many supplements at the moment, much less anything stronger.

I'll post my lab results once I get them and hopefully shed some light....but they haven't done the full panel like I asked, and only drew blood not urine or saliva. I was very disappointed, but I couldn't afford more elaborate tests since my insurance doesn't cover them.

Oh, and I have to mention this study, especially the section on sex hormones and melasma. There does seem to be a correlation, however inconclusive. Thoughts? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991712/

This is about pregnancy hormones, but can relate also to bcp and other hormonal imbalances:

Elevated levels of estrogen, progesterone and MSH, especially in the third trimester, have been found in association with melasma³⁰. In vitro studies have shown that cultured human melanocytes express estrogen receptors³¹. Estradiol increases the level of melanogenic enzyme especially TRP-2 in normal human melanocytes³². Additional supporting evidences showed increased expression of estrogen receptors in the melasma lesional skin^33,34. It is speculated that melanocytes in melasma patients may be inherently more sensitive to the increased concentration of estrogens and possibly to the other sex hormones

Hey wishclean, greengables and everyone else commenting on this helpful thread. I have been reading the hormonal forum for a while now, and decided to join so I can ask some questions because wishclean seems to have the same symptoms as me with both androgens and estrogens causing problems.

I have been taking spironolactone for a few months now, and I think it's giving me estrogen dominance symptoms. Before spironolactone, I had actually seen a natureopath who recommended a mixture of saw palmetto, vitex, prickly pear, and some other herbs, but I didn't stick with it long enough to see if it worked and I decided to go with spiro instead. However, my estradiol levels were a bit high (but considered normal range) along with normal androgens on the high end of the scale I guess...I don't remember my progesterone but I think it was low so I think I have the same issues as wishclean and I hope I can get some help here.

Well, now I Have developed some hyperpigmentation, bloating, weight gain, and just a general feeling of discomfort. My skin is a bit better, but I still get breakouts around those crucial times of the month. Is it possible that spiro is giving me estrogen dominance? Do women combine spiro with something else to regulate estrogen? I feel like I'm on birth control all over again...bloated, moody, depressed. please offer me some feedback on what to do.

Hi softfocus. See, I thought the same thing about hyperpigmentation and estrogen dominance. I developed melasma after taking saw palmetto for a few months. My hirsutism had slightly decreased during that time, but then I noticed some hyperpigmentation. I initially thought it was from a glycolic acid product I was using that was too harsh for the sensitive area near my eyes or my salicylic makeup removing wipes because they burnt me in that area, but I'm not sure... a dermatologist and a doctor both told me it's melasma but I got it in a very unusual area.

I haven't taken spironolactone but I read some studies on it a while ago. This in particular might help you:

Spironolactone decreases 5-alpha reductase activity via increased clearance of testosterone secondary to augmented liver hydroxylase activity. In addition, it increases the level of steroid hormone binding globulin (SHBG), thus providing a sink that reduces circulating free testosterone as more is bound by the increased quantity of SHBG. The resultant effect of reducing free testosterone in circulation is an increased estrogenic state, which can lead to gynecomastia or decreased libido, especially when higher doses of oral spironolactone are used.

This is from a recent study done in 2012. Breast cancer is mentioned, but nothing conclusive that would connect it to long term use of spiro. I personally think that estrogening BCPs are more dangerous than DHT blockers. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3315877/

I hope greengables can weigh in on this and be more helpful because I haven't research this topic enough.

I want to make a few quick points. Your doc is saying something unusual.

An aromatase inhibitor will slow the conversion of testosterone to estradiol. So, the conversion will be pushed toward DHT. It does nothing for existing estradiol. DHT will exacerbate hirsutism.

Estrogen dominance does not cause melasma. Hormonally it occurs when the pituitary attempts to increase cortisol output by the adrenals (if they are strong enough) by increasing ACTH. Overproduction of ACTH (with weak adrenals) can result in melanine production by the melanocytes causing excessive pigmentation (melasma among others)..

DIM and aromatase inhibitors are very different. An aromatase inhibitor results in decreased estradiol metabolism from testosterone and increased DHT production. DIM positively changes the metabolism of estradiol and imporves the ratio of 2-hydroxy estrogens : 16 and 4-hydroxy estrogens. It's believed that 2-hydroxy estrogens are protective and the 16 and 4-hydroxy extrogens are associated with an increased risk of breast/prostate cancer.

Hmm...what you are saying makes sense, but how can I hormonally treat melasma? My mom had it and it went away when her hormones got balanced, so maybe I have a chance of it going away. Will stress reduction help at all?

So, you are saying that neither myomin (aromatase inhibitor) nor DIM would work for me?

So far, the only thing positively working is inositol, which boosts progesterone and works as an anti-androgen, and also controls glucose. But it's not helping with estrogen dominance. I would need something separate for that. But now that other factors are thrown into the equation, it complicates things. I don't want to fix one issue and make others worse. My liver and digestion are also problematic, so I can't take too many supplements at the moment, much less anything stronger.

I'll post my lab results once I get them and hopefully shed some light....but they haven't done the full panel like I asked, and only drew blood not urine or saliva. I was very disappointed, but I couldn't afford more elaborate tests since my insurance doesn't cover them.

This is actually not complicated. You balance all basic hormones:

Thyroid, cortisol, progesterone, estradiol and testosterone.

You must have all the appropriate lab testing and an exam by a qualified doc that can spot your imbalances. A good physician looks at your silhouette, then body along with complete history and shouldn't be surprised by the lab data. It's fairly easy to detect most imbalances by looking at nothing more than the silhouette and face.

Progesterone balances Estradiol

Estradiol balances Testosterone

Cortisol is critically important for thyroid metabolism and can balance testosterone, deal with the hirsutism and inhibit excessive pigmentation.

If you have been under chronic stress, then your adrenals could very well be weak. You will feel tired and fatigued, experience excessive inflammation and inflammatory diseases, run on adrenaline, have a sense of being victimized, be irritable, have poor resistance to stress, upper respiratory infections, low tolerance to stress, tired look, conjunctivitis, dark circles under eyes. Also digestive issues such as colitis with abdominal pain, bloating, diarrhea, nausea. There are some others as well.

Cortisol is responsible for:

Increasing blood sugar and blood pressure

neutralizing inflammation

When at the proper physiologic levels it increases work capacity, dynamism and the immune system. It also calms down the parasympathetic nervous system that produces adrenaline. Those deficient in cortisol miss the energy and mood calming action of this hormone, so they compensate by making more adrenaline that routinely results in explosive emotional outbursts.

Yeah, but I don't "look" like I have PCOS. I'm not overweight and my hirsutism is mild enough that it doesn't show under makeup. Also, I usually tend to respond to hormone treatments in ways that the typical woman who takes them doesn't. For instance, I can't clear my acne on just androgen/DHT blockers like androcur, saw palmetto, spearmint tea...those make me bloated and irritable, and I think even taking something like spironolactone would have the same effect if it can be estrogenic. When my doctor combined androcur with diane many years ago, I rapidly gained a lot of weight and was hungry all the time. I think anything that adds estrogen to my body, directly or indirectly, throws me off. I'm trying to see what I would tolerate based on what I tolerated in the past, and the most successful treatment so far for acne was vitex, but it made hirsutism worse. So it seems that I have to choose acne or facial hair in many cases. Idk what a customized treatment would entail, I guess I'll share my lab results on here and the dr's recommendations to see what to make of it. I'm interested in long term solutions, not short term fixes, that's why I find it hard to commit to strong drugs or even strong herbs.

Have you seen this study, especially the section on sex hormones and melasma? There does seem to be a correlation, however inconclusive. Thoughts? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991712/

This is about pregnancy hormones, but can relate also to bcp and other hormonal imbalances:

Elevated levels of estrogen, progesterone and MSH, especially in the third trimester, have been found in association with melasma³⁰. In vitro studies have shown that cultured human melanocytes express estrogen receptors³¹. Estradiol increases the level of melanogenic enzyme especially TRP-2 in normal human melanocytes³². Additional supporting evidences showed increased expression of estrogen receptors in the melasma lesional skin^33,34. It is speculated that melanocytes in melasma patients may be inherently more sensitive to the increased concentration of estrogens and possibly to the other sex hormones

thanks, that study on spiro is interesting and a bit concerning. so many factors to consider. My doctor only tests the basics. Should I get retested now that spiro seems to be causing me estrogen dominance symptoms?

Note that DIM is NOT an aromatase inhibitor, i.e. it does not inhibit the CYP19 enzyme.

DIM upregulates CYP1A1, CYP1A2 and CYP1B1 enzymes. This increases the speed at which you clear active estrogen from the body, or in other words converts estrone and estradiol (two types of estrogen) into estrogen metabolites. DIM generally gives you more "good" estrogen metabolites (2OH and 4OH) than "bad" estrogen metabolites.

However these metabolites that DIM promotes are still estrogenic. What is the benefit? Well, the metabolites are not as estrogenic as estradiol. So the hope is that you reduced your overall estrogenic activity a little bit. Here is where the effects of DIM will vary from person to person.

No reduction in estrogen from DIM can occur because:

1. In some, the increase in estrogenic activity from the increased estrogen metabolites is roughly equal to the reduction of precursors estradiol and estrogen. So DIM didn't do much for this person.

2. DIM requires certain cofactors in the body to work. We don't really know what all these cofactors are. DIM's results can vary from person to person without a clear answer why.

Increase in free testosterone:

Increased estrogen metabolites from DIM can increase free testosterone by knocking them off binding proteins. Generally in someone with more bad metabolites than good, adding DIM will increase good metabolites but will also increase free testosterone. However...

Decrease in free testosterone:

Some people already have high levels of "good" estrogen metabolites, or 2OH and 4OH. Raising these levels further with DIM creates negative feedback on testosterone that outweighs the estrogenic effects of the estradiol and estrone you had before DIM.

Umm...what?

Now, as interesting as this all is, it's not an easy thing for the average person to determine if DIM will have the desired effect.

In my opinion, DIM does not work very well if you are trying to decrease androgenic and estrogenic activity at the same time. If you don't care about a possible rise in androgenic activity (e.g. if you think you mostly have a progesterone/estrogen balance problem, not an androgenic problem), then go for it.

But for those of us who clear primarily on anti-androgens, DIM is a poor choice. Personally, it made me break out while still on 100mg of spiro after a very long time being clear.

We can go on for pages and pages about all the possibilities here, but in the end, you can either spend a lot of time finding a practitioner who gives a shit, and has actually looked at research since they graduated from medical school, and then paying them an arm and a leg to take some tests. And hopefully between the two of you, those results will give you something that can be translated into take this drug -> clear your skin.

Or you can take the cheap way and just try something, and record how you feel and how your skin fares. It's not terribly scientific, but it doesn't cost an arm and a leg, either.

So what...

So if you just want to inhibit estrogenic activity, honestly I would go for an actual aromatase inhibitor, not DIM.

There are over-the-counter compounds that are supposedly aromatase inhibitors, if that's a route you're interested in going.

If you have estrogen dominance, though, it's worth noting that spironolactone is not the way to go either. Estrogen dominance is not going to be solved by taking an anti-androgen with some estrogenic properties. For estrogen dominance you're better off with progesterone supplementation.

Study on "natural" products as aromatase inhibitors

I also want to note that DHT itself inhibits aromatase. But I haven't seen conclusive evidence showing that inhibiting aromatase through other means (drugs, supplements) does the reverse and increases DHT.

Hi Wishclean.

No I'm not a doctor. I am familiar with endocrinology, in part, because the subject area interests me.

There is zero chance hirsutism is caused by elevated estrogen. It's only caused by unopposed DHT. As I mentioned you need to understand the testosterone source to come up with the best treatment plan. It could be adrenal (but may not be) based on your last comment. You mentioned melasma in your last post. That could be caused by a cortisol deficiency.

Cortisol is the most important hormone in the human body. If levels drop low enough it becomes a medical emergency and without intervention death can occur. This hormone is responsible for regulating blood pressure, regulating the immune system, fighting inflammation, increasing dynamism and regulating glucose. It's incredibly important to have this hormone regulated if you are correcting thyroid hormone, IGF-1. growth hormone or melatonin.

A few common signs of cortisol deficiency are - fatigue, excessive negativism, feeling like you are a victim, low stress tolerance and periods of yelling and screaming. The latter is caused by an increase in ACTH attempting to stimulate cortisol production by the adrenals. Since this isn't occurring, adrenaline is produced instead.

8 am cortisol should be around 20.

Hormone testing:

The female hormone cycle is well known. Depending on what the complaint looks like we may want to test on a day other than day 21, however testing on a day when progesterone and estradiol just dropped to relatively low concentrations isn't going to provide AS MUCH information. It isn't useless.

Generally, the best lab testing is to combine serum (blood) with urine. It depends what you are looking for though. Saliva testing has some benefit, however it's diagnostic value is low. So why don't we like it? You end up with a free hormone value (free hormones fluctuate substantially throughout the day) and a reference range for the analyte that is large. This makes interpretation more difficult.

You can test for testosterone just about any day of the month (slight increase at ovulation). Best tests to order for testosterone are:

Total testosterone

SHBG

Androstanediol Glucoronide (fist metabolite of DHT)

Of course we need the adrenal androgens, female sex hormones, fsh, lh, etc, etc.

Histamine:

I suggest you order the Array 1 panel from Cyrex labs. This is a saliva sample.

Www.cyrexlabs.com

This test will look for a gluten intolerance. If it comes back positive, then try Array 4 next. This will test for cross gluten sensitivity based on specific foods.

I would think that based on chronic stress and some mid-section weight gain, my cortisol is high, not low. Again, symptoms of high and low cortisol overlap, which makes it confusing. I'm not even sure they are testing my cortisol. The doctor's office didn't like the fact that I was asking too many questions about the blood test (bc I didn't think it would be that useful) so I didn't get a chance to see which hormones they are checking. I'm pretty sure though they are not checking for all testosterone, which is frustrating.

Right now I'm betting on high androgens (or androgen sensitivity) and high estrogen, with low progesterone. I'm treating high testosterone with inositol, which has reduced my hirsutism, but I still get some breakouts around ovulation and my period. Not sure if I need to up my inositol dosage or not, because when I first started taking it, it minimized all those breakouts, even the ovulation ones.

Hi Wishclean:

I'm not familiar with overlapping symptoms of cortisol deficiency/excess. They symptoms look very different. If you have chronic stress it may be that your adrenals are fatigued, leading to cortisol deficiency.

Extreme cortisol deficiency results in a vey thin sillouette.

Extreme cortisol excess results in muscle wasting (thin legs and arms), a large square-like torso, purple stretch marks on the upper body and a "moon face". Your face will look nearly round and very large.

At ovulation estrogen drops and testosterone increases. Since estrogen neutralizes the side effects of testosterone you get not only increased testosterone, but it's unopposed since estrogen declines.

Testosterone doesn't change at the end of the month but estrogen drops off. So, you seem to get acne when estrogen declines.

Would you be interested in posting your lab work?

Lef.org is a great place to purchase lab work without having to nag the doc. You can order what you want and it's discounted if you are a member. They also have an annual sale that drops the pricing further.

Note that DIM is NOT an aromatase inhibitor, i.e. it does not inhibit the CYP19 enzyme.

DIM upregulates CYP1A1, CYP1A2 and CYP1B1 enzymes. This increases the speed at which you clear active estrogen from the body, or in other words converts estrone and estradiol (two types of estrogen) into estrogen metabolites. DIM generally gives you more "good" estrogen metabolites (2OH and 4OH) than "bad" estrogen metabolites.

However these metabolites that DIM promotes are still estrogenic. What is the benefit? Well, the metabolites are not as estrogenic as estradiol. So the hope is that you reduced your overall estrogenic activity a little bit. Here is where the effects of DIM will vary from person to person.

No reduction in estrogen from DIM can occur because:

1. In some, the increase in estrogenic activity from the increased estrogen metabolites is roughly equal to the reduction of precursors estradiol and estrogen. So DIM didn't do much for this person.

2. DIM requires certain cofactors in the body to work. We don't really know what all these cofactors are. DIM's results can vary from person to person without a clear answer why.

Increase in free testosterone:

Increased estrogen metabolites from DIM can increase free testosterone by knocking them off binding proteins. Generally in someone with more bad metabolites than good, adding DIM will increase good metabolites but will also increase free testosterone. However...

Decrease in free testosterone:

Some people already have high levels of "good" estrogen metabolites, or 2OH and 4OH. Raising these levels further with DIM creates negative feedback on testosterone that outweighs the estrogenic effects of the estradiol and estrone you had before DIM.

Umm...what?

Now, as interesting as this all is, it's not an easy thing for the average person to determine if DIM will have the desired effect.

In my opinion, DIM does not work very well if you are trying to decrease androgenic and estrogenic activity at the same time. If you don't care about a possible rise in androgenic activity (e.g. if you think you mostly have a progesterone/estrogen balance problem, not an androgenic problem), then go for it.

But for those of us who clear primarily on anti-androgens, DIM is a poor choice. Personally, it made me break out while still on 100mg of spiro after a very long time being clear.

We can go on for pages and pages about all the possibilities here, but in the end, you can either spend a lot of time finding a practitioner who gives a shit, and has actually looked at research since they graduated from medical school, and then paying them an arm and a leg to take some tests. And hopefully between the two of you, those results will give you something that can be translated into take this drug -> clear your skin.

Or you can take the cheap way and just try something, and record how you feel and how your skin fares. It's not terribly scientific, but it doesn't cost an arm and a leg, either.

So what...

So if you just want to inhibit estrogenic activity, honestly I would go for an actual aromatase inhibitor, not DIM.

There are over-the-counter compounds that are supposedly aromatase inhibitors, if that's a route you're interested in going.

If you have estrogen dominance, though, it's worth noting that spironolactone is not the way to go either. Estrogen dominance is not going to be solved by taking an anti-androgen with some estrogenic properties. For estrogen dominance you're better off with progesterone supplementation.

Study on "natural" products as aromatase inhibitors

I also want to note that DHT itself inhibits aromatase. But I haven't seen conclusive evidence showing that inhibiting aromatase through other means (drugs, supplements) does the reverse and increases DHT.

Yep. I know of no well informed, competent doc that treats estrogen dominance with aromatase inhibitor or dim as first line treatments.

Progrsterone is always used to treat excessive estrogen in women. If testosterone is contributing to this through excessive aromatase activity and everything else has been tried, then possibly an aromatase inhibitor can be used caution.

This will sound arrogant and condecending, however after a decade or more of studying this material, I truley believe that the vast majority of physicians were not trained in endocrinology, are uninformed on the subject and don't believe it has much relevance in the clinical picture.

Even more frustrating is this phenomena is not limited to the physician. It also extends into the research community. Because of their ignorance they tend to design studies that are baseless (don't consider the full breadth of our understanding) and then end up with an erroneus conclusion. A perfect example of this is a recent study indicating that Omega 3 fatty acids cause prostate cancer. Complete BS.

Hey wishclean, greengables and everyone else commenting on this helpful thread. I have been reading the hormonal forum for a while now, and decided to join so I can ask some questions because wishclean seems to have the same symptoms as me with both androgens and estrogens causing problems.

I have been taking spironolactone for a few months now, and I think it's giving me estrogen dominance symptoms. Before spironolactone, I had actually seen a natureopath who recommended a mixture of saw palmetto, vitex, prickly pear, and some other herbs, but I didn't stick with it long enough to see if it worked and I decided to go with spiro instead. However, my estradiol levels were a bit high (but considered normal range) along with normal androgens on the high end of the scale I guess...I don't remember my progesterone but I think it was low so I think I have the same issues as wishclean and I hope I can get some help here.

Well, now I Have developed some hyperpigmentation, bloating, weight gain, and just a general feeling of discomfort. My skin is a bit better, but I still get breakouts around those crucial times of the month. Is it possible that spiro is giving me estrogen dominance? Do women combine spiro with something else to regulate estrogen? I feel like I'm on birth control all over again...bloated, moody, depressed. please offer me some feedback on what to do.

Would you be interested in posting your lab data?

Spiro is an aldosterone antagonist. In other words it blocks aldosterone and decreases blood pressure. One side effect is it also tends to act as an anti-androgen leading to it's off label use as a treatment for acne.

It's very typical for cross binding to occur between cortisol and aldosterone. This is why they both cause water weight gain and elevated blood pressure as well as some other actions. They two hormones are not exactly the same in action.

Melasma is caused by your body's attempt to increase cortisol production by increasing ACTH.

Hypothesis: spiro is mildly decreasing cortisol.

Possible Mechanism: spiro binding to aldosterone receptors is also cross binding and antagonizing cortisol.

Result: increased ACTH production stimulating melanocytes that cause hyperpigmentation/melasma.

So, what am I saying? It's only an educated guess but spiro may result in melasma in those susceptible.

Yeah, but I don't "look" like I have PCOS. I'm not overweight and my hirsutism is mild enough that it doesn't show under makeup. Also, I usually tend to respond to hormone treatments in ways that the typical woman who takes them doesn't. For instance, I can't clear my acne on just androgen/DHT blockers like androcur, saw palmetto, spearmint tea...those make me bloated and irritable, and I think even taking something like spironolactone would have the same effect if it can be estrogenic. When my doctor combined androcur with diane many years ago, I rapidly gained a lot of weight and was hungry all the time. I think anything that adds estrogen to my body, directly or indirectly, throws me off. I'm trying to see what I would tolerate based on what I tolerated in the past, and the most successful treatment so far for acne was vitex, but it made hirsutism worse. So it seems that I have to choose acne or facial hair in many cases. Idk what a customized treatment would entail, I guess I'll share my lab results on here and the dr's recommendations to see what to make of it. I'm interested in long term solutions, not short term fixes, that's why I find it hard to commit to strong drugs or even strong herbs.

Have you seen this study, especially the section on sex hormones and melasma? There does seem to be a correlation, however inconclusive. Thoughts? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991712/

This is about pregnancy hormones, but can relate also to bcp and other hormonal imbalances:

Elevated levels of estrogen, progesterone and MSH, especially in the third trimester, have been found in association with melasma³⁰. In vitro studies have shown that cultured human melanocytes express estrogen receptors³¹. Estradiol increases the level of melanogenic enzyme especially TRP-2 in normal human melanocytes³². Additional supporting evidences showed increased expression of estrogen receptors in the melasma lesional skin^33,34. It is speculated that melanocytes in melasma patients may be inherently more sensitive to the increased concentration of estrogens and possibly to the other sex hormones

I read the paper. The problem I have with their analysis is that they didn't address cortisol. Look at the very last line of your quote. Even they admit that it's SPECULATED...melasma patients MAY be more sensitive to estrogen.

It looks to me based on everything you've said (which is incomplete, of course) that your problem is:

Unopposed free testosterone. How do you treat that:

Low transdermal estradiol, higher miconized progesterone.

I know you are thinking that sounds crazy because you are estrogen dominant. Here is the way to look at high/low estrogen.

It's either estrogen deficiency; or

Progesterone deficiency.

Think of estrogen dominance as progesterone deficiency. If you have acne the entire month, then what I said is not valid.

The only way to really know what's going on without an exam, history etc is with lab data.

thanks to you all for weighing in! The endocrine system is so complex, and noone can accurately predict how the body will react to a treatment especially long term. I feel that I'm always the guinea pig for doctors (including naturopaths) because I don't tend to fully respond to any treatments. Vitex took care of my estrogen/progesterone ratio, but didn't help with androgens. I had clear skin, though, but signs of high testosterone like high libido and hirsutism. Anyway, it sounds like based on what you are both saying, progesterone cream would be the safest bet at the moment. The dr I'm seeing specializes in bioidentical hormone therapy, but so far the other patients I have seen there are much older than me, and are probably using bio-identical hormones for pre/post menopause. I also get the impression that once I'm on a bio-identical treatment, I would have to stay on it forever, albeit with tweaks to the dosage, correct? I know the ideal is for the body to learn how to stimulate and regulate its own hormone production via bio-identical therapy, but how often is this successful?

I guess I need to get over my trust issues with doctors and see what she has to say when I get my lab work back. I wasn't able to get much information over the phone, but she did say that my vitamin D (another thing I was tested for) is still not where it needs to be, which means that 3 months of D2 supplementation weren't as strong as I wished.

Anyway, I'll be posting my labs when I get them and hopefully figure this out soon bc it's driving me crazy! Last night, I couldn't even fall asleep until 5am from stress. I 'll definitely need to work on my sleeping patterns, like greengables suggested, because that's part of the problem. If only my stressful daily life could be avoided, I would be a more balanced person for sure.

This is my exact situation, though spiro is not controlling my acne and I've taken it for much longer.

Hey wishclean, greengables and everyone else commenting on this helpful thread. I have been reading the hormonal forum for a while now, and decided to join so I can ask some questions because wishclean seems to have the same symptoms as me with both androgens and estrogens causing problems.

I have been taking spironolactone for a few months now, and I think it's giving me estrogen dominance symptoms. Before spironolactone, I had actually seen a natureopath who recommended a mixture of saw palmetto, vitex, prickly pear, and some other herbs, but I didn't stick with it long enough to see if it worked and I decided to go with spiro instead. However, my estradiol levels were a bit high (but considered normal range) along with normal androgens on the high end of the scale I guess...I don't remember my progesterone but I think it was low so I think I have the same issues as wishclean and I hope I can get some help here.

Well, now I Have developed some hyperpigmentation, bloating, weight gain, and just a general feeling of discomfort. My skin is a bit better, but I still get breakouts around those crucial times of the month. Is it possible that spiro is giving me estrogen dominance? Do women combine spiro with something else to regulate estrogen? I feel like I'm on birth control all over again...bloated, moody, depressed. please offer me some feedback on what to do.

Most studies suggest that excess estrogen is not going to cause acne. Stay with me NPC folks, because I agree that NPC can help acne in a lot of cases. Read on.

Estrogen:

- Thins out sebaceous secretions

- Reduces size of sebaceous glands

- Reduces sebaceous activity

- Estrogen increases cell turnover in the basal epidermis (without increasing collagen)

- Upregulates hyaluronidase, which increases skin's ability to retain water

Androgens:

- Increase cell turnover in basal epidermis, but also increase collagen at the same time. Sometimes a good thing, but remember that more collagen = stronger but also coarser "male" skin. The baby soft skin we associate with women is from estrogen and hyaluronidase. A lot of collagen also means thicker skin around the openings of the follicles. Read on to see why that's an issue.

- Increase hair growth

- Without adequate levels of estrogen, your sebum becomes more viscous (thick)

Okay, let's talk about some things that androgens do. They simulataneously increase cell turnover in the basal layer while also producing more sebum. This THICKENS the skin around the opening of a follicle and then also tries to push more sebum through a tighter hole. So you get more blockages = acne.

So, okay, how does someone with estrogen dominance have acne? There isn't a lot of conclusive research on this. But this is what I hypothesize:

- Estrogen dominance from low progesterone means your body is not properly regulating estrogen. So your estrogen is FLUCTUATING as your body fails to control the levels.

- Just the mere fact that your estrogen is fluctuating up and down can cause acne. The body does NOT LIKE extreme hormonal fluctuations. Yes, women cycle, but in the ideal body that cycle is subtle, not invasive.

- Estrogenic effects are slow to manifest in the skin. So you need a constant flow of estrogen to see the softening and brightening effects. If your estrogen is up one minute and down the next, it doesn't have the time to get to your skin. When it swings up, you will bloat and feel tired, but it doesn't make it to your face before it swings down again.

- So, with all the fluctuations, your estrogen is swinging up just enough for you to feel heavy and tired, and swinging down just enough to let androgens (which manifest very quickly in the skin compared to estrogen) cause a pore blockage which develops into acne before your estrogen swings back up.

Personally, I believe progesterone supplementation can work so well simply by keeping estrogen at a more constant level. But that's an important distinction to make...it is typically not the estrogen itself that is causing acne, but the fact that your body cannot maintain a regulated, healthy level of it.

 

 

WishClean,

As you know, I am supplementing NPC, but in another post jlcampi said that it can contribute to acne (I can't find where that was written so I apologize if this is a repeat) but what do you make of this?

Aha! Makes sense, I wish my doctor could explain this as well. She said: well, you could try this, or try that...but didn't seem too confident for anything. Maybe that will change now that she has my lab results,but even she was telling me to reconsider vitex.

Greengables, you think then that I should just stick with inositol for both the progesterone boost and anti-androgenic effect? I took a break for a few days and started again yesterday and my mood already seems to have stabilized. I'm thinking of also adding chiro inositol, since it's supposed to be stronger. My myo-inositol dose is still too low,partly because I haven't figured out a way to divide my dose into 2 during the day on an empty stomach (I'm always snacking on something or forgetting to take it at work). Would NPC be worth adding to inositol, or would it be unnecessary?

I could possibly get a compounding recipe next week for it.

Most studies suggest that excess estrogen is not going to cause acne. Stay with me NPC folks, because I agree that NPC can help acne in a lot of cases. Read on.

Estrogen:

- Thins out sebaceous secretions

- Reduces size of sebaceous glands

- Reduces sebaceous activity

- Estrogen increases cell turnover in the basal epidermis (without increasing collagen)

- Upregulates hyaluronidase, which increases skin's ability to retain water

Androgens:

- Increase cell turnover in basal epidermis, but also increase collagen at the same time. Sometimes a good thing, but remember that more collagen = stronger but also coarser "male" skin. The baby soft skin we associate with women is from estrogen and hyaluronidase. A lot of collagen also means thicker skin around the openings of the follicles. Read on to see why that's an issue.

- Increase hair growth

- Without adequate levels of estrogen, your sebum becomes more viscous (thick)

Okay, let's talk about some things that androgens do. They simulataneously increase cell turnover in the basal layer while also producing more sebum. This THICKENS the skin around the opening of a follicle and then also tries to push more sebum through a tighter hole. So you get more blockages = acne.

So, okay, how does someone with estrogen dominance have acne? There isn't a lot of conclusive research on this. But this is what I hypothesize:

- Estrogen dominance from low progesterone means your body is not properly regulating estrogen. So your estrogen is FLUCTUATING as your body fails to control the levels.

- Just the mere fact that your estrogen is fluctuating up and down can cause acne. The body does NOT LIKE extreme hormonal fluctuations. Yes, women cycle, but in the ideal body that cycle is subtle, not invasive.

- Estrogenic effects are slow to manifest in the skin. So you need a constant flow of estrogen to see the softening and brightening effects. If your estrogen is up one minute and down the next, it doesn't have the time to get to your skin. When it swings up, you will bloat and feel tired, but it doesn't make it to your face before it swings down again.

- So, with all the fluctuations, your estrogen is swinging up just enough for you to feel heavy and tired, and swinging down just enough to let androgens (which manifest very quickly in the skin compared to estrogen) cause a pore blockage which develops into acne before your estrogen swings back up.

Personally, I believe progesterone supplementation can work so well simply by keeping estrogen at a more constant level. But that's an important distinction to make...it is typically not the estrogen itself that is causing acne, but the fact that your body cannot maintain a regulated, healthy level of it.

WishClean, honestly I would do the boring, tedious thing and make a log for the next month. Stay consistent on whatever you are taking (inositol and anything else). Same dosage, same time each day. Then log when you

- Get acne

- Acne continues forming

- Acne disappears

- When you feel bloated, tired, etc.

- When you feel normal

- When you feel too androgenic / pumped with testosterone

If you have the patience for it, I would also log when you get up and when you go to sleep each day.

Sometimes the only way we can make hormonal stuff work is to change our supplementation with our cycle. For example, some doctors cycle spironolactone dosages. But this only works if we start with a good picture of what your body is currently doing. So you really need a log so you can see EXACTLY when your hormones are swinging up and down.

WishClean, honestly I would do the boring, tedious thing and make a log for the next month. Stay consistent on whatever you are taking (inositol and anything else). Same dosage, same time each day. Then log when you

- Get acne

- Acne continues forming

- Acne disappears

- When you feel bloated, tired, etc.

- When you feel normal

- When you feel too androgenic / pumped with testosterone

If you have the patience for it, I would also log when you get up and when you go to sleep each day.

Sometimes the only way we can make hormonal stuff work is to change our supplementation with our cycle. For example, some doctors cycle spironolactone dosages. But this only works if we start with a good picture of what your body is currently doing. So you really need a log so you can see EXACTLY when your hormones are swinging up and down.

Yep, I'll do that. I already keep a food log which is helpful, and I include stomach pains and other feelings after eating.

Mood is very important too, it definitely messes me up when I am under a lot of stress.

You're right about hormonal fluctuations. The blood tests will basically only show me which hormones were making me so "hormonal" that day, so at least I'll know why I was such a mess during my period.

It's true what they say about inositol's calming effect though because I took it yesterday and today, and I feel like a different person. I might order the chiro too for extra boost.

thanks for the feedback! It's giving me a lot to think about.

OHMYGOSH! This does make sense but I'm in a more confused place than ever now! Should I stop NPC? Lower my dose? Wean down? How can I better keep my hormones (estrogen and androgens) in check? I have been getting more and more nodules during my long, heavy period. What do you think this indicates? Would Vitex be better than NPC?

Most studies suggest that excess estrogen is not going to cause acne. Stay with me NPC folks, because I agree that NPC can help acne in a lot of cases. Read on.

Estrogen:

- Thins out sebaceous secretions

- Reduces size of sebaceous glands

- Reduces sebaceous activity

- Estrogen increases cell turnover in the basal epidermis (without increasing collagen)

- Upregulates hyaluronidase, which increases skin's ability to retain water

Androgens:

- Increase cell turnover in basal epidermis, but also increase collagen at the same time. Sometimes a good thing, but remember that more collagen = stronger but also coarser "male" skin. The baby soft skin we associate with women is from estrogen and hyaluronidase. A lot of collagen also means thicker skin around the openings of the follicles. Read on to see why that's an issue.

- Increase hair growth

- Without adequate levels of estrogen, your sebum becomes more viscous (thick)

Okay, let's talk about some things that androgens do. They simulataneously increase cell turnover in the basal layer while also producing more sebum. This THICKENS the skin around the opening of a follicle and then also tries to push more sebum through a tighter hole. So you get more blockages = acne.

So, okay, how does someone with estrogen dominance have acne? There isn't a lot of conclusive research on this. But this is what I hypothesize:

- Estrogen dominance from low progesterone means your body is not properly regulating estrogen. So your estrogen is FLUCTUATING as your body fails to control the levels.

- Just the mere fact that your estrogen is fluctuating up and down can cause acne. The body does NOT LIKE extreme hormonal fluctuations. Yes, women cycle, but in the ideal body that cycle is subtle, not invasive.

- Estrogenic effects are slow to manifest in the skin. So you need a constant flow of estrogen to see the softening and brightening effects. If your estrogen is up one minute and down the next, it doesn't have the time to get to your skin. When it swings up, you will bloat and feel tired, but it doesn't make it to your face before it swings down again.

- So, with all the fluctuations, your estrogen is swinging up just enough for you to feel heavy and tired, and swinging down just enough to let androgens (which manifest very quickly in the skin compared to estrogen) cause a pore blockage which develops into acne before your estrogen swings back up.

Personally, I believe progesterone supplementation can work so well simply by keeping estrogen at a more constant level. But that's an important distinction to make...it is typically not the estrogen itself that is causing acne, but the fact that your body cannot maintain a regulated, healthy level of it.

 

WishClean,

As you know, I am supplementing NPC, but in another post jlcampi said that it can contribute to acne (I can't find where that was written so I apologize if this is a repeat) but what do you make of this?

Progesterone is regulatory and is also a precursor. Precursor means it can contribute to the formation of something else.

Here is the precursor chain:

Progesterone -> aldosterone -> 17-hydroxyprogesterone -> cortisol

Progesterone -> aldosterone -> 17-hydroxyprogesterone -> androstenidone -> testosterone, estrone, and estradiol

So, if you think about, progesterone has the capability to convert into both testosterone and estrogen. If you have a lot of excess progesterone, it may be doing just that, which could wreak havoc on your skin.

It can also convert into cortisol, which can cause some of the symptoms we typically associate with estrogen dominance. If you live a stressful lifestyle and also use progesterone cream, it's possible you're just reinforcing the cortisol pathway and actually making things worse.

Bremnc, are you taking the recommended dose of NPC? And how much spiro along with it?

Do you have any symptoms like weight gain, bloating, anxiety? From what I read, it's very hard to have HIGH progesterone; most young women (you are young, right?) either have regular progesterone levels or, if they have PCOS for example, have low progesterone. Mine is on the lowest range of normal, I think that's why I respond to things like vitex and inositol that boost progesterone.

I also did some reading up on glucosmart, and that helps with acne too due to the DCI. It would seem like you are doing the right things, but you won't know unless you get tested. Not that testing is conclusive, but when I got my blood tests last year at least I knew I had low progesterone, not high, so I felt more confident using NPC. Of course, the best thing would be for everyone to test their hormones every day of their cycle, twice a day, and then receive a chart with how each hormone fluctuates. That costs a lot of $$$ and you'd have to go to a private clinic or online to find that type of detailed hormone testing.

Why don't you start a log like greengables suggested? I will do that too...I have a food diary but the log might help me detect mood patterns when I look back on it.

Okay...Vitex now...let's discuss what this actually does.

The only thing Vitex has been shown to do in clinical trials is:

- Inhibit follicle stimulating hormone (FSH)

- Increase luteinising hormone (LH)

- Reduce acne sometimes

What does this mean in practice?

- Increasing LH generally increases progesterone.

- Increases the length of your luteal phase. The luteal phase is the second half of your menstrual cycle. It starts when you begin ovulating and ends when your period begins. Optimum time to get pregnant, which is why Vitex is often used by women trying to get pregnant.

- Again, increases fertility, because it lowers FSH.

Vitex dosage averages are 900 - 1000mg daily if you're using capsules, 60-90 drops daily if using a tincture.

I should note here that women with PCOS generally have a higher than normal LH/FSH ratio. So taking Vitex would not be recommended for PCOS since all it does is increase the LH/FSH ratio.

Surges in LH sometimes trigger sebaceous gland activity. Some women get worse acne during the luteal phase precisely because of LH. Yet Vitex has also been shown in a handful of studies to reduce acne. Again, this may be a similar mechanism to progesterone cream, where it has a regulating effect on hormones that fluctuate too dramatically, and it's the regulation itself that clears the skin.

There are some hormonal treatments you can combine. However, I would not really recommend combining spiro with NPC, or spiro with vitex, or NPC with vitex.

Spiro is a great tool if it works for you. But because it is multi-faceted (anti-androgen, progestogenic, estrogenic, diuretic, messes with your electrolytes a bit), it is too difficult to predict what will happen when you combine another treatment with spiro. It works okay with SOME birth control pills, but anything else doesn't fare too well.

If spiro has stopped working for you, then either add birth control to the mix, or really you should just quit and move onto something else.

I don't recommend combining NPC with Vitex because frankly it's kind of redundant. If progesterone doesn't work for you, there's a chance that the slightly different mechanism of Vitex may work better. But there's no real point in using them both, and certainly not using spiro + NPC + vitex.

So with the choice of Spiro, NPC, and Vitex, please just pick one. Combining any of these is just going to give you trouble.

So again, we come full circle to basically the idea...that you just gotta try it and see if it does anything for you.

Yeah, that makes sense. I combined vitex with evening primrose both times and it seemed to work faster, but then for some reason I couldn't tolerate EPO or anything oily (like fish oil supplements). If you are trying to guess your imbalance, it's very hard because one of the other hormones like DHEA, FSH, LH, T3/T4 might be the main reason for causing hormonal problems.

I was only taking 25-30 drops of vitex and that worked for me. At times, I even reduced the dose. I had no idea women take such high doses.

Brenmc, glucosmart's d chiro inositol might be all you need because it not only regulates glucose, it can act as an antiandrogen and a progesterone booster. Maybe combining 2 DHT blockers (I think chiro is a DHT blocker...it has anti-androgenic properties but not sure it blocks DHT or something else) was too much? Could it be that your testosterone is LOW compared to your other hormones? I'm just speculating here, I don't mean to throw more questions into the mix, but if you are taking 2 antiandrogens, and they can both stand on their own, that might be a bit redundant.

On the glucosmart forum, they say it's ok to combine the 2, but of course they want to sell their product. This is what they say:

Yes you can take Glucosmart on top of the anti-androgen. Just take them 2 hours apart.

Estrosmart (4 a day) would also be helpful for you as well, especially with the acne. It will also help to remove any harmful estrogen you may be getting from the pill.

You are going have to decide how you want to go about dealing with this. The pill and the anti-androgen will not fix the root problem. If you want to get off of either of these at some point you will have to address the underlying issue. I would take both Estrosmart and Glucosmart for a few months before you adjust anything else.

Brenmc,

I would also add, if you are getting deeper cystic acne than you ever have before, maybe you're not really estrogen dominant and the progesterone is not helping.

It takes months and months for GOOD hormonal changes to finally settle in and manifest in the skin. I was still getting new acne 4-5 months into spironolactone. I already had pretty severe cystic and nodular acne. HOWEVER, even though I was getting new acne, I was not getting cysts that were more massive than I already have. Does that make sense?

Getting more acne for a long while is expected. But if you're getting zits that are bigger and deeper than you ever have before, that may be a bad sign.

As frustrating as this is, I would really recommend gradually weaning completely off both spiro and NPC. Once you are off of them completely, let's re-assess what your skin is doing without the help of any medications, and find a treatment plan that works better for you.

That's true...I noticed I was breaking out less and only during crucial times of my cycle, not continuously so I took that as a good sign.

Brenmc, did you get herpanacine? That's a useful supplement to take and it contains l-lyseine which is good, and dandelion to gently support your liver. I think it's a good quality supplement of some key vitamins and minerals. But if you want to give your liver a complete break, then stop all oral medications & supplements for a few weeks, and then you may be able to just get away with using herpanacine & maybe later add some vitamin D.

The first time I came off vitex it was almost like coming off birth control. I had a relapse, and what I did to clear my skin completely was simply take a whole food multi (solgar earth source, which unfortunately I can't fully stomach it right now) and acai berry supplements for antioxidants. Also, I started taking yoga and fitness classes with a friend, started socializing more, getting regular sunlight and - after an allergic reaction to a toothpaste - switched all products with sulfates to less harsh ones. I didn't even consciously think that these small changes would make a difference but after a few months I was clear and everyone was complimenting me on my skin. I was able to maintain for about 2 years before going back on vitex.

Btw, I ordered d chiro-inositol today. I spoke with their customer service and they emailed me links to some interesting studies that show the benefits of combining myo and chiro. Might help me speed things up and also help my hair. I figured, why not stick with something that my gut tells me it's working? I stopped myo for a few days and I was a hormonal mess during my period (which I wasn't the last 2 months), I had mood swings and anxiety. Today I was calm, productive, and - given that I only got a few hours of sleep last night- very energetic. Plus, my numbness is gone again. So I'm sticking with that and digestive enzymes until I go get my labs.

WishClean, honestly I would do the boring, tedious thing and make a log for the next month. Stay consistent on whatever you are taking (inositol and anything else). Same dosage, same time each day. Then log when you

- Get acne

- Acne continues forming

- Acne disappears

- When you feel bloated, tired, etc.

- When you feel normal

- When you feel too androgenic / pumped with testosterone

If you have the patience for it, I would also log when you get up and when you go to sleep each day.

Sometimes the only way we can make hormonal stuff work is to change our supplementation with our cycle. For example, some doctors cycle spironolactone dosages. But this only works if we start with a good picture of what your body is currently doing. So you really need a log so you can see EXACTLY when your hormones are swinging up and down.

Yep, I'll do that. I already keep a food log which is helpful, and I include stomach pains and other feelings after eating.

Mood is very important too, it definitely messes me up when I am under a lot of stress.

You're right about hormonal fluctuations. The blood tests will basically only show me which hormones were making me so "hormonal" that day, so at least I'll know why I was such a mess during my period.

It's true what they say about inositol's calming effect though because I took it yesterday and today, and I feel like a different person. I might order the chiro too for extra boost.

thanks for the feedback! It's giving me a lot to think about.

Hi Wishclean,

Keep in mind that your hormones fluctuate in approximately the same way each month. You may "feel" hormonal one particular day, however that simply may be nothing more than the drop in progesterone near the end of your cycle. For women that are estrogen dominant/progesterone deficient, we want to understand the peak output of the corpus luteum during the last half of your cycle. This is why it's so important to test on day 21.

I also agree that it a log would be helpful. If you feel up to it, it would also be very helpful to include your cycle day number in the log.

Combine the symptom log with lab data and your food log and I bet you get some feedback from us that you and your doc can chat about.

Hi Wishclean,

Keep in mind that your hormones fluctuate in approximately the same way each month. You may "feel" hormonal one particular day, however that simply may be nothing more than the drop in progesterone near the end of your cycle. For women that are estrogen dominant/progesterone deficient, we want to understand the peak output of the corpus luteum during the last half of your cycle. This is why it's so important to test on day 21.

I also agree that it a log would be helpful. If you feel up to it, it would also be very helpful to include your cycle day number in the log.

Combine the symptom log with lab data and your food log and I bet you get some feedback from us that you and your doc can chat about.

The blood was drawn on day 2 of my cycle... Noone ever told me that day 21 is the best day to get tested. Argh! Will my results be completely useless then? I figured, day 2 of my cycle is right in the midst of my hormonal moods, so maybe the tests may show something. Actually, when the dr's office called to tell me that they have my lab work, they said there is something hormonal and I need to discuss it with the endocrinologist. So it did show something, I just don't know what.

I'm back on myo-inositol now, and will be receiving d chiro-inositol soon. It's the only thing that's helping my hormones so far, and keeps the facial hair under control. Actually, myo worked faster than any other anti-androgen I have taken and I was quite surprised.

brenmc, what dose of spiro got you clear at first and how long did it take?

It's scary to me that I may have to be on a medication forever...I was hoping to do a course of spiro and then be done with it but I guess it's not accutane.

This is my exact situation, though spiro is not controlling my acne and I've taken it for much longer.

Hey wishclean, greengables and everyone else commenting on this helpful thread. I have been reading the hormonal forum for a while now, and decided to join so I can ask some questions because wishclean seems to have the same symptoms as me with both androgens and estrogens causing problems.

I have been taking spironolactone for a few months now, and I think it's giving me estrogen dominance symptoms. Before spironolactone, I had actually seen a natureopath who recommended a mixture of saw palmetto, vitex, prickly pear, and some other herbs, but I didn't stick with it long enough to see if it worked and I decided to go with spiro instead. However, my estradiol levels were a bit high (but considered normal range) along with normal androgens on the high end of the scale I guess...I don't remember my progesterone but I think it was low so I think I have the same issues as wishclean and I hope I can get some help here.

Well, now I Have developed some hyperpigmentation, bloating, weight gain, and just a general feeling of discomfort. My skin is a bit better, but I still get breakouts around those crucial times of the month. Is it possible that spiro is giving me estrogen dominance? Do women combine spiro with something else to regulate estrogen? I feel like I'm on birth control all over again...bloated, moody, depressed. please offer me some feedback on what to do.

GreenGables,

What do you then suggest if someone's acne is a result of both androgens and estrogen?

>

Note that DIM is NOT an aromatase inhibitor, i.e. it does not inhibit the CYP19 enzyme.

DIM upregulates CYP1A1, CYP1A2 and CYP1B1 enzymes. This increases the speed at which you clear active estrogen from the body, or in other words converts estrone and estradiol (two types of estrogen) into estrogen metabolites. DIM generally gives you more "good" estrogen metabolites (2OH and 4OH) than "bad" estrogen metabolites.

However these metabolites that DIM promotes are still estrogenic. What is the benefit? Well, the metabolites are not as estrogenic as estradiol. So the hope is that you reduced your overall estrogenic activity a little bit. Here is where the effects of DIM will vary from person to person.

No reduction in estrogen from DIM can occur because:

1. In some, the increase in estrogenic activity from the increased estrogen metabolites is roughly equal to the reduction of precursors estradiol and estrogen. So DIM didn't do much for this person.

2. DIM requires certain cofactors in the body to work. We don't really know what all these cofactors are. DIM's results can vary from person to person without a clear answer why.

Increase in free testosterone:

Increased estrogen metabolites from DIM can increase free testosterone by knocking them off binding proteins. Generally in someone with more bad metabolites than good, adding DIM will increase good metabolites but will also increase free testosterone. However...

Decrease in free testosterone:

Some people already have high levels of "good" estrogen metabolites, or 2OH and 4OH. Raising these levels further with DIM creates negative feedback on testosterone that outweighs the estrogenic effects of the estradiol and estrone you had before DIM.

Umm...what?

Now, as interesting as this all is, it's not an easy thing for the average person to determine if DIM will have the desired effect.

In my opinion, DIM does not work very well if you are trying to decrease androgenic and estrogenic activity at the same time. If you don't care about a possible rise in androgenic activity (e.g. if you think you mostly have a progesterone/estrogen balance problem, not an androgenic problem), then go for it.

But for those of us who clear primarily on anti-androgens, DIM is a poor choice. Personally, it made me break out while still on 100mg of spiro after a very long time being clear.

We can go on for pages and pages about all the possibilities here, but in the end, you can either spend a lot of time finding a practitioner who gives a shit, and has actually looked at research since they graduated from medical school, and then paying them an arm and a leg to take some tests. And hopefully between the two of you, those results will give you something that can be translated into take this drug -> clear your skin.

Or you can take the cheap way and just try something, and record how you feel and how your skin fares. It's not terribly scientific, but it doesn't cost an arm and a leg, either.

 

So what...

So if you just want to inhibit estrogenic activity, honestly I would go for an actual aromatase inhibitor, not DIM.

There are over-the-counter compounds that are supposedly aromatase inhibitors, if that's a route you're interested in going.

If you have estrogen dominance, though, it's worth noting that spironolactone is not the way to go either. Estrogen dominance is not going to be solved by taking an anti-androgen with some estrogenic properties. For estrogen dominance you're better off with progesterone supplementation.

Study on "natural" products as aromatase inhibitors

 

 

I also want to note that DHT itself inhibits aromatase. But I haven't seen conclusive evidence showing that inhibiting aromatase through other means (drugs, supplements) does the reverse and increases DHT.

WishClean,

In hearing, through this forum, that estrogen dominance is not a major cause of acne, rather it's important to keep hormone levels stable, I wonder if vitex would do a better job than NPC? Absorbed better, more consistent? I'm just considering it as something to look into. Vitamins still on the way.

SoftFocus,

I took 100mg-150mg. It took me less than a month to get clear but some people take much longer. I'm still taking 100mg but am not clear anymore, so I'm reviewing my treatment options.

WishClean,

In hearing, through this forum, that estrogen dominance is not a major cause of acne, rather it's important to keep hormone levels stable, I wonder if vitex would do a better job than NPC? Absorbed better, more consistent? I'm just considering it as something to look into. Vitamins still on the way.

SoftFocus,

I took 100mg-150mg. It took me less than a month to get clear but some people take much longer. I'm still taking 100mg but am not clear anymore, so I'm reviewing my treatment options.

I don't think estrogen dominance is discussed enough on this forum, I think that's why...but if you widen your research you can read more about it on various sites. In my case, vitex cleared my skin by balancing my estrogen:progesterone ratio. It didn't do much for my androgens,that's why I experienced an increase in body hair and hair loss on my head. Some women experience a decrease in hirsutism from vitex, though, so I guess everyone reacts differently. But what this showed for me was that I can have clear skin AND symptoms of high testosterone, so I figured that estrogen and progesterone played a part in my acne, maybe an even bigger part than testosterone. The second time on vitex, though, I didn't have the same success as the first time. I remember having allergies to various things like dust and humidity, runny nose, etc...so maybe my immune system wasn't coping well with taking vitex plus other supplements I had taken before. It did clear me consistently, but I still had the occasional flare up here and there....I would also get flare ups whenever I ate too much sugar or if I washed my face with harsh water, so it didn't make me "immune" to other triggers.

If you go with vitex, try to find it in liquid form so that it's easier on your liver. I think your liver might need a break from drugs and supplements..the tincture is much easier. I was taking under 30 drops. I read somewhere that the dose can be adjusted according to your cycle - maybe that would have helped me even more. I was taking the same dose every day. I'm thinking that perhaps the dose needs to be lowered during the days progesterone peaks.