Estrogen, Total

What is Estrogen?

Estrogens are a group of steroids that play a major role in the development and normal functioning of the reproductive systems and secondary sex traits in women. Estrogens have many additional functions like regulating menstrual cycles, growing women’s breasts and uterus as well as keeping pregnancies healthy. They are found in both men and women and help maintaining a proper bone metabolism and growth. There are three main estrogens: Estrone (E1), Estradiol (E2), and Estriol (E3).

E1 is formed either by being converted from androstenedione or from androgens. It can also be formed in the ovaries, testicles, and fat tissues. Pregnant women produce E1 in their placenta. It is also the major estrogen in men and women undergoing post-menopause. Estrone can have the same functions as estradiol; but it is a weak hormone that is rarely used as a supplement.

E2 is a potent hormone that is formed in women’s ovaries with the help of the FSH and LH hormone, and men’s testicles. E2 and E1 can be converted into each other, depending on the body’s need. Estradiol is an effective hormone that tames down hot flashes, genitourinary symptoms, osteoporosis prophylaxis. It helps promote psychological wellbeing and protects against coronary artery disease.

E3 is mainly found in the placenta of pregnant women and its levels keep increasing through pregnancy. As long as its levels keep growing, the baby and pregnancy are healthy. Women in their second trimester test for this hormone to identify risks of some chromosomal abnormalities. Women who are not pregnant have very low levels of E3. Estriol is considered to be the weakest hormone of them three, which explains its protective properties against the production of cancer cells. However, studies are showing this hormone to be the most effective for vaginal, cervical and vulvar health. When a woman experiences vaginal dryness and atrophy, leading to vaginitis and cystitis, topical estriol is the most effective and safe treatment.

Why take the estrogen test?

The total estrogen lab test is a great tool to measure and monitor estrogen levels and distinguish any abnormal levels and imbalances. It is the perfect way to identify if a woman has deficiency or excess of one of the hormones and what could be causing it. The total estrogen test is also used to monitor the effectiveness of infertility treatment by determining the right timing of ovulation and the signs of menopause. Estrogens are also used to test the fetal-placental health at the beginning of the pregnancy.

Men can also benefit from this test. It can help them determine if they have any excess in a hormone and its possible cause. For both men and young boys, both estradiol and estrogen tests are essential to help diagnose delayed puberty and the cause of enlarged breasts and other feminization signs. This test can also help detect an estrogen excess that is caused by a deficiency in testosterone and androgen, and estrogen-producing tumors.

For women, E3 testing is essential to help monitor a high-risk pregnancy. In that case, the test has to be done everyday at the same time. This estriol test is highly recommended in the second trimester to identify any potential risks on the fetus. Low levels of this hormone have been associated with genetic disorders such as down syndrome, neural tube defects common and renal abnormalities.

E2 and E1 tests are ordered in girls and women to help identify an early or a late onset of puberty. This is when a girl develops secondary sex characteristics and start her menstruation. This test is also used to investigate menstrual abnormalities like their absence, infertility and abnormal vaginal bleeding. From another angle, it helps evaluate the proper functioning of the ovaries and detect any possible ovarian failure. You need to take this test to monitor anti-estrogen therapy (like in the case of breast cancer); hormone replacement therapy, which is given for infertility; and menopausal hormone replacement therapy, to alleviate signs and symptoms.

If you have signs of low estrogen levels, you need to get tested. These include feeling pain during sexual intercourse caused by low natural vaginal lubrication; being more prone to urinary track infections that would be caused by thinning of the urethra; having hot flashes and mood swings, feeling headaches and accentuated pre existing migraines; feeling tired and having trouble concentrating; having tender breasts and finally feeling depressed. Low estrogen levels can also lead to more breakable bones, which might lead to a decrease in bone density. Strong bones are normally maintained by collaborative efforts between estrogen, calcium, vitamin D and minerals.

What causes levels of total estrogens to rise?

While eating and drinking before taking the test may not have any impact on your estrogen levels, some medications might. Medications and supplements like birth control pills, and hormone therapies can alter your levels of estrogen at the time of the test. Your food choices have a saying in your estrogen levels. A study, done in collaboration between Honolulu and Los Angeles, showed that lower serum estrogen levels may be significant in those who were following semi-vegetarian diets.

On the other hand, illnesses like high blood pressure, anemia, and impaired liver and kidney functions may impact your test results.

What your Estrogen total test results mean?

The total estrogen test measures the levels of three hormones: E1, E2 and E3. Individually tested, levels are dependent on tanner stages. These are the measure of development for children.

Tanner stages occur at different ages for boys and girls. Stage 1 happens where first signs of puberty start appearing. It occurs at the age of 7.1 years for girls and boys. Stage 2 if when hormones begin to send signals and physical development starts. It occurs at the age of 10.5 years for girls and 11.5 years for boys. Stage 3 is when physical changes become more obvious. It occurs at the age of 11.6 years for girls and 13.6 years for boys. At this stage, girls start having breast buds, and hair starts growing in the pubic area and under the armpits. This stage also marks the beginning of acne on the face and back and the buildup of fat on the hips and thighs in girls. For boys, the third tanner stage is when the penis gets longer and testicles grow bigger, muscles get larger, and the voice starts changing. Stage 4 is when puberty has run its course: girls have fuller breasts, get their first period and get thicker pubic hair, while boys starts growing armpit hair and continue to grow sexually. It occurs at the age of 12.3 years for girls and 15.1 for boys. Stage 5 is when your child is fully mature, physically. It happens at the age of 14.5 years for girls and 18 years for boys and marks the full sexual maturation for both genders.

For estrone (E1), interpreting results is based on the age and gender of the person being tested. Children have very high levels of this hormone at birth from day 1 and for a period of two weeks, after which levels fall significantly.

For boys and men, these are the normal E1 values, per tanner stage:

• Stage I: normal values are either undetectable or within the range of 0 to 16 pg/mL.
• Stage II: normal values either undetectable or within the range of 0 to 22 pg/mL.
• Stage III: normal values are between 10 and 25 pg/mL.
• Stage IV: normal values have to be between 10 and 46 pg/mL.
• Stage V: normal values have to be between 10 and 60 pg/mL.

For girls and women, normal estrone levels need to be as follows:

• Stage I: normal values are either undetectable or within the range of 0 to 29 pg/mL.
• Stage II: normal values are between 10 and 33 pg/mL.
• Stage III: normal values are between 15 and 43 pg/mL.
• Stage IV: normal values have to be between 16 and 77 pg/mL.
• Stage V: normal values have to be between 17 and 200 pg/mL.

For adult men, normal values are between 10 and 60 pg/mL. For adult women, levels depend on menopause. Premenopausal levels are between 17 and 200 pg/mL while postmenopausal levels are between 7 and 40 pg/mL.

For estradiol (E2), levels are high at birth and fall down to puberty levels two weeks after birth. For boys and girls, these are the normal reference ranges.

For boys and men, these are the normal E2 values, per tanner stage:

• Stage I: normal values are either undetectable or within the range of 0 to 13 pg/mL.
• Stage II: normal values either undetectable or within the range of 0 to 16 pg/mL.
• Stage III: normal values are either undetectable or within the range of 0 to 26 pg/mL.
• Stage IV: normal values are either undetectable or within the range of 0 to 38 pg/mL.
• Stage V: normal values have to be between 10 and 40 pg/mL.

For girls and women, normal estradiol levels need to be as follows:

• Stage I: normal values are either undetectable or within the range of 0 to 20 pg/mL.
• Stage II: normal values are either undetectable or within the range of 0 to 24 pg/mL.
• Stage III: normal values are either undetectable or within the range of 0 to 60 pg/mL.
• Stage IV: normal values have to be between 15 and 85 pg/mL.
• Stage V: normal values have to be between 17 and 350 pg/mL.

For adult men, normal values are between 10 and 40 pg/mL. For adult women, levels depend on menopause. Premenopausal levels are between 15 and 350 pg/mL while postmenopausal levels are less than 10 pg/mL.

For estriol (E3), normal values differ according to the pregnancy stage. During the first trimester, this hormone’s normal levels need to be less than 38 ng/mL. During the second trimester, its values have to be between 38 and 140 ng/mL. Finally, during the third trimester, values are expected to be between 31 and 460 ng/mL.

When it comes to total estrogen levels, normal values differ according to the woman’s cycle. During puberty, levels need to be less than 40 ng/mL. Within a woman’s cycle, normal values are different:

• 1 to 10 days, levels have to be between 61 and 394 ng/mL
• 11-20 days, levels need to be between 122 and 437 ng/mL
• 21-30 days, levels need to be between 156 and 350 ng/mL
• Post-menopausal women have normal ranges less than 40 ng/mL

If women’s estrogen levels are lower than the normal values; then, it can indicate many conditions such as Turner syndrome, hypopituitarism, hypogonadism, failing pregnancy (if low levels of estriol), eating disorders like anorexia nervosa, the beginning of the post menopause, polycystic ovary syndrome and extreme endurance while working out.

When estrogen levels are higher than the normal values, they may indicate many malfunctions. For both men and women, elevated levels may be caused by hyperthyroidism or liver cirrhosis. For boys and men, they could be the cause for enlarged breasts, testicular cancer and delayed puberty. For girls and women, high estrogen levels are linked to precocious puberty and tumors of the ovaries or adrenal glands. To effectively diagnose a specific condition, the health care giver would need to look at hormonal trends as values can be different for every day.

Low levels of estrogen are normally treated by deciding on a hormonal therapy. Some benefit from estrogen therapy that can prevent some effects of low estrogen levels, such as bone loss, cardiovascular illnesses and hormonal imbalances. Doses of this hormone are given orally, topically, vaginally or via ingestion. Women undergoing menopause, or those who have had hysterectomy are recommended to be on long-term estrogen therapy. Hormone replacement therapy is another way to regulate estrogen levels. Despite the benefits that HRT offers women close to their menopause, this treatment can increase the risks of developing cardiovascular disease, having a stroke or developing breast cancer.

What are environmental estrogens and phytoestrogens? Are they the same as serum estrogen?

It may be confusing when you come across words like environmental estrogens and phytoestrogens. Are these hormones? Are they factors affecting our serum estrogen levels? So, here is a small explanation about these two terms.

Phytoestrogens are compounds that are derived from plants and found and numerous food item, such as soy. Their health benefits are numerous and include lowering the risk of osteoporosis, minimizing the risks for heart disease and breast cancer, as well as alleviating menopausal symptoms. What is special about these phytoestrogens is said they are considered to be endocrine disrupters: they have adverse health effects on some of your glands. These phytoestrogens have been adopted as dietary supplements and natural replacement to estrogen replacement therapy. Their mode action is binding to estrogen receptor, instead of estrogen hormones produced in our body, causing numerous side effects. These include disrupted lactation and fertility, as well as untimed puberty. Environmental estrogen, on the other hand, is a term used for both natural and synthetic substances found in the environment that can have the same effect as estrogen when absorbed by the body. Chemical estrogens are also referred to as xenoestrogen s. There are more than seventy thousand registered chemicals in the United States that can lead to estrogen dominance and cause toxic effects. These include BPA, Bisphenol A, pesticides, herbicides, fungicides, plastic containers, parabens, and gases derived from copiers and printers, among many others.

Both groups can mimic the effect of estrogen and cause health-related disruptions such as infertility, thickening of the endometrial lining, the premature development of breasts as well as feminization of young males.

Where can I get an estrogen test near me?

Please use our Lab Locator to find find a convenient estrogen testing location.

Reviewed By: Dr. Kurt Kloss, MD
Last Reviewed Date: Mar 12, 2020