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Dear Pharmacist,

I am debating whether or not to fill the prescription for Estradiol, and I want more information on this drug and estrogen in general. I need it for hot flashes.

--M.G., San Diego, California

Answer:Estrogen is a highly misunderstood hormone that both men and women have. Some men don't even realize they have estrogen, likewise, women have testosterone, the "manly" hormone. It's the amount of each that helps shape us.

When the word "estrogen" is used, it's really defining three different hormones, estrone, estradiol and estriol. Estrone or "E1" as we call it, is the predominant estrogen post-menopausally. It's important because there's a strong correlation between healthy levels of estrone and your bone health, as well as proper insulin and BMI (body mass index) values which translate to diabetes risk.

Estradiol or "E2" is the most potent estrogen, and it's what you have most of before menopause hits. Estradiol in a drug version as you have been prescribed is considered bio-identical (because we make estradiol), but if it's a prescription cream or tablet, the dosage is much higher than what you need physiologically. It may help reduce hot flashes but I worry about long-term use (unless you test your levels). Now, contrast that with estradiol that is sometimes put into compounded bio-identical creams, they are using a fraction of the prescription dose, and it's customized based upon your lab work. Keep in mind, the higher your serum estradiol, the greater the risk of certain cancers. Estradiol, in normal physiological amounts, assists the body in many good ways, it's not to be feared, it's to be respected and dosed only according to your needs. With a prescription dose, I fear it may be too much if taken daily for more than a few weeks or months.

Estriol or "E3" as we call it in the literature is actually derived from the other two estrogens. It's the least potent of all three estrogens, and considered the safest.

Estrogen levels that are erratic or low, can cause menopausal symptoms like hot flashes, vaginal dryness, urinary leakage (incontinence), chronic anxiety, and increased risk of cardiovascular disease. Low estrogen in a man can result in some bone loss, high insulin, elevated blood sugars and abnormal cholesterol ratios. They don't get the hot flashes!

What about high estrogen? Termed "estrogen dominance" or "progesterone deficiency" it could cause heavy, painful periods (bad PMS), uterine fibroids, endometriosis, fibrocystic breasts, higher risk of breast cancer, and increased TH1 immune activity which increases risk of autoimmune disorders like Hashimoto's or Lupus.

In men, high estrogen tilts the hormone see-saw such that testosterone (T) goes down and estrogen goes up! Darn because that may cause low sex drive, erectile dysfunction, shrinking muscles, increased fat tissue (remember, estrogen causes weight gain), a disappearing 6 pack in trade for a 'beer belly,' enlarged prostate, diabetes and higher risk of cancer. For an expanded version of column, sign up for my free newsletter at

Suzy Cohen

Suzy Cohen, is known as America’s Pharmacist. She has been a licensed pharmacist for 24 years and is a Functional Medicine practitioner. She’s the author of 6 books, including her most recent Amazon #1 best-seller, “Thyroid Healthy: Lose Weight, Look Beautiful and Live the Life You Imagine.”

She was the host of The Thyroid Summit which broadcast worldwide in June 2014. Suzy has been a syndicated columnist for 19 years reaching 20 million in circulation each week. She is a Huffington Post writer, and also hosts her own syndicated medical minute on TV. Suzy has been featured on The Dr OZ Show 6 times, and has appeared on The View, Good Morning America Health, The Doctors and hundreds of other networks. She is a member of The Institute of Functional Medicine, also the American Academy of Anti-Aging Medicine, The American Pharmacists Association and ILADS, the International Lyme and Associated Diseases Society. You can read free articles and receive your free newsletter by visiting her website,

Books authored by Suzy Cohen include:

  • Thyroid Healthy
  • Headache Free
  • Drug Muggers
  • Diabetes Without Drugs
  • The 24-Hour Pharmacist
  • Eczema: Itchin’ for a Cure (kindle only)
  • Understanding Pancreatitis & Pancreatic Cancer (kindle only)