Estrogen use and its side effects from an East Asian medicine perspective

Estrogen is a complex hormone with myriad effects on many systems throughout the body. Over centuries of medical research characterized by sexism, it has been cast as a hormone that governs cycles solely in the bodies of cisgender women, and also as a chemical that is “less strong” than testosterone. These beliefs are not accurate appraisals of human physiology, however. Estrogen has diverse effects throughout all kinds of bodies, many of which are vital to the health and wellbeing of everyone.

It is true that estrogen creates feminine secondary sex characteristics, IE breast growth, pubic and armpit hair growth, and hip widening. Estrogen regulates menstruation in people with uteruses, along with progesterone. It regulates breast milk production in people who are nursing babies. It is also vital to the clotting process, which is initiated when a person is injured and bleeding, as well as to the cycle bone formation , repair and growth. Estrogen strengthens the lining of vaginal and uterine walls, and also the walls of people’s urethras.

I want to stress the universal nature of estrogen’s power because, in the context of hormonal transition, pernicious narratives about estrogen’s “weakness” play a particularly intense role in the framing of transition as a medical process.

The mythology goes like this: the effects of estrogen are “easy to erase”, which the effects of testosterone are more “resilient”. These ideas happen to neatly dovetail with prevailing sexist notions that femininity is “weak” and masculinity is “strong”, and the projection of these ideas onto the biochemical processes that people feel correlate with gender expression is pretty transparent, and leaves a lot to be desired on a scientific level. For example, the fact that beard growth is difficult and painful to reverse through electrolysis is often put forward as proof of testosterone’s superior “staying power”, but no one ever raises the fact that the widened hips brought about by estrogenic puberty are impossible to erase.

All of this is to say that, when considering how to think about the effects and side effects of estrogen in Chinese Medicine, there is a lot that needs to be unpacked before we can ever begin.

There is a parallel retrograde school of thought within some corners of Chinese Medical thinking, wherein testosterone is yang and therefore “good” and estrogen is yin and “bad”. Men are more yang, and therefore virile and stalwart, while women are more yin, and must be protected because they are fragile and retiring. Similar sexist imperatives have been at work in China over the last many hundreds of years as in the west, and it shows. This view, however, is also a willful misrepresentation of science, within our medical framework, and must be similarly challenged.

Yin and yang can be seen as concepts of duality. In the world of philosophy and metaphysics, they are often positioned as light and dark, good and evil, sun and moon, etc. This is all well and good, and the philosophical roots of Chinese Medical theory should be kept in mind, but we need to also remember that there is no good and evil in human physiology. The human body is a finely balanced organism that constantly keeps all factors within a tight range of homeostasis to avoid death. We can characterize disease as evil, perhaps, but parts of human physiology not so much.

A more defensible definition of yin, in physiological terms, is that which is physical, and also fluid.

Yin builds the bones, the blood, and regulates the spaces in the body where new human beings are grown. Yin produces the fluids in the body that moisten and protect, while yang causes things to move and expand. The complementary nature of two becomes clear when framed in this light. A person with only yang in their body would soon dry up and become a fiery, desiccated husk. Similarly, a person who was solely yin would overflow and spill out into the world with no perceptible boundary, much like the “Blob” of the 1950’s horror movie. Of course neither of these extremes exist in nature, but we can see the symptoms of imbalance in this light.

Here are some potential side effects of too-high estrogen levels: fatigue, depression, loss of sex drive, weight gain, abdominal pain, cold hands and feet, breast tenderness, insomnia, and anxiety. For the most part, they fall mainly into the Chinese Medical categories of yin accumulation and blood stagnation. We must remember that too much yin also inherently means too little yang, because they are relational concepts. So if a person is producing more fluids or blood than their body can move properly, they will settle around the body and cause problems. The body will work harder to move them, and if it still cannot summon the yang needed to do so, heat will be produced in the effort, which leads to heat symptoms like insomnia and anxiety.

It must be said that these are symptoms of internal imbalance, not inevitable effects.

Often lowering estrogen dose, adding progesterone, or supplementing very small doses of testosterone will resolve them. However this is not always possible, as some of these effects are the result of an internal imbalance that preceded hormone therapy, and is being worsened by it. This imbalance would need to be treated either way, and the effects of hormone supplementation are simply revealing it.

Chinese medicine has been used for thousands of years to regulate hormones, particularly estrogen.

The use of acupuncture and herbal medicines for key hormonal experiences like pregnancy, menopause and andropause far predates the practice of hormone prescribing. The two together can be even more powerful, as the blunt power of the hormones can be directed more precisely by the subtlety of acupuncture and herbs.

One excellent formula to consider is the formula “Wen Jing Tang” or “flow-warming decoction”. It pairs herbs that warm and transform fluids, such as ginger and pinellia, with herbs that supplement and move blood like Angelica and Chinese lovage root. The picture of this formula is a person who is quite depressed, with cold and hands and feet, nausea, abdominal pain, menstrual irregularity and/or infertility. Menstruation is not a required feature however, but an expression of blood stagnation and cold in the lower abdomen, which cause the other symptoms as well. Along with warming and clearing acupuncture techniques, this formula will resolve the above symptoms within a few weeks.

Estrogen, like all things in the human body, is powerful and vital in the correct balance. Any person with a hormonal imbalance can experience unpleasant effects as a result, and Chinese Medicine can be an important tool in righting the ship. As medical providers, acupuncturists and Chinese herbalists are bound by the same medical ethics as any other profession: to see our patients and their suffering clearly, and treat accordingly.

This article describes some possible ways that estrogen imbalance could look or feel, but there are many possibilities. If you want to start feeling better now, come on in for a new patient visit!

Here are some articles that I used in researching this piece:

  • Bienfield, Harriet , and Efram Korngold . “Menopause, Hormones and Chinese Medicine.” Acupuncture.Com – Menopause, Hormones and Chinese Medicine – February 2009, www.acupuncture.com/newsletters/m_feb09/menopause%20chinese%20medicine.htm. Accessed 26 Sept. 2017.
  • Blakeway, Jill, Ms LAc. Addressing Estrogen Dominance in Perimenopausal Women Using TCM.” Pacific College, 14 Sept. 2016, www.pacificcollege.edu/news/blog/2016/01/14/addressing-estrogen-dominance-perimenopausal-women-using-tcm. Accessed 26 Sept. 2017.
  • Bradford, Alina. “What Is Estrogen?” LiveScience, Purch, 2 May 2017, www.livescience.com/38324-what-is-estrogen.html. Accessed 26 Sept. 2017.
  • Weizenbaum, Sharon. “Wen Jing Tang according to Huang Huang” http://www.pdxacustudio.com/wp-content/uploads/2015/10/Wen-Jing-Tang-.pdf. Accessed 26 Sep. 2017.

Written by Rowan Everard


I discovered Chinese medicine shortly after moving to Portland to complete my undergraduate studies. I began my journey as a patient, but after several years of being an increasingly curious patient I found myself drawn into the formal study of this medicine. In Chinese medicine, I found tools that helped me to transform myself, and which I have seen lead to dramatic positive shifts in patients.