The orexigenic effect of melanin-concentrating hormone (MCH) is influenced by sex and stage of the estrous cycle

Recently, it was shown that the orexigenic effect of melanin-concentrating hormone (MCH) is attenuated by estradiol treatment in ovariectomized (OVX) rats. This suggests that female rats may be less responsive than male rats to the behavioral effects of MCH. To investigate this hypothesis, the effects of lateral ventricular infusions of MCH on food intake, water intake, meal patterns, and running wheel activity were examined in male and female rats. To further characterize the impact of estradiol on MCH-induced food intake, female rats were OVX and tested with and without 17-beta-estradiol benzoate (EB) replacement. In support of our hypothesis, food and water intakes following MCH treatment were greater in male rats, relative to female rats. Specifically, the orexigenic effect of MCH was maximal in male rats and minimal in EB-treated OVX rats. In both sexes, the orexigenic effect of MCH was mediated by a selective increase in meal size, which was attenuated in EB-treated OVX rats. MCH-induced a short-term (2 h) decrease in wheel running that, unlike its effects on ingestive behavior, was similar in males and females. Thus, estradiol decreases some, but not all, of the behavioral effects of MCH. To examine the influence of endogenous estradiol, food intake was monitored following MCH treatment in ovarian-intact, cycling rats. As predicted by our findings in OVX rats, the orexigenic effect of MCH was attenuated in estrous rats, relative to diestrous rats. We conclude that the female rat's reduced sensitivity to the orexigenic effect of MCH may contribute to sex- and estrous cycle-related differences in food intake.     

Cyclic estradiol treatment normalizes body weight and test meal size in ovariectomized rats.

We tested whether cyclic estradiol treatment, like continuous estradiol treatment, is sufficient to normalize meal size and body weight in ovariectomized rats. In Experiment 1, adult Long-Evans rats were ovariectomized and subcutaneously injected with 0, 0.2, or 2.0 microg estradiol benzoate (EB) in sesame oil each Tuesday and Wednesday. Oil-treated ovariectomized rats gained more weight during 4 weeks of ad lib feeding (48 +/- 5 g) than intact rats (16 +/- 1 g, p < 0.01). Cyclic treatment with 2.0 microg EB normalized weight gain (11 +/- 2 g). During the next week, plasma samples were assayed for estradiol. Cyclic treatment with 2.0 microg EB produced excursions of plasma estradiol that appeared similar to those of intact, cycling rats: estradiol level reached 190 +/- 60 pmol/L after the second EB injection before decreasing to undetectable levels (<30 pmol/L) by cycle end. In Experiment 2, test meal sizes after overnight food deprivation were measured. Cyclic treatment with 2.0 microg EB produced both tonic (i.e., at cycle onset, meal size was smaller in estradiol-treated than oil-treated rats) and phasic (i.e., meal size was smaller late in the EB-treatment cycle than early in it) decreases in meal size. Thus, a weekly cyclic regimen of estradiol treatment that produces changes in plasma estradiol concentration similar to those in intact cycling rats is sufficient to produce the body weight and meal size patterns that characterize normal hypothalamic-pituitary-gonadal function.     

Estradiol increases the anorexia associated with increased 5-HT(2C) receptor activation in ovariectomized rats

Estradiol's inhibitory effect on food intake is mediated, in part, by its ability to increase the activity of meal-related signals, including serotonin (5-HT), which hastens satiation. The important role that postsynaptic 5-HT(2C) receptors play in mediating 5-HT's anorexigenic effect prompted us to investigate whether a regimen of acute estradiol treatment increases the anorexia associated with increased 5-HT(2C) receptor activation in ovariectomized (OVX) rats. We demonstrated that intraperitoneal and intracerebroventricular (i.c.v.) administration of low doses of the 5-HT(2C) receptor agonist meta-chlorophenylpiperazine (mCPP) decreased 1-h dark-phase food intake in estradiol-treated, but not oil-treated, OVX rats. During a longer feeding test, we demonstrated that i.c.v. administration of mCPP decreased 22-h food intake in oil-treated and, to a greater extent, estradiol-treated OVX rats. In a second study, we demonstrated that estradiol increased 5-HT(2C) receptor protein content in the caudal brainstem, but not hypothalamus, of OVX rats. We conclude that a physiologically-relevant regimen of acute estradiol treatment increases sensitivity to mCPP's anorexigenic effect. Our demonstration that this same regimen of estradiol treatment increases 5-HT(2C) receptor protein content in the caudal hindbrain of OVX rats provides a possible mechanism to explain our behavioral findings.     

Differential effects of estradiol on drinking by ovariectomized rats in response to hypertonic NaCl or isoproterenol: Implications for hyper- vs. hypo-osmotic stimuli for water intake

We examined the effects of estradiol on behavioral responses to osmotic challenges in ovariectomized (OVX) rats to test the hypothesis that estradiol enhances sensitivity to gradual changes in plasma osmolality (pOsm) in stimulating water intake. Despite comparably elevated pOsm after a slow infusion of 2 M NaCl, the latency to begin water intake was significantly less in estradiol-treated OVX rats compared to that in oil vehicle-treated rats. Other groups of OVX rats were injected with isoproterenol, which increases circulating angiotensin II. These rats then were given 0.15 M NaCl to drink instead of water, to prevent decreased pOsm associated with water ingestion. Isoproterenol stimulated 0.15 M NaCl intake by both groups; however, estradiol-treated rats consumed less 0.15 M NaCl than did oil-treated rats, findings that are similar to those reported when estradiol-treated rats consumed water. The estradiol enhancement of sensitivity to increased, but not to decreased, pOsm suggests that estradiol has directionally-specific effects on osmoregulatory drinking. Moreover, the estradiol attenuation of 0.15 M NaCl intake after isoproterenol suggests that estradiol effects on osmoregulatory drinking are independent of those on volume regulatory drinking.     

Estradiol-mediated increases in the anorexia induced by intraperitoneal injection of bacterial lipopolysaccharide in female rats

Lipopolysaccharide (LPS) derived from the cell walls of gram-negative bacteria causes a robust acute phase response (APR) that includes fever, anorexia, and many other elements. Because immune system function, including some models of illness anorexia, is sexually differentiated, we investigated the sexual differentiation of the anorexia induced by intraperitoneal LPS injections in rats. Cycling female Long-Evans rats tested either during diestrus or estrus ate less following 6.25 microg/kg LPS than did intact males. Following 12.5 microg/kg LPS, females in estrus ate less than either females during diestrus or males. Similarly, a more pronounced anorexia occurred following 12.5, 25, and 50 microg/kg LPS in ovariectomized females that received cyclic estradiol treatment and were tested on the day modeling estrus than in untreated ovariectomized rats. LPS also increased the length of the rats' ovarian cycles, usually by a day, especially when injected during diestrus. As in male rats, when LPS injections were repeated in the same rats, both estradiol-treated and untreated rats failed to display any significant anorexia. The inhibitory effects of LPS on eating in intact and ovariectomized rats were expressed solely as decreases in spontaneous meal frequency, without significant alteration of spontaneous meal size. These data indicate that anorexia following peripheral LPS administration is sexually differentiated and that estradiol is sufficient to produce this response. The mechanism of the pathophysiological effect of estradiol on meal frequency appears to be different from the physiological effect of estradiol on food intake because the latter is expressed solely as a change in meal size.     

Identification of proteins regulated by estradiol in focal cerebral ischemic injury—A proteomics approach

Estradiol protects neuronal cells against permanent and focal ischemic brain damage. We identified the proteins that are expressed following estradiol administration during cerebral ischemia in an animal model. Adult female rats were ovariectomized and treated with oil or estradiol prior to middle cerebral artery occlusion (MCAO) to induce cerebral ischemia, and brains were collected 24 h after MCAO. Protein analysis was performed on the cerebral cortex using two-dimensional gel electrophoresis. Protein spots with difference in intensity between oil- and estradiol-treated groups were identified by mass spectrometry. Among these proteins, levels of protein phosphatase 2A (PP2A) and astrocytic phosphoprotein PEA-15 were significantly decreased in the oil-treated group in comparison to the estradiol-treated group. Moreover, Western blot analysis demonstrated that estradiol treatment prevents injury-induced decrease of PP2A and PEA-15 levels during both MCAO-induced injury and glutamate exposure in HT22 cells. In contrast, levels of the 60 kDa heat shock protein (Hsp 60) were significantly increased in oil-treated animals, while estradiol prevented the injury-induced increase of Hsp 60. The results of this study provide an evidence that estradiol protects neuronal cells against ischemic brain injury through the up- and down-modulation of specific proteins.     

Ovarian influences on the meal patterns of female rats.

A series of experiments examined the effects of estrous cycles, ovariectomy, and estradiol-replacement on free-feeding meal patterns of female rats maintained on a liquid diet. The proestrous decrease in food intake was accomplished by a decrease in meal size and a less than fully compensatory increase in meal frequency. The hyperphagia induced by ovariectomy was reflected in an increase in meal size and a decrease in meal frequency. When food intake returned to preoperative levels, meal size remained elevated while frequency decreased further. Estradiol benzoate (2 μg/day) permanently decreased meal size in long-term ovariectomized rats. The subsequent return to food intake levels of controls was due primarily to an increase in meal frequency. These results suggest that the transient changes in food intake caused by estradiol withdrawal and replacement are accomplished by permanent changes in meal size followed by compensatory changes in the number of meals consumed per day. They suggest that the decrease in meal size at proestrus is due to a direct effect of estradiol on the mechanisms that terminate short-term food intake and are not secondary to changes in the level of total daily food intake.     

The anorectic effect of fenfluramine is increased by estradiol treatment in ovariectomized rats

The emergence of sex- and estrous cycle-related differences in the anorectic effect of fenfluramine, a serotonin (5-HT) agonist, prompted us to investigate whether these behavioral changes are mediated by estradiol. Rats were ovariectomized and housed in cages that permitted the analysis of feeding and locomotor activity via an automated, computerized system. Using a within-subjects design, we investigated the effects of 1 mg/kg d-fenfluramine and saline vehicle on food intake and wheel running in ovariectomized rats following estradiol benzoate (EB) and oil vehicle treatment. A cyclic regimen of EB treatment was used to mimic the changes in endogenous estradiol secretion over the rat's 4-day estrous cycle. The decrease in food intake following fenfluramine treatment was greater in EB-treated rats, relative to oil-treated rats. Fenfluramine also produced a small but significant decrease in wheel running in ovariectomized rats that was not modulated by EB treatment. Thus, EB's ability to increase the anorectic effect of this dose of fenfluramine appears behaviorally specific. Although the inhibition of food intake by fenfluramine is largely attributed to its ability to increase synaptic levels of 5-HT, additional research involving selective 5-HT receptor agonists and antagonists is necessary to determine whether estradiol interacts with the endogenous 5-HT system to control food intake in the female rat.     

Effects of estradiol on food intake and meal patterns for diets that differ in flavor and fat content

Apart from the well known inhibitory effects of estradiol on food intake, meal size, and body weight in female rats that have been documented over the past thirty years, a more recent report presents the opposite finding; that a large dose of estradiol can increase food intake and weight gain in gonadally intact female rats presented with a palatable diet. The purpose of the present experiment was to further examine this hypothesis by evaluating the ability of estradiol to influence feeding behavior in ovariectomized rats presented with diets that differ in flavor and fat content. Female rats were given a cyclic regimen of estradiol benzoate treatment (5.0 or 20.0 µg) or the oil vehicle and were presented with the standard chow diet or a diet with a higher fat content and chocolate flavor. Food intake, meal size, and meal number were monitored three days after the first injection of estradiol or oil. Compared to the chow diet, food intake increased when animals had access to the chocolate/fat diet during the vehicle treatment condition. Both doses of estradiol significantly decreased food intake, meal size, and body weight gain when animals were presented with either the standard chow diet or the chocolate/fat diet. These findings indicate that estradiol does not stimulate the intake of a palatable diet in ovariectomized rats, and suggest that previous results showing that estradiol enhanced eating and weight gain stemmed from a disruption of the hypothalamic-pituitary-gonadal axis when intact females received a large dose of exogenous estradiol.     

Devazepide fails to reverse the inhibitory effect of interleukin-1beta on food intake in female rats

Proinflammatory cytokines released during the course of infection elicit numerous behavioral and metabolic changes. The decrease in food intake that accompanies infection is mediated in part by interleukin-1 (IL-1). Cholecystokinin (CCK) is a neuropeptide released during a meal, decreases food intake, and previous research suggests that CCK mediates the anorectic action of IL-1. The effects of estrogen on food intake are also thought to involve CCK, as the satiety action of CCK is increased by estradiol in both intact and ovariectomized rats. Estradiol also modulates many of the behavioral and physiological effects of IL-1. The present experiment examined the ability of the CCK(A) receptor antagonist devazepide to block the effects of IL-1 and estradiol on food intake in female rats. Adult animals were ovariectomized and given two daily subcutaneous injections of estradiol benzoate (EB; 5.0 microg) or the oil vehicle 3 weeks after surgery. Three days after treatment onset, animals were pretreated with devazepide or its vehicle 30 min prior to intraperitoneal injections of IL-1beta (4.0 microg/kg) or saline given 1 h before light offset. Food and water intake was measured following 2 h of spontaneous feeding. The results indicate that devazepide failed to reverse the anorectic action of IL-1beta, although the effects of estradiol on food intake were blocked by devazepide. These data do not support a role for CCK in IL-1-induced anorexia, and suggest that cytokines may act directly on neural systems involved in the control of food intake.     

Ovarian hormones and meal patterns in rats: effects of progesterone and role of gastrointestinal transit

Three experiments determined: (1) whether progesterone treatment would reverse the effects of estradiol benzoate (EB) on meal patterns of ovariectomized (OVX) rats, and (2) whether changes in gastrointestinal transit were responsible for the EB-induced changes in meal patterns. Progesterone (5 mg/day) reversed the effects of EB by increasing meal size and decreasing meal frequency in OVX, EB-treated rats. Progesterone had no effect on these measures in OVX rats that were not given EB. In a comparison of the rate of gastrointestinal transit, the rate of gastrointestinal transit was found to be faster in OVX rats injected with EB daily for two weeks than in OVX, oil-treated controls as measured under anesthesia with infusion of ten ml of liquid diet. However, this alteration in gastrointestinal transit does not appear to be responsible for the decreased meal size of EB-treated, OVX-rats, because the gastrointestinal changes are not observed 34-38 hr after an EB injection, a time at which meal size is already affected.     

The effect of cholecystokinin-octapeptide on food intake and consummatory behavior in lactating rats.

Rats are less sensitive to the satiating effect of CCK-8 during some reproductive states such as estrus and proestrus, and in ovariectomized rats following the administration of estradiol and progesterone. The sensitivity of rats to CCK-8's effect on food intake decreases as lactation progresses. During lactation, prolactin and progesterone levels are elevated. Implantation of ectopic pituitaries increases prolactin levels in males and females as well as progesterone levels in females. To evaluate whether or not prolactin elevation modifies CCK's effect on feeding, we studied the effect of CCK-8 on food intake during the early dark cycle in male and female rats implanted with ectopic pituitaries. As previously demonstrated, prolactin levels were elevated in both male and female pituitary-implanted rats and progesterone levels were elevated in the female rats. CCK-8 inhibited food intake in sham-operated male rats, but did not reliably decrease early dark cycle food intake in sham-operated or pituitary-implanted female rats or pituitary-implanted male rats. Thus an elevation in prolactin levels does not appear to modify the effect of CCK-8 on food intake in female rats. We also evaluated the effect of CCK on consummatory and maternal behavior in lactating rats. CCK-8 altered the meal patterns of lactating rats primarily by decreasing the rate of food consumption and increasing the latency to the first meal. The latency to the first meal of rats receiving CCK was increased during early and mid-lactation and the PW period, but not during late lactation compared to that of the saline-injected rats. CCK-8 did not modulate any of the maternal behaviors studied.(ABSTRACT TRUNCATED AT 250 WORDS)     

Conditioned taste aversion induced by estradiol pellets.

In two experiments, ovariectomized rats were given a novel diet prior to the implantation of a fused pellet of estradiol (E2 pellet). In short-term (3 weeks) ovariectomized rats, the suppression of food intake induced by estrogen was not affected by the introduction of the novel diet. However, a sensitive two-choice preference test revealed that subjects implanted with the E2 pellet had a lesser preference for the novel diet than controls implanted with the vehicle pellet. In long-term (18 weeks) ovariectomized rats, implantation of the E2 pellet had a large effect on the consumption of the novel diet. Intake was reduced to less than 1 g in all subjects on Days 3-7 after E2 pellet implantation. A subsequent two-choice preference test indicated the presence of a strong aversion to the novel diet in the estradiol-treated rats relative to the controls. These experiments show that estradiol can induce conditioned taste aversions that have either no effect on intake or totally suppress food intake, depending upon postovariectomy time.     

Estradiol: a rhythmic, inhibitory, indirect control of meal size

The classic analyses of the inhibitory effects of cholecystokinin (CCK) on meal size, conducted by Professor Gerard P. Smith and his colleagues at the Bourne Laboratory, inspired my initial interest in this field. My current research, which investigates the role of estradiol in the control of meal size, continues to be guided by Gerry's thoughtful, scientific approach to the study of ingestive behavior. In 1996, the year I arrived as a Postdoctoral Fellow at the Bourne Laboratory, Gerry published a new theory of the controls of meal size. In this important paper, Gerry proposed that the controls of meal size can be either direct or indirect. He argued that direct controls of meal size interact with peripheral, preabsorptive receptors that are sensitive to the chemical, mechanical, and colligative properties of ingested food and that indirect controls of meal size function to modulate the activity of direct controls. The purpose of this review is to illustrate how Gerry's theory has guided much of what is known about the mechanism by which estradiol inhibits food intake in female rats. I will provide evidence, primarily from behavioral studies of gonadally intact and ovariectomized rats, that estradiol exerts phasic and tonic inhibitory effects on food intake by acting as a rhythmic, inhibitory, indirect control of meal size.     

The effects of estradiol on body weight and food intake in normal weight VMH-lesioned rats.

The effects of estradiol on food intake and body weight were examined in ovariectomized and VMH-lesioned, ovariectomized rats that were prevented from supranormal weight gain by food restriction. Estradiol injections that were effective in reducing weight in supranormal weight, ovariectomized rats had no effect on weight in normal weight, ovariectomized or VMH-lesioned, ovariectomized rats. Estradiol did not prevent hyperphagia and weight gain in VMH-lesioned, ovariectomized rats when they were provided with ad lib food.     

Estradiol and the control of food intake

Gonadal steroids are among the many factors that influence food intake and body weight in mammals. Hormonal effects on these processes are particularly striking in female rats, which show large increases in food intake and body weight after ovariectomy. A key role of estradiol in the control of food intake and energy balance in humans is evidenced by the fact that the incidence of obesity increases greatly after menopause [American College of Obstetricians and Gynecologists. Body mass index and insulin resistance. Obstet Gynecol 2004;104:5s-10]. The actions of estradiol on neural systems that regulate eating may also account in part for sex differences in food intake and eating disorders, which occur much more frequently in young women [Sodersten P, Bergh C. Anorexia nervosa: towards a neurobiologically based therapy. Eur J Pharmacol 2003;480:67-74]. This paper presents a minireview of research examining the changes in feeding that occur during the ovarian cycle, the effects of estradiol withdrawal and replacement on food intake and body weight, and the neurobiological mechanisms by which estradiol influences feeding behavior. A model of hormone action on food intake that emerges from this research views estradiol as an indirect control of eating and meal size, producing changes in feeding behavior by modulating the central processing of both satiating and orexigenic peptides that represent direct controls of eating. Some of the shortcomings of the model and directions for future research are discussed.     

The effect of naloxone on nocturnal food intake in female and male rats

Previous studies have shown that estradiol and progesterone can alter the response of female rats to naloxone. For example, ovariectomized rats receiving estradiol were found to be less sensitive to the anorexic effect of naloxone than ovariectomized rats receiving oil (vehicle) or progesterone. In the present paper, we evaluated the effect of naloxone on nocturnal food intake in female rats during each stage of the estrous cycle to determine whether changing levels of gonadal hormones in intact female rats would affect their response to naloxone. To evaluate the role testosterone might play in modulating the male rat's feeding response to naloxone we studied the effect of peripherally administered naloxone (0.1, 1.0 and 10 mg/kg) on nocturnal food intake of intact, castrate and castrate + testosterone propionate male rats. During late metestrus, diestrus and proestrus, female rats decreased nocturnal food intake following the administration of naloxone (1.0 and 10 mg/kg) SC (p less than 0.05). During estrus, female rats failed to decrease food intake following any of the doses of naloxone administered. The male rat's response to naloxone does not appear to be altered by the presence or absence of testosterone. Thus, the level of estradiol and progesterone at different stages of the estrous cycle may affect the female rat's response to the satiety effect of naloxone.     

Feeding and drinking behavior responses of adult Zucker obese rats to cholecystokinin

Increased meal size in obese animals may occur because of decreased sensitivity to satiety factors. Feeding and drinking behavior responses of Zucker obese and lean rats to two forms of cholecystokinin (CCK), a putative satiety factor, were compared in these experiments. Octapeptide of CCK (CCK-8) in both obese and lean rats decreased meal size (47 and 65%) and rate of eating but not meal duration, and increased satiety ratio but not postmeal interval. Impure CCK decreased first meal size after a 6-hr fast similarly in obese and lean rats (33 and 40%, respectively); however, meal duration was decreased only in lean rats, and rate of eating was decreased only in obese rats. Postmeal interval was decreased in lean rats, while satiety ratio was increased only in obese rats. In spite of decreased first meal size daily food intakes were increased by both impure CCK and CCK-8 in lean rats. In 6-hr water-deprived rats injected with CCK-8, decreased water intake was associated with decreased food intake. However, while impure CCK in lean rats elicited similar responses as CCK-8, impure CCK in obese rats decreased food but not water intake. Feeding behavior response to the putative satiety agent, cholecystokinin, depended on form of the peptide administered and phenotype.     

The effect of cholecystokinin on food intake in gonadectomized and intact rats: the influence of sex hormones

Cholecystokinin (CCK) suppresses food intake in a number of animal models, but appears to be less effective in females [5,23]. We studied the effect of CCK on food intake in female rats on each day of the estrous cycle. In addition, we evaluated the effect of sex hormones on food intake in intact and castrate male rats which had been injected daily with oil or testosterone propionate + oil and ovariectomized female rats injected daily with oil, estradiol, progesterone or estradiol + progesterone. Food intake in intact, castrate and castrate + testosterone replaced male rats was decreased by CCK (5, 10 and 20 micrograms/kg) IP (p less than 0.05). Food intake was decreased by CCK (20 micrograms/kg) only during diestrous and metestrus in cycling female rats. During metestrus, a period of low estradiol in the presence of progesterone, food intake was also suppressed by CCK (5 and 10 micrograms/kg). CCK failed to decrease food intake in ovariectomized females receiving oil, estradiol and estradiol + progesterone. However, animals receiving progesterone alone responded to the high dose of CCK (20 micrograms/kg). Our data suggest that the effect of CCK on food intake in female rats may be dependent on the presence of progesterone. The lack of sensitivity to CCK during proestrus and estrus suggests that estradiol may be modulating the "permissive" action of progesterone on CCK's satiety effect.     

Effect of estradiol and progesterone on daily rhythm in food intake and feeding patterns in Fischer rats

The product of meal number x meal size, over time, is food intake. Because estrogens modulate feeding activity via their action on the hypothalamus, and because there is a diurnal rhythm in the expression of cytoplasmic estrogen receptors and in estrogen binding activity, the present study examined the effects of ovariectomy and later hormone therapy on acute changes in body weight, and on the meal number-to-meal size relationship as reflected by food intake in the dark/light feeding patterns, in adult female rats in the intact state and after ovariectomy. Twelve female Fischer rats were randomized into ovariectomy and sham operation groups. A rat eater meter measured the feeding indexes for 15 days before and 25 days after ovariectomy, and later for 35 days with hormone therapy. We report: (a) mean body weight gain was linear before and up to ovariectomy, while exponential after ovariectomy; (b) increase in daily food consumption is mainly via an increase in food intake during the light phase; (c) light phase meal number remains unchanged, meal size significantly increases, with the resultant increase in overall food intake; (d) during the dark phase, meal size also significantly increases, but is accompanied by a proportional decrease in meal number, resulting in unchanged dark-phase food intake; and (e) estrogen restoration with either estradiol valerate or estradiol-progesterone combination, reversed the above changes. Data show that in the female Fischer 344 rat: (a) changes in daily rhythm in food intake are brought about by differential effects of the hormones on both meal size and meal number in both the total daily levels as well as in the dark-to-light distribution; (b) estadiol appears to have a tonic inhibitory effect on the light phase meal size and a phasic effect on the dark phase meal size and number, but no significant effect on the light-phase meal number; and (c) in the Fischer rats, progesterone augments estradiol's effect on these indicies.