What do you think of when you hear or read the word “hormones”?
Some may immediately think of anabolic steroids, bodybuilders, or professional athletes. For others, symptoms such as pre-menstrual syndrome, hot flashes, night sweats, or mood swings may come to mind.
Your hormones dictate how you feel and function every day, and when they’re off-kilter, you’re likely to feel it — in a variety of far-reaching ways. Because the types and impacts of hormones are so expansive, in this guide I’ll focus primarily on your reproductive (or sex) hormones, which includes estrogen, progesterone, and testosterone, among others.
Let’s take a look at what could be going on with them in your body — and what you can do about it.
Why Sex Hormones Matter
Hormones are chemical messengers that are made in all areas of the body and travel through the bloodstream to their site of action. They include reproductive hormones, thyroid hormones, blood-sugar-regulating hormones, stress hormones, and more.
The function of sex hormones (or reproductive hormones) extends far beyond libido, intimacy, and fertility. Your energy levels, body composition, and mood also all hinge on them being in the right balance.
Sex hormone issues — and their unpleasant symptoms — are surprisingly common. Although balancing them is key to your health, doing so can get tricky. Optimal levels can shift throughout the month (such as in a menstruating female), as well as change in the life cycle (such as during puberty, menopause for females, and andropause for males). Also, they operate like a symphony, so when one is out of tune, the rest of them are impacted as well.
How do I know if my hormones are off?
Sex hormone symptoms are highly variable, and a lot of them are mistaken as “normal” just because they’re common.
For pre-menopausal women, a common issue is extreme discomfort leading up to and through menstruation. Bad cramps, extremely tender breasts, significant mood swings, and a flow that is irregular, scant, or very heavy doesn’t need to be an acceptable monthly experience. For those who still have a cycle, estrogen dominance — when estrogen is too high or progesterone is too low — is a common culprit.
In women around menopause, hormone levels decline as the ovaries cease production and the adrenal glands take over. When the decline of hormones is too steep or out of sync, severe hot flashes and night sweats, wild swings in emotions, and pain during sex are often reported. Unfortunately, those symptoms are often brushed off as a part of aging — but really, they can indicate that the expected hormonal shift in this life stage is happening less than gracefully.
Both pre-menopausal women and women around the menopausal years may experience adult acne and excess facial hair growth. To boot, female hormone balance in general — and throughout all stages of life — can be complex and delicate.
Men with low testosterone or excess estrogen can often notice a decrease in strength, endurance, or libido. Feelings of apathy can spring up, as can difficulty obtaining or maintaining an erection. Often, an absence of morning erections is a sign that something is awry.
For both men and women, unwanted hormonal shifts can lead to a low sex drive and excess belly fat. In men, research has shown that belly fat goes up as testosterone goes down, and that low testosterone can also lead to blood-sugar issues and type 2 diabetes. Imbalanced estrogen in women can also create issues with proper blood-sugar regulation and make belly fat more stubborn.
Try not to compare your symptoms to those others might be experiencing, though. Hormone issues show up differently for different people. One male with low testosterone might be able to build muscle mass but struggle with low mood and apathy. Another, however, might be in generally good spirits but have a hard time losing fat and getting lean.
The above examples highlight subjective symptoms to look out for, but the best way to objectively track hormone levels is through regular lab testing.
What testing should I get?
Testing hormones in isolation — i.e. looking only at levels of testosterone or a singular progesterone reading, for example — usually leads to more questions than answers.
Whether your hormones are high, low, or simply out of balance with each other dictates the next question: Why are they off? The answer to this comes from adequate testing of the whole hormonal symphony.
Let’s use testosterone as an example. If a male is symptomatic and discovers his testosterone is low, one or all of the following could be true:
There are production issues.
Perhaps the testes are having trouble producing testosterone despite getting the signal to do so from the pituitary gland at the base of the brain. Or, maybe the pituitary gland never sent the signal in the first place, and so the testes aren’t producing it because they aren’t being told to do so.
There’s enough, but it’s unavailable.
Let’s say the testes are getting the right signal and producing testosterone in the right quantity, but the testosterone being produced is bound to certain blood proteins. These proteins can act like sponges and hold on to the testosterone so that it is not available to do its job. In this case, there’s enough total testosterone in the body, but it’s not being used.
It’s being converted to something else.
If the testosterone isn’t bound, perhaps it’s being converted to estrogen from too much of an enzyme called aromatase. Or, maybe the enzyme 5-alpha-reductase is too high and is causing the testosterone to convert into dihydrotestosterone (DHT), which is another type of sex hormone. Excess of either one of these — especially in the context of lower free testosterone — is not a good scenario.
There’s poor clearance.
When the body is done using hormones, they’re metabolized by the liver, and waste is excreted. If there’s any congestion in how these detoxification and elimination systems are working, a bottleneck or backup can occur, also throwing off the appropriate balance.
The example issues above have parallels to the ovaries in menstruating women and the adrenal glands in menopausal women — both of which produce sex hormones. To know the most effective approach to take, it’s important to figure out if there is an issue with production, binding, conversion, or clearance.
As I stated above, testing just one hormone is likely to leave you without a firm direction for your next steps. The more of the hormonal cascade that is tested, the more effectively a qualified practitioner can help you address it.
At a minimum, ask for the following when you’re trying to better understand your sex hormone levels:
- FSH and LH
- Free and Total Testosterone
- Estrone and Estradiol
It’s even more beneficial to have these hormones levels tested alongside markers of inflammation, cortisol, nutrient status, and blood-sugar control to get a broader picture of health. These metabolic systems all interplay with one another.
Note: It’s likely you’ll need to pay out of pocket for this level of testing, depending on your insurance plan and medical conditions. Most insurance plans with lab testing coverage only pay for tests that are “medically necessary.” And if you don’t meet diagnostic criteria, evaluating this whole balance may not be deemed medically necessary, even though the information can help optimize your nutrition, exercise, lifestyle, and health plan.
Let’s say there’s an issue — now what?
If an issue is confirmed through lab testing, many folks are quick to jump on the next one-pill-wonder in an attempt get their hormones in line. Or maybe they go immediately to hormone replacement therapy (HRT) as a first-line defense. Hopefully, after reading the above, you realize it’s not usually that easy.
Hormone replacement has a time and a place, but I’ve often seen people jump to it as a solution without addressing underlying issues. In those cases, it’s common to feel good initially, but then inevitably run into a roadblock again later.
Here’s the thing: There are certain prerequisites your body requires to achieve healthy hormone levels.
Start by addressing the non-negotiables to equip your body with the right tools to achieve healthy hormone levels in the first place. If these are habitual and you’re still experiencing issues, you may discover that additional support is needed. If that’s the case, you know it’s actually needed — and having these foundations in place can make any other interventions work even better.
Boost your nutrients.
The idea of using vitamins, minerals, and key nutrients to help support hormones might sound vanilla, especially when you’re bombarded with aggressively-marketed, hormone-balancing miracle supplements, or T-boosters.
However, the body is smart. Optimal nutrient levels support cell health, and good cellular health leads to better hormonal health.
How important are these basic nutrients? Here are just a few highlights:
- Zinc is a required nutrient for testosterone production. When zinc status is low, testosterone levels drop.
- Magnesium has been shown to increase free testosterone levels in both sedentary and active individuals and help with hot flashes. A deficiency can also trigger premenstrual symptoms.
- Vitamin B6 has been implicated to help with PMS symptoms and mood swings around menstruation.
- Adequate folate can help with alleviating hot flashes.
- Vitamin D deficiency can intensify PMS symptoms. And on a more drastic note, it has implications in certain hormone-based cancer pathways. Inadequate levels also could lead to issues with libido and erectile dysfunction.
- Omega-3 fatty acids are anti-inflammatory and can help with cramps, menstrual regularity in women with PCOS (polycystic ovarian syndrome), and testicular function in young men.
These are just a few selected examples. Rather than mega-dosing individual nutrients, the better solution is to use a balanced food approach and foundational supplementation to support appropriate adequacy.
This boils down to using core supplementation options and eating a diet rich in whole foods. Include lots of fruits and vegetables (heavier on the veggies than fruit); ample quality proteins from meat, fish, poultry, eggs, and dairy (if tolerated); the inclusion of healthy fat from foods such as olive oil, nuts, and seeds; and mindful incorporation of nutrient-dense carbohydrate choices, such as legumes, beans, and root vegetables.
Focusing on a colorful diet can go a long way. High produce intake is even linked to a lower recurrence of hormone-based cancers, while compounds called lignans found in plant foods, such as ground flax, can play a role in lowering the levels of estrone, the less friendly form of estrogen.
Balance your blood sugar.
Blood-sugar regulation and sex hormones are closely linked, and imbalances seem to be a two-way street.
Insulin resistance, which typically precedes type 2 diabetes, is associated with hot flashes in women. In fact, those with hot flashes and night sweats may have an 18 percent higher risk of developing diabetes. For pre-menopausal women, the second half of the menstrual cycle (leading up to the monthly period) is marked with decreased sensitivity to insulin. As a result, blood sugars can run higher— and carbohydrate cravings often spike.
In men, low testosterone can lead to blood-sugar issues, associated belly fat, and diabetes. When markers of blood sugar are off, the development of fat and breast tissue (called gynecomastia) can result. Highlighting the intimate relationship between blood glucose and hormones, repletion of a hormone called DHEA (which is needed to produce both testosterone and estrogen) along with exercise helped to optimize blood-sugar control, at least according to one rat study.
No doubt, achieving healthy blood-sugar control is an essential goal for anyone’s health plan.
Important note: Quality, uninterrupted sleep hinges on steady blood sugar as well. And since most areas of health rise and fall on the tide of sleep, achieving steady levels of blood-sugar control is table stakes to feeling like your best self.
Focus on cruciferous vegetables.
Cruciferous vegetables are in the Brassica family and include common selections such as broccoli, cauliflower, cabbage, kale, bok choy, radishes, and Brussels sprouts.
These veggies contain a substance called Indole-3-carbinol, or I3C. After ingestion, stomach acid acts on I3C and produces another compound called diindolylmethane, or DIM.
These compounds play a role in regulating the activity of estrogen and its metabolism — and are even being explored for their impact on tumor growth in hormone-responsive cancers, lung cancer, and colorectal cancer.
While DIM and Indole-3-carbinol are available in supplement form, aim first to include both cooked and raw cruciferous veggies in your regular nutrition plan, and try several methods of preparation to get the most taste and variety. Try using riced cauliflower as a side, shredded Brussels sprouts with a spring mix salad, or shredded broccoli and cabbage as a coleslaw base.
Support your digestion and detoxification.
Good liver function and regular bowel movements are required for the proper clearance and elimination of hormone by-products. For starters, make sure to consume adequate water daily (aim for half of your goal body weight (in pounds) in ounces of water each day), slowly increase your fiber intake, and get in regular exercise to help aid in moving your bowels.
Avoiding constipation is required for the proper removal of estrogen. Recent research has also shown that the balance of good-to-bad bacteria in our digestive tracts can also impact how estrogen is managed, so the inclusion of fermented foods (such as sauerkraut, plain yogurt, and kimchi) and considering a probiotic supplement might be helpful.
You’ll also want to limit your intake of alcohol, especially when dealing with sex hormone issues. Drinking alcohol has been linked to breast cancer, likely because it can increase estrogen levels, even at the dose of one drink per day.
If you’re looking to kickstart several key habits at once, such as boosting hydration, increasing fiber, and reducing alcohol, consider doing a structured habit reboot such as the Life Time D.TOX program.
Reduce your toxic burden.
Part of supporting your detoxification system includes reducing your cumulative exposure to environmental pollutants in the first place.
The environmental compounds we’re exposed to in today’s world have some concerning impacts. For example, phthalates — found in many soaps, body care products, and makeup options — have been linked to endometriosis, a condition that impacts more than one in 10 women and is dependent on estrogen. If a pregnant woman carrying a baby boy is exposed to excess phthalates, it can abnormally alter the development of certain male characteristics.
Recently, exposure to flame retardants has been linked to genetic abnormalities in sperm, leading to negative health consequences for future generations. Parabens, which are used as a preservative in foods and cosmetics, can disrupt the endocrine system and have estrogenic effects. And PFAs, which are found in food packaging, stain-and-water-repellant fabrics, and nonstick cookware, have been linked to early onset of menopause.
This is not a cause to live in constant fear or panic. However, there is power in working to control what you can control. Pay attention to the cleaning products and toiletries you use and make step-by-step changes. For example, try using vinegar and distilled water to clean windows, or baking soda to clean your bathtub; consider using a water filter; as you finish a toiletry, aim to swap it out for a more natural product; ventilate your home with open windows and fresh air often.
Toxins are everywhere, and while they have potential to disrupt your hormones, avoiding exposure entirely is impractical and can cause even more stress. Instead, be mindful and make one change at a time.
Balanced training and exercise is not a punishment; it’s literally life-giving. Study after study shows the wide-ranging positive impacts of exercise on your health — including supporting healthy hormonal balance.
When you’re short on time, try prioritizing strength training and high-intensity interval training.
Studies show that, when compared to aerobics, resistance training has greater benefits for metabolism and levels of growth hormone, which is important for muscle growth and development. Regardless of your goals, gaining and maintaining muscle is key to long-term health. Additionally, as little as 10 minutes of high-intensity exercise can increase circulating levels of growth hormone, too.
As we age, hormonal changes can make it harder to hold on to lean body mass. Luckily, studies have shown that progressive weightlifting can combat the age-related decline of testosterone in older men. And in women, the decline of lean body mass during menopause, thought to occur from a drop in estradiol, can also be minimized with regular physical activity.
If needed, consider specialized support.
You might see supplements such as vitex, black cohosh, horny goat weed, evening primrose oil, Tribulus, and Tongkat Ali promoted as the solution to your hormonal woes. However, there’s no such thing as a quick fix — and none of these options restore optimal physiology in the same way the non-negotiables above do.
These herbs and botanicals can be helpful when used at the right time, place, duration, and dosage. However, their efficacy relies on proper oversight from a practitioner, adequate lab testing at regular intervals, consideration of current symptoms, and implementation of the other prerequisites above. The same applies to hormone replacement therapy.
One caveat: When working with your healthcare team, specialized botanicals and hormone replacement therapy can be successfully implemented as you’re concurrently working on the foundational habits and non-negotiables above, especially if you discover that your hormones are so imbalanced that your quality of life is disrupted. However, the key is not to use them as a way to side-step addressing the true underlying issues.
Addressing hormone issues can initially seem like a bear, but feeling like your best self depends on it — and makes it well worth it. Instead of getting overwhelmed with all the physiology jargon and complex options in addressing hormone health, simply start with the basics.
Work to prioritize your vitamin, mineral, and nutrient status through balanced nutrition and foundational supplementation. Experiment with cruciferous vegetable recipes, strategies to support your digestion, and reduction of your cumulative exposure to toxins. Exercise and sweat consistently and on most days of the week. To objectively track your progress, aim to do regular, complete lab testing — and re-test every 12 to 16 weeks as you implement changes.
If you’re doing the above, and your hormones are still out of balance, be sure to continue to work with your healthcare provider to explore which specialized supplements, hormone replacement therapies, or treatment options are best for you.
Whatever you do, don’t accept anything less than feeling your best.