What Your Medical Doctor Didn’t Tell You About Hormone Imbalance and What To Do About It

Have you noticed a change in any of these areas?

  • Body weight or composition?
  • Mood, focus, irritability?
  • Energy, fatigue, or lack of motivation including sex drive?
  • Hair loss or brittle nails?
  • Growth of hair in new places it shouldn’t be growing?

An important question is: What do all the above have in common?

The answer: They all require the right balance of hormones.  These are just a small number of signs of hormone imbalance.  If you suspect you may have a hormone imbalance, but the test results and doctor’s visits haven’t turned up any answers, have no fear, you’re not alone!

Most hormone imbalances often go undetected for months and even years!

Oftentimes, medical doctors are not looking for subtle shifts in hormone levels.  Even if your doctor runs a few hormone tests, you’ll usually receive a diagnosis that simply describes the symptoms you’re experiencing without an explanation of what is causing your hormones to go haywire.  Medical training is mainly concerned with screening severe hormonal diseases like Addison’s disease, Cushing’s syndrome, hypogonadism, tumors of the pituitary/adrenals, or other rare genetic conditions.  But 90% of hormonal imbalances are much subtler and more related to our environment and lifestyle, not genetics.[1]  In this article we will cover the basics of hormone production in the body, and will discuss the more nuanced approach to how hormonal imbalance occurs.

The Hormone Pathway

As you can see in the pathway above, all sex hormones, including testosterone, estrogen, and progesterone, all have the same starting molecule: cholesterol.  Contrary to what some nutritional experts will tell you, cholesterol is not the enemy!  It shouldn’t be eradicated or decreased to the lowest level possible through statin medication because cholesterol is essential for hormone production.  I’ll talk more on cholesterol in later posts, but for now, just realize that it is essential as a building block for other hormones.

The above diagram also illustrates how cholesterol can either be used to make testosterone, estrogen, progesterone, or cortisol.  Now, this is very important when it comes to producing our sex hormones because cortisol competes for the same cholesterol needed to make the other three.  Can you see how our production of sex hormones can be negatively affected if we experience stress on a regular basis, requiring lots of the stress hormone, cortisol, to be produced?  In the past, this has been referred to as the “pregnenolone steal.”

Another type of imbalance that can occur is the relationship between progesterone and estrogen.  You can see from the same diagram that pregnenolone is not only used to produce cortisol, it can either be pushed towards production of estrogen through DHEA or directly to make progesterone.  Many women may be familiar with the term “estrogen dominance.”  Estrogen dominance can come in a couple different forms:

  • Elevated estrogen in relation to low progesterone
  • Elevated estrogen in relation to normal progesterone

Low progesterone has been linked to anxiety, mild depression, brain fog, dysthymia, and social phobia.  Low progesterone causes infertility, night sweats, sleeplessness, and irregular menstrual cycles.  Pair that with high estrogen and you’ve got a recipe for some serious, chronic health problems.  High estrogen increases the risk to develop breast tenderness, cysts, fibroids, endometriosis, and breast cancer.[2]

It’s a delicate balance, because too low estrogen can cause depressed mood and libido, vaginal dryness, less flexible joints, and less focused mental state.[3]

This is one of the biggest problems with hormonal birth control: your body’s cycle of naturally balancing estrogen to progesterone is altered with synthetic hormones that can lead to a host of health problems including increased of stroke, cancers, depression, and more.  See this article for information on hormonal birth control.


What do I do about hormonal imbalance?

Most women are told by well-meaning medical doctors that if they are deficient in one hormone, then the treatment is to simply boost the level of hormones through bio-identical hormones or even, synthetic hormones.  These come in many forms; creams, subcutaneous pellets, shots, etc.  Unfortunately, the answer is not so straightforward.  Why?

Let’s look at a widely studied hormone therapy used for postmenopausal women.  Prempro, or Premarin, was used as a therapy by the Women’s Health Initiative in a placebo controlled trail, the gold standard of medicine.  The research was stopped early because of the increase in invasive breast cancer, coronary heart disease, colon stroke, and a number of other diseases [4].

Unfortunately, this is how PMS is still treated. PMS is usually considered a problem with progesterone.  Smearing progesterone cream on yourself will not fix the problem.  We need to understand why your body is not producing or responding to progesterone.  In many cases, cells have become resistant to progesterone (in the same way a diabetic’s cells have become resistant to insulin).  Many times, we need to address the upstream causes like stress (cortisol levels), nutrient deficiencies, detoxification and liver health, etc.

How Test For Hormonal Dysfunction

Even if your doctor is willing to run a hormone test, they usually will only order the most basic of hormone panels.  It will only give you a spot measurement, not a dynamic measurement (think of a still frame photograph compared to a movie).  The better information you get from a test, the better you’ll be able to treat the underlying cause(s).  The DUTCH test we offer measures testosterone, estrogen, progesterone, cortisol, and multiple metabolites of each which really gives a lot of valuable info.  Testing your sex hormones will give you important information, but they won’t tell you the whole story.  Look at biomarkers for inflammation, stress, and nutrient deficiency.  These biomarkers are sometimes more valuable than looking at the sex hormones because they may lead you to address things you didn’t realize were causing the imbalance.

In conclusion, hormones can be an overwhelming concept to grasp.  We may be tempted to identify one or two hormones that show up as low on a lab test and treat it with hormone replacement therapy (HRT), but that rarely addresses the underlying problem since much of our hormones are regulated by many different factors including environment and lifestyle.  If you suspect hormone imbalance and want to address the cause, the best option is to look at biomarkers for inflammation, stress, nutrient imbalance, etc.  Find out how a functional medicine approach can help you uncover the cause of hormonal imbalance.

  • [1] 90% of all chronic diseases are not genetically related
  • [2] The Hormone Cure Book, Dr. Gottfried, MD
  • [3] Dr. Gottfried MD
  • [4] FDA.gov – Women’s Health Initiative Prempro Study shut down early