Think of your hormones like chemical messengers of your body. Each hormone sends specific instructions to every organ, making hormones responsible for just about everything your body does – how it works, how it feels, and how healthy it is. Hormones influence your mood, energy level, weight, temperature, digestion, and many other aspects of your health. And yet, we don’t often think about, let alone appreciate, our hormones until they stop working the way we want them to. And when that happens, because of their wide influence, we definitely notice.
Your hormones are produced in the major endocrine glands – your brain (hypothalamus, pineal, and pituitary glands), thyroid, parathyroid, adrenals, pancreas, and reproductive glands (ovaries and testes). Some hormones are also produced in your gastrointestinal tract. With hormones, it’s all about balance. As Goldilocks lamented (and I’m paraphrasing here), there can’t be too much or too little. Hormones have to be just right. Otherwise, a myriad of health issues can happen.
But when you suspect hormone imbalance, mainstream medicine typically runs only basic labs. If your labs don’t come back “normal,” you’re typically given a synthetic hormone cream or pill that could have side effects. If those labs come back “normal” and you’re still experiencing symptoms, you may be told you’re either depressed, just getting older, or need to lose weight.
Functional medicine wants to find out the root cause of patients’ hormonal symptoms as well as support the body’s natural mechanisms for healthy hormone balance, and that makes a lot more sense to me. Let’s go over some of the most common hormone problems that I see in patients, and that you may be going through right now. I’ll also explain which labs you may want to consider asking your doctor about.
1. Cortisol
Our adrenal glands secret several hormones, and one of them is cortisol, your body’s primary stress hormone. Adrenal fatigue happens when there’s an imbalance in this cortisol rhythm: Cortisol is high when it should be low, low when it should be high, or always high or always low. Adrenal fatigue is really a dysfunction of your brain’s communication with your adrenals – not the adrenal glands themselves. Because adrenal fatigue is mainly a brain stress problem, the functional medicine solution focuses on minimizing chronic stressors.
What you might experience:
Trouble getting started in the morning
Craving salty or sugary foods
Low sex drive
Fatigued in the afternoon but you get a “second wind” in the evening
Trouble staying asleep at night
Dizziness after standing up too quickly
Afternoon headaches
Blood sugar issues
Chronic inflammation
Weak nails and brittle hair
Moodiness
Trouble losing weight
The Labs: I run a 24-Hour Adrenal Stress Index, a salivary test that tracks your cortisol levels, and an HPA (brain-adrenal) axis quality lab.
2. Thyroid
Every cell of your body needs thyroid hormones to function optimally. There are many underlying thyroid problems that won’t show up on standard labs. For example: thyroid conversion issues, thyroid resistance, or autoimmune attacks against the thyroid (Hashimoto’s or Graves’ disease).
What you might experience:
Feeling tired
Cold feet, hands, or cold all over
Requiring extra sleep to function properly
Rapid weight gain
Constipation
Depressed or lack of motivation
Morning headaches that subside as the day goes on
Thinning of the outer third of eyebrows
Excessive hair loss or thinning
Dry skin
Brain fog
The Labs: Mainstream medicine typically just runs TSH and T4 (inactive thyroid hormone) to determine thyroid hormone dosage. A functional medicine thyroid panel involves looking at many other labs such as Free and Total T3 (active thyroid hormone), Reverse T3, and thyroid antibodies to rule out autoimmune thyroid problems. For a full list of thyroid labs and how to interpret them, read my previous article here.
3. Estrogen
The ratio of the three forms of estrogen – estrone (E1), estradiol (E2), estriol (E3) – is important for both women and men. Some research has linked imbalances in estrogens to increased mortality rates in those with heart disease as well as the progression of some cancers.
What you might experience with low estrogen:
Vaginal dryness
Night sweats
Brain fog
Recurrent bladder infections
Feeling lethargic
Depression
Hot flashes
What you might experience with high estrogen:
Bloating
Rapid weight gain
Breast tenderness
Mood swings
Heavy menstrual bleeding
Anxiety
Depression
Migraine headaches
Cervical dysplasia (abnormal pap smear)
Insomnia
Brain fog
Gallbladder problems
The Labs: A full blood and salivary female hormone panel, including all estrogen isomers, can shed light on the specific problem.
4. Progesterone
Both men and women need healthy progesterone balance. Progesterone helps balance and neutralize the effects of too much estrogen. Without proper progesterone levels, estrogen becomes out of control, also known as estrogen dominance.
What you might experience:
PMS
Insomnia
Poor complexion
Painful breasts
Stubborn weight gain
Cyclical headaches
Anxiety
Infertility
The Labs: A full blood and salivary female hormone panel.
5. Testosterone
I often see low testosterone in both men and women in my functional medicine clinic. Studies have linked low testosterone in women to heart disease, low sex drive, and breast cancer. One study found that men with low testosterone had a great rate of death. But you can also have too much.
What women might experience with excess testosterone:
Acne
Polycystic ovary syndrome (PCOS)
Excessive hair on the face and arms
Hypoglycemia and/or unstable blood sugar
Thinning hair
Infertility
Ovarian cysts
Mid cycle pain/cramping
Irritability
What women might experience with low testosterone:
Weight gain
Fatigue
Low sex drive
What men might experience:
I often see the over-conversion of testosterone to estrogen in men. Men don’t produce estrogen like women but convert it through a process called aromatization. Excess activity of the enzyme aromatase can cause low testosterone and high estrogen in men resulting in:
Erectile dysfunction
Low sex drive
Weight gain
Irritability
Breast enlargement
The Labs: Blood and saliva testosterone and DHEA panel.
6. Leptin
Your fat cells aren’t just some unsightly nuisances that jiggle and make clothes not fit; they’re actually an intelligent part of your endocrine (hormonal) system. Fat cells produce a hormone called leptin.
One of leptin’s jobs is to tell your brain to use the body’s fat stores for energy. Leptin resistance occurs when your body – specifically your hypothalamus in your brain – stops recognizing leptin. This can trick your brain into thinking you are starving, resulting in excessive and inappropriate fat storage.
What you might experience:
Rapid weight gain
Weight loss resistance
Frequent strong food cravings
High stress levels
The Labs: Serum leptin.
7. Insulin
Just like leptin resistance, insulin resistance is not a hormonal deficiency but a hormonal resistance pattern. Most people know insulin resistance when it comes to type 2 diabetes, but insulin resistance can also happen in those who are pre-diabetic, or have sub-clinical blood sugar imbalance.
This pre-diabetic metabolic syndrome is marked by this resistance to insulin meaning your body is producing insulin but the insulin is not doing what it should, i.e., shuttling blood sugar into your cells where you can use it. Instead, this ineffective insulin, through a cascade of reactions, results in excessive fat storage, making weight loss seem impossible.
What you might experience:
Cravings for sweets
Irritability or lightheadedness if you miss a meal
Dependence on coffee
Shaky, jittery, or tremors
Feeling uncharacteristically agitated, upset, or nervous
Poor memory
Blurred vision
Fatigue after eating
Sugar cravings
Waist girth equal to or larger than hip girth
Frequent urination
Increased thirst or appetite
Weight loss resistance
The Labs: Serum insulin, c-peptide, fasting blood sugar, and HgbA1c.
The Bottom Line
Because all the systems in the body are interconnected, if you have one hormone problem, you might have other ones as well. In other words, to say you have only one of these seven issues might be oversimplification – it could be all of these issues or a combination of some of these. It’s important to work with your health care provider to find out what hormone issues might actually be at play.
Recently, I’ve been working on rehabbing my own adrenal fatigue and have shared my journey to hormonal balance in my 90-day hormone reset.
If you want to learn more about your own health case please contact Dr. Sandra DeCarlo to schedule an appointment.
Credit: Dr. Will Cole
