5 Things Most People Get Wrong About Hormones: A Doctor Explains
Hormones drive so many actions in the body, from your metabolism to mood to whether hair stays on your head. They’re complex. They’re interdependent. And in the decades that I’ve spent as a board-certified gynecologist helping women balance their hormones naturally, I’ve found that most people believe one or more of the following hormonal myths:
1. "I’m too young to have a hormone problem."
The problem: When I was younger, I also figured that menopause was some future cliff I’d fall from, around age fifty or so, in the distant future.
The truth: Not so. Your body has been prepared for the menopausal cliff for decades before, and it will pay future dividends for you to understand the more subtle hormone imbalances that begin as early as your late 20s. Most commonly, testosterone, DHEA, progesterone, and even estrogen can start to wane. In my 30s, I had signs of hormonal imbalance already—more frequent periods (every 26 days instead of the usual 28), PMS, deteriorating libido, and a growing waistline were the big clues.
2. "I feel flat (or fat, or fatigued). I must be doing something wrong."
The problem: It breaks my heart when a patient assumes that her moodiness or sense of depletion are a moral failure, and doesn’t look first for a biological explanation.
The truth: Before you go popping antidepressants or hunting down a therapist, know that biology is most likely to blame for many of your emotional symptoms. (That’s not to say you shouldn’t seek expert help if you have severe, long-term symptoms—please do.) But about 20 percent of women with mood issues and depression have problems with their thyroid. Low estrogen and progesterone can also cause your mood to tank.
For many women, a few tweaks to your hormones can help you feel like a completely different person.
3. "My doctor says hormones change too much for measurement to be meaningful."
The problem: In my medical education and residency, I was taught that measuring hormone levels is a waste of time and money, because hormone levels vary too much.
The truth: We track hormones such as estrogen, progesterone, thyroid, and testosterone when women are trying to conceive or are in the early months of pregnancy. I wondered why these numbers would be important indications of a woman’s health in one situation but not another? Wouldn’t my hormone levels be as reliable an indicator of my health after my pregnancies, as before them? Why the double standard?
In my 30s, when I was a frazzled new mom, harried wife, and busy doctor, I struggled with low energy, belly fat, a nonexistent libido, and a less-than-sunny disposition. It was only when I tested my hormones that I found they were seriously out of whack. In fact, my blood cortisol was three times what it should have been. I wouldn’t have known that hormones were the main culprit if I didn’t measure them.
You should measure your levels. too. What you measure improves. Your hormones may just be the most important plants in your garden for us to nurture and help bloom.
4. "I’m tired and gaining weight—I just need to accept that I’m getting older."
The problem: You may think it’s normal to feel this way as you get older. And if you’ve heard this from your doctor, you may be afraid to disagree for fear you don’t have any data to back you up. Don’t disempower yourself.
The truth: Too often, we think the problems we're having are age-related, but a simple test can indicate if they are hormone-related. For example, fatigue and weight gain are classic examples of low thyroid. Additionally, too many doctors mistake the symptom for the problem, and may put you on a nutritional and exercise regimen to manage your weight without going deeper and looking for the root cause of your symptoms.
This reminds me of the diagnosis for cataracts. Doctors used to tell patients complaining of blurry vision that they were just getting older, but now we take them seriously and send them straight to an ophthalmologist for further testing.
5. "My doctor says my hormone levels are normal."
The problem: Your doctor is old school and looking at the normal reference range for 95 percent of the population, not the optimal range.
The truth: Your doctor may be well intentioned, but under-informed. They may be using an outdated reference range, using "normal" reference ranges from their medical school days, and are unfamiliar with newer guidelines that in fact have a narrower optimal range (see the conventional versus optimal lab ranges below).
They may also be unaware of current findings, or they may just rely on the myth that numbers don’t lie. Too many doctors rely on a limited lab test more than what the patient is telling them.
Conventional lab ranges:
Free T3 (blood spot): 2.5-6.5 pg/ml.
Free T4 (blood spot): 0.7-2.5 ng/dL.
Estradiol (serum): Premenopause: depends on timing with cycle. Overall 15-350 pg/mL in premenopause. Postmenopause and not on hormones < 32.
Progesterone (serum): Luteal phase: 8 to 33 ng/mL.
Cortisol (serum): 7-28 ug/dL morning, 2-18 ug/dL afternoon.
Optimal lab ranges:
Free T3 (blood spot): Top half of normal range (varies by lab), 4.5-6.5 pg/ml.
Free T4 (blood spot): Top half of normal range (varies by lab), 1.45-2.5 pg/ml.
Estradiol (serum): Day 3: < 80; Day 14: 150-350; Postmenopause approximately 50 for bone strength.
Progesterone (serum): Luteal phase: 15-33 ng/mL.
Cortisol (serum): 10-15 ug/dL morning, 6-10 ug/dL afternoon.
“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as self-evident.”