When our hormones are out of balance, our energy levels, our zest for life, and our moods go haywire. The main hormones we address in this video are sex hormones (testosterone, estrogen, progesterone, LH, FSH), thyroid hormones, and adrenal hormones (like cortisol). We also have to balance our insulin, but we cover that later in the course. There are many other hormones, for sure, but problems with those are more rare and specialized.

What could a hormone imbalance look like for you? Do your mood and energy levels swing up and down, making you feel crazy? Do you require coffee to wake you up in the morning and wine to calm you down at night? Has your libido or sex drive decreased and you're writing it off as aging, or has your mental endurance plummeted, making it hard to focus on tasks? Do you get brain fog? These are just some symptoms of what could be a hormonal imbalance.

I hope all the tests I mention in this video are helpful in determining what’s happening with your hormones, but in Functional Medicine it's essential to remember that we want to dig deeper and find a root cause. So if you have abnormal lab tests that point to low testosterone or PCOS, for example, the story should not end there. You don't want to take the pill and cross your fingers. You want to go back and find the real issue, which is often the metabolic disturbance caused by a diet that is high in starch and sugar.

~Dr. Mark Hyman

MEN’S HORMONES

Testosterone (total): This is the main male hormone for brain health, motivation, optimal energy, heart health and more. It is estimated that 39% of men over the age of 45 have low testosterone. Why such a huge percentage? Well, diabesity is a leading contributor to this because elevated insulin levels decrease testosterone levels and can cause an increase in estrogen levels in men. As your belly fat goes up, your testosterone goes down and so does libido and sexual function. Basically when your consumption of sugar and starch go up, your sex hormones get messed up—both for men and women in slightly different ways.

• Normal: 264-916 ng/dL
• Optimal: >500 ng/dL

Free Testosterone: The majority of testosterone is bound to sex hormone binding globulin (SHBG). Free testosterone is the amount of testosterone that is actually able to produce its effect on the body because it is not bound to a protein carrier.

Normal: 

• 20-50 years old: 7.2-26.5 pg/mL
• > 50 years old: 6.6-24.0 pg/mL

Optimal:

• >15-25 pg/mL

Sex Hormone Binding Globulin (SHBG): This is the protein that binds testosterone (making it unusable). 

Normal:

• 20-49 years: 16.5−55.9 nmol/L
• >49 years: 19.3−76.4 nmol/L

DHEA: DHEA is  the precursor to testosterone. We need this hormone for optimal energy levels. If DHEA is low it can indicate that your adrenal glands, which are responsible for responding to stressors, may not be functioning optimally. 

• Normal: 71.6-530 µg/dL
• Optimal: 200-530 µg/dL

Estrogen (estradiol): Estrogen is an important hormone for both men and women, though it is often demonized in men’s health because some men have too much estrogen. However, normal levels of estrogen are essential to maintain balanced hormones and a happy brain. Estrogen becomes elevated in men due to diabesity, and insulin can actually increase the conversion of testosterone into estrogen, which can add to the fatigue and sexual dysfunction that is already prevalent in insulin resistance. Too much estrogen causes man boobs, beer belly, loss of hair on chest and limbs—basically turning a man more into a woman!. 

• Normal: 7.6−42.6 pg/mL
• Optimal: 20-40 pg/mL

Luteinizing Hormone (LH): LH causes the production of testosterone in men and stimulates the release of an egg in women. 

Normal: 1.7−8.6 mIU/mL

Follicle Stimulating Hormone (FSH): FSH is responsible for the production of sperm in men and develops the follicles in the ovaries of women. 

Normal: 1.5−12.4 mIU/mL

WOMEN’S HORMONES:On day 19-21 of menstrual cycle

Day 1 = first day of bleeding (first day of a women’s period)

Progesterone: Progesterone is a female hormone that is calming (reduces anxiety) and prepares the uterus for pregnancy. Some women have normal values of progesterone but have too little progesterone when compared to the amount of estrogen they produce, which is why we want to look at the ratio of estrogen to progesterone. Ideally we want about estrogen to be 10x the amount of progesterone at this time of the cycle.

• Normal: 1.8−23.9 ng/mL
• Optimal: >5 ng/mL

Estrogen (estradiol): Estrogen is a female hormone responsible for female sex characteristics, memory, and heart health. While it is essential, women can have too much estrogen due to sub-optimal detoxification pathways, or constipation—both of which are how we clear estrogen from the body. But remember, the ratio of estrogen to progesterone is just as important as absolute values.

• Normal: 43.8-211.0 pg/mL
• Normal post-menopausal: <6.0−54.7 pg/mL
• Optimal: 80-200 pg/mL (~10x the amount of progesterone)

Follicle Stimulating Hormone (FSH): FSH is responsible for developing the follicles in the ovaries of women. In polycystic ovary syndrome (PCOS), FSH can be low, so low that ovulation and conception can’t occur, which is why women with PCOS have infertility. 

• Normal (d 19-21): 11.7-7.7 mIU/mL
• Normal Post-Menopausal: 25.8-134.8 mIU/mL

Luteinizing Hormone (LH): See above. 

• Normal: 1.0-11.4 mIU/mL
• Normal Post-Menopausal: 7.7-58.5 mIU/mL

DHEA: See above. 

• Normal: 41.2-432 µg/dL
• Optimal: 200-432 µg/dL

Testosterone (total): Testosterone is responsible for male sex characteristics in men, but is also essential in women’s health. Testosterone ensures that we have optimal energy levels, motivation, and a healthy sex drive.

Normal:

• 20-49 years: 8−48 ng/dL
• >48 years: 3-41 ng/dL

Optimal: 60-80 ng/dL

Free testosterone: See above.

• Normal: 0-4.2 pg/mL
• Optimal: >0.5 pg/mL

Sex Hormone Binding Globulin (SHBG): See above. 

Normal:

• 20-49 years: 24.6−122.0 nmol/L
• >49 years: 17.3−125.0 nmol/L

Optimal: 16.5-80 nmol/L

Additional hormone testing: DUTCH Test by Precision Analytical or Essential Estrogens by Genova Diagnostics

Both of these tests look into downstream breakdown products of hormones and tell you a lot more about what’s happening with your hormone metabolism. These are measured using urine, not blood.

THYROID PANEL

Thyroid stimulating hormone (TSH): This is the most commonly run test to check for thyroid disease. 1 in 5 women and 1 in 10 men have low thyroid function. Common signs of hypothyroidism are cold hands and feet, trouble losing weight or weight gain, brittle hair and nails, dry skin, constipation, being tired all of the time, having trouble getting up in the morning, and brain fog or memory issues or depression. These symptoms warrant a thyroid panel to see if this gland is not kicking out the fuel it should be.

• Normal: 0.45-4.5 µIU/mL
• Optimal: 1.0-2.0 µIU/mL

Free T3 (fT3): This is the active thyroid hormone that actually exerts its effect on the cells. It is responsible for energy production, hormone production, regulating bowel movements, and so much more.

• Normal: 1.81−4.06 pg/mL
• Optimal: 3.2-4.4 pg/mL

Free T4 (fT4): T4 is the majority of the thyroid hormone that is produced. It must get converted to active thyroid hormone (fT3) in order to have any effect in our body. If free T4 is normal but fT3 is low, then you are not converting properly and might require supplementation with nutrients to help this processes along.

• Normal: 0.82-1.77 ng/dL
• Optimal: 1-1.5 ng/dL

Thyroid Peroxidase Antibodies (TPO antibodies): 90% of the individuals who have hypothyroidism have autoimmune hypothyroidism (Hashimoto’s disease). TPO is one of the markers for Hashimoto’s. It is important to know the cause of hypothyroidism because you treat it differently from non-autoimmune hypothyroidism.

• Normal: 0−34 IU/mL
• Optimal: 0 IU/mL

Anti-thyroglobulin antibodies: Another marker for autoimmune thyroid disorder (Hashimoto’s).

• Normal: 1-115 IU/mL
• Optimal: 0 IU/mL

Reverse T3: Reverse T3 is like the brake that stops your thyroid hormone production. Sometimes there are good reasons for higher Reverse T3 but often it’s because something’s wrong. Unfortunately, toxins, stress, inflammation all increase levels of reverse T3, which blocks your thyroid. Even if the regular thyroid tests appear normal, high levels of reverse T3 mean your thyroid is not really working properly.

• Normal: 9.2-24.1 ng/dL

ADDITIONAL TESTS

Cortisol Test (Adrenal Stress Index): Cortisol is a hormone that is produced by your adrenal glands. It is responsible for waking you up in the morning and responding to stressful situations. The adrenals are two small glands that sit on top of your kidneys and they produce cortisol as well as the reproductive hormones above. These glands are one of our first responses to stress, and in chronic stress your adrenals get fatigued, your energy plummets, and it becomes difficult to manage your life. You could feel tired and wired, all at the same time. You might get palpitations or feel anxious or have trouble sleeping. You might crave salt. You may get dizzy when you stand up. You might have low blood pressure. You might even have sugar cravings, because your body can’t regulate your blood sugar properly. All these are clues that you could have adrenal problems.

To test cortisol, it is best to test it at multiple time points throughout the day to ensure that your levels are normal AND that you have a normal pattern of cortisol release (highest upon waking, and lowest before bed).

Companies who test cortisol measurements throughout the day using saliva:

• Adrenal Stress Hormones-Salivary by ZRT Laboratories
• Adrenocortex stress profile by Genova Diagnostics
• Adrenal Stress Index by Diagnos-Techs

Additional Resources:

• How To Boost Testosterone Naturally by Dr. Mary Pardee, Modrn Med
• HPA Axis Questionnaire: This is a great place to start to see if you fit more of the high cortisol pattern or the low cortisol pattern. If you really want to get answers, then testing is the only really way to know.

The content in this course has been made available for informational and educational purposes only. This content is provided on the understanding that it does not constitute medical or other professional advice or services. Always work with qualified healthcare practitioner when making changes to your medication, diet or overall healthcare plan.