Warning Signs of a Hormonal Imbalance

People young and old experience symptoms of hormonal dysfunction.

Men who present with hormonal imbalance may note changes in libido and sexual performance, weight gain, hair loss, and decreased muscle mass. Women may come to you with changes in their energy levels, food cravings, weight gain, and hair and skin problems.

Oftentimes, patients will attribute these changes to the normal process of aging. We talked to Dr. Ramneek Bhogal, Professor at Life Chiropractic College West and functional medicine practitioner, about the driving forces behind these imbalances and how functional medicine practitioners can identify them in their patients.

Hormonal Imbalance in Women

Dr. Bhogal has found that in most cases women are more willing to discuss their health concerns than men, readily identifying historical health patterns in their menstrual cycles and bodies.

Younger women often present with acne or painful or irregular periods. Women who are having difficulty getting pregnant may start to question their fertility and experience mood changes, cysts, low mood, and anxiousness. Dr. Bhogal also says that statistically, patients with signs of hormonal imbalances are often women between the ages of 30 and 55, in the peri-menopausal through post-menopausal window.

Hormonal Imbalance in Men

Some men may not appear in your office for treatment until there’s more at stake.

They may have put off making an appointment and chalked up hair loss and belly fat to aging. Your conversations with male patients regarding hormonal imbalance may occur later in the game. The tipping point for making the appointment may be sexual challenges or loss of sex drive. Men between the ages of 40 and 50 years of age will often take the initiative when they suspect something’s up, but that doesn’t mean that a hormonal shift just started. In many cases, men are dealing with the effects of a hormonal imbalance years before seeking treatment.

The Role of Stress

Spend an hour watching television and you’ll see your fair share of commercials aimed at men who are experiencing symptoms of hormonal shifts: muscle building powders and workout machines, and other proposed solutions to symptoms of hormonal imbalance. These messages tend to focus on the symptoms rather than the root causes.

For men and women, addressing the underlying issue and causes of hormonal imbalance is key to shifting levels back to the normal range and avoiding more serious, systemic issues. Hormonal imbalance doesn’t occur overnight and likely started much earlier in your patient’s life—even in their 20s or teens. Lifestyle has a real impact on hormones. What your patients eat, what they’re exposed to, and what levels of stress they experience are all factors that can influence hormone production.

Dr. Bhogal names stress as a major player with a direct impact on steroid hormone production; in women, it’s namely progesterone and estrogen, while in men, it’s testosterone. He finds that cortisol levels are a good predictor of stress levels. During an initial intake, Dr. Bhogal takes a healthy history that includes a kind of road map of the patient’s life changes. This allows him to look at historical patterns of stress in the patient and where hormonal changes may have occurred, based on their ability to produce steroid hormones at any given place on that map.

Cortisol and Progesterone

When he begins gathering information about a patient’s physiology, Dr. Bhogal looks for information about their cortisol and DHEA output. He then looks downstream to progesterone, estrogen, and testosterone and checks insulin. Patients can exhaust their body’s ability to produce adequate amounts of cortisol, and the body will compensate by finding sources to turn into cortisol to make up for the deficiency. One of the first options it turns to is progesterone.

Cortisol that’s functioning normally operates in three different stages. In the first stage, where the body reacts to stress in a normal way and cortisol spikes and comes back down, saliva testing can help determine whether cortisol function is normal. Stage two is a hyper reactive state, an anxious state where cortisol production continues. Progesterone shunting, or stealing, can occur between the second and third stage, when cortisol production isn’t working well anymore. It’s in this shunting process that symptoms of hormonal imbalance begin to crop up, because when progesterone dips, estrogen begins to have a more dominant effect in the hormonal relationship.

A similar pattern occurs with insulin, and lifestyle is again a key player. When someone feels depleted in energy, she may reach for sugar or caffeine boosts and that creates a feedback loop that has negative effects on the body’s resistance to sugar and insulin. As this loop continues, metabolic changes can occur and the thyroid’s function can be impacted. As we discussed in a previous post, high cortisol is linked to metabolic issues, thyroid issues, and insulin resistance issues that can lead to greater complications down the line.

Dietary Supplements, Stress Management, and Lifestyle

We know it takes considerable effort and financial expense to eat well. We know that poor habits are hard to break, and the standard American diet and culture is rigged against good health. No one is ever truly shielded from stress. Yet, as functional medicine practitioners, there are a few things we can do to help foster greater hormonal balance and, thus, better overall health:

• Listen to your patient. Most of the time, patients will have some answers in the stories they tell you.
• Know the physiology. Be aware of where hormones come from, which ones are impacted, and what’s impacting them based on what the patient tells you.
• Use your tool set. Know how you can test and evaluate with some level of reproducibility and be able to relate that to the patient.

“If you do these three things,” says Dr. Bhogal, “you’re not only beginning to understand what the cause of the problem is, but you’re also setting up an environment for sustainable change.”

Supplement dosing will depend upon the severity of the issues the patient presents, the patient’s metabolism, weight, and size, as well as the specific brand of supplement you choose to use. As with many health issues patients face, listening and looking at the bigger picture goes a long way in identify the symptoms and sources of hormonal imbalance.