Functional Medicine Q&A: Hormone Health

Episode 62

Podcast Drop Date: 

7/23/2025

What if balancing your hormones wasn’t just about taking medication, but about working with your body to uncover the root causes? In this Functional Medicine Q&A episode, host Amber Warren, PA-C, answers our listeners' top 10 most common questions about hormone health. She explores signs of imbalance in both women and men, overlooked symptoms, and how birth control can impact hormones long-term. You’ll also learn about the differences between bioidentical hormone therapy and lifestyle-based approaches and when each might be right for you.

Amber shares her top five hormone health essentials and practical ways to support your hormones through perimenopause and menopause, often without relying on medications. She also explains the powerful connection between gut health, nutrition, and supplements in achieving hormone balance. If you’re ready to take control of your hormone health and feel your best, this episode is a must-listen.

Transcript:

Amber Warren, PA-C: Welcome to the Functional Medicine Foundation's podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts, and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper.

Amber Warren, PA-C: Welcome back everybody. So today's episode is another functional medicine Q&A where I'm answering your top ten questions, but this time about hormone health. I'll be talking on signs of imbalance in both women and men. Overlook symptoms, the effects of things like birth control, bioidentical hormones, and the difference between therapy and lifestyle approaches. I'll also share my top five hormone health essentials how to support your hormones through perimenopause and menopause without the necessary medications, and the role of gut health food and supplements. So if you're ready to better understand your hormones and take back control, this episode is for you. Let's dive in.

Amber Warren, PA-C: Okay, so on the topic of hormones, I think it's really important to just put a little disclaimer that hormones are signaling molecules. So we tonight we're focusing on sex hormones. But we also have insulin. That's our fat storage hormone. We have thyroid hormones. We have growth hormones. We have. Um. Oh my goodness. Leptin is a hormone that makes us feel full and satiated and can cause a lot of inflammation. So tonight the topic is is focused mostly on sex hormones. So the first question was what are the top three signs of hormone imbalance in men and women? Um, I'm so sorry I can't stick to just three because there's just too many top signs that I want to capture.

Amber Warren, PA-C: So for women, I would say mostly fatigue, um, weight gain, mood. So anxiety, depression, irritability. Hot flashes, which also can be called night sweats. Those go hand in hand and then definitely libido and or sexual dysfunction. Those are um I would say the top, top five symptoms in women. For men it's somewhat similar, but more so fatigue, mood, sleep issues and then libido. And also for men I see a lot of exercise, lack of benefits or just a poor recovery from exercise. So the second question goes, um, what are some early symptoms of hormonal balance that often get that often get overlooked? Excuse me? Um, so really, for both sexes, we've got joint pain. Muscle pain, especially in women, as we start to lose estrogen, we start to see a lot of women complaining of joint pain. Frozen shoulder has been linked very closely with estrogen loss in our menopausal women. Um, but even muscle pain, muscle ache, which could be related to poor exercise recovery, low drive, motivation. We start to see fluctuations in blood sugar as we lose estrogen and testosterone. So that can lead to a lot of that menopausal or hormonal changes that that can cause weight gain, um, irritability. You're annoyed by little things, annoyed by loud noises, your children, your spouse. Although you can't always blame that one on hormone issues, your spouse just might be a little obnoxious sometimes. But as I already mentioned this, you're not just recovering either from a good night's sleep or from exercise. Um, like you like you previously did. So sleep can become an issue. It's either falling asleep or you're waking up at a out of nowhere at 2 or 3 a.m. for an unknown reason. Skin and hair changes. This is one that people don't often, um, link to hormones, estrogen and testosterone are both really important in maintaining healthy, uh, skin. Uh, collagen elasticity, especially estrogen, uh, irregular periods. They either become painful, um, prolonged or shortened. Shorter cycles, you were a very regular, and now you're having periods every three weeks instead of four. I already kind of mentioned this a little bit. All of a sudden, you find that you're just more sensitive to certain stressors. Um, a big one is you're more sensitive to alcohol. All of a sudden, alcohol is really disrupting your sleep and your mood. Um, also more sensitive to caffeine, uh, brain fog, that that brain fog. It just makes it harder to think harder, um, to wake up and feel feel rested. You just don't feel like yourself. Um, a lot of the women come into me and just say, I just don't feel like I did five years ago, and I want to know more about what's going on with my body and my hormones.

Amber Warren, PA-C: Um, so I think those are all things that that are often under looked when we're talking about hormone health. So in the next question, can birth control or fertility medications lead to long term hormone disruption? Resounding yes. And if so, how can someone recover? So when we're talking about birth control, that is an umbrella of synthetic hormones. And synthetic hormones do not belong in the same conversation as our bioidentical natural hormones that God designed us to make. So birth control would be under that category of synthetic hormones. So would a lot of different fertility agents, um, it's very commonly misunderstood, but our progestins that are in our birth controls or even can be given over the counter are synthetic progesterone and so different. Um, it's really it's your own endogenous chemical versus a manmade chemical. And so when you're receiving synthetic hormones through birth control or other medications, you will shut down your ability to make hormones. So these women that come to me that have been on birth control since they were 15 years old for hormone regulation or acne, and they come to me at 35, just coming off birth control. That's 20 years of your body not making your own endogenous, important messengers. And so there's a lot of work that has to that needs to go into that to restore that hormonal balance.

Amber Warren, PA-C: The first thing we need to do is actually detox those synthetic hormones. And there's a lot of different herbs and supplements we use to detoxify the body. Oral birth control specifically is a really hard on your gut lining. A lot of women will come to me with significant and advanced leaky gut. And so we need to restore the gut, the gut barrier, so that your body can start making your own hormones and you can absorb nutrients to make hormones. So there is a certain process of detoxing those hormones and restoring function. And then sometimes not always, but oftentimes depending on that client and their age and stage of life, they actually do need the bioidentical hormone replacement if they have been completely shut down of some of their natural hormones. Um, but everyone's a little bit difficult to predict, and not everyone lives in a box, so you definitely have to approach that from a personal perspective.

Amber Warren, PA-C: How can someone tell if they need bioidentical hormones? Um, it again, it's all personalized medicine. We do a lot of testing and not guessing. We ask a lot of the questions. When did you start to notice hormonal fluctuations? Um, what are your cycles doing? And then of course we test. We test through, um, mostly blood in urine. So we'll do serum testing.

Amber Warren, PA-C: It's actually a really good way to look at hormone levels in the body through a blood test. It does need to be tested for most perimenopausal or premenopausal women during your luteal phase. So for most women that stay 19 through 22 and we can use some really over-the-counter, pretty simple, straightforward modalities to check when you're in your luteal phase. Um, to get accurate estrogen to progesterone ratios, testosterone, things like DHEA, sex hormone binding globulin, those can be checked at any time during your cycle. Um, but really it's it's if you're looking to age more gracefully, you want to get more out of your workouts, enjoy a better sex life, therefore leading to a better marriage, you would likely benefit from some kind of modality that would help balance your hormones. The need for bioidentical really does depend depend on on age. Um, we start to lose a lot of progesterone and testosterone in our mid 30s so that for some women, if they're indeed low, becomes a really good time to replace those two hormones. Perimenopausally, when you're seeing huge swings to estrogen, some women do benefit from a little bit of estrogen support. But we we mostly look to replace estrogen when you hit menopause, when you have that dramatic drop in estrogen and therefore the pronounced, pronounced symptoms. So what's the difference between hormone therapy and hormone regulation through lifestyle changes? So there is a difference.

Amber Warren, PA-C: But I'm a big believer that you have to do both. Bioidentical hormone replacement therapy is a tool. And it's kind of like building your house on sand. The house will fall down if it's not built on rock and you don't have a firm foundation. Um, your body needs to know what to do with these healthy hormones. Gut health, liver health, healthy detoxification pathways. So you have to have that healthy foundation before you'll really benefit from hormones. You might get benefit from 4 to 8 weeks, maybe three months, but your body will still crash if you're still sleeping four hours a night. If you're in a really toxic relationship, if you have a really crappy diet with low protein and low micronutrient status. Those are things that all have to be in check. So managing your stress, that's another really big one. Cortisol is absolutely a Kryptonite to our sex hormones. Meaning if you're producing a lot of that stress hormone, cortisol, you're going to literally steal things like progesterone, which are our brain calming, body calming hormone. Um, to keep making more cortisol because that's how your body keeps functioning. That's by design, right? If you're running from a tiger, you still have to have energy to run from that tiger. And your body still has to make more cortisol so you can run faster. Um, so we need to calm down to be able to make healthy hormones and then benefit from bioidentical hormone replacement therapy.

Amber Warren, PA-C: Other things that are really important to naturally balancing hormones. The right kind of exercise. Not too much, not too little. We really, um, are very personalized on how we approach our exercise recommendations. It's more often than I than you would think that I'm telling women, stop running, stop doing your sprint training. Stop doing your hit exercise. I want you lifting heavy weights and walking and breathing and doing yoga for a period of time until we can get your hormones back online and get your cortisol back online. Get your nervous system healed. Before you can engage in that kind of, um, that kind of activity.

Amber Warren, PA-C: The next question would be, what are your top five non-negotiables for maintaining hormonal health? So I feel like I touched on this on the last question, but if I had to say five, which I think is good so people don't get overwhelmed and think this is just too much for me to do and too much for me to take on. I would say calm down. Eat clean with plenty of protein. Lift heavy. Sleep well and support your detox pathways. And I know that last one, um, can be a little bit more complicated. But really, it's it's eating clean, breathing clean air, drinking good quality water and enough of it, because we are exposed to so many different toxins. I'll touch a little bit more on this a little bit later. But chemicals and toxins in our environment can really mess with our hormones.

Amber Warren, PA-C: The next question would be how can women support hormone health during perimenopause and menopause without medication? So I don't really consider bioidentical hormone replacement therapy HRT, as true medication because these are innate, endogenous hormones that our bodies produce. But I do know some women are really trying to avoid, um, bioidentical hormones or some women just aren't great candidates. Maybe they have a really strong family history or BRCA genes or our genes that are heavily related to breast cancer. And so they're really trying to avoid bioidentical hormone replacement therapy. I think that's appropriate. And my job is to always work with my clients and help them reach their goals. So in this case, chastetree berries is actually an herb. It's also known as Vitex that really can support natural progesterone levels. It takes a while to work, but when it works, it can work really well. There's some newer products out there containing maca, which is an herb that's been around for a long time, an adaptogens herb, but it's being used to balance hormones naturally and specifically, can also be very helpful for men and women to naturally increase testosterone levels. Um, so there's definitely herbs out there.

Amber Warren, PA-C: There's rhubarb type of supplements that can be used to help with post-menopausal hot flashes. So increasing estrogen levels, actually Siberian Rhubarb, which is which is really interesting. We've been using that one for for a while. It's a great supplement. So there's definitely things out there. But I'm finding more and more in my clinical practice just because of the potency and all of the benefits we get from these bioidentical hormones, estrogen is such a powerful antioxidant. It's so good for brain health, cardiovascular health, and bone health. So many of my clients want to feel better in the here and now, but they also want those protective benefits further down the line. Because of our epidemic of of cardiovascular disease and things like Alzheimer's and dementia.

Amber Warren, PA-C: So the next question would be what role does gut health play in hormone balance. So I'm going to divide this into two categories. There's direct ways and indirect ways. So the direct ways would be um so somebody that might be dealing with constipation if you're constipated your body can't detox poor forms of estradiol or excess forms of estrogens out of the body. So you would want to fix that. So you're detoxing adequate hormones. Um, there's actually beneficial bacteria that break down estrogen and help push it out of the body. And there's actually an enzyme in the gut called beta-glucuronide, so that we can test on different stool tests and gut health to see if you have enough of this enzyme to help cleave estrogen and push it out.

Amber Warren, PA-C: So there are interesting tests we can do to look at gut health. Um, there's there's actually some newer data that imbalances in, um, the gut microbiome of men. So dysbiosis meaning an imbalance gut microbiome can lower levels of testosterone. So we're starting to take that into account more and more. Um, and then the gut microbiome and how it drives insulin resistance. Right. And therefore can drive hormonal imbalance conditions like polycystic ovarian syndrome.

Amber Warren, PA-C: And then there's indirect ways, right? We know that gut health is directly tied to things like inflammation, which inflammation will, um, will destroy our own hormones. Inflammation is a huge driver in oxidative stress. And that destroys your mitochondria and just leads to a very vicious cycle. Liver health is so closely related to gut health. And I mentioned before the reasons we need our liver to detox unhealthy or imbalanced levels of estrogens in the body. And then we need a healthy gut to absorb nutrients and nutrients are really important. They act as different cofactors and enzymes to help balance out our hormones in multiple different ways.

Amber Warren, PA-C: The next question is what are the best foods or supplements to naturally support estrogen and progesterone? So when we're looking at supporting progesterone levels, when it comes to nutrients and foods, we're looking at foods that are rich in vitamin B6, magnesium, zinc, uh, those are all very calming nutrients to the body.

Amber Warren, PA-C: And then we need healthy fats to support progesterone levels as well. So foods like leafy greens, healthy nuts and seeds, whole grains, avocados and oily fish ideally fish that are high in omega three and low in mercury. So the acronym I use for those type of fish is SMASH. So salmon, mackerel, anchovies, sardines, and herring. Who I'm glad I got that. Those are all fish I recommend because of their high omega three low omega six content. And then fish can be very high in mercury and lots of different chemicals because they're bottom dwellers. So we want to go for smaller type fish. So those are them. And then we're looking to naturally support estrogen levels as we're getting close to menopause and starting to see those levels decline. Or women that have been on, um, synthetic forms of estrogen, we're looking at foods that are rich in phytoestrogens. So naturally occurring environment. So usually plant compounds um, that can mimic estrogen. So those are a lot of soy products. Be very careful with soy. You want to make sure you're choosing non-GMO. Majority of the soy out there is genetically modified. Um so tofu edamame, flax seeds, legumes, things like chickpeas and lentils and then cruciferous vegetables like broccoli and kale. Um, and there's some kind of fruits, like berries that are also rich in antioxidants and can support estrogen levels.

Amber Warren, PA-C: Um, this last question is such a good question. Um, because we talk about it a lot. Uh, what is estrogen dominance and how do you address it effectively? So estrogen dominance is a term, um, that we use a lot to describe really a couple of different states in the body, and this can happen at any, any age. Um, it can commonly drive heavy periods, things like headaches, weight gain, mood irregularities. Um, but but two reasons to have are two states you could be in if you're going to carry that diagnosis of estrogen dominance. Either you want to have normal or high normal levels of estrogen, but really low levels of progesterone. So progesterone works to really balance out high levels of estrogen. So that would be a state of estrogen dominance. And in that case we would work to support estrogen detoxification but also really work to support healthy normal progesterone levels. The other time you might find yourself in a state of estrogen. Dominance is someone that maybe has PCOS, um, where you have high, high levels of estrogen and actually pretty normal levels of progesterone. And that would be a case where we're really working on gut health and detoxification and liver health and things like insulin resistance to drive out excess estrogen.

Amber Warren, PA-C: And that's where we would be, um, testing somebody's gut. Looking at beta-glucuronide levels, um, carefully, you know, trying to do a liver cleanse or clean up a liver to help support estrogen detoxification that way. So those are those terms estrogen dominance and the root cause, there would be yes, gut health, insulin resistance, things I've already mentioned. But the really big player in a state of estrogen dominance would be something we call xenoestrogens or things we call xenoestrogens. And these are estrogen mimicking chemicals in the environment. And newsflash, they are all over. So we're talking about scents and smells and perfumes and tide laundry detergent and candles. Anything that says perfume or parfume is likely a endocrine disrupting chemical or a xenoestrogen. And so they are. They act as estrogen in the body. They're nasty little guys that can hook on to our estrogen receptors, and therefore our body can actually use the endogenous estrogen. And as we learned before, when we're getting some kind of synthetic source, we can shut down our own ability to make our healthy, antioxidant rich estradiol levels, our estrogen levels. So we want to really try and clean up our environment. And just doing that can really help you get out of this estrogen dominant state. Um, and that's where we see, unfortunately, when we when we are living in a state of estrogen dominance for too long and we also have things like poor gut health and poor liver health at bay, that's when we see these estrogen rich or estrogen dominant cancers at play.

Amber Warren, PA-C: So things like endometrial cancer or breast cancer, um, down the line, that can definitely happen. So, um, cleaning up your environment, cleaning up your diet and making sure you're eating a nutrient rich diet with plenty of good quality clean protein, um, becomes really important in this in the state. And with carrying this diagnosis, I use supplements like DIM or calcium d-glucarate. Those are supplements that can really help support the liver and support the body's natural detoxification of estrogen. Um, Environmental Working Group, EWG.org. They are a great resource. They've got a great app where you can actually scan things like laundry detergent or personal care products because they can hide a lot of these things in their labels, and it can be really hard to detect if you're not really well educated in this space. Um, so that's, that's a great, a great way where you can actually see if your product is A, B, C, D, or F and see how potentially toxic and therefore disruptive it is to your hormones. So I'd encourage you to download that app. It's called EWG's Healthy Living. And it's a wonderful app where you can scan it to actually assess at the store, at home, your personal care products or or household products. And you can assess the app will help you assess how dirty they are and therefore how disrupting they are to your hormones.

Amber Warren, PA-C: That's all the questions we had today on hormone health. So thank you so much for submitting your questions. Um, if you're ready to dig deeper into Hormone health, where we'd love to help reach out to us at any one of our locations in Boise, Meridian, or Eagle oryou can always book a consultation on our website, www.fmioptimal.com. Thank you so much.

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Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundation's podcast. For more information on topics covered today, specialties available at the FMI center for Optimal Health and the highest Quality of supplements, and more go to funmedfoundations.com.