Raj K. Syal, M.D., F.A.C.O.G.    |    Jenna A. Everson, M.D., F.A.C.O.G.    |    Holly Westmoreland, M.D., F.A.C.O.G.   

The most frequent question asked daily by patients

Throughout my experience I have found, many patients believe that because they have no energy, weight gain, and low sex drive their hormones must be unbalanced. Although hormones can certainly cause these symptoms, other factors are much more likely to affect the way you feel. Treating patients with low energy, weight gain and low sex drive requires evaluation of their nutrition, exercise, emotions, and hormones. In the following monograph I have broken down these factors to explain how they affect your overall well-being.

The single most important factor in your well-being is nutrition. The quality of the food you eat affects every function of your body. The nutrients you consume are used by your body not only for energy, but also for the production and regulation of every hormone you produce. A diet lacking the appropriate nutrients is responsible for the way you feel and most medical conditions. Poor dieting has been blamed for the epidemics of obesity, diabetes, heart diseases and even cancers. The amount of information and opinions available regarding a proper diet is overwhelming. It would be impossible to follow every diet or take every supplement recommended by the “experts.”

I suggest the following modifications as a start:

  1. Eat less food
  2. Eat less processed food. Processed means foods that are ready to eat.
  3. More of what you consume should be cooked at home or raw (fruits and vegetables)
  4. Learn to eat a low Glycemic diet. See my article on weight loss with a low glycemic diet
  5. Avoid soft drinks, sugar substitutes, and excessive caffeine
  6. Consider adopting a gluten free diet
  7. Vitamins and supplements as needed.

You may also want to consider food allergy and micronutrient testing. We offer testing from ZRT Labs and ALCAT allergy testing. As we gain a better understanding of the effects of the environment on our genetics we realize food sensitivity can occur at any age and is responsible for many illnesses. We cannot change our genetics, but we can change what affects our genetics.

“I don’t have time to exercise.” “I don’t have the energy to exercise.” “I am moving and busy all day.” These are the three most common excuses for not exercising. Exercise does not need to be a 2 hour session at the gym with a personal trainer. A simple 30 minute walk daily will greatly improve your well-being. Most people today do not even get 30 minutes of activity a week. Daily activity helps stabilize glucose levels, improve circulation, promote weight loss and elevate your mood. Even your stress hormones, such as cortisol will improve.

If you will commit to 30 minutes of activity daily for two weeks, you will become addicted to the way you feel and start to make the time to exercise daily. Over time you may even progress beyond walking and start strength training and steps to improve your core muscles. Strengthening these muscles will improve posture and reduce chronic pain. Outdoor activities will also improve your vitamin D level. Physical activity has even been shown to reduce the risk of Alzheimer and dementia.


Lifestyle is a broad category of activities, relationships, and habits that affect your well-being. You need to take a survey of your life and change the factors that cause you stress and prevent you from achieving maximum health and well-being. Excessive stress causes inflammation and affects the body’s ability to produce the appropriate hormones. Things to consider changing include:

  • Stop smoking
  • Avoid excessive alcohol
  • Improve your sleep
  • Improve stressful relationships (family, spouse, friends)
  • Achieve a healthy balance at work
  • Time for hobbies
  • Learn techniques to reduce stress

Hormones are vital for the normal function of our bodies. Every organ and every process in the body is dependent on the presence of appropriate hormones. All hormones change as we age. Nutrition affects the production of hormones. Without the necessary nutrients the body cannot produce adequate thyroid, adrenal, or sex hormones (estrogen, progesterone, and testosterone).
Exercise regulates the production of cortisol, insulin, and growth hormone. And finally, stress affects the production of most hormones.

Can an imbalance of hormones cause you to feel bad?

Absolutely. The key is to find which hormone is the culprit and why its production is altered. Too much hormone can be just as bad as not enough hormone. Adopting the strategies above, most people will improve and balance their hormones naturally. However, if symptoms persist, hormone and nutrient testing may be necessary to help you improve. Testing identifies specific deficiencies which then determine treatment. Hormones we typically check depends on the symptoms you are experiencing. Click here for our patient symptoms form.

The adrenal glands are a pair of small glands located above the kidney. Most people are unfamiliar of their presence and the role they play in hormone balance. Fatigue is a common complaint of patients. Adrenal fatigue symptoms include, tiredness, anxiety, allergies, frequent influenza, arthritis, fearfulness, depression, reduced memory, insomnia, worn-out, difficulties in concentrating and the inability to lose weight.

Adrenal fatigue has an extensive range of non-specific, but often weakening symptoms. The beginning of this condition is often slow and dangerous. Patients are told that it is simply stress and they need to relax more or that nothing is wrong with them or that they must be depressed. Over time, the condition worsens as the as the adrenal production continues to decline.

Signs and Symptoms of Adrenal Fatigue

  • Propensity to add on weight and incapable to lose it, particularly around the waist
  • Elevated recurrence of the flu and other respiratory diseases. These symptoms most likely last longer than common.
  • Tendency to tremble when pressured
  • Reduced sex drive
  • Lightheaded when rising from a horizontal position
  • Incapable to remember things.
  • Lack of energy in the mornings and in the afternoon between 3:00 PM to 5:00 PM
  • After a meal feeling better for a short period of time.
  • Cannot sleep, even though often feel tired from 9-10 pm
  • To get going in the morning need coffee or other stimulants
  • Cravings for fatty, salty, and high protein food like meat and cheese
  • Increased symptoms of PMS for women; periods are heavy and then stop, or are almost stopped on the 4th day, only to start flow again on the 5th or 6th day
  • Discomfort in the upper back or neck without logic
  • Feels better when stress is relieved, for instance on a vacation
  • Difficulties in getting up in the morning

Other signs and symptoms include:

  • Alternating constipation and diarrhea
  • Decreased ability to handle stress
  • Dry and thin skin
  • Dyspepsia (heartburn)
  • Food and or inhalant allergies
  • Hypoglycemia
  • Increased effort to perform daily tasks
  • Lethargy and lack of energy
  • Low body temperature
  • Mild depression
  • Nervousness
  • Palpitation
  • Unexplained hair loss

The adrenal gland handles the daily stress of life. To accomplish a total body hormonal balance, woman must regulate her adrenal glands. Many times the replacement of deficient hormones without addressing the overall health of the adrenal gland is simply a band-aid technique that becomes ineffective long term. By disposing of stressors the course of normalization begins. Stressors are often deep-rooted, and can be linked to lifestyle, dietary, mental, and inflammatory causes.

Removal of these stressors followed by treatments to support the adrenal hormone production can result in the improvement of symptoms over time. If you feel you are experiencing these symptoms, complete the adrenal fatigue questionnaire prior to your appointment. Based on your symptoms, saliva testing may be recommended.

The thyroid gland acts like the body’s regulator. Converting oxygen and calories into energy is its primary purpose. It also serves as a regulator of heart rate, blood pressure, body temperature, metabolism, and growth. Almost any aspect of health can be perturbed by an inadequate thyroid. This commonly unseen disease affects around ten percent of the adult population. Along with adrenal fatigue and estrogen dominance, a thyroid problem is one of the most under- diagnosed hormonal irregularities of aging. It is estimated that one out of every twelve women will have some degree of hypothyroidism by the age of 50, and by age 60 one out of six. Many times, hypothyroidism is misdiagnosed as dementia.

As one of the master regulators of body metabolism, symptoms of low thyroid function generate a global response. Symptoms include:

  • Diminished muscular movement of bowl wall, which provokes abdominal cramping and IBS
  • Insufficient thyroid levels in the brain develop brain fog and depression
  • Constipation that is resistant to magnesium supplementation
  • Due to reduction of cell turnover and tissue/hair growth there will be unexplained hair loss.
  • Malfunction of cellular energy conversion and T4 to T3 conversion will lead to fatigue and low energy, with need for frequent naps
  • High cholesterol unable of being controlled with cholesterol lowering drugs
  • Irregularity of testosterone, estrogen, and progesterone causing low libido, PMS, miscarriage, and infertility
  • Inactive shift of nutrients and oxygen into heat will lead to sensitivity to the cold while others are warm
  • Dry, scaly, rough, and cold skin due to greater demand on metabolism with limited thyroid back-up
  • Isolated T4 caused by a minimized metabolism that broadens fat cells, produces an unexplained weight gain and continues to generate apathy and depletion

A fragile adrenal system may not be able to bear extra energy. In the case of advanced adrenal fatigue, providing thyroid medication without coexisting care to adrenal recovery often results unsuccessful. The adrenals does not need an extra burden, what it needs is rest. Those who have hypothyroidism but fail to improve after taking thyroid replacement medication should therefore always investigate adrenal fatigue as a possible etiology for their thyroid problem. Normalization of the adrenal function in such cases is the key and often leads to spontaneous resolution of hypothyroid symptoms.

If you feel you are experiencing these symptoms, complete the symptoms questionnaire prior to your appointment.

Ovarian Hormones
The ovaries are the source of the majority of estrogen and progesterone production. The effects of estrogen are balanced by progesterone. Both hormones are needed for optimal function. Swollen breasts and ring fingers, impatience and irritability, stomach cramps before menstrual cycle, irregular periods, fluid retention, cloudy thinking, depression, and debilitation are the most common complaints given my patients suffering with estrogen dominance.
Estrogen Effect | Progesterone Effect
  • Causes breast simulation that can lead to breast cancer/ Protects against fibrocystic breast and prevents breast cancer
  • Increases blood clot risk/Normalizes blood clotting
  • Increases body fat/ Helps use fat for energy
  • Increases endometrial cancer risk/Prevents endometrial cancer
  • Reduces vascular tone/ Restores vascular tone
  • Slows bone breakdown/ Promotes bone growth.
  • Thins the endometrium/ Stops bleeding

While sex hormones such as estrogen and progesterone decline with age gradually, there is a drastic change in the rate of decline for these two hormones during the perimenopause and menopausal years for women. During the ages of 35 to 50, the production of progesterone decrease seventy-five percent, while estrogen only declines approximately thirty-five percent. The volume of progesterone is scarce, whereas estrogen is present at around half its pre-menopausal level, by the time menopause begins.

After ovulation desists, progesterone is only created by the adrenal gland in a small scale. The steady decrease in estrogen and the drastic drop in progesterone create an unbalance level of progesterone and estrogen. The lack of progesterone to neutralize the volume of estrogen in the body is called estrogen dominance.

Many women in their mid-thirties, most women during perimenopause (mid-forties), and essentially all women during menopause (age 50 and beyond) are overloaded with estrogen and at the same time suffering from progesterone deficiency because of the severe drop in physiological production during this period. Menopause, with its drastic drop in estrogen and progesterone requires special consideration. Hormone replacement is vital to your health, vitality and longevity.

Other causes of estrogen dominance include environmental estrogen exposure, obesity, stress, poor diet, lack of exercise, and incorrect hormone replacement. Adrenal and thyroid dysfunction can also contribute to the imbalance of estrogen and progesterone. If you feel you are experiencing these symptoms, complete the symptom questionnaire prior to your appointment. Based on your symptoms, saliva testing may be recommended. Therapy using high quality bio-identical hormones is available.

Testosterone is another hormone produced by both the ovaries and adrenal glands. Levels of this hormone peak at about age 23 in women. After that, there is a 2-3 percent drop each year in testosterone production. Many of the common complaints of tiredness, low motivation, trouble sleeping, and loss of sexual interest can be related to low testosterone. See my article on testosterone therapy using bio-identical pellets.

Raj K. Syal, M.D., F.A.C.O.G.