In this Friday‑podcast episode, Dr. Aaron Hartman expands on his series about holistic hormonal health, focusing on how chronic stress and trauma disrupt the hormonal balance of women entering perimenopause. He explains that persistent activation of the HPA axis can lead to thyroid resistance (high reverse T3 with low free T3/T4 despite normal TSH) and a hibernation‑type metabolic state. This stress‑induced dysregulation amplifies typical perimenopausal symptoms—hot flashes, night sweats, fragmented sleep, heightened sympathetic tone—by lowering the body’s temperature set‑point tolerance. Hartman outlines practical, evidence‑based lifestyle interventions: tracking sleep and HRV with devices like the Oura Ring, aligning meal and sleep timing, incorporating breathwork, meditation, physical activity, and regular nature exposure (forestry medicine). He also highlights the therapeutic value of creative hobbies (painting, crocheting) for emotional regulation. Throughout, he frames the discussion within psychoneuroendocrinology, urging listeners to adopt a holistic, resilience‑focused plan that goes beyond conventional hormone replacement therapy toward true hormone optimization.
Chapters
Holistic hormonal health, the next level of hormonal treatment, the next level of hormonal health. Many of us are familiar with hormone replacement therapy. It's now been approved to do since November 2025 by the FDA, which many of us have been doing for years before. We knew how helpful it was for our patients. But there's a next level of that, which is hormone optimization, which we've talked about many times in other podcasts. And the last several episodes on our Friday podcast, we've talked about the idea of a holistic hormonal hierarchy. How does everything interact with your hormones? And we gave out the different factors. And this is the third episode and last in this series I want to talk about, but I want to mention a few things in regards to that, which are trauma, nervous system security, emotions, how all these impact our hormones, particularly our sex hormones. Chronic stress, little t trauma, big T trauma can over time suppress your HPA axis. One of the things that happens is you'll get thyroid resistance. Your body wants to go into a state of basically hibernation. So if you do a complete thyroid panel, you actually see your reverse T3 being high, either the 4th quartile or above. And then you'll see your free T3 and your free T4 be the bottom, 1st quartile or below. But at the same time, your TSH is normal. Maybe it's even the optimal range. It could be even 1. Well, the reality is that your HPA axis is trying to put you into a hibernation-type state because of the stressors. And they can be acute. We do see this with acute traumas. And it can be a low-grade stressor dealing with, you know, a sick loved one. You know, our family have had issues with just dealing with kids with special needs and how that's caused a lot of issues. And I see a lot of patients that have that same thing as well. It could be job stress. It could be, you know, residual COVID stress. It could be social media stress. There's actually literature on this, on social media exposure and news feed exposure being directly related to elevated cortisol and dysregulating this neurohormonal axis. The point is these are external factors that can have an impact on your brain-body access. Um, your mind-body medicine that I kind of used to make fun of and say it's weird, woo-hoo nonsense, right now psychoneuroimmunoendocrinology is now cutting-edge science in the space of how your mind, your psyche affects your nervous system, your hormonal system, your thyroid system, your gut system, your entire body. And external factors, external stressors, low-grade stress can actually impede this or impact this. So I have a lot of patients I'm working with who, as they go through from, you know, regular female aspect of their life, getting towards that perimenopause area, the estrogen starts to do its funny stuff, progesterone's already been down, testosterone's already been down. All of a sudden they can no longer deal with stress like they used to, and they start having hot flashes, night sweats. They start having a lot of hormonal symptoms, even though this is a normal changing phase of life, because the cortisol is so high and their sympathetic nervous system is so high, their riostat, their temperature thermometer set in their brain gets dysregulated and all of a sudden all the stimuli they're used to are now exaggerated. So a small fluctuation in their body temperature results in a big perceived fluctuation to the extent you can have vasodilation, you can have sweating. Poor sleep is a common thing that happens during this time. Being awakened easily, startled easily, wake up in the middle of the night in a startled kind of state. Awaking early, it's, yeah, this is a phenomenon that the daytime intrudes into the night. So you wake up early and then throughout the day you feel tired early. A lot of these can simply be the end result of chronic stressors, whether it's job stress, work stress, family stress, et cetera. Lack of rest, lack of sleep makes all this worse. If you're a shift worker, you're a nurse, physician who works— like I used to work for years, works graveyard, whatnot— all of a sudden that's going to impact all this. And the lack of varied mental activities, doing the same thing over and over and over, not varying up what you do mentally with your, with yourself can lead to that as well. And that's where stagnation in personal pursuits, which unfortunately happens with life. Always can play into this, this idea of emotional factors and your brain-body access affecting your hormones. This is one of the more difficult areas I have to deal with with patients because one, people aren't as aware of the mind-body connection, aren't as aware of the science behind this. And literally you can get a PhD in this. It's called psychoneuroendocrinology. You can actually get a doctorate level degree in this and there's tons of research in it. And because they're not aware of it, they don't realize they can start looking at things like tracking your sleep. I track mine with an Oura Ring. Look at your day-night sleep cycles. Look at your gut. There's an interesting association with when you eat, when you go to bed, for example, is a stressor to your body. If you eat right before you go to bed, you'll see your heart rate variability is low for the first 3 to 4 hours. For me, it takes about 4 hours before it starts going back up. You'll notice your heart rate being high. Mine will be like as much as sometimes 70, 75 when I'm sleeping the first part of the night, just because I had a big meal before I went to bed. It's doing the wrong things at the wrong time when your body can have negative impacts. You know, you're supposed to eat certain times, you're supposed to sleep certain times, you're supposed to be physically active certain times. Switching those things around can have a negative impact on your physiology. So realizing that these stressors and re-regulating your body, having normal daily patterns of living, of stress reduction, breathwork, prayer, meditation, physical activity, being outside— there's actually a field of medicine in Japan called forestry medicine. Where they'll actually measure people's cortisol levels. They go out in the forest and have these little beautiful paths. They'll measure your oral cortisol levels as you're walking and they'll see them come down just in a 45-minute walk in nature. So just nature exposure can have a massive impact on your body's resilience or ability to deal with stress. So maybe for you, it's not that you need to change a lot of stuff. It's just need to be in nature more. You go for a walk during lunch, you start your day with a walk, you end your day with a walk outside or time in nature. One thing my wife recently has fallen back in love again with is painting. She really loves just being distracted painting. I've also found it interesting how many young people are getting back into crocheting. I've actually seen multiple young people doing that. You talk with them and it's just like, and they tend to be more anxious predisposition and they find like crocheting just kind of helps get them in the zone, helps relax them. So the idea is that if you're having hormonal issues, you've done all these things, you've done the, this typical replacement, you've done the optimization, you're still not optimal. Looking at hormones, your hormones holistically from a holistic viewpoint and dealing with all these factors that I've mentioned in the last 3 podcasts can be super huge. And last of which is actually probably the most important, that stress, the neurological aspect, including the emotional aspect and how figuring out your own body's resiliency plan can have a massive impact on your hormones. Hopefully this information's been helpful. If you have any thoughts you'd like to share with us, please put 'em below. I'd like to hear from you if you, if this has been helpful and if there's any other things you'd like know about on these Friday episodes. The purpose of these is for education, encouragement, empowerment. So if you let us know what you'd like to learn about, we can put them into our series and talk about them as time permits. Take care, we'll talk to you soon.
