Hormones & Mental Health: What Every Counselor Should Know (CEU)

Foreign. I'd like to welcome everybody to today's presentation on sex hormones and mental health, the 2025 update. I'm your host, Dr. Donnelly Snipes. So sex hormones, or our gonadal hormones, are very important in helping regulate inflammation and neurotransmitters and mood and cognition and energy and all kinds of other stuff. Stuff. So it's important for us to understand that if people are not feeling well, if they are depressed, if they have low energy, if they have brain fog, it could be because of changes in sex hormones. It could be because of a variety of other things. But we don't want to ignore some of the things that are kind of obvious and relatively easy to adjust. So today we're going to identify the effects of estrogen, progesterone and testosterone levels on mood, cognition and neurotransmitter levels. Now, yes, we're actually going to briefly talk about dhea. There are other sex hormones in the body, but we're just. For time's sake, we're just going to focus on the big three. We'll explore the effect of cortisol, your stress hormone, on sex hormones and mood and energy, and identify the causes of sex hormone imbalances and possible interventions. Again, most of us in this room right now are not prescribers, so we are not going to help people get on hormone replacement therapy, for example. But there are a lot of things like stress and circadian rhythm imbalances that directly negatively impact our sex hormone balance. So there are a lot of behavioral and lifestyle strategies that people can use to optimize the gonadal hormone balance in their body, such as it is estrogen. Now, remember, estrogen, progesterone, testosterone are present in all humans. It doesn't matter what your assigned sex is. You have all three of them. If you are male, then testosterone is your primary, but you still have estrogen and progesterone. If you are female, then estrogen is your primary, but you still have some testosterone, some progesterone. Estrogen is linked to mood disruptions in women in particular. Now, why are we saying that? Well, because it's our primary gonadal hormone, so we have a lot more of it, if you want to think about it that way. So when it gets imbalanced, it's much more noticeable than maybe if our testosterone gets a little bit wonky. So in women and. And all of our hormones. I know, I'm kind of all over the place. Sorry. All of our hormones kind of operate on the Goldilocks principle, too little not good. Too much not good. We need it to be just right for us. And when people go to the doctor and they get blood tests, there is a average range or a normative range that people are in. Well, normative may not be ideal for you. And that is something we need to encourage our patients to talk about with their providers. If the doctor says, yeah, you're still within the normal range, and the patient's saying, well, I still feel like crap, doc, that indicates that something, something in that blood work may not be optimal for that person. I know for me, I am in the optimal or the average range for estrogen, you know, but I was at the very, very, very low end and the doctor upped my estrogen and I felt so much better. So now I'm in the mid range, which is optimal for me. Was I normal before? Well, yeah, but I am optimal for, for me now. So anyway, estrogen is linked to mood disruptions in women. Premenstrual syndrome, premenstrual dysphoric disorder, and postpartum depression are all strongly implicated or caused by estrogen imbalances. And postpartum depression is not just not having that baby in there anymore and all the hormone changes that take place. It's also the stress of circadian rhythm disruption and sleep disruption. Both of those not only increase stress, but they also throw the body clock off, which throws estrogen production off a little bit. I also have postpartum depression starred, if you will, because right after the baby is when people, most people think big hormone changes, blah, blah, blah. This is all we've got to worry about. Once that passes, we're good. If the mother decides to breastfeed, when the mother stops breastfeeding, there is another huge hormone shift. So it's important to normalize for and validate for that person. Yeah, you know, your hormones are all over the place right now, stopping breastfeeding, and we're going to talk about this in the oxytocin presentation a little bit more. But stopping breastfeeding has psychological consequences as well as hormonal consequences for a lot of women. So we do want to recognize that. And all of that, all of those consequences are stressful. Stress will alter estrogen availability. Estrogen is extremely neuroprotective. So when our estrogen levels are too low, we tend to have more mood variability and we tend to feel flatter, if you will, more depressed, more brain fog. So we do want to pay attention to that as well. A lot of brain fog is caused by neuroinflammation. Estrogen really neuroprotective, low estrogen, more neuroinflammation, more brain fog. You know, it's really when you stop to think about it, when we start looking at the. The mechanisms of what's happening under the hood, a lot of this stuff makes sense, and we can trace it back and figure out some lifestyle interventions that can be helpful. Estrogen levels in women with PMS or PMDD are almost always normal, which is maddening. Remember I said not necessarily optimal for that person. The problem may lie instead in the way that estrogen talks to parts of the brain involved in mood or the levels of other hormones or neurotransmitters. Estrogen, testosterone, progesterone, kind of like all of our neurotransmitters, they all work together in our thyroid hormones. When one of them gets out of whack, it throws the entire system out of balance. So maybe estrogen levels are normal for that person. Maybe they're even optimal for that person. But something else may be out of whack. It may communicate differently. It may be more stimulating of the receptors or other hormones, maybe increasing or neurotransmitters increasing. They're not really sure. But if somebody comes and tells us, you know, their symptoms, their monthly increases in anxiety and moodiness and anger, and they have identified that it really relates to their. Their period, that's important information that needs to be validated. And a lot of times they'll go to the doctor and the doctor says, now there's nothing wrong with you, your estrogen levels, your hormone levels are fine, and the person's going. So you're telling me it's all in my head and it's not. So many times women in particular, unfortunately, report going to the doctor and being told that they're either depressed or having anxiety attacks. And, you know, that's okay, sweetie. And it feels very patronizing and very invalidating. So one of our goals is to say, you know what, I hear you. Let's get curious about what's going on. We can't necessarily fix it again, because we're not medical providers, we're not prescribers. But let me help you gather some information that may help you advocate for yourself with your provider. Let me help you identify other strategies you may be able to use to help your body function better. The way it's wired. During perimenopause, up to 10% of women experience depression that may be caused by unstable estrogen. Some studies suggest that using a transdermal estrogen patch by itself can improve depression. During perimenopause. This is true for a lot of people. The transdermal creams, gels, patches provide a much more stable estrogen dose to people throughout the day than oral estrogen does. So it is definitely the preferred administration. And when you recognize that estrogen tends to be neuroprotective in the appropriate areas in, in that appropriate level for that person, it helps moderate mood, too little estrogen, flatness, low mood, low energy, depression, too much estrogen, anxiety, anger, irritability. So if you help that person get their estrogen back into that ideal range a lot of times, and they call it hormone induced depression, it may improve. Now there's a lot of things besides perimenopause that can cause estrogen to go too low. And that's something else that we want to look at. If somebody is having persistent depressive symptoms, we may encourage them to talk with their doctor about whether there's a possibility that their gonadal hormones or their thyroid could be contributing to that. Easy enough to test and rule out. So you know, why not? Mood related functions of estrogen include increasing serotonin and the number of serotonin receptors in the brain. Well, there you go. That's one big issue. If estrogen is lacking, then serotonin availability is going to be lacking. Modifying the production and effects of endorphins is also an important aspect of estrogen. Well, endorphins are our feel good chemicals. They're kind of our natural opioids, if you will. So if we're not getting the feel good chemicals and we're not getting the serotonin, we're going to have a lot more difficulty. And other videos I talk in depth about serotonin, but serotonin does so much more than stabilize mood. It's integrated in your gut, motility and your gut, whether you have leaky gut or not. It's integrated in your heart rate, in your blood pressure, in obviously in your mood, in your cognition. So serotonin has its grimy little mitts in just about everything that we look at in terms of symptoms. Oh, and pain perception. When serotonin gets too low, pain perception goes up. Your, your nociceptive sensors, your pain receptors become more sensitive when serotonin goes down. So we want to make sure that people have adequate serotonin, noting that it may not be that the person's not quote, producing enough serotonin, as in this case, we give them or the doctor gives them an ssri, the person produce person produces more serotonin. But if estrogen's not there to make the receptors receptive, then there's going to be a breakdown in the system. So it's not always about just brute increase in the amount of a neurotransmitter. Sometimes there's a breakdown somewhere else in the system. Estradiol, the predominant form of estrogen, is essential for moderating libido, erectile function and, and spermatogenesis obviously in men. So yeah, both sexes need estrogen. As testosterone decreases with age, porn use, illness, chronic stress and estrogen levels tend to increase, which can make older men more vulnerable to mood disorders like depression. So okay, again that's interesting because women, since it's our primary gonadal hormone, we want a fair amount of estrogen. For men, they want to have their predominant sex hormone being testosterone. So when their testosterone declines and their estrogen goes up, they start feeling depressed. For us, for, for women, when our estrogen declines and our testosterone goes up, we start seeing symptoms of polycystic ovarian syndrome, depression, metabolic disorders, etc. Disorders that mimic PMS and PMDD can be mood and anxiety disorders. So let's rule out mood and anxiety disorders. Now estrogen imbalances can cause PMS and depression. We want to figure out what are we dealing with. And, and again, that's why blood testing is so important. And having a medical provider who understands the difference between normal levels and optimal levels is also really important postpartum, because your hormones are all over the place as your body adjusts. I mean your body is healing from basically a great big old eight pound injury. So as your body adjusts to not having to maintain pregnancy levels of hormones anymore, there's a huge transition. And we want to pay attention to whether somebody is experiencing these changes in relation to a recent pregnancy, a recent miscarriage, recently stopping breastfeeding, any of those things can contribute to hormone fluctuations. The good news is if it's due to a identifiable stressor like that, the body will often recalibrate itself. But it takes time. That's going to have a slightly different treatment approach probably than somebody who is experiencing suppressed gonadal hormones because of chronic stress and trauma, menopausal transition and menopause. Once you're in menopause, some of these things just don't exist anymore. So there are a lot of women who really struggle after menopause because they don't have the levels of estrogen that they had back way back when. Now your body still does make a little bit in other areas. The ovaries have shut down, but other parts of your body still manufacture small bits of estrogen. Thyroid disorders can also look a lot like estrogen problems. Low estrogen may look like low thyroid and vice versa. High estrogen may look like hyperthyroid and vice versa. Easy enough to test. No amount of talking in the world and talk therapy and Carl Rogers himself would not help somebody reach maximal gains if the main their main issue is an organic hormone imbalance. Substance abuse also impacts hormone levels because substance abuse and addictions, even behavioral addictions, stress the body. Activating that stress response increases cortisol, which suppresses gonadal hormones. So we do want to look at addictive behaviors and chronic stress. And some medical disorders can also worsen before menses in women. Migraines, irritable bowel syndrome, chronic fatigue syndrome, some of these can get a lot worse right before somebody has their period. And validating that, understanding that, helping them make a plan for how to live in the and how to live their rich and meaningful life, understanding that there are going to be a few days every month that just really suck and being compassionate with themselves in that during that time. Because getting mad at yourself for having migraines prior to your period ain't going to make the migraine go away. It's going to make it worse. Estrogen can increase serotonin synthesis and release as well as enhance serotonin receptor sensitivity and function. It modulates serotonin transmission, binding and metabolism in the brain regions involved in regulating mood and cognition. Now remember I talked earlier about it modulating serotonin, but it's also again neuroprotective and helps modulate neuroinflammation. High neuroinflammation means high brain fog. Some of the physical effects attributed to estrogen, such as changes in pain perception, may be mediated through estrogen induced alterations in serotonin systems. Adequate estrogen, adequate serotonin, adequate pain, pain management internally, low estrogen, low serotonin, much higher perception of pain, not all in their head. The receptors actually become more sensitive to pain input. Estrogen also down regulates the enzyme monoamine oxidase. Old, old, old fashioned antidepressants were MAOIs, monoamine oxidase inhibitors. Monoamine oxidase is the enzyme that's responsible for breaking down serotonin. So maois kept that enzyme at bay. So serotonin would sit in the synapse for longer. Estrogen would downregulate that sometimes. So that's interesting because estrogen by downregulating MAO actually keeps serotonin in the synapse for longer itself. Chronically elevated levels of estrogen can induce depression by contributing to functional hypothyroidism. Now we've talked last week about non thyroidal illness syndrome, ntis, and that's what we're essentially looking at here. Estrogen increases thyroid binding globulin tbg, which increases the amount of free thyroid hormone available to the body, triggering symptoms of an under active thyroid. So it's the thyroid binding hormones are getting, you know, attached basically, so they're not free to do their job. And this can lead to not Enough active available T3. Chronically elevated levels of estrogen and low progesterone can also contribute to anxiety. So elevated levels of estrogen, too much is not better, it's not more is better. It's goldilocks. Estrogen enhances with the release of cortisol, dopamine and norepinephrine, so it enhances motivation and attention. But again, to a certain extent, you have too much cortisol, you're going to feel like you're crawling out of your skin. That's your stress hormone. But you need a little bit of cortisol. That's why in the morning, our circadian rhythms have cortisol spike in the morning to help us feel like we're ready to get up and face the day. And then it declines throughout the day, as cortisol declines, serotonin goes up, which is really interesting. Then serotonin is converted to melatonin at night. But I digress. So estrogen can enhance our motivation and attention when cortisol, dopamine and norepinephrine are released. But it's all in this very limited recipe, if you will. Estrogen decreases the release of GABA and promotes increased glutamate and dopamine transmission. Now remember, GABA is our main relaxation chemical. It's our natural volume, if you will. So estrogen decreases that and it increases glutamate, which is one of our main energy and stress neurotransmitters. So our relaxation neurotransmitters are suppressed and our active neurotransmitters are enhanced. And again, you can see how this works in the Goldilocks principle. If you don't have enough estrogen, then there's not enough glute, glutamine or glutamate, there's not enough cortisol and the person's going to feel flat and unmotivated. If you have too much, then the person is wired and feeling really stressed and irritable and agitated. So we want that happy. Middle estrogen also reduces the Fear response. When estrogen is low, people may be more likely to startle and have an exaggerated fear response and increased anxiety. So I know it's like, well doc, you just said that when estrogen's too high we have increases in anxiety. Yes, that's true. And when estrogen is too low, the body perceives the person as being vulnerable, so they tend to startle more easily and which can promote feelings of anxiety. Causes of low estrogen Age. As we age naturally, our estrogen levels decline. Not much we can do about that. Can't stop the clock. But we can recognize age related changes and optimize other lifestyle factors to try to modulate the impact that our natural hormone reduction has. Stress related autonomic nervous system activation I. E. High cortisol to make it really simple, lots of cortisol, lots of stress leads to lots of inflammation, leads to estrogen suppression. Sleep loss from anxiety. You're ruminating, you're tossing, you're turning from apnea. That's a big one for a lot of people from discomfort, whether it's chronic pain or you're pregnant or you just have a bad mattress. Sleep loss and for those who experience them, hot flashes, those are a bugger and a half. Anything that disrupts your sleep, increases your stress, increases your sympathetic nervous system. Your stress response increases that activation. So sleep loss is one of the things that we can really harp on that people can address. They may need to have a sleep study done. If you think they've got sleep apnea, if they're having difficulty with sleep structure, if they are having difficulty going through the night without having to get up to pee. There are a few things like reducing fluids four hours before bed. But it's also something that may be needed to be examined by a physician because some people have bladders that are much more irritable. And some people, men may also have enlarged prostates. There may be an underlying physiological cause of frequent urination that can be addressed. So sleep loss need to address it. Circadian rhythms. Every single cell in our body has a circadian clock. Our when our body is ready to and most sensitive to increased glucose is in the morning, not at night. Our body actually produces more saliva to help digest food in the morning and early afternoon, not so much at night. So there's a lot of things that our circadian rhythms regulate, not the least of which is the production and release of gonadal hormones. And in women we see this much more clearly, much more obviously based on their menstrual cycles, because that is based on the circadian clock. And for women who are having irregular periods, extremely long periods, absent periods, that tells us that something's going on. Now, it could be their circadian rhythms are disrupted. It could be something else causing hormone disruption. But it's something to look at because that is not typical. And a lot of times the causes are relatively easy to be addressed by an endocrinologist or an ob GYN or something. Premature ovarian failure causes low estrogen. I'm in that camp. You know, mine crapped out when I was in my early 40s. So going to the doctor, you know, they still expected me to be having normal levels of estrogen. I didn't. And unfortunately, the doctors I was going to did not understand that. And at that point, neither did I. So I thought I was depressed. And come to find out after I got to the right doctor who said, well, let's just run a Go Nadal panel on you. And lo and behold, my gonadal hormones, all of them, progesterone, estrogen, testosterone, they were off the charts in the nothing range. They were, like, way below where they were supposed to be. So that really helped my doctors create a treatment plan that worked for me. Postpartum stress from not sleeping. In men, we see hormone changes, and we haven't even gotten down to the men yet, but we see hormone changes in men in the postpartum period as well due to. Mainly due to stress and circadian rhythm disruption and sleep fragmentation. But the more stress, circadian disruption, and sleep fragmentation that the man experiences, the more likely that he is to also develop postpartum depression. Now, obviously, the woman's only going to be the only one that has the placental removal, and that is a big thing. You know, it changes your hormones. The body's like, hey, I don't have to manage this anymore. And I should have added it here again. Stopping breastfeeding, it is huge how much it impacts you mentally. Not only not just during that initial couple of weeks where it's uncomfortable, but also after that because you're not bonding with the child in the same way, and your hormones have altered because you're not having to produce milk anymore. Hypothyroid will also contribute to low estrogen. A lot of times we see the same thing, both things con concurrently. This is another reason a lot of older women also have hypothyroid, because they have low levels of estrogen, and they. Everything works in balance, everything works in synchrony. So. So when one goes low, the other one tends to go down. And or be less available. Congenital conditions such as Turner syndrome, thyroid disorders. I already said that. Being severely underweight, having poor nutrition or poor nutritional absorption. People who've had bypass, if they've got leaky gut, and now we add GLP1s may have gonadal hormone imbalances. I was just reading an article this morning that was in indicating in recent studies, they found that people that are on GLP1s because their appetite is so suppressed, a lot of them are not getting the macros, the protein, the carbs, and the fat that they need in order to minimally maintain. But they're also not getting the amount of vitamins and minerals that they need for their body to actually do all these things it needs to do. And we've talked before about how you can eat food and it's broken down. How is it broken down? Well, there's a lot of enzymes and things, but for those enzymes to do their job, they need certain vitamins and minerals to act kind of like spark plugs. And if people are deficient in folate, in B12 in full, and in iron, in calcium, it's not going to work. So even if they're eating a great diet, if it's not balanced, if they're not getting enough of the right micronutrients, then they may feel poorly. Now, I say that, but the answer is not just take a multivitamin. No. We need to understand what is low for that person. Too much iron, too much B12, too much calcium can be just as devastating, sometimes even more than too little. So it is up to the physician to talk to the person about their macro and micronutrient levels. But bearing in mind that malnutrition is going to contribute to low, low estrogen and low testosterone cholesterol, I know everybody's like, oh, cholesterol bad? No, cholesterol is not all bad. Cholesterol actually has been shown to have some neuroprotective effects in older adults. But I digress. Cholesterol is the precursor for all steroid hormones, including the gonadal hormones. And cortisol is a steroid. You don't have enough cholesterol, you can't produce enough cortisol, you can't produce enough testosterone, progesterone, estrogen. It's just not possible. So saying all cholesterol is bad is set. People are setting themselves up for a problem not eating enough fat. I know a lot of people are like, oh, what did she just say? Because we've been programmed that fat is bad. Too much fat is Bad. Just like too much sugar is bad, too much salt is bad. Goldilocks. We don't want too little, we don't want too much. We need it to be just right. But anyhow, cholesterol is necessary for gonadal hormones to be produced. End of story. Hard stop. And chemotherapy. Chemotherapy screws with everything. But if you've got a person on chemotherapy who is experiencing low mood, low energy, depressive like symptoms, especially if they've also got the vasomotor symptoms like hot flashes and stuff, encourage them to talk with their doctor about whether there's anything they can do to help balance their estrogen. Now, obviously, if they've got hormone receptor positive tumors or whatever, it's probably going to be a no go, but they can ask. A low functioning pituitary gland can also cause low estrogen deficiencies in pituitary hormones can result in decreased production of all sex hormones, including estrogen and testosterone. Now, okay, you're like, okay, well, what's this pituitary gland? I've heard of it. Remember hypothalamic pituitary adrenal axis. We'll talk about that next week. Hypothalamic pituitary thyroid axis. We talked about that last week. And the hypothalamic pituitary gonadal axis, it's what we're talking about this week. All three of those axes work together when we're stressed to help us fight or flee, and when we're relaxed to help us repair and rest. Relax, I guess. But the hypothalamus and the pituitary are at the forefront of all three of those. So if your hypothalamic pituitary adrenal axis is constantly or nearly constantly on, then the body is going to become resistant not only to cortisol, but also to some of those pituitary signals for the same reason that our body develops tolerance to dopamine in addiction or anything else over stimulation, the body naturally has its own little thermostat and it says, nope, running too hot. We're not going to respond to this. So chronic stress can reduce pituitary efficiency, if you want to say it that way, which can downstream impact adrenaline, cortisol, gonadal hormones, thyroid hormones, et cetera. Gut microbiome is another area that we want to look at. Gut microbes, all those little workers in your gut that take food in and they break it down and they repackage it for what it needs to do. They build hormones like estrogen, progesterone and testosterone in their day to day work disruptions in the gut microbiome, such as through antibiotic use have been linked to alterations in estrogen levels. And they found that people who use antibiotics and you know, I know sometimes we have to, it's just what we've got to do. But the use of antibiotics alters the gut microbiome for up to two years. And for some people, you know, they've done some studies that have shown that certain antibiotics targeting certain pathogens or microbes can actually improve certain behavioral symptoms in people with autism, for example. So sometimes there's a benefit. But for the vast majority of us, when we take antibiotics because they're non selective, they just go in and wipe it all out. It alters the balance and that can impact mood, it can impact energy, it can impact a lot of things, including estrogen and testosterone levels. High estrogen in both sexes can be caused by hyperthyroid. The use of pharmaceutical drugs, which or non pharmaceutical drugs, many of which because of the stress they add to the body may change the ph of the gut flora. They may change the microbiome. Obesity, especially in the abdominal area can increase estrogen levels due to the aromatase enzyme present in fat tissue. And they found this in all humans, that when you have excess fat tissue, adipose tissue, estrogen levels are higher. When you have insufficient fat tissue, estrogen levels are lower, maybe too low. Just right, we want just the right amount of fat tissue alcohol use and this one is really interesting. Typical non dependent levels of alcohol use. So moderate drinking actually may increase estrogen temporarily. But if you're moderately drinking every single day, then it's going to be, you know, high estrogen a lot of the time. Those who abuse alcohol tend to have suppressed levels of estrogen due to the stress and the inflammation and everything else that goes along with ingesting a toxin. Liver disease, the kidneys and the liver help get rid of toxins. If your liver ain't working well then it's going to have more difficulty getting rid of the estrogen metabolites and endocrine disruptors. Bpa, some thiolates and certain pesticides can cause high estrogen levels. Encourage people to use BPA free plastic if they're going to use plastic. I mean even those you have microplastic issues. But you know, we'll take the small wins glass whenever, use glass whenever possible. Encourage them to use like stainless steel cookware, not using that old fashioned non stick cookware that has a lot of endocrine disruptors in it and eating organic if they can, if not Washing food as well as they can to get as many of the pesticides off will help a lot. And drinking filtered water, you don't have to get it bottled. That gets really expensive. You can get a water filter and usually get 75 to 250 gallons per water filter. It's not free, I get that, but it helps. And in places where the water supply is still running through really old pipes or, you know, there are a variety of issues that can help even more than in other areas that have good water. Progesterone has anti anxiety and neuroprotective effects in the brain. It can influence cognitive function, mood and behavior. Progesterone can antagonize the effects of cortisol. So progesterone can blunt cortisol, helping to mitigate the negative impacts of chronic stress. They found that progesterone may help reduce anxiety in some people, especially postmenopausal women. GABA and glutamate are also impacted by progesterone. Remember, estrogen suppresses gaba, progesterone increases it. Progesterone helps us relax. We like progesterone. It activates those GABA receptors in the brain and can modulate glutamate to maintain the balance between excitation and inhibition. So it's the one in there that's kind of serving as the gatekeeper. How much estrogen and cortisol are we allowing through Progesterone can be converted in both sexes to testosterone. It may also modulate the effects of testosterone in the brain and body. Cortisol and progesterone are both made from pregnenolone. So that's kind of interesting. So you have this precursor here, pregnenolone, and it can either be diverted to make progesterone and then estrogen or testosterone, or it can be converted to make cortisol. What do you think happens to progesterone in people who are chronically stressed? Does it get routed to help make the GABA activator or does it get routed to help make cortisol? Just saying. When we're chronically stressed and make more cortisol, cortisol production steals from those progesterone levels. Progesterone, as I said earlier, is generally anti anxiety and estrogen is generally antidepressant. Too much of either can produce an on edge feeling or a increase irritability. The higher estrogen levels go, the more cortisol is released, making us less able to adapt to stress. High estrogen levels can contribute to subclinical hypothyroidism which decreases GABA release. So we already talked about functional hypothyroidism earlier. But another thing that it does is with high estrogen we see a decreased in, a decrease in GABA release, which means an increase in glutamate, an increase in stress hormones, which causes inflammation and suppresses estrogen. The stress response. Estrogen can activate the HPA axis. Our stress response, increasing cortisol, estrogen increases dopamine synthesis. That helps us, motivate us to fight or flee. So we have this cortisol and then, you know, we have this release of dopamine that says, hey, we ought to get up and do something. Progesterone modulates the effect of estrogen on the dopaminergic system. So progesterone is the one, like I said, that acts as a gatekeeper in terms of testosterone. It also has significant impacts on mood. Low dose testosterone has been shown to improve depression, symptom severity, fatigue, anxiety and sexual function in both sexes. Interesting. Now yes, if you look at the PubMed research and everything, testosterone is not recommended for women, but it is prescribed off label by a lot of physicians for just this reason. Depression and anxiety are well known symptoms of low testosterone in adolescent males, but not females. Decline in salivary testosterone throughout the day is due to circadian flux and it's correlated with an increase in anxiety and depressive like measures. Well so again, think about it. Women are more susceptible to significant declines or alterations in estrogen levels because that's our primary gonadal hormone. Men are more susceptible to changes in their testosterone levels. And in these adolescent males, this is what we're seeing. Surgical remover of the ovaries. Obviously in women, increased mood disturbances and depression, an effect reversed by testosterone. And you're scratching your head. I know I did the first time I read that. You're like, ovaries produce estrogen. Well, androgens, including testosterone are essential for the production of estradiol by the ovaries. So it's important to understand that again, both, both genders, both sexes have all of these hormones and they work in a cohes cohesive state. Now a lot of people, a lot of people are taking supplemental DHEA right now. DHEA is sort of a ANS stimulant for a lot of people. So number one, being aware of that, it can make people feel very edgy, very irritable, very anxious. Multiple randomized control trials show that in men, DHE supplementation raises estradiol more consistently than testosterone. In all of these studies, literally all of Them testosterone, if it ra increased, only increased modestly or minimally, whereas estradiol was consistently higher in men taking DHEA. RCTs in young healthy men show that DHEA can raise androstenidione, which is the precursor to testosterone, testosterone or estrogen, but it didn't raise testosterone or estradiol at normal doses. So in young healthy men, what they're finding is DHEA in non super therapeutic doses doesn't tend to do a lot. It raises the precursors, but then doesn't actually finish doing the job and raising the gonadal hormones like they had hoped. If DHEA is chronically pushing their arousal circuits, the brain tends to recalibrate receptor sensitivity. So they may start taking DHEA and feel wired and then after a week or two weeks, they're not feeling it anymore. It could be because their brain has become desensitized or resistant, if you will, to stimulation by DHEA because it was just overwhelming the circuits and or it could be because the body is taking that DHEA and shunting it over to the creation of estradiol. And that is something we have seen in men, especially older men, who are taking too much dhea. A lot of times it gets shunted over to estradiol instead of testosterone in men with chronic stress or depression. Trials show that mood, fatigue or libido improvements happened with DHEA more often than with those with a balanced autonomic nervous system. So in people who are already feeling depressed, there were some modest improvements in symptoms, not necessarily in testosterone or estrogen levels. Oral DHEA, 50-100mg per day raised DHEA to young adult range, didn't change testosterone, but did increase estradiol and estrone in a dose dependent way. And if you look at a lot of supplements, a lot of people are taking sort of mega doses of dhea, which actually may in the long term work against them. Just educate them or encourage them to educate themselves if they're taking DHEA or they're thinking about it to see if it's actually worth the effort, worth the risk, and it's going to do what they think it's going to do. And of course encourage them to talk with their doctor before starting any supplements. Testosterone has organizing effects on brain development and several psychological traits in behaviors in both sexes. All right, we need it at proper levels. It helps with one's sense of well being and self confidence, which are obviously important aspects to a positive mood. We need to feel efficacious, we need to feel, feel confident. We need to Feel okay. I mean, if you feel like crap, then it's going to be hard to have a good mood. So testosterone is essential in the right doses. Numerous clinical studies in postmenopausal women and in older men in in andropause showed improvements of learning and memory after testosterone supplementation. This is not dhea, this is prescription testosterone supplementation. High cortisol can have a direct inhibitory effect on testosterone production which impacts learning, memory and aggression. Okay, so we know that when our stress response goes up, cortisol goes up. We know when our stress response goes up. Our brain disengages from our wise mind, our prefrontal cortex, and is operating in fight or flee. It's operating in basically our emotional mind. So that's one thing that's going on. But it's also inhibiting testosterone, which is neuroprotective and can help regulate the nervous system. So we're getting less regulation. There's a positive relationship between cortisol and free testosterone during exercise recovery that may be due to the concurrent production of both hormones from the same precursor in the adrenal gland. So right after somebody works out, they may have higher cortisol, usually do, and they may have higher free testosterone. And what they suspect is exercise actually boosts both of those. So it's not the same pattern we see under stress where when cortisol goes up, testosterone goes down. Acute stress, cognitive stress, you know, etc. Can temporarily suppress testosterone levels, while chronic stress can have long term negative impacts on testosterone production. Chronic stress means cortisol loses its ability to suppress inflammation, which means we've got chronic inflammation which suppresses testosterone in the long term. Helping people eat a healthy diet, get good sleep, regulate their circadian rhythms, and address as much unnecessary chronic stress as possible and even acute stress as possible. Those are huge wins. We can't eliminate all stress from people's lives. Just not possible. But we can eliminate a lot of unnecessary stress. It's kind of like driving a car. You're going to get a whole lot better gas mileage if you don't have 500 pounds of dog food in the trunk. You know, when the, the trunk's like kind of dragging on the back, your gas mileage is going to be crap. Same sort of thing for, for our bodies when we remove as much unnecessary stress as possible. Yeah, there's still stress, there's still weight, but we're able to function a lot more effectively. The relationship between testosterone and status seeking behaviors like leadership and aggression is also moderated by cortisol Levels. So people who have low cortisol often are low status seeking lower aggression. People who have chronic stress tend to show lower cortisol patterns because they've become inhibited over time. Testosterone is associated with improved serotonin receptor binding, especially in men, which helps adjust depression and anxiety, or helps address depression and anxiety. Testosterone modulates serotonin receptor activity in a way that directly affects aggression, fear and anxiety. High testosterone and and low serotonin tends to lead to aggressive like behaviors. So let's think about people whose hormones are imbalanced for their assigned sex. What's going on? Because we know the wiring is different, we know changes. For people who were assigned the male sex at birth, they're going to be more sensitive to changes in testosterone. The central fatigue hypothesis suggests that an increase in the ratio of serotonin to dopamine is also linked to fatigue. During sustained stress, serotonin rises and the person starts to feel tired. Makes sense unless dopamine rises more. So if you're doing something that you really, really like, you're getting a really good burst of dopamine from and endorphins from. Then even though serotonin's going up, dopamine may be going up enough to counterbalance it. Low testosterone is also associated with decreased GABA and increased glutamate levels, which is may contribute to symptoms of anxiety and depression. So a lot of times we think of testosterone as causing aggression and all that kind of stuff, but again, too much or too little. When men have too little testosterone, they also often experience a lot of anxiety and, and low mood and low motivation. Higher testosterone levels may increase dopamine, which is associated with reward and motivation. So lower testosterone means lower gaba, but also lower dopamine. So low motivation, high anxiety, you know, sounds like it really sucks. Testosterone can also affect dopamine receptor density and sensitivity, resulting in increased mood, motivation and cognition. So we do want those dopamine receptors to be active, which means we need a healthy environment, which is populated in part by adequate levels of testosterone. Increased dopamine can also cause increases in testosterone and possible aggression. So we have all these things that work imbalance. And if dopamine goes up and it causes an increase in testosterone, we could potentially have more aggressive behaviors. So what about people who are addicted? When they engage in their addictive behaviors, they are ramping up their dopamine like nobody's business. Hmm. Adolescent males have an increased risk of developing psychotic disorders in implicating testosterone overload in the precipitation of dopamine related psychopathology. So when they looked at adolescent males, especially those who were engaged in addictive behaviors, they saw a much higher risk of potential psychotic symptoms. Norepinephrine is increased by testosterone and can stimulate the conversion of testosterone into estradiol. Who knew? So norepinephrine can also help balance things out. When testosterone gets too high, it can help shunt it over to estradiol and balance the system. Low testosterone levels trigger symptoms such as anorexia, lack of desire to eat, lack of hunger. Not necessarily the the DSM diagnosis. So low appetite, fatigue and decreased libido, all of which may impact mood. Well, yeah, if your sex drive is in the crapper, you have no energy and you're not giving your body the building blocks it needs. Yeah, it's going to impact mood. Testosterone may also have antidepressant effects in women with dysfunctional pituitary glands and low testosterone and people with SSRI resistant depression. In terms of what causes low T sick guts imbalance in the gut Microbiome can directly impact the ability of the body to produce testosterone. Endocrine disruptors, including fluoride and pfas or your non stick pans. Again, sleep loss and fragmentation. Hypertension, which is generally associated with high cortisol and high stress. And again postpartum in men, their testosterone can go down in the postpartum period. Trauma, excessive exercise or other forms of chronic stress can cause high cortisol, inducing a state of glucocorticoid resistance. This resistance can also extend other hormones like thyroid hormones, progesterone, estrogen and testosterone. Because when one is released, all of them are released. When estrogen sensitivity is reduced. Adding estrogen may not necessarily improve symptoms. Instead, it can lead to side effects like weight gain, water retention and mood swings, which are signs of estrogen excess because you're putting more estrogen in the system, but it's still not able to be utilized, so the system is getting overburdened. Cortisol inhibits GnRH and LH and can directly reduce testicular testosterone synthesis, leading to a lower total and free testosterone level. Testosterone normally dampens HPA reactivity like estrogen does in women, and low T is associated with stronger stress responses and dysregulation, which increases stress and creates a vicious loop. Low T can be caused by obesity because fat cells are making estrogen which can overwhelm the the system. When testosterone levels decline in men, so does estrogen. Since your body converts some free testosterone into estrogen, it's important to recognize that testosterone declines faster than estrogen in men. Because some of that estrogen is being stolen, if you will, to make estrogen, insulin resistance and diabetes create issues with testosterone signaling. And porn. Porn can disrupt testosterone and other reproductive hormone levels due to receptor resistance. You're just overwhelming the system. And in men, often real women, IRL no longer increase testosterone levels so they don't have this natural surge when they see women around town. Hormone production takes place in our gut. The estrobolome is the collection of microbes capable of metabolizing estrogens. When estrogens swing or drop because the gut isn't recycling them normally, mood stability and cognition are impaired when the microbiome is disrupted. Immune and metabolic signals from the gut can also suppress the gonadal hormones, lowering production and altering the downstream effects. Remember that progesterone reduces depression and anxiety in a lot of people, but only when the microbiome is intact. People who've been taking antibiotics don't experience the same benefit from progesterone as those with a healthy microbiome. Sex hormones help maintain gut junction integrity and prevent leaky gut hormone deficiency worsens permeability and permeability increases inflammation, which worsens hormone levels. So we want to help people make sure that they are make maintaining a healthy gut. Prebiotics like yogurt and fermented foods and or those probiotics like yogurt and fermented foods and prebiotics like fiber will help keep that gut healthy and feed the best microbiomes. Both men and women have testosterone, estrogen and progesterone, all of which impact serotonin and GABA levels. Cortisol reduces the amount of sex hormones available. Too much estrogen or testosterone can contribute to anxiety, too little depression, fatigue, brain fog. Progesterone is one of your great big balancers out there. Cortisol is made from pregnenolone, the same hormone that progesterone is made from. So if you've got high cortisol, you're probably going to have low progesterone because that precursor is being diverted. Leaky gut also contributes to estrogen, dominance and excessive cortisol. Hypertension, obesity, diabetes and stress all impact leak leaky gut. So for the counselor, the take home is hormones need to be in the optimal range for that individual, which may or may not be in right in the middle of the normal range. Additionally, stress, emotional stress, cognitive stress, physical stress from pain or illness, sleep disruption, circadian rhythm disruption and poor nutrition all contribute to imbalances in gonadal hormones which contribute to imbalances in neurotransmitters worsened mood and brain fog. All of those things are things that we can help people either address themselves or advocate for themselves with their doctor.