In this segment of a 16‑part Long COVID series, Dr. Paul Anderson explains how the immune response to COVID‑19 can disrupt the endocrine system, leading to hormone imbalances that mimic or worsen Long COVID symptoms. He outlines the most common hormonal axes that should be evaluated after three to six months of persistent illness: adrenal cortisol (including circadian rhythm disturbances), thyroid function with a focus on reverse T3, reproductive hormones (estrogen, progesterone, testosterone) and their gender‑specific shifts, and insulin/blood‑sugar regulation (A1C and fasting insulin). For each axis he describes typical symptom patterns, why the imbalance occurs, and the specific laboratory tests clinicians should order (morning cortisol, full thyroid panel plus reverse T3, gender‑appropriate sex hormone panels, A1C and fasting insulin). He emphasizes that these imbalances are often functional rather than overt disease, that they can perpetuate inflammation, and that addressing them is essential for recovery. The segment concludes with a brief recap, a reminder to involve a healthcare provider—preferably one familiar with integrative or naturopathic approaches—and a call to like, share, and subscribe, with links provided on dranow.com.
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Hi, it's Dr. Paul Anderson with Medicine Health, and we're going through a fairly long series of videos and audio here on the podcast on Long COVID. And so, uh, we're heading towards the middle of that series of 16 little installments, and this one is about hormone changes that go on during and after COVID that could set you up for trouble that would match the symptoms of Long COVID. So early in the experience of people being starting to describe long COVID and asking for help and you know coming in and seeing us for this sort of thing, started to see a pattern that I had seen before with other post-infectious illnesses. And so we have a patient. And they're not getting better. They have fatigue, they have pain, they have whatever the symptoms are. And some of the symptoms seem almost like maybe there is a hormone dysfunction or something happening because of the type of symptoms they are. And no one's checked for these things, so it's an obvious area to look for if you have persistent symptoms. So in the hormone world, what happens is if you get an initial insult and your initial viral infection, for example, really stirs your immune system up, your hormone system, the endocrine system, has to respond to all that immunologic being stirred up. And so patient will come in and they'll say, I've got these symptoms, I'm taking these different things for the symptoms, but I'm not really getting better. So among other things, for example, we talked about infections you don't know you had. We might test for that. We would also look at particular parts of the hormone system in lab tests to see if the balance has been thrown off or not, which an immune insult like an acute infection can do. Now, when we see that, first question you have to ask is, why would it happen? Why would it happen? Well, when your immune system suddenly goes from medium working, and it modulates up and down every day to keep you from getting sick, and then you do get sick, your immune system goes into a very particular set of changes that it does, and part of those changes are modulated by hormones. Now, they're modulated by other stuff too, but hormones are one of them, and hormones then have feedback to each other, So if you are modulating these inflammatory infectious things and the hormones are continually having to respond, then you can wind up with a situation where maybe you didn't have a lot of hormone trouble before, but all of this response of the hormones to the infectious inflammatory immune response cause your hormones then to sort of get off-kilter a little bit. Or a lot. And a lot of people have, you know, mild hormone imbalances that no big deal, they don't really need any help for, but then you have a big stressor and an insult, and then they wind up having, you know, after the stressor being COVID in this case, the hormones being a little more off, and so now they're symptomatic. So, when we see this, what What hormones are we usually looking at? Well, the first one that responds very aggressively during infectious activity made by your adrenal glands, and it's called cortisol. Now, there's other hormones made there, but your cortisol has a circadian rhythm. It's supposed to be high in the morning and wake your brain and your body up, and then at night it goes down. It's lower at night. In some people, that can get turned around where it's low in the morning and high at night. That will present sometimes as a sleep disturbance. You're not sleeping appropriately or like you, you know, were before you were sick. It also can be kind of low and then it can get lower and just not be enough to totally satisfy all your hormonal needs during the day. Now, there's a disease called Addison's disease where the adrenals basically start to wear out and they keep making less. It's usually not that. This is more of a functional problem. So cortisol is something that we will check, usually do a morning cortisol level because that's when it's supposed to be the highest, and just make sure it's not either overreacting or underreacting. And there's other testing that can be done there. Now, another one that can be triggered by the cortisol stress inflammatory group of things going on with the COVID that's very common and not tested commonly except in chronically ill people is called reverse T3. So thyroid hormone has multiple different forms. There's T4, if you take, say, Synthroid or levothyroxine, that's T4. There's also T3, which is a more active version, and then there's an isomer of T3 called reverse T3. And I just tell patients this is basically evil T3. It goes in and blocks the receptors. where the thyroid is supposed to work, and it makes you functionally low thyroid. You're not really low thyroid, but your body has made this weird reverse T3 to go block the receptors. Now, the body usually has some reason for doing things, and the reason to kick up reverse T3 activity and slow the thyroid function down is that you were sick, you're compromised, and when you get your stress hormones are kicked Especially, you know, during an inflammatory process like that, reverse T3 can be increased in the body to kind of slow your metabolism down. The idea being that we— if you're going to be that sick, we don't want you to have your body working really fast, and that is a very important thing that can happen. Now, because reverse T3 is not on a standard thyroid panel, etc., if you don't know to look for it, you won't find it. So normally, in addition to morning cortisol, we will also look for the regular thyroid markers, T3, T4, thyroid antibodies, and then we'll add on reverse T3, which any lab can do. It's just, it's not normally done, say, in primary care medicine because you don't need to do it. But in people with post-COVID, you've got to check the reverse T3 to make sure the body's not still sending that hormonal message out to slow your metabolism down. Most common symptoms there are going to be fatigue-oriented and pain and stuff like that, but really any long COVID patient should have reverse T3 and then all the other thyroid markers checked. Now, what else have we seen? We've also seen an inflammatory pattern with reproductive hormones. This tends to happen if you've had long COVID for more than 3 to 6 months. So these are people with real long, long COVID symptoms. And again, it doesn't matter what post-infectious illness you have, they all kind of play by the same rules. But with long COVID, if you're going, you know, 3, 4, 5, 6 months, nothing's getting better, we also then will, will add on to the cortisol and the big thyroid panel, we'll add on checking reproductive hormones. And the big 3, of course, are estrogen, progesterone, and testosterone. And men or women, the balance between estrogen and testosterone is very important. Now, obviously, in men, there's always more baseline testosterone and pretty low estrogen. In women, that is the opposite. But what happens if you've been sick a long time? A lot of times what will happen is that men or women, the estrogen levels will start to rise because of cytokine inflammatory triggering. The testosterone can go down a little or a lot, and then progesterone can shift in different ways for people. People that have a lot of neurological long COVID symptoms, for example, a lot of times their progesterone will shift downward. Progesterone has a job in the brain to be protective, and so if your brain's really inflamed, you may not have enough. But the other thing to remember is that estrogen and testosterone are both needed whether you're a man or woman, just in different ratios. But during inflammatory and long illness processes, sometimes the testosterone goes down to a level where healing is very, very difficult. So, and there's, there's specific tests for male versus female with some of these things, and your healthcare provider will know which one that you need, obviously, based on, you know, what, what gender you're testing. But it is important, and I think it's more important in people who've had long COVID for longer. Like, like I'm saying, 3, 4 months, you start to get there, you're not getting better, all of these hormones really should be checked. And then there's another one that's real sneaky, and it can be triggered and thrown off by the cortisol changes, by the inflammatory changes, etc., and that is your insulin balance and your blood sugar balance. So we see people who maybe had like a little prediabetes, but they're doing pretty good and they're taking care of it with their diet, et cetera. And then they get really sick and then they're sick longer and they're sick longer, and you can actually see their insulin control and their blood sugar control getting less controlled. So again, you get out to 4, 5, 6 months, it would be really good to recheck your hemoglobin A1C and see what your blood sugar management looks like. It would be, uh, what we do is we do, when we do that morning cortisol and the other hormones, we also will just do a fasting morning insulin level just to make sure it's not, you know, super high or going crazy, something like that. And then there's some other testing as well that can be helpful, especially if you already know you have a blood sugar problem. But why would that then create more trouble in Long COVID? Well, in Long COVID, if your blood sugar is also not well managed, your inflammatory levels will rise. So most of these long COVID hormonal things, again, if you don't look, you don't find them, but they can, because your hormone system is so important to the baseline of your health. If you're not checking them and you are not addressing imbalances, if you find them on the labs, it's just like not addressing another infection that you picked up that you didn't know you had. You're just going to be perpetually sick. as you go forward. So that's really the big deal with the hormone shifts and changes. Now we just got about 2 minutes left here, but in those 2 minutes I just want to summarize to say, you know, in this part of the 16-part series we're talking about other shifts that go on in the body because of the initial COVID infection and how they might be a problem later. We talked about other infections in a different podcast. This one we're talking about hormone changes that just go along with the inflammatory infectious process, and the longer you get past your initial COVID, so you hit like 3, 6 months, the more likely it is that these things should be checked for and looked into. As we kind of wrap up here, just keep in mind that these are things that you would need to check in with a doctor healthcare provider about. In the show notes that we're going to put in for the YouTube and other show notes that we do, I have some referrals to integrative medicine and naturopathic medicine providers and other people who often will be likely to look into these things and who are getting, you know, more of the long COVID type Certainly, if you already have a healthcare provider and, you know, you just talk to them about these things and they're willing to do some looking and some lab testing, that's great too. Now, always start at home, always start with what you already have. All right, please do like, share, and subscribe, and do notifications, because sometimes the algorithm shoves us over where you can't see us. And you can find all of the links, whether it's audio or video, on dranow.com, D-R-A-N-O-W dot com. And you'll get links there to Pod Burners, also our YouTube channel, which has of course the videos of these and a number of other videos that I do for patient interaction. But that's all we got for this segment. We're going to move on and do another segment here in just a moment. Recording stopped.
