25 Years of Hormone Chaos: What’s Really Driving the Fatigue, Fog, and Mood Swings?

She's looking for something simple, the energy to do the basics, homeschool her kids, and actually enjoy her life instead of wanting to crawl into a hole while feeling guilty about it. Why can symptoms like fatigue, brain fog, and mood swings plague someone as they have this woman for over 20 years without being fully explained? I often make the comment that hormones are like light switches. You can't think about hormones in terms of the symptoms they cause or alleviate. You have to think about them as signaling molecules that turn on processes in your body. Good morning, everyone. Good morning. Dr. Stillman here. Very excited to be coming to you all with another public Q&A. We're doing these now, 9:00 AM Wednesdays, Central Time. You submit questions, link is below. I choose one of them to answer and give you a lot of context and background on every week. These then get launched as podcasts later. So if you don't have time to catch the live and you're not in a position to say, watch the video later, you can always download the podcast and listen to it. Whenever you like. Today's question comes from someone, we're going to call her Julia. She's homeschooling 7 kids, including a newborn, while also recovering from birth at home and preparing for a move in the Pacific Northwest. She's doing the things she knows help— more light, exercise, sleep, protein— but she says the tools are clear. The toolbox is often just out of reach. She's scared of slipping back into a dark, difficult season that she's faced before, especially with what that could mean for her family. She's looking for something simple. the energy to do the basics, homeschool her kids, and actually enjoy her life instead of wanting to crawl into a hole while feeling guilty about it. We actually see this a lot. And the title of today's episode is 25 Years of Hormone Chaos: What's Actually Driving the Fatigue, Fog, and Mood Swings. We see this all the time in the practice. And the core question is what's actually at the root of all these years of hormone dysfunction, especially when it comes to mood, brain function, and energy levels. By the way, we do have a chat feature here. Drop your questions in the chat live, and I'll do my best to answer them as we go. I do enjoy interacting with you guys here. All right. So first question to answer, why can symptoms like fatigue, brain fog, and mood swings plague someone as they have this woman for over 20 years without being fully explained? What a great question. So first of all, let's start by unpacking what kinds of things women see when their hormones are not balanced. So I often make the comment that hormones are like light switches. You can't think about hormones in terms of the symptoms they cause or alleviate. You have to think about them as signaling molecules that turn on processes in your body. So you flip a light switch on, the light comes on, but the light doesn't come on because of the light switch. It comes on because the switch is in the right position for energy to flow into the light bulb in the light fixture. There has to be energy in the grid. There have to be power substations. There has to be power generation, power plants, solar, Wind, whatever. There has to be a breaker box in the right position on the outside of your house. I could go on, but you get the idea. So whenever I think about hormones, I think about all of the things that are actually upstream from hormones, because one of the reasons that we as a practice don't just do hormone replacement medicine, which we do, and hormone balancing, is really that if you do not have the right nutrients, or if your body is loaded with toxins, or you have certain infections, things in your body that shouldn't be there, uninvited guests as we like to euphemistically call them, then you are probably gonna have Some combination of symptoms that could be attributed to hormones. So let me just give you one example. So fatigue, brain fog, mood swings could easily indicate a thyroid hormone imbalance. But what's so interesting is when you look at thyroid hormone, you need the amino acid tyrosine to make thyroid hormone. You need the vitamin B6 to make thyroid hormone. You need vitamin C. You need minerals like zinc. I could go on and on and on. All of these things play a role in making something as simple as thyroid hormone. And so a defect in many different nutrients can re— yield that problem. So the first thing that I do is I look at to explain these problems in a specific case is what nutritional issues or metabolic imbalances could explain this. And have they been adequately screened for? Testing of nutrients is a long story. I cover a lot of it in my book coming out this week, now available on Amazon. Go pick up your copy there. I COVID testing in chapter 5, including a lot about nutrients and particularly our favorite test, the hair tissue mineral analysis. So that's metabolic imbalances, nutrients. Okay. That, by the way, is the first cause of disease that I always look for because it's the first one we have to remedy. It's the most foundational or most important for us to find and remedy. And by fixing that, you'll also start to fix the other 2 causes of disease that I look at. And the second of these is toxins and stress. So we live unfortunately in a very polluted world and the toxins in our environment, many of them have hormone disrupting qualities to them. Now, sometimes this is a direct effect. Sometimes it's an indirect effect, but regardless of, you know, the mechanism, and there's many different mechanisms for many of these different chemicals, what we end up seeing in our modern world is that people have never been more disrupted in terms of their hormones. And you'll be surprised to find that you have someone who's got low hormone symptoms, but maybe they have normal hormone levels, right? I look at this as you have interference of these hormone disrupting toxins of the hormones. So in other words, the hormone has to get to a receptor site, has to interact with the cell, has to vibrate at a certain frequency, and the toxin can prevent the hormone from doing its job. This would be like having a light switch that is stuck in the off position, okay? Or maybe having a break in the wire. Now you can usually overcome this interference by adding more and more and more of the hormone, but then you'll get this paradoxical scenario where the patient has symptoms of hormone excess and hormone deficiency. So I'll give you a really clear example. A woman is having very poor sleep, which is a symptom of low progesterone arguably, but then she's also feeling dizzy when she wakes up, which can be a symptom of hormone excess. Do you give her more progesterone to make her sleep better, but then it makes her dizziness worse? You cannot do some kind of cookie-cutter protocol here. You have to talk to the patient. You have to be in relationship to them. You have to get a history. You have to listen to them. And you also have to follow up. You have to listen to what happens based on what you've recommended and agreed upon with the patient through the process of informed consent. Okay. Then there's another element to this, which is resistance. So you'll see that patients have very high levels of hormones sometimes. Sometimes you're creating the high levels of hormones with supplements or a prescription. Sometimes they just happen to have endogenously elevated hormones, like say women with PCOS who have elevated levels of DHEA. But what you'll see is that even though they have the elevated level, they have symptoms of deficiency. How do we square that? Well, I mentioned this direct interference of a hormone disrupting compound with a hormone. I want you to think hormone trying to bind to receptor interference, stopping the hormone from doing that. Then I think of this concept of resistance where in many different processes, like the hormone is signaling this cascade of events, the body may resist that cascade. And you might also think of this as like the body being unable to translate the signal into the effect. Okay. So hopefully that's clear. And if what that really comes back to and down to is patients do best and have the most balanced hormones when they have a low total toxic burden and they are not under a lot of stress. And particularly for women, this becomes something where sometimes what you'll find is, for example, you know, a woman has issues with her periods. They're very heavy. They're very painful. There's a lot of bleeding. And I'm not saying this is the case in any given person. I need to be really careful here because there's a lot of emotion around this guilt. Shame, sorrow, anger, frustration, just to name a few. But, you know, you'll find out, for example, that she was molested or that she was abused or something maybe more banal and seemingly benign. Like her father never really expressed love to her. And those are just examples. It can be anything. It can be things she witnessed, things she heard about, things she just thought, but these thoughts can have a very profound effect on the hormones. And so you'll hear stories from patients like their hormonal imbalances resolved or their illness resolved, their brain fog their fatigue, their mood swings when they forgave someone, when they surrendered an emotion, when they learned to relax, they'll contextualize it many different ways. But the end process that I want you to be aware of is that, and then I think it's lost in translation, particularly with hormones sometimes, is that it is sometimes not just about you need more sauna or you got to do a coffee enema or you need to go sweat or you need to move your lymph or whatever. All those things are good, by the way. But sometimes it's this emotional catharsis, this emotional detoxification. And I gotta tell you, sometimes it's people in someone's life who are toxic. I mean, I've heard women say, you know, all my symptoms went away after my divorce. Not saying divorce is a good thing, but I've had patients have pretty remarkable recoveries after divorce. There are some people who are literally toxic. And because hormones are really about our relationships in many respects, you always have to look at this dimension. And I'm making a particular point about this because it's come up for me multiple times in the last few weeks and months with real patients in the practice. So, okay. Let me get back to the point. Nutritional deficiencies, metabolic imbalances, toxins, and stress, including people in our relationships and past experiences, and maybe trauma that's been stored in the body. The third thing I always look for is there some kind of infection that we need to be thinking about? Now, this may sound strange to some of you, you know, but I'll tell you, like when you look at patients' microbiomes, You'll frequently see in cases like this, an abnormality called elevated beta-glucuronidase. Now, I don't want to get too technical on you all, but I'm going to go there because I think without a little bit of background, you'll just be lost. But beta-glucuronidase is an enzyme that cleaves a glucuronate molecule off of a chemical the body is trying to detoxify. So when your liver is trying to get rid of a toxin, it looks at a toxin and says, we need to get rid of that. It attaches A glucuronidate molecule. And I may be mispronouncing that. And the chemistry geeks can correct me in the comments if they wish to, but either way, it tags it with that molecule. And then that gets excreted in the gut because it's more water soluble. And so it tends to stay in the gut instead of being recirculated through what we call enterohepatic circulation, gut to liver recirculation. Now, why does your body recirculate these things in the first place? Because it's got bile acids. That are very valuable and difficult to produce. And so it wants to recycle them. It really has to, you might call it upcycle them. When that process happens, it actually can't discriminate between the things that are expensive to create and necessary for digestion of your food and the toxins that go along with them. It can just, it just sees the toxin or it just sees it as the same thing and it recirculates it. So what ends up happening when you have elevated levels of beta-glucuronidase, which is an enzyme created by the microbiome potentially, When you have high levels of this enzyme and you can detect this in stool, and we do measure it sometimes, you'll find that these patients have more symptoms of hormone imbalance. And believe it or not, these patients get a lot of relief when you give them antibiotics. Now, a lot of people in my world of natural and integrative medicine sort of clutch their pearls and say, oh no, we can't give the patients antibiotics. That's bad. Antibiotics are bad. We only use antibiotics like when people are really sick, right? Yes and no. You know, first of all, I always have a shared decision-making conversation with the patient because I have patients who just absolutely refuse, and I respect that. And you know what? Darned if some of them don't get better anyway. God bless them. Or they'll try these herbs, garlic, berberine, black walnut hulls, wormwood, you name it. And they'll feel better. They'll get a good result, but I offer antibiotics because I found them to be very, very helpful. And you can really knock this beta-glucuronidase number back. And this then helps the body to excrete the hormones and toxins that the body is trying to excrete through the glucuronidation pathway. This is just one example of how the microbiome, bugs in your gut, things that are in your body are creating the clinical picture. And we could talk about parasites, bacteria, fungi, viruses. It's a big topic. I don't want to get too deep into the weeds. I just want you to understand there's many different factors that can drive this. Our process is always the same, and it's as basically simplified and efficient and streamlined as we possibly could make it. We don't start with stool testing. We reserve that for later in resistant cases or extreme cases where there's a lot of illness or when patients are just really curious and wanna do more testing. But anyway, those are the things that I look for in a 25-year-plus symptom case in order to try and get to the bottom of like what's been missed and what do we need to do next? Okay. Why does postpartum recovery hit some women so much harder than others, especially in the middle of a full demanding family life? So I would take you back to what I said about hormones earlier, right? So hormones create this signal that the body then has to act on. Right. And there's a couple of things about hormones peripartum that are really interesting. So first of all, there are these huge swings. And one of the things that can happen is women can have a really precipitous drop in progesterone that's so sharp that they wind up with postpartum depression, psychosis, anxiety, et cetera. Now I have many colleagues who maintain that this is always, or almost always, a deficit of progesterone. And I even have a colleague, Neil Rousier, if I recall correctly, and he teaches this in his courses, would walk around the ER with a pre-drawn syringe of, I think it was an oil-based injection of progesterone. And he did that because he knew that if he found a woman who was having one of these peripartum, postpartum issues, that injection could really change her life. Not making a medical recommendation, not practicing medicine via Q&A, just telling you that was his practice, if I recall correctly, from his teaching, right? And something you may want to discuss with a qualified provider who can help you with that. We use progesterone all the time. Now, why can lack of progesterone cause all these symptoms? I think progesterone is one of the most underappreciated hormones in women's health, even though it arguably might be the most appreciated. And I say that because I just don't think people really appreciate how powerful it is. So why is it so important? So progesterone works with a neurotransmitter called GABA in order to downregulate The nervous system. What is GABA? Gamma-aminobutyric acid. It's your main inhibitory neurotransmitter. If you've ever felt like your brain is on fire, you can't slow down your thinking. You can't relax. You can't stop ruminating. You can't sleep. You feel like you're stuck doing 7,000 RPMs in your brain and you just wish to God you could slow down to just 2, let alone a dead stop. Chances are in that moment, whatever was happening in your life, your glutamic acid system, which is your main stimulatory neurotransmitter, was in overdrive and your GABA was downregulated and was not working. Now, what's interesting about GABA in women is that it requires progesterone to work. Think about it this way. Progesterone is the lock on the door. GABA is the doorknob. So you can bang on that door, you can twist that doorknob, you can push on that doorknob, doesn't matter. If the lock is thrown, the progesterone is not in the system. The door is not open. A lot of women wind up running around chasing one thing after another. They're on SSRIs, they're trying SNRIs, they end up on gabapentin, they end up on all these different drugs. They're in a low progesterone state. Now, I think the skeptical person should rightly question, why should we need a hormone that our body makes? Well, let's talk about it. We live in an environment where toxins are Very present, you know, from fire retardants in furniture and children's clothing. Like, did you know that they spray toddlers' clothes with fire retardants that are hormone disrupting chemicals? And people wonder why these kids today, like, don't know if they're cats or girls or boys. Just saying, just throwing it out there. Anyway, we're surrounded by these things. It's in our air, it's in our water, it's in our food, it's in our clothing, it's in our furniture, it's in our personal care products, right? So we have these disruptors that prevent the hormones from operating The way they're supposed to. We also have what I referred to earlier in this, in this Q&A, which is resistance. The body is resisting or is not able to respond to the hormone because downstream things that are necessary for the work to be done are not present. Like you can signal all you want all day to produce hormones and neurotransmitters and proteins and whatever that are going to make you feel a certain way or heal a wound or recover from an injury. But guess what? If you don't have, say, zinc or other critical minerals or vitamins in order to produce the things that your body is being signaled to make, the end result will not happen. It would be like, for example, president writes an executive order, you know, make a billion missiles. If there's no aluminum, if there's no munitions, no gunpowder, I don't know what they use in missiles, but you get the idea. There's no rocket fuel. There's no explosives. There's no people to work the machinery, the production line. They can't make the thing. Right. So between all of that, I think we're living in a time when women more than ever need supplemental hormones and also diet and lifestyle changes that will help them balance and support their natural hormone production. And I could go on and on about that all day, but I think this is why so many women struggle postpartum, because you have to wonder, right? This is such a critical time in our lives, right? And I say our, because I mean, you know, if you're a dad, you know how important this period in your life is. If your wife is out of her mind, I mean, how do you, how do you deal with that? It's very, very difficult. And it's, you know, a really important time for the child to be getting these, these messages of mom and dad know how to regulate their nervous systems. And they're imprinting this ability to regulate their nervous systems on the baby. So the baby will grow up to hopefully be a healthy, well-adjusted adult who can deal with their environment and adapt and thrive and survive. Right. And if the baby's getting from mom anxiety and depression and an inability to bond and all these things, right? What does that mean for the child long-term? By the way, if that's happened to you or it's happening to someone you love, I also don't want you to freak out about that. I really believe strongly that it's important to just say, okay, this is not ideal and not dwell on it and just say, how are we going to move forward? And how are we going to solve this problem and get things back on track and love this person and the child so that they can regain their health, right? Anyway, I think that's why this happens. It's the pollution in our environment and it's the lack of nutrition in our food, which is necessary to making these hormones and so on and so forth. Okay. Why do the right tools, right? What you hear about all the time on social media, in books, et cetera, sleep, protein, light, movement. Why do they sometimes feel out of reach? Or I would also submit to you, feel like they're not working, right? Even when you know that they're good for you. This is such a great question. What we find in these cases when we take them on and we bring them through our process, because I designed our process to be as focused on, because what you'll find if you really take care of patients is that it's never one thing, but sometimes there's 1 or 2 or 3 levers you pull that really move the needle. And so the name of the game is finding what those are. So most people know, you know, diet, exercise, eat right, this, that, the other thing, but I'll tell you the devil's in the details and you really have to take a good look at them in order to figure out what that means. So I'm just going to give you one example. We'll often have patients telling us, I eat a lot of protein. Well, what does that mean? Give me an 84-year-old lady who's retired and lives at home and has very low activity levels, and she'll tell me she eats a lot of protein. And I'll ask a 26-year-old bodybuilder who's twice her, you know, size or 3 times her size if he eats a lot of protein or if he eats enough protein. He'll say, yeah, I eat a lot of protein. These people both say, I eat a lot of protein. They mean radically different things. The 84-year-old woman probably means she has 1 or 2 ounces of chicken breast at lunch. The bodybuilder might mean that he crushes an entire bird in an afternoon. These are different things. Believe it or not, you have to get into these levels of detail in order to really help crack these difficult cases, because what you'll find is there's often these little things that they've missed. And it's hard to watch podcasts and listen to reels and read blog posts and cover all this the way we set up our curriculum in the practice, which you get access to when you join. If you book an evaluation with a member of my team, that's how you join. You'll see that we have a system for working through these things from the most important to the least important. And we really try to focus on things that actually matter and actually work. So sometimes you've got the right tools, but you haven't really learned how to use them the way you need to. Because that's the other thing, all of you are different. So, you know, I'll have a patient who, you know, they're taking our usual dose of methylated folate for their situation. And we'll run an extra lab test because they're not seeing the results they want. And we'll find out, aha, They have an abnormally elevated requirement for folate. Is that genetic? Is that environmental? I think some of that becomes academic. You can find those answers to those questions if you want. I just focus on, okay, what do we need to do in order to get this patient better? So that's why those tools sometimes don't feel like they're working. When they feel like they're out of reach, it's because your body doesn't have the bandwidth to reach for them. When I have somebody who's overwhelmed, who's exhausted, who doesn't have the energy, who doesn't have the bandwidth to do what they need to do in order to be well. I always look for, okay, what can we use to get them the energy, the physical energy they need to engage in the right diet, lifestyle, behavior change? I didn't always do it this way. I sort of tried to get people to do all the right things. And then I appreciated, okay, the person who's feeling overwhelmed and anxious and depressed, if I just get them less overwhelmed, less anxious, and less depressed, they'll be able to do more of the things I know they need to do in order to be healthy and recover their health. Dave, good to see you here in the comments. Appreciate your gratitude. So that's what I think about these tools. You have to really think about the details. A lot of the time you need a guide for that. We're happy to help book an eval. And you also have to understand that sometimes you need something beyond just the basic tools, like give a woman who's in a really bad low progesterone state progesterone, and she may find the energy, the focus, the mood, the motivation in order to go out and do all the stuff she knows she's supposed to be doing, but she just doesn't have the wherewithal to do when she's totally exhausted because she's sleeping terribly at night and she's depressed and horribly anxious in the middle of the day. That's what I got for you all today. Only got to 3 questions today because they were such good questions and there was so much for me to cover in each one of them. As always, you can ask me questions. The link is below wherever you're watching this. If you book an evaluation with a member of my team, we can show you how to get access to all the other resources I talked about today. The book available for purchase on Amazon. Go get a copy. It's great. I unpack tons of stuff like this in here, and there's more coming in what we call the companion resources online. Take care, everyone. Have a great day. Thanks for joining me.