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Hormones have a widespread effect on an individual’s mental, physical, and emotional health. When they are dysregulated, hormones can cause profound imbalances throughout the body. Studies show that sex hormones and their metabolites may even influence brain areas that regulate mood, behavior, and cognitive abilities.¹

Interestingly, research has found that many lifestyle factors can disrupt hormone balance, including nutrition,^2-4 exposure to air pollution,⁵ and chronic stress.⁶ However, the converse is also true. Evidence continues to grow demonstrating that many lifestyle factors can be altered and improved to reverse hormonal dysregulation and bring the body back into equilibrium. Joel Evans, MD, a longtime IFM educator, describes the impact of chronic stress on hormonal balance in the following video.

As Dr. Evans describes, the adrenal hormones have a powerful effect on all other hormones. Stress can both predispose patients to and precipitate hormonal imbalances.^6,7 Stress may also increase symptoms for patients with existing hormone imbalances.^8-10 This outsized influence of adrenal hormones is the reason that, when treating hormone imbalances, there is a functional medicine tenet that says to “start with the adrenals.” In functional medicine, evaluation of stress and stress management strategies offers a low-harm, high-benefit intervention that can assist with downstream thyroid and sex hormone production, transport, and processing. The steroidogenic pathways are modulated by many factors, of which stress is just one example.

Functional Medicine Interventions

One lifestyle factor, physical activity, has many beneficial effects, including decreased levels of stress;^11,12 it may also boost levels of muscle-maintaining hormones that decline with age.^13,14 For patients who are unable to perform vigorous exercise, regular walking may improve hormone levels and potentially improve strength and quality of life.¹⁵ Research has also shown that lower levels of stress biomarkers are associated with stress-reducing techniques like meditation^16,17 and massage.^18,19 A 2005 review of studies found that massage therapy not only reduced cortisol levels by an average of 31% but also increased levels of the mood-boosting hormone serotonin by 28% and levels of dopamine by 31%, on average.¹⁸

IFM recently revised a two-page patient handout in the IFM Toolkit entitled “Effects of Chronic Stress” that overviews some of the common chronic stressors and outlines various strategies to decrease those stressors. To access the toolkit, simply log in to your IFM account and select “My Toolkit” in the menu on the left. Select “Recently Updated” or browse the other available resources.

At IFM’s Hormone Advanced Practice Module (APM), expert educators like Dr. Evans provide the foundational knowledge needed to understand and influence the steroidogenic pathways, central in the formation of all steroid hormones. The course presents novel assessment strategies and highlights the many points of leverage for restoring patients to hormonal balance before resorting to hormone replacement therapy. To learn more about how the web of hormones may be affected by modifiable lifestyle factors, please read the following IFM-authored articles.Learn more about tools and strategies to help patients achieve sustainable lifestyle change and improve their well-being through IFM’s new course Lifestyle: The Foundations of Functional Medicine.

A Functional Medicine approach to PMS

How and when to consider estradiol for cognitive decline

Chronic illnesses, menopause, and the role of nutrition

References

1. Del Río JP, Alliende MI, Molina N, Serrano FG, Molina S, Vigil P. Steroid hormones and their action in women’s brains: the importance of hormonal balance. Front Public Health. 2018;6:141. doi:3389/fpubh.2018.00141
2. Köhrle J. Selenium and the thyroid. Curr Opin Endocrinol Diabetes Obes. 2015;22(5):392-401. doi:1097/MED.0000000000000190
3. Jain RB. Thyroid function and serum copper, selenium, and zinc in general U.S. population. Biol Trace Elem Res. 2014;159(1-3):87-98. doi:1007/s12011-014-9992-9
4. McCabe D, Lisy K, Lockwood C, Colbeck M. The impact of essential fatty acid, B vitamins, vitamin C, magnesium and zinc supplementation on stress levels in women: a systematic review. JBI Database System Rev Implement Rep. 2017;15(2):402-453. doi:11124/JBISRIR-2016-002965
5. Li H, Cai J, Chen R, et al. Particulate matter exposure and stress hormone levels: a randomized, double-blind, crossover trial of air purification. Circulation. 2017;136(7):618-627. doi:10.1161/CIRCULATIONAHA.116.026796
6. Ranabir S, Reetu K. Stress and hormones. Indian J Endocrinol Metab. 2011;15(1):18-22. doi:4103/2230-8210.77573
7. Vita R, Lapa D, Trimarchi F, Benvenga S. Stress triggers the onset and the recurrences of hyperthyroidism in patients with Graves’ disease. Endocrine. 2015;48(1):254-263. doi:1007/s12020-014-0289-8
8. Pimenta F, Leal I, Maroco J, Ramos C. Menopausal symptoms: do life events predict severity of symptoms in peri- and post-menopause? 2012;72(4):324-331. doi:10.1016/j.maturitas.2012.04.006
9. Matsuzaki K, Uemura H, Yasui T. Associations of menopausal symptoms with job-related stress factors in nurses in Japan. 2014;79(1):77-85. doi:10.1016/j.maturitas.2014.06.007
10.  Hirokawa K, Taniguchi T, Fujii Y, Takaki J, Tsutsumi A. Job demands as a potential modifier of the association between testosterone deficiency and andropause symptoms in Japanese middle-aged workers: a cross-sectional study. 2012;73(3):225-229. doi:10.1016/j.maturitas.2012.07.006
11.  Vankim NA, Nelson TF. Vigorous physical activity, mental health, perceived stress, and socializing among college students. Am J Health Promot. 2013;28(1):7-15. doi:4278/ajhp.111101-QUAN-395
12.  Pedersen BK. Physical activity and muscle-brain crosstalk. Nat Rev Endocrinol. 2019;15(7):383-392. doi:1038/s41574-019-0174-x
13.  Sato K, Iemitsu M, Matsutani K, Kurihara T, Hamaoka T, Fujita S. Resistance training restores muscle sex steroid hormone steroidogenesis in older men. FASEB J. 2014;28(4):1891-1897. doi:1096/fj.13-245480
14.  Seo DI, Jun TW, Park KS, Change H, So WY, Song W. 12 weeks of combined exercise is better than aerobic exercise for increasing growth hormone in middle-aged women. Int J Sport Nutr Exerc Metab. 2010;20(1):21-26. doi:1123/ijsnem.20.1.21
15.  Yamada M, Nishiguchi S, Fukutani N, Aoyama T, Arai H. Mail-based intervention for sarcopenia prevention increased anabolic hormone and skeletal muscle mass in community-dwelling Japanese older adults: the INE (Intervention by Nutrition and Exercise) study. J Am Med Dir Assoc. 2015;16(8):654-660. doi:1016/j.jamda.2015.02.017
16.  Dada T, Mittal D, Mohanty K, et al. Mindfulness meditation reduces intraocular pressure, lowers stress biomarkers and modulates gene expression in glaucoma: a randomized controlled trial. J Glaucoma. 2018;27(12):1061-1067. doi:1097/IJG.0000000000001088
17.  Fan Y, Tang YY, Posner MI. Cortisol level modulated by integrative meditation in a dose-dependent fashion. Stress Health. 2014;30(1):65-70. doi:1002/smi.2497
18.  Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C. Cortisol decreases and serotonin and dopamine increase following massage therapy. Int J Neurosci. 2005;115(10):1397-1413. doi:1080/00207450590956459
19.  Chen PJ, Chou CC, Yang L, Tsai YL, Chang YC, Liaw JJ. Effects of aromatherapy massage on pregnant women’s stress and immune function: a longitudinal, prospective, randomized controlled trial. J Altern Complement Med. 2017;23(10):778-786. doi:1089/acm.2016.0426