Hormone Balance

Hormone surges and imbalances are well-known at puberty and menopause. However, everyone experiences fluctuations all the time. It’s a question of balance and rhythm, as if the human body were a symphony orchestra with melody, harmony, and interactions among many players — hopefully under the guidance of an excellent conductor.

When we feel good, we are making beautiful music ourselves, and we are participating in the beautiful music all around us in the form of loved ones, our work, our communities, and Nature itself. On the other hand, feeling crummy, getting off-key, having disrupted rhythms, or otherwise falling out of harmony are all clues that something is wrong with our internal hormone symphony. This is where self-assessment, laboratory testing, and professional consultation come into play.


The single most common hormone imbalance today is low thyroid function. It is also the single most under-diagnosed and under-treated endocrine problem. Symptoms may include depression, cold hands or feet, thinning or dryness of hair-skin-nails, trouble with memory or concentration, and heavy or frequent menstrual cycles. Dr. McKay often observes enlarged tongues with scalloped edges (due to pressing against the teeth) in people with years of low thyroid function. A stunningly long list of other thyroid-related symptoms may also be present, because thyroid hormone is the master regulatory hormone setting metabolic rate in every tissue of the body.

Low thyroid function may show up on lab tests as low or low-normal free T4 and free T3, with elevated or high-normal TSH. Excessively broad laboratory reference ranges lead to much misery: The upper end of normal TSH should probably be 3.0 according to the AACE, American Association of Clinical Endocrinologists, and the upper end of “optimal” TSH may actually be lower. But TSH by itself is a notoriously poor predictor of good health, and it can be completely unreliable in the presence of prescription thyroid replacement therapy.

Low thyroid function can also occur even if lab tests are seemingly normal, in part because of skewed laboratory reference ranges, and in part because of thyroid hormone resistance, where the cellular receptors for thyroid hormone fail to respond properly. Many people have heard of “insulin resistance” which precedes adult-onset diabetes, but most are unaware that other hormones can also have their own “resistance” syndromes. In these cases, tracking body temperature using a trustworthy liquid thermometer (available in our clinic) can be a real eye-opener; it is all too common to see average daily temperatures a full degree, sometimes even two full degrees, below the human average normal of 98.6 degrees Fahrenheit. Many people spend years and years with low body temperatures, with no comment or help from their attending physicians, despite the fact that most enzymes (the proteins that do the real “work” inside each cell) do not function well below about 98.2 degrees Fahrenheit. There are multiple causes for low body temperature or low metabolism, but surely it is not too much to expect a thorough assessment of thyroid function in these cases.

Dr. McKay is a certified WTS Practitioner, and is able to administer the complex protocol for Wilson’s Temperature Syndrome. She finds it shocking that so many people are abandoned by mainstream healthcare when they have been walking around for years with a body temperature that is well below normal. “If you’ve got a one-half degree fever of 99.1, then you and your doctor pay attention, you call in sick, you get treated for an illness, and you don’t just shrug it off. And yet if your body temperature is too cold, doctors typically just ignore it without comment. This is so wrong!” asserts Dr. McKay. “It’s like putting your olive oil into the refrigerator — it turns solid, it’s no longer a liquid oil, and it doesn’t do what you need it to do,” she explains. “Solidifying or chilling tissues has undesirable consequences throughout every body system.”

Restoring thyroid function involves much more finesse and expertise than simply taking T4 (Synthroid or its generic equivalents), which in some cases actually worsens the slow metabolism. Assessing the body’s ability to convert the pre-hormone T4 into the biologically active hormone T3 is essential; supporting the thyroid gland itself is equally essential.

The single most common cause of low thyroid function is auto-immune disease (Hashimoto’s Thyroiditis), where the immune system gets de-regulated and accidentally attacks “self” tissue rather than pathogenic invaders such as foreign bacteria or viruses. Dr. McKay has seen many, many cases of undiagnosed auto-immune disease and views it as a national tragedy that so many people are not being diagnosed or treated appropriately.


Excess stress, low blood sugar or hypoglycemia, and high blood sugar or pre-diabetes, as well as hypertension or high blood pressure, are all closely tied to the typical American status: “over-fed but under-nourished.” All of these disorders involve deregulation of carbohydrate metabolism, specifically overproduction of the hormones insulin and cortisol. Together these two hormones act in concert to maintain blood glucose homeostasis, or stability. The more sugars and starches we consume, the more insulin we need to process those carbohydrates, and therefore the more frequently we are going to dip down to low glucose (hypoglycemia) states. These low blood sugar episodes in turn trigger stress reactions from the adrenal glands, which give us bursts of cortisol (the main stress hormone), which causes release of stored glucose from body tissues in order to raise blood glucose concentration back up to normal levels. In healthy people, this adaptation occurs gently and un-noticed a few times daily.

However, for those in the grips of unrelenting stress, or for those who are habituated to SAD, the Standard American Diet (with its surfeit of sugars, starches, and additives), then insulin overload, insulin resistance, hypoglycemic episodes, and frequent spontaneous stress reactions are all too common.

Dr. McKay calls this “The blood sugar roller coaster,” and notes that mood swings, drowsiness, irritability, allergies, a spare tire around the middle, and overwhelming cravings for starches, sweets or alcohol, are par for the course. And if that’s not enough, we also see increases in triglycerides (blood fats) and the bad cholesterol, LDL (low-density lipoprotein), made by the liver to carry around the heavy burden of blood-borne fats that are made from all those sugars and starches.

You read that right: Body fat and high cholesterol both come more from eating excessive sugars and starches, rather than from eating animal fats. Of the cholesterol measured in blood tests, the huge majority is endogenous, made by our own livers; only a tiny portion comes directly from the animal fats in our diet. And all of this responds to hormone rebalancing! Not with a little pill, but with well-informed choices about feeding our bodies real foods, the foods our bodies were designed to use for fuel and repair — not synthetic food-like substances that burden the liver with even more toxins. (Thank you, food journalist Michael Pollan, for the phrase “synthetic food-like substances.”)

As for stress, the modern epidemic that seems inescapable: Stress comes in many forms — the body doesn’t really distinguish between stress from an injury, stress from an argument, stress from a virus, stress from being stuck in traffic, or stress from planning a wedding. There is only one basic stress reaction, commonly known as “fight or flight.” Dr. McKay likes to add “freeze or squeeze” as well, because what happens in a stress reaction is a surge of adrenal hormones which cause a rush of blood to the muscles (high blood pressure, ready to flee or fight an enemy), cessation of digestion (you don’t want to waste energy in the digestive tract if you are running from a tiger), excessive blood clotting (to prevent bleeding to death if the tiger actually scores one), and a peculiar type of paralysis that may be physical or emotional (the deer in the headlights phenomenon). If we literally run away from a stressful situation, we often receive temporary relief; many people over-exercise for this very reason. But if we must stay in our seats (driving, at work, at school) then the stress hormones continue to circulate for hours, cutting off circulation, fogging brain function, and derailing digestion the whole time.

Despite the extreme popularity of Valium, Xanax, and their many pharmaceutical brethren, suppressing our stress reactions with prescription drugs does not get to the root of the problem, and often makes things worse when the rebound reaction occurs (even greater anxiety than before, once the drugs wear off). Climbing off the blood sugar roller coaster is a obvious and simple first step to reducing excessive spontaneous stress reactions, and Dr. McKay has seen swift and permanent cures from this one suggestion alone. But if that’s not enough by itself, then many other lifestyle, herbal, and even BHRT solutions are available. Because it can be so destructive, Dr. McKay treats stress with great respect and diligence.


Women’s monthly hormone cycles make themselves known in obvious ways. Missed periods, excessive bleeding, disruptive mood changes or cravings, infertility, or sadly even downright pain, are hard to miss. Restoring hormone balance and rhythm can have profound benefits for well-being, fertility, and overall health throughout the reproductive years of a woman’s life cycle.

During “peri-menopause” (five years before and five years after the last menstrual cycle), as the ovaries are preparing to go dormant, the ideal pattern is a gradual tapering-off, with a missed period here and there, and then peaceful cessation of menses, with no drama and no upset — and then, welcome to revered elder status! Sadly, few of us are so lucky. Surgical menopause (hysterectomy) is especially harsh, but even without surgery, the hormone fluctuations at this time of life can cause unexpected misery. Besides bleeding disorders which can be life-threatening in severe cases, it is common for the brain itself to become inflamed when deprived of its accustomed hormone cocktail, leading to “brain fog” (difficulties with memory, concentration, focus) and emotional unsteadiness. Estrogen deprivation can also affect the brain by causing embarrassing tearfulness, as if the “off switch” for weeping had been taken away; not a pretty picture for a professional woman trying to hold her own in a meeting. Diagnosis is simple with a take-home saliva test kit from ZRT Lab.

Bio-identical hormones — real human hormones, not horse estrogens and not synthetic progesterone caricatures — when prescribed skillfully, will provide safe relief from hot flashes, night sweats, mood swings, brain fog, lost libido, dried-up skin, and much more. Sometimes relief and well-being can be found with herbs, nutrition, and lifestyle improvements. Every woman deserves to find her own unique answer.

The #1 best-selling prescription drug for several decades was Premarin, the commercial hormone blend targeting menopausal women. Premarin and Prempro fell from grace a few years ago when it was revealed that they actually worsen heart disease. This is just one of many reasons to favor real human (bio-identical) hormones over their synthetic mimics. The names of these two drugs tell the story: Premarin is made from PREgnant MARes’ urINe, loaded with horse estrogens, some of them similar to human estrogens, but some of them 10 times stronger than human ones. Prempro adds synthetic PROgestin, a bizarre mimic of real human progesterone that is infamous for causing mood disorders due to brain inflammation.

Birth control pills contain synthetic progestins, as well. There is a prevalent confusion about the difference between synthetic progestins and real human progesterone. Please be aware that real human progesterONE is bio-identical and typically quite beneficial, while artificial progesTINs have partially similar and partially opposite effects in the female body. “I am reminded of the 1960’s commercial that said It’s Not Nice to Fool Mother Nature,” says Dr. McKay, “because the effects of synthetic progestins can be so paradoxical, including lots of brain effects.” Birth control pills suppress women’s own hormones so much that natural libido often disappears as well. This is not a side effect that most women would willingly accept, if only they were fully informed. There is no valid one-size-fits-all answer here, and a well-informed discussion every few years is essential to good health and a great quality of life.


“It’s not a character flaw, it’s a hormone imbalance,” Dr. McKay says to many men and their loved ones. “When men change from formerly active, lean, cheerful go-getters, into grumpy, irritable couch potatoes — blame it on a decline in hormones.” In fact one of the better books on this subject is entitled (and we are not making this up), The Irritable Male Syndrome. Sadly, it’s no joke.

Testosterone is essential to men’s well-being, but it cannot do its work in the presence of massive hormonal interference from excessive stress, the blood sugar roller coaster, low thyroid function, prolonged stress … nor indeed the overwhelming hormonal disruption generated by large amounts of adipose tissue. Sad but true, anything over about 10 pounds of excess body fat turns out to function like another endocrine gland, sending out a steady trickle of pro-inflammatory hormones and cytokines, and turning good useful Testosterone into hazardous Estradiol, courtesy of the enzyme Aromatase which is abundant in adipose tissue. So it’s a vicious cycle: Fatness begets Aromatase, which converts Testosterone into Estradiol, which inflames the prostate and shrinks muscle tissue, while the loss of Testosterone causes muscle atrophy, increased cholesterol, depression, and… you guessed it, an increase in adipose tissue. It’s almost as if fatty tissue has a mind of its own, and it knows how to protect itself and increase itself, even at the expense of the owner. Meanwhile, just to dig the hole a bit deeper, excess Estradiol signals the Liver to produce more SHBG (sex-hormone binding globulin) which has a preferential affinity for Testosterone. In other words, the precious little Testosterone that is left behind gets locked onto giant protein carrier molecules and thereby becomes unavailable to do its work in body tissues. Starvation for bio-available Testosterone has caused many good men to become high-fat, high-cholesterol, depressed, irritable, muscle-wasted heaps of pre-diabetic frustration.

Relief may come from hormone testing, lifestyle and nutrition improvements, or BHRT (bio-identical hormone restoration therapy). There is no such thing as one-size-fits-all when it comes to restoring balance and well-being; be suspicious of any promises of a quick fix. Declining hormones, increasing aches and pains, and an expanding waistline usually take years to develop. While Dr. McKay observes that her treatment yields improvements usually within a few weeks, complete restoration of full health is often a project, something that cannot be found in a single pill or cream.

And all that hype about getting to the gym? It is partially true, because resistance training causes the male body to naturally produce more Testosterone — which in turn reduces cholesterol, burns fat, supports lean tissue, and clears the mind. However, Dr. McKay cautions, the “weekend warrior” experience too often leads to injuries, which keep men away from their workouts; the ensuing lack of exercise contributes to depression, poor digestion, poor sleep, and a host of other problems. As she reminds her patients, “No pain… that’s good!”


Sleep is essential, and good quality, restorative sleep is worth its weight in gold (OK, maybe sleep doesn’t have a measurable weight, but it is certainly precious). Falling asleep quickly and effortlessly, staying asleep peacefully, and awakening refreshed should be the norm. Adequate Melatonin is essential to good sleep, as is normal overnight respite from the main stress hormone, Cortisol. Awakening already fatigued might be a marker for low Thyroid function.

Dr. McKay continues to be amazed by how many people experience insomnia, or disruptions to this ideal sleep pattern, and more shockingly, how many people unwittingly have habits that give them poor sleep. “Good sleep hygiene is so basic, I wish it would be taught in school,” she says. However, in many cases, even with good habits, insomnia or sleep disturbances can be ruinous to quality of life and even to overall health. In these cases, hormone imbalances and brain disruptions are usually the culprits. Saliva hormone testing can reveal important patterns that are amenable to supplementation and lifestyle management. Dr. McKay observes that the single most common reason for disrupted sleep is the blood sugar roller coaster, which, once identified, is fairly simple to heal.

Persistent sleep deprivation has been identified as a major hazard to overall health, and is a known risk for developing cancer, according to WHO, the World Health Organization. Rotating night work shifts are the worst sleep hazard, according to WHO. Dr. McKay uses a wide range of approaches to solve sleep problems, and finds it rewarding to do adjunct care for patients who have already done their mainstream sleep lab studies and might have been sold CPAP machines (continuous positive airway pressure) intended to control snoring and apnea (involuntary breath-holding while asleep). She’s also had a very good success rate treating twitchy legs and cramping feet or calves, utilizing a mixture of holistic techniques and collaborating with her patients to get to the root of problems.