Hormones: We all have them, but we seldom notice them — until the balance shifts. Mood changes, fatigue and new physical developments can all signal a hormone imbalance.
Hormones can fall out of sync and lead to a panoply of physical and emotional changes, most of them unwanted. The good news is that a basic evaluation of hormonal balance — and potential early detection — is normally just a blood test away.
We talked to medical professionals to learn how to spot common hormonal balances and how they’re typically treated. The diversity of hormonal imbalances reflect the huge role they play in our bodies.
What is a hormone imbalance?
Generally speaking, hormones are the signaling chemicals secreted by our endocrine glands, which regulate bodily functions.
Hormones regulate an extensive list of bodily functions, including reproduction, brain function, growth, sleep, mood and metabolism.
Hormone imbalances are abnormalities in the endocrine system that can impede physical and mental well-being. Since hormones regulate so much, if they’re off-balance, they can affect everything from heart rhythms (tachycardia) to menstrual cycles (premenstrual dysphoric disorder).
Most hormone imbalances are quite subtle, and not every change to the body caused by hormones is distressing. A transgender person might seek out hormone replacement therapy (HRT), which is often used to treat hormonal imbalances, to change their body’s sexual characteristics. This can grant emotional relief from gender dysphoria, a sense of unease that comes when your gender identity doesn’t match your biological sex. HRT can change body hair, breast development, fertility and muscle tone.
We break down the five most common hormone imbalances and how medical professionals can treat them.
Polycystic ovary syndrome
When the ovaries produce more androgens, like testosterone, than they’re supposed to, this can create an imbalance in hormones. The resulting condition, PCOS, can cause excess body hair growth, head hair loss, acne and ovarian cysts.
Having too many androgens in the body can also interfere with ovulation, which makes PCOS a leading cause of infertility. It can develop as early as age 15 or as late as 45.
“There is also an increased rate of anxiety and depression with PCOS,” says internist Dr. Raj Singh.
“The relationship between PCOS and gender euphoria is complex and multifaceted,” he says. “For some transgender men with PCOS, the physical changes that come with the condition may align with their gender identity and be affirming.”
Experts don’t fully understand what causes PCOS, but potential causes include genetics, insulin resistance and low-grade inflammation throughout the body. It’s also strongly correlated with obesity.
Although diagnosis can be difficult due to the diverse manifestation of symptoms, PCOS is one of the most common hormone imbalances and is well-known to doctors. General practitioners can work with patients to identify core symptoms and arrange for diagnostic tests to narrow down the cause. There are numerous treatment paths for PCOS, including medication, lifestyle adjustments and symptomatic treatment.
Hypothyroidism
The thyroid gland is a butterfly-shaped gland at the front of your neck that produces hormones which guide most of your body’s functions. Hypothyroidism stems from the insufficient production of thyroid hormones. You’re more likely to develop hypothyroidism if you’re a cisgender -woman.
Symptoms include fatigue, weight gain, cold intolerance and joint stiffness. Hypothyroidism can also cause hair loss, mood swings and fluctuations in your sex drive. Genetics, pregnancy and autoimmune disorders can also contribute to insufficient production of thyroid hormones.
Fortunately, thyroid function tests can provide a multipronged diagnosis by examining levels of TSH (thyroid-stimulating hormones). Ideally, multiple tests performed over a period of time can reduce error and identify a sustained pattern of low thyroid activity. Hypothyroidism is commonly treated with hormone replacement medications.
Thyroid conditions can also present differently in trans people. “Transgender individuals on feminizing hormone therapy with estrogen can have a higher incidence of hypothyroidism than the general population,” Singh says.
Hypothyroidism may also impede HRT for transmasculine patients by increasing bound or inactive forms of testosterone. “Transgender men with untreated hypothyroidism can require higher doses of testosterone to achieve the desired results,” says Singh.
Hyperthyroidism
The names may sound similar, but hyperthyroidism is the inverse of hypothyroidism; it’s characterized by an overproduction of thyroid hormones. This can lead to weight loss, tremors, anxiety and a rapid heart beat. Further symptoms include heat intolerance, increased urination, hair loss and tremors.
Hyperthyroidism is commonly caused by Graves’ disease, which is an autoimmune condition, as well as benign tumors on the pituitary gland, thyroid inflammation and other issues.
To diagnose hyperthyroidism, a clinician would evaluate your symptoms and prescribe thyroid function tests to identify the root issue. You might get a prescription for a medication that slows hormone production of the thyroid gland.
Adrenal insufficiency
Your adrenal glands, located on top of each kidney, are responsible for releasing adrenaline. Beyond regulating your body’s response to stress, they also play a key part in regulating various bodily functions, including metabolism, blood pressure and immune system functions.
Adrenal insufficiency, in which the adrenal glands don’t produce enough hormones, can lead to fatigue and low blood pressure. The most common cause of adrenal insufficiency is Addison’s disease, an autoimmune condition that gradually erodes adrenal function.
Extreme cases are life-threatening, but those usually come about because of severe trauma or injury which has caused direct damage to the adrenal glands.
In nonemergencies, diagnosis requires identifying a cortisol deficiency and tracing it back to the adrenal glands, rather than another gland. If a clinician suspects that the hormone deficiency is located in the adrenal glands, further testing can evaluate the type and severity of the condition. Hormone replacement medication is normally used to treat this condition.
Hypogonadism
Anyone can be affected by hypogonadism, characterized by decreased function of the gonads, which include the testes and ovaries. It can lead to decreased sex drive, infertility and muscle loss. Symptoms can also differ based on the type of the gonad.
People with testes may experience gynecomastia (breast development), muscle loss, infertility and erectile dysfunction related to low testosterone levels. People with ovaries may experience irregular periods, infertility, osteoporosis or hot flashes due to low levels of estrogen.
Everything from autoimmune disorders to inflammation to obesity can cause hypogonadism. Since the gonads are the primary producer and converter of sex hormones, this can simplify diagnosis. A blood panel prescribed by a physician can find out how your body’s production of sex hormones compares to the norm. The most common treatment is hormone replacement therapy.