How to achieve optimal hormone balance, regardless of age

Hi everyone –

It’s spring, and hormones are in the air in all the ways. This week I’m headed to the annual SXSW conference in Austin to speak at a couple of events, including one on AI and Women’s Health, and one on how to optimize hormones called Your Hormones Are In Your Hands 😀

And after my last newsletter a lot of you reached out and asked questions like, “Ok, HRT sounds promising, but what if I want to maximize my own hormones? Is there anything I can do to juice my estrogen, testosterone and progesterone now? Can I avoid the symptoms of menopause and andropause all together? What do I do to keep the juices flowing?”

So inspired by the above, today we are talking about what it takes to have optimal hormone health naturally, right now.

It’s a topic that’s highly personal to me. I’m 42, my youngest baby turned two last fall, and it’s honestly hard to believe, but I have officially put my years of focusing on fertility optimization in the rear view, and now I’m focused on slowing the aging process, and optimizing my own hormonal balance. I know that I can – and will – go into my 50s with maximum vitality using every tool I have studied and prescribed for a decade. This includes ensuring that I maintain balanced, healthy sex hormones, thyroid hormones and adrenal hormones now, so that I glide into menopause in 10ish years like it’s Not. A.Thing.  

So here is your cheat sheet, which requires starting with a little Biology 101.

  • Hormones are chemical messengers and each day your body manufactures hormones and breaks them down (aka “metabolizes” them) and excretes them.
  • Sex hormones typically decline with age, with estrogen and progesterone declining for women after 50 and testosterone slowly drifting down with age for everyone – unless you intervene.
  • Hormones are made from cholesterol, which is one reason you need healthy fats, and why the “avoid fat at all costs” mantra of the 90’s was so off-base.
  • Every cell in your body has receptors for your hormones. The hormone locks into the receptor, acts like a key to open a door, and kicks off a cascade of signals through the cell leading to the cell changing behavior in a multitude of ways, including synthesizing new proteins and displaying new receptors.  
  • Hormones are all connected and influenced by one another: Cortisol, DHEA, and the neurotransmitters norepinephrine and epinephrine are from your adrenals; free T4 and free T3 come from the thyroid; and Estrogen, Progesterone, and Testosterone come mostly from the ovaries or testicles, respectively, but also are made in the adrenals. Additionally, fat tissue also produces estrogen. These hormones work in concert, where higher levels of one  can drive lower or higher levels of the other.

So how do you tap into this beautiful dance and create the conditions for healthy hormone production and sustained hormone longevity? The following applies to hormones if you’re 18, 38, 58 or 68… and beyond.

  • Start with testing, and know where you are. Are you 30 and your testosterone is already low? It’s not going to magically get better, but it can get better if you act now.
    • The Parsley Health Baseline Male and Female Hormones panel looks at estrogen (total estrogens and estrogen metabolites like estradiol and estrone), progesterone, DHEA-S, a core adrenal hormone which is a testosterone precursor, and free and total testosterone along with SHBG (sex hormone binding globulin) which is the school bus that ferries your sex hormones around your body, and DHT (di-hydrotestosterone) the testosterone metabolite which is known for male pattern baldness.
    • The Parsley Baseline panel also evaluates thyroid function for men and women, including TSH, Free T4, Free T3 and key nutrients that support thyroid health like Zinc, Selenium, Iron and Vitamin D3.
    • To evaluate Cortisol, we use at home test kits that look at either salivary or urinary Cortisol patterns over the course of the day and tell us if your pattern is optimal, or indicative of Adrenal Fatigue.

Once you know where you stand, and you’ve determined that you want to optimize, I recommend starting with the following:

For Everyone:

1) Actively Build Long Term Testosterone through Body Composition and Blood Sugar Balance. Interestingly, research shows that exercise in the form of resistance (weight) training and high intensity exercise increases testosterone levels in the short term (i.e in the hour after exercise) but not long term as a stand-alone intervention. However one’s body composition, specifically lower overall fat mass, is associated with higher long term testosterone levels, while obesity is associated with lower testosterone levels. A recent 2023 study of 163,000 men in the UK evaluated 13 variables associated with lower vs higher testosterone and showed that lower adipose mass (fat tissue) was most correlated with higher testosterone levels. (Personally I would love to see a similar analysis of women – women’s health tends to be left behind in the research).

Regardless of biological sex, if you live a relatively sedentary lifestyle, that will yield a body composition with greater fat mass and reduce your testosterone production over the long haul. Testosterone is key to being able to build more lean muscle mass so it can be a slippery slope or a virtuous cycle. High sugar diets and sedentary lifestyles are the biggest culprits I see leading to younger people having low T.

My body composition prescription:

  • HIIT (High intensity interval training) 10-30 min, 1-2x weekly. My fav online HIIT is from Rocamoons.
  • Weight training 2-3X weekly. 15-30 min. Body weight is not enough. Use weights or resistance bands.
  • Yoga/activity that stretches and stimulates the fascia (connective tissue) 1-2x weekly, improving hyaluronic acid production and joint flexibility.
  • Eat adequate protein. To build muscle you need 1 gram per pound of body weight per day. So if you’re 150bls, yes that is 150 grams of protein daily. It can be hard to do but it’s key for building muscle and bone.
  • This combination will help build muscle, improve skeletal health, and stimulate connective tissue health, and in turn improve resting metabolism and insulin sensitivity, improving overall blood sugar balance. This matters even if you’re not overweight.

2) Fully Metabolize Your Estrogens

  • For men and women, the MTHFR and COMT enzymes are critical for healthy estrogen metabolism, breakdown and excretion, so supporting this process with methylated cobalamin (ie Methylated B12) and 5-MTHF (ie methylated folate) helps ensure your enzymes have the co-factors they need for estrogen metabolite break down and disposal.
  • Foods like cruciferous vegetables (broccoli, brussels sprouts), dark purple/red berries (blueberries, acai), and flax seeds to name a few also support healthy estrogen metabolism.
    • I recommend taking Parsley’s Daily Dose Multi or a similar methylated multi daily made by a professional grade, GMP certified manufacturer.

3) Use Targeted Supplements Based on your Test Results. There are thousands of internet sites that will promise the moon and the stars when it comes to hormones, and because supplements are not regulated in the same way as drugs, the claims out there get fuzzy. If it sounds too good to be true, it’s marketing;-) That said, here are some supplements I like and use routinely to support hormones:

  • Testosterone: Start with adrenal support through a supplement like HPA Adapt by Integrative Therapeutics, an adaptogenic blend that supports adrenal balance. This includes Maca which by the way has been shown to improve libido but not necessarily change testosterone levels.
  • Progesterone: Vitex, AKA Chaste Tree Berry, can support progesterone balance in premenopausal and perimenopausal women.
  • Estrogen metabolism: Meta-I3C by Metagenics, DIM Detox by Pure Encapsulations or similar product with indol-3-carbinol as the active ingredient can help the body break down and dispose of excess estrogens.
  • Resveratrol, Magnesium Glycinate and N-Acetyl Cysteine all support COMT enzyme activity and overall detoxification processes.

For Women:

4) Rest and De-Stress your Way to Healthier Progesterone Levels Through Cortisol. Chronically high cortisol levels due to chronic stress create a phenomenon called “cortisol steal”  which depletes progesterone by speeding up the pathway that converts progesterone to cortisol. Low progesterone levels are associated with irregular periods, impaired fertility and PMS, as well as worse menopause symptoms.

  • Perpetually high cortisol also increases blood sugar, which in turn increases insulin, which leads to poor blood sugar balance over time.
    • How: Spend 1 hour daily, awake, in a rested state. This could be through meditation, gentle yoga, breathwork, a bath, cooking, walking or Tai Chi/Chi Gong or other practices. This means you are awake, relaxed, and out of fight or flight.

I’d love to hear your stories of implementing my prescription above. One of my patients recently celebrated having optimal testosterone levels after years of seeing levels sub par. How did he do it? He cut out alcohol and refined carbs and started working out with a trainer and lost 40lbs while increasing muscle mass. The impact on resting testosterone was to nearly double his total and 3X his free testosterone.

Have you implemented any of the above and seen better hormone balance based on symptoms or tests? Which supplements have you seen have the biggest impact? I’d love to hear your stories.



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