How to Know if Your Hormones are out of Whack

By Kim Crawford, M.D. Last updated: January 10, 2019

Hormonal Health

Each decade after age 25-30 we start losing hormonal function. The symptoms are very subtle at first. The signs that your hormones are out of balance may masquerade as sleep or energy issues. They can even mimic or cause cognitive or mood issues. There’s a reason the divorce rate is highest for menopausal women and andropausal men. Indeed, getting a divorce might be a symptom caused by two people with hormonal issues. Are your hormones out of whack? A thorough medical history report with lab testing by a qualified anti-aging specialist will determine this. If you think you have hormonal issues, see if you fit into a typical “by-decade” pattern.

Age 30-40

We start to lose melatonin by the time we hit age 30. As a result, we can start having sleep issues. Loss of melatonin is made worse by our poor sleep hygiene habits of having TV’s, computers, tablets and bright lights in the bedroom. Symptoms can include having trouble falling asleep, staying asleep, or just awakening feeling unrefreshed. Make sure that you have good sleep hygiene to keep your natural melatonin levels up and then supplement if needed. To review what’s best, read about the best natural sleep aids.

Mid 30’s

Human Growth Hormone (HGH)

In our mid 30’s, a drop in Human Growth Hormone (HGH) is noticeable. This is not usually dramatic, but sometimes, the following changes are indeed present in our mid to late 30’s:

  • Increase in body fat
  • Increase in wrinkles and the beginning of sagging, thinning skin
  • Less of a feeling of well being
  • Sagging of muscles and breasts (usually doesn’t start until the late 40’s)
Age 30-40 in Women

Progesterone deficiency

Progesterone deficiency is the great masquerader. It can cause sleep issues which then decrease your energy levels. It can decrease serotonin levels which make you irritable, anxious (low GABA)  and/or depressed. You may experience minor memory issues such as name recall, and some concentration issues too. Peri-menopause may start as early as 25! Mood swings and PMDD may be other symptoms. However, typically this starts around 40.

A decrease in testosterone in women is often responsible for a decreased sex drive and tends to occur after we see a drop in progesterone; usually when you are in your 40’s but possibly prior.

If you feel you have a progesterone deficiency, then the hormone pregnenolone, with its breakdown product of progesterone, will help you sleep better and have improved cognition and mood. It also staves off low progesterone; which may lead to constipation issues. (Yes, low progesterone decreases gut motility and can cause constipation). Take pregnenolone in doses up to 200 mg at bedtime. Note it is often a good substitute for progesterone until close to menopause. Take 5-HTP to elevate serotonin levels. For anxiety, use pharmaGABA to elevate GABA levels.

Age 40-50 in Men

Testosterone deficiency

A variety of factors can cause “Low-T.” Real “andropause” is typically a drop in testosterone usually occurring in men in their 50’s; It can happen earlier though. However, non-andropause induced “low-T” needs a bit of investigation.

Low testosterone levels can be caused by rough sports with knocks to the head or groin. It can be caused by previous use of testosterone for bodybuilding purposes with disruption of the normal pituitary-testicular axis. Additionally, testicular tumors or varicoceles can also cause it. Nevertheless, have a Specialist do an evaluation; not a counselor in a “hormone mill.” signs that your hormones are out of balance

Testosterone deficiency can also cause memory, mood, and sleep issues, usually resulting in unrefreshed sleep.

Energy is also impacted as well, with an all-day feeling of sluggishness, which includes lack of drive, inability to start an exercise regimen, and loss of muscle mass.

Libido is down, and erectile dysfunction is possible, but (believe it or not) it’s usually not due to having a low level of testosterone. If you have “E.D.”, more often it’s from vascular disease and/or high glucose levels.

IMPORTANT NOTE: If you are experiencing the symptoms described above, there is the remote possibility of a testicular nodule that may or may not be serious. If you feel one, seek medical help immediately. I’ll discuss testosterone replacement below.

Age 40-50 in Men and Women

By our mid 40’s, we recognize the need for progesterone in women. In fact, sometimes we even see early menopause which I’ll discuss in detail in a moment. With the passage of time, we notice the effects of having less HGH (human growth hormone). Have you noticed how injuries heal more slowly than in years past? That’s why.  Also, we sometimes see testosterone levels decrease in both men and women.

Age 50 in Women

how to know if your hormones are out of whackIn our early 50’s, women will experience irregular periods, hot flushes, a definite drop in libido, and vaginal dryness. All of these symptoms, other than the libido drop (due to a loss of testosterone levels), are due to estrogen loss. There are other hormonal “disasters” which occur and contribute to what I call the “menopause 25 pounds” and menopausal belly fat. All of these hormonal changes are treatable meaning 100% reversible.

One quick word about hot flushes/flashes or whatever you’d like to call them.

Adrenal fatigue, with its high cortisol levels, is sometimes associated with hot flushes.

If you have undiagnosed energy issues and hot flushes too, don’t assume this is due to low estrogen. Read the articles on this blog about adrenal fatigue and find out if you “see yourself.”

Note: If your adrenal fatigue is severe enough to cause hot flushes, you will not get better on your own.

Estrogen deficiency

Estrogen deficiency is the “usual” cause of hot flushes. Do not consider taking a synthetic estrogen pill prescribed by your regular doctor. Synthetic estrogen is associated with breast and uterine cancer as well as Alzheimer’s! Why is this still on the market? Your guess is as good as mine.


Treatment is a combination of Estradiol and Estriol creams or pellets (bioidentical hormones). Even if you have had a hysterectomy, you need bio-identical progesterone to protect breast tissue, as well as sleep and immune function.

Before menstruation stops fully, women’s adrenal glands try to “pick up the slack” by producing estrone, which functions like estradiol (neutral) and estriol (healthy), with one huge exception.

Many studies on breast and uterine cancer make a correlation between estrone (the “bad estrogen”) and cancers. The problem appears to be with the metabolites of estrone. However, these can be modified to transform into the useful metabolites which come from the breakdown of estradiol and estriol. You can supplement to shift bad estrogen/estrone to metabolites of good estrogens with products that contain “DIM.”

Age 50-60 in Men

In our 50’s, most men definitely go through through “andropause,” much the same as women go through menopause. Testosterone levels drop causing a drop in energy, motivation, mood, libido, sometimes causing erectile dysfunction, as well as unrefreshed sleep. The optimal treatment is an easy, self-administered once weekly injection of bio-identical testosterone.

The vast majority of testosterone topical preparations are not strong enough. At some point, (probably related to hair follicles), men stop absorbing topical testosterone.

Note of Caution:

If you are a man getting testosterone from your general doctor, he/she is most likely unaware that testosterone converts to estrogen, and therefore, most men require an “estrogen-blocker“. Please have testosterone, free testosterone, and estradiol measured by a specialist!

How to know if your hormones are out of whack by the time you are Age 60-70

In our early 60’s, cortisol levels start creeping up. It is quite common for people to experience a drop in energy and attribute it to age. There is no reason energy or cognition should fall off at 60. We have cortisol which can be lowered and mitochondria which can be amped up. Don’t settle for “feeling older” when it’s unnecessary. I haven’t mentioned insulin levels, but you should have them under control by the time you hit 60. Insulin is a great marker for inflammation, and it’s easy to get it down to 2 IU/ml (optimal). If it isn’t and you’re 60, it’s time to take control of your health.

Age 70-100

Some “forgotten” hormones can diminish as we age. These include parathyroid hormone and calcitonin, both of which are needed for bone health and other “odds and ends.” Also, hypothyroidism can be due to a diminution of TRH—thyrotropin releasing hormone. Doctors measure the pituitary TSH and thyroid hormones T3 and T4 (free T3 and free T4 are correct), but no one seems to consider TRH. My 92-year-old father was “visibly” hypothyroid, and his regular doctor plus a Specialist told me he was fine. I then ordered the correct tests, and yes, now my dad is fine, on bio-identical thyroid hormone I prescribed.


I have always found that if someone thinks something is “out of whack,” it is. Don’t let your doctor tell you the sky is pink when you know it’s blue. If you have a problem that is being scoffed off as “depression” or “stress” and you know there’s “something wrong,” listen to your instincts. Find someone who will take you seriously.


  1. Can I be in pre-menopause at age 24? I feel so anxious like half of the month!

    • Yes you can-just have a luteal phase (around day 21 of cycle) progesterone and estradiol done to see if you are progesterone deficient. Best, Dr. Kim

  2. Wow, great stuff, especially about the energy and the other taboo male topic….thanks!

  3. Great blog-my husband was telling me I was “crazy” thinking I was pre-menopausal at age 36 but I fit the profile exactly! Thank you Dr. Kim, I’m going to try your pregnenolone.

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