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Hormone health basics

Hormones are the most-misrepresented topic in the wellness internet. The honest version is more complicated, less prescriptive, and considerably more dependent on context than the typical “optimise your testosterone” framing suggests. This is the calm primer.

Thyroid

The thyroid produces hormones (T4, T3) that regulate metabolism, energy, body temperature, and many other systems. Persistent unexplained fatigue, weight changes, cold intolerance, dry skin, hair changes, mood changes, and menstrual changes are all potential thyroid signals. Subclinical thyroid issues are common and frequently under-diagnosed.

The first test is TSH (thyroid stimulating hormone), often supplemented by free T4 and free T3 when symptoms warrant. The TSH reference range is the subject of ongoing debate; some clinicians argue the standard range catches abnormalities late. If you have classical hypothyroid symptoms and a ‘high-normal’ TSH, push for further testing rather than accepting reassurance.

Iodine, selenium, and stress affect thyroid function. Treating thyroid dysfunction usually requires medication (levothyroxine and variants); supplements alone rarely solve overt thyroid disease.

Sex hormones

Testosteronein men declines roughly 1% per year from age 30; the rate varies. Clinically low testosterone (hypogonadism) with symptoms (low libido, fatigue, depression, loss of morning erections, reduced muscle mass) is a real condition that responds well to medically supervised TRT. Most men aren't hypogonadal; they're in the normal range and frustrated with normal-range life.

Oestrogen and progesterone in women follow predictable cycles in reproductive years, then change substantially in perimenopause (typically 40s) and after menopause. Perimenopause can produce a wide variety of symptoms — hot flashes, sleep disruption, mood changes, brain fog, joint pain, cycle changes — often years before menopause itself. HRT for perimenopausal and early-postmenopausal symptoms has accumulated strong evidence; the older fear-based framing from the WHI study has been substantially revised.

Both: don't self-diagnose from a single lab value. Hormones fluctuate by time of day, week, cycle, sleep, stress, and recent illness. Trends across multiple measurements matter more than any single number.

Cortisol and stress hormones

Cortisol follows a diurnal rhythm — high in the morning, declining through the day, low at night. Chronic stress, poor sleep, and disrupted circadian rhythm can flatten this curve, with downstream effects on energy, weight distribution, and mood.

The marketed concept of ‘adrenal fatigue’ — your adrenal glands wearing out from stress — isn't a recognised medical diagnosis. Genuine HPA-axis dysfunction exists and can be measured by clinicians; the supplement-driven version online is mostly marketing. If you suspect cortisol issues, a clinician can run salivary cortisol curves or other diagnostic measures.

The interventions that actually move cortisol patterns are unsurprising: sleep, sufficient daylight exposure, structured downtime, reducing chronic threat signals (over-stimulation, news, certain workplaces), and addressing underlying anxiety or depression where present.

What lifestyle actually moves

Most hormonal optimisation is downstream of the same handful of unglamorous interventions:

When to test (and when not)

Reasonable triggers for hormonal testing: persistent symptoms (fatigue, mood changes, sleep disruption, libido changes, cycle changes, weight changes uncorrelated with lifestyle), considering hormonal treatments, evaluating fertility, post-illness or post-pregnancy assessment, suspected thyroid dysfunction.

Reasons to be cautious about testing: no symptoms, you've seen an Instagram post, an online service is offering to optimise you, you're going to act on a single value without context. The downside of testing without need isn't the test — it's the pressure to treat values that don't need treating.

Common mistakes

  1. Self-diagnosing from a single lab value.
  2. Believing ‘optimised’ hormones from an online service equal health.
  3. Treating ‘adrenal fatigue’ with supplements without medical workup.
  4. Starting TRT or HRT through services that don't require proper monitoring.
  5. Ignoring perimenopause symptoms as ‘just stress’ for years.
  6. Chasing exotic peptides instead of fixing sleep, food, and movement.
  7. Treating any hormone change as something to fix rather than something to understand.

Related

FAQ

Should I get my hormones tested?
If you have symptoms (persistent fatigue, mood changes, weight changes that don't match diet and activity, sleep disruption, libido changes, cycle changes, hot flashes) — yes, talk to a clinician. Testing without symptoms can produce numbers without context and a temptation to chase them. Most healthy adults don't need routine hormone panels.
What about online hormone optimisation services?
Wildly variable in quality. Some are responsible; some prescribe testosterone or HRT to anyone who asks. The risk isn't the drug per se — it's the lack of monitoring and the long-term consequences of being on hormone therapy you didn't actually need. Treat any service that doesn't require multiple labs, real symptoms, and ongoing monitoring as a red flag.
Is TRT a longevity intervention?
It's a treatment for hypogonadism (clinically low testosterone with symptoms), not a generic longevity protocol. The long-term safety data in eugonadal men (normal testosterone) using TRT for performance or appearance is thin. We'd label its use outside of clinical hypogonadism as ‘emerging to speculative’.
What about perimenopause and HRT?
HRT has been one of the most contested topics in women's health for two decades. The current weight of evidence is that for many women in perimenopause and early postmenopause, the benefits (symptom relief, bone, cardiovascular if started early) outweigh the risks when properly prescribed. Discuss with a menopause-literate clinician — not all GPs are.
Is cortisol ‘adrenal fatigue’ real?
‘Adrenal fatigue’ as it's marketed online — your adrenal glands burning out from stress — isn't a recognised medical condition. There are real conditions involving cortisol dysregulation (Cushing's, Addison's, hypothalamic-pituitary-adrenal axis issues), and chronic stress does affect cortisol patterns. But the ‘adrenal fatigue’ diagnosis from supplement-selling websites is unreliable.
Should I take peptides?
The peptide space has exciting early data and very little long-term safety data. Most peptides being sold direct to consumers are unregulated, of variable purity, and outside the human RCT evidence base. We'd label them as ‘emerging’ under our evidence policy. If you're considering peptide therapy, work with a clinician who knows the literature and monitors you properly.