Sex Hormones in Men and Women (Everything You Wanted To Know But Didn’t Know Whom To Ask)

Today I want to talk about one of my favorite topics:  hormones. In particular, I’ll tell you everything you ever wanted to know about sex hormones in both women and men...but didn’t know whom to ask! 

It’s an important topic no matter how old you are, and regardless of whether or not you are actually in a sexual relationship right now. 

You may already know that as you age your sex hormone levels change. This affects women, who then often suffer from vaginal dryness and hot flashes, and men, who may experience erectile dysfunction or a loss of libido. But these vital hormones do much more than support libido and sexual function.

They also influence many other important health conditions in your body including brain function, bone health, metabolism, and the stress response.

The good news is that throughout all stages of life (puberty thru menopause/andropause and beyond) you can do many things to support and balance all your hormones: cortisol, insulin, oxytocin, and more.

In this article I’ll be talking about what you can do to support healthier levels of your sex hormones (and maybe your mate’s, too). We’ll talk about:

  • The key sex hormones in women and men (Guess what? They are the same!)
  • Estrogen dominance (a common issue for both women and men)
  • The impact of endocrine disruptors and xenoestrogens (causing moods and moobs!)
  • The importance of Sex Hormone Binding Globulin (SHBG) levels
  •  How stress robs your sex hormones
  • The power of sleep (for good sex)
  • Additional natural treatments for sex hormone optimization

By the way, before we start, if you aren’t really sure  what a hormone is, I have recorded  this short 6 minute video which may help you better understand where sex hormones come from in the first place.

So let’s begin.

The Key Sex Hormones In Women and Men 

You may think you already know all about estrogen, the key female sex hormone. But estrogen is only one of the sex hormones in women’s bodies. We’ll also talk about FSH, LH, progesterone, pregnenolone, testosterone (yes women have that, too!), and DHEA. 

Oh and by the way, the male sex hormones are the same as those found in women, except in different amounts, of course. 

The Hormone Fix Timeline

Female sex hormones as women age.

Let’s start with the women.

Female sex hormones start to increase prior to puberty, peak in a woman’s fertile years (20s – 40s) and then start to decline during peri-post menopause. These naturally fluctuating and declining hormone levels affect fertility as well as the integrity of the vaginal lining. Shrinkage of the vaginal lining, loss of elasticity, and vaginal dryness start to occur in per-post menopause due to decreased secretions.  Vaginal dryness  can cause irritation and pain, especially during sex. Muscle loss starts to occur and many women (and men!) start to experience  involuntary bladder leakage (incontinence) and other pelvic health symptoms.  Hot flashes and other peri-menopausal symptoms also often occur. Reductions in female sex hormone levels can impact inflammatory markers, insulin control, brain health, heart health, bone health and more.

But what sex hormones are responsible for what?


Estrogen is certainly the primary sex hormone in women and extremely important to women’s overall sexual health and fertility. But estrogen is also important in regulating many other systems in women’s bodies, including those needed for sleep (insomnia anyone?), thermoregulation (hot flashes  anyone?),  circadian rhythm  (which is important to overall hormone production, and the sleep cycle and digestive processes), and very importantly,  cognitive function (brain fog anyone?). 

Estrogen is vital to energy metabolism in the brain, handling the transport of glucose to the brain (literally feeding the brain). It makes perfect sense that women start to experience symptoms in their forties like memory loss, brain fog and mood fluctuations, as estrogen levels decline. A Keto-Green® diet can help lessen these declining brain functions by producing ketones, which can take over estrogen’s role in  providing fuel to your brain.

In women, estrogen is produced primarily by the ovaries and is intimately involved in supporting healthy sexual functions such as:

  • The development of female sex characteristics
  • The development of follicles (needed to release an egg)
  • The growth of endometrial tissue (needed to implant an egg)
  • The growth of breast tissue (which is why additional circulating estrogen, such as from oral estrogen hormone replacement therapy, can be a problem for women having  breast cancer) 
  • Vaginal integrity
  • Maintaining collagen in the skin and connective tissue 

Along with fueling the brain’s need for glucose, estrogen is also important because it:

  • May have anti-obesity and antidiabetic effects. Estrogen interacts with the circadian clock and adipose (fat) tissue, preventing abnormal lipid accumulation caused by circadian disruptions (such as lack of sleep, stress, jet lag, etc.). These disruptions contribute to metabolic dysfunctions such as obesity and insulin resistance. (1) 
  • Improves insulin sensitivity (studies have shown the reduction of estrogen in postmenopausal women accelerates the development of insulin resistance and Type 2 diabetes). (2)  
  •  Increases serotonin (the happy hormone!)
  • Stores fat

Low levels of estrogen in women

In my clinical practice, I generally look for optimal levels of estrogen in women to be within the range of 100-300 pg/mL (depending on age). You can easily test for estrogen and other sex hormone levels; I’ll explain how at the end of this article. It is important for you to know your hormone levels and monitor them annually as they change over time. It is best to prevent a hormone imbalance before it occurs instead of reacting after you discover it. I’m talking about sexual function as well as the health of other body organs and functions like bone, brain, breast, metabolism, and more.

There are many natural therapies that can help balance estrogen levels. Two easy changes you can implement today to support healthier estrogen levels are to: 1)  get your body alkaline (to reduce overall inflammation, reduce your risks for metabolic diseases and support overall hormone balance) and 2) start taking maca!  

Maca is an adrenal adaptogen (which means it helps your body deal with stress which is a common underlying root cause for hormone disruption). But more importantly, maca has been found to regulate estrogen levels without being estrogenic or hormone stimulating. It helps regulate or normalize both low and high levels of estrogen, and  supports fertility as well. You can read more about  maca’s many health benefits in this article. (3)  

Hormone replacement therapy can also be an option for low levels of estrogen. I suggest you have your doctor customize a prescription just for your particular needs. (Of course, I hope your doctor is  a good functional doctor interested in combining hormone replacement therapy with treating the root causes that may be throwing your sex hormones out of balance in the first place.) I have found most women need more than just estrogen; they may require progesterone or testosterone as well. You can learn more about how to deal with declining levels of estrogen through  bio-identical hormone replacement therapy, and its pros and cons.  

Note that there are also topical solutions for many hormone-related symptoms (such as vaginal dryness, irritation, incontinence, etc.) such as my restorative cosmetic cream for the vulva,  Julva®, that also contains an important sex hormone, DHEA. Read about all of the  solutions for vaginal dryness, here.   

Women can suffer from too much estrogen as well. That is a common issue in men, so let me talk about that first. 

Estrogen in men

Surprise! Men have estrogen too (and they need it!)

For men, a small amount of estrogen is needed to support bone health and other processes in the body. This estrogen is produced in men’s bodies by aromatase enzymes which is found in fat tissue. Aromatase enzymes convert testosterone into estrogen. The fact that these enzymes are found in fat tissue is key as the more fat a man packs on, the more enzyme activity occurs in his body (so the more his testosterone is used to make estrogen).

Estrogen helps balance a man’s testosterone levels. Men need to maintain a healthy Testosterone to Estrogen (T/E) ratio, which supports: the sex drive, the ability to have an erection, and the production of sperm.

Too much estrogen affects this T/E ratio, as does too little testosterone. As men age, their body naturally produces less testosterone (we’ll talk more about testosterone in a bit). If they have put on some belly fat (or eat unhealthy “white and sugary meals”) aromatase enzyme activity increases. Their already diminishing levels of testosterone is further robbed to make more and more estrogen. As you can see, the T/E ratio is greatly affected.

This can result in “Low T” symptoms (erectile dysfunction, low libido, and increased risk for many metabolic conditions) as well as all that estrogen resulting in fat storage in man-boobs or “moobs”!

All of this estrogen is produced just as men’s natural progesterone levels drop due to age, as well. This sets the stage for a condition known as estrogen dominance.

Estrogen Dominance: A Common Issue In Both Women And Men 

So let’s talk about when estrogen levels get too high compared to progesterone levels. This is called estrogen dominance. It’s all about the ratio of estrogen to progesterone. Progesterone is another key sex hormone found in both women and men and we’ll talk more about it in a moment. For now, just know that progesterone starts to naturally decline in your 30s so many women and men have low levels even in their 40s. 

It’s important to understand that estrogen dominance does not necessarily mean your estrogen levels are high. Your estrogen level can actually be very low, but if your progesterone is also very low your estrogen level may still be higher (compared to the progesterone level). This confuses a lot of people if they test estrogen levels and find they are low (but they are told by their doctor that they have estrogen dominance). 

Estrogen dominance causes a variety of miserable symptoms including anxiety, mood swings, irritability, skin conditions, decreased sex drive, fatigue, short term memory loss, bloating, heavy or irregular periods, weight gain, sleep disruptions, hot flashes, and more. 

I often have clients experiencing significant vaginal dryness and vaginal atrophy symptoms due to low levels of estrogen and they are surprised when I tell them they have estrogen dominance. Again, it’s all about the ratio of estrogen to progesterone; these women may have little or no progesterone when tested.

Women having PCOS, or hypothyroidism, are also frequently diagnosed with having estrogen dominance. This is often the underlying root cause for women having painful periods, ovarian cysts, endometriosis, and fibroids (issues often addressed via a – perhaps unnecessary -  hysterectomy).  

The impact of endocrine disruptors and xenoestrogens 

Estrogen dominance is greatly influenced by hormone exposures (toxins and other endocrine disruptors such as xenoestrogens – hormones that mimic estrogen - found throughout our environment and food) as well as the body’s ability to detox toxins and spent hormones such as estrogen. 

Endocrine-disrupting chemicals (EDCs) have been noted to, “Interfere with the synthesis, secretion, transport, binding action, or elimination of natural hormones in the body that are responsible for the development, behavior, fertility and maintenance of homeostasis.” EDCs are suspected to be associated with abnormal growth patterns in children, changes in immune function, altered reproductive function in females and males, and increased incidence of breast cancer. (4)  

EDCs stimulate lipid accumulation in cells involved in metabolic syndrome and are thought to cause the dysfunction of those cells, resulting in metabolic syndrome. (5)  Endocrine disruptors are often found to be a root cause for thyroid hormone imbalances as well. (6)  

Estrogen dominance in men 

The main cause for too much estrogen and estrogen dominance in men is often tied to hormone disruptors, as well as men putting on weight and belly fat as they age (remember those testosterone-to-estrogen-converting enzymes are found in fat!). Too much estrogen is associated with loss of muscle mass, increased body fat (moobs!), mood changes, a lack of energy, and fatigue. It can cause “Low T” issues such as erectile dysfunction, too.

I also see estrogen dominance in men when they are suffering from chronic stress (cortisol imbalance) or have other hormone imbalances (insulin issues, thyroid, etc.). 

So looking at some of the typical causes for estrogen dominance, here are a few things both women and men can do – starting today – to reduce your risk of estrogen dominance (or to address a current condition):

  • Reduce exposure to endocrine disruptors and xenoestrogens (estrogens in meats, endocrine disruptors in personal care products/the kitchen/your home). Check out Environmental Working Group’s informative site at  EWG.ORG. They publish a  dirty dozen list of endocrine disruptors in your environment and have several guides focused on eating clean foods and using clean personal care products and cosmetics. I strongly endorse this group!
  • Support your body’s ability to detox: Spent hormones such as estrogen sometimes just recycle versus being eliminated by the body so you need to support your body’s ability to detox (try my  21-day detox program here).. A good  Keto-Green® diet  with lots of cruciferous veggies is a good start.  
  • Eat betaine-rich foods, as well as those high in vitamin B, choline and folate: all are supportive of methylation which helps the body metabolize and detoxify estrogens and other toxins (such as heavy metals). My favorites include spinach, Brussels sprouts, eggs, shrimp, fish, quinoa, beets and chicken/beef liver.
  • Support your adrenals and stress response (reducing cortisol). You just know I’m going to recommend  Mighty Maca® Plus here since it is an adrenal adaptogen along with being a beautiful Keto-Green alkaline superfoods drink. And don’t forget maca has been shown to help regulate estrogen levels. 

In my book,  The Hormone Fix, I talk a lot about these strategies and the health risks of having hormones such as estrogen recycle versus detoxed/eliminated.

And you may want to bump up your levels of progesterone (the other key hormone involved in estrogen dominance in the first place).


Progesterone in women:
Progesterone is produced by the ovaries of menstruating women at the time of ovulation, and by the placenta during pregnancy. There are progesterone receptors all over a woman’s body. Progesterone is anti-inflammatory and a natural diuretic (so can help detox harmful levels of recycling estrogen). It is good for your brain, heart, breasts and bones and has been found to prevent and protect against breast cancer. You can see how important progesterone levels are to the common condition of estrogen dominance.

Progesterone is one of my favorite hormones and using  my topical progesterone cream is part of my nightly routine.

Progesterone performs myriad different functions throughout your life. As you get to about age 35, your progesterone levels start to fall. Many women start to suffer from anxiety issues, mood issues and even depression. 

Declining levels of progesterone often result in poor sleep as well as an increase in uncomfortable PMS symptoms. Unfortunately many women end up getting a prescription for Valium or selective serotonin uptake inhibitors to address these hormone-imbalance issues (often estrogen dominance); or many just suffer.

I always recommend people routinely test their hormone levels (“test, don’t guess!”) and will usually recommend topical progesterone cream in most women (after age 35) even prior to testing, as progesterone levels are typically less than optimal due to natural age-related decline. 

When testing, I generally look for serum levels of 10-28 ng/mL on cycle day 19-21 in menstruating women (it will also depend on age and if supplementing). If menopausal I recommend > 1. 

I often find that people who experience low levels of progesterone are living with chronic stress. When under chronic stress the stress hormone cortisol initially increases, but then decreases as the adrenals (the stress glands) become dysfunctional. Eventually the adrenals need to look elsewhere in order to produce more cortisol. Progesterone is eventually stolen and converted to cortisol thus decreasing levels of this so-important hormone. Look here for my  recommendations to manage stress, including specific nutrients. I wrote this article for my good friend Dana Trentini, aka Hypothyroid Mom).

Adrenal glands role in producing hormones

Pregnenolone/progesterone are stolen to make additional cortisol during periods of adrenal dysfunction and chronic stress

You can balance progesterone levels naturally. To help, I routinely recommend my  Balance Cream, which features progesterone as its main ingredient.

Balancing progesterone levels can help address estrogen dominance and also:

  • Stabilize the endometrium
  • Maintain a healthy pregnancy
  • Support hormone balance...with protective and health-promoting properties
  • Improve a woman’s response to stress
  • Promote a balanced mood
  • Support a better night’s sleep
  • Support bone metabolism
  • Reduce premenstrual symptoms (PMS)
  • Reduce hot flashes
  • Reduce anxiety (it is an anxiolytic, helping our body control anxiety)
  • Support neurotransmitter production such as GABA, the calming hormone
  • Provide neuroprotective effects (lots of great research relating to the use of progesterone and improved memory; it may be helpful in treating traumatic brain injury and stroke)
  • Reduce cholesterol
  • Inhibit coronary vasospasm
  • Support TH2 immunity
  • Promote osteoblasts
  • Promote cell differentiation
  • Enhance thyroid hormone activity (reduces TBG) 

Do you see why I always ask, “What doesn’t progesterone do?”

In working with thousands of patients and clients over the years I have commonly recommended and prescribed bio-identical progesterone hormone replacement: from postpartum women, to those in the perimenopause suffering estrogen dominance, to those in menopause. I have found it helps women get a handle on anxiety, mood swings, and sleep.  With or without a uterus, women need progesterone (no matter what you may have been told after having a hysterectomy). 

Progesterone in men

Men need a healthy level of progesterone to counteract the effects of higher levels of estrogen.

Progesterone levels decrease as men age (and testosterone declines, too) and estrogen often rises (resulting in symptoms of estrogen dominance).

Progesterone is also a precursor to testosterone, so it is important for healthy testosterone levels.

A low level of progesterone in men also puts them at a higher risk for certain health conditions such as prostate cancer, osteoporosis, and arthritis.

Along with focusing on reducing estrogen levels and  supporting his adrenals a man can have his progesterone levels tested. Some men may benefit from 5-10 mg of a topical progesterone cream at night (but use only under a doctor’s supervision as a little goes a long way). 


Pregnenolone is another neuro-steroid in both women and men. It is referred to as, “The mother of all hormones” because all your other hormones are derived from it. It is a precursor to other downstream steroids including cortisol, DHEA and progesterone. It supports your nervous system, memory and mood; and is vital for neurotransmitter production.

In women, I look for a serum level above 20 ng/dL. Where a woman is in her cycle can affect the results.

Pregnenolone has many important attributes, including being:

  • Anti-stress – shown to reduce fatigue and improve well-being
  • Supportive of improved cognitive function such as memory (7) 
  • A natural antidepressant. Studies suggest that pregnenolone may exert antidepressant effects and have a role in regulating anxiety and depression. (8) 

Like many health-promoting hormones, levels of pregnenolone drop with age. At age 75, women’s bodies typically make 60% less pregnenolone than at age 35. This is why I added pregnenolone to my Pura Balance PPR Cream along with progesterone. 


Before I talk about androgens (testosterone and DHEA, important for libido and so much more!) let me talk briefly about a few hormones particularly important to reproduction.

Hormones affecting the gonads, or sex organs, are referred to as gonadotropins. One such hormone, called gonadotropin releasing hormone (GnRH), stimulates the pituitary gland to produce two other gonadotropins of importance. One of these is the follicle stimulating hormone (FSH). In women, FSH is responsible for starting follicle (egg) development; it also causes the level of estrogen to rise. Luteinizing hormone (LH) then kicks in and aids in egg maturation as well as providing the trigger to cause ovulation and the release of eggs from the ovary. 

In men, LH causes the testicles to make testosterone (needed for producing sperm). FSH helps control the production of sperm. 

While these hormones aren’t necessary in order to live they are essential for reproduction. Levels that are too high or too low can point to specific problems (PCOS, primary ovarian insufficiency, pituitary gland disorders, and other infertility issues). 

You can learn about how these hormones interact with other sex hormones as part of a women’s monthly cycle by watching this short video. 

Androgens in Women 

Androgens (Testosterone and DHEA) are sex hormones produced by the ovaries, fat cells and adrenal glands in women. They are later synthesized into estrogen. Androgen levels in women typically peak during their 20s. When a woman reaches menopause her androgen levels are likely to be about half of what they were at her peak. Too little or too much of these sex hormones cause several common hormonal imbalances in women. 

Androgens play a key role in libido, sexual desire and satisfaction. Low levels result in fatigue, low libido, lack of mental alertness, a reduced sense of well-being, and vaginal dryness (and vaginal atrophy symptoms particularly in older women). 

Androgens also regulate many functions throughout the body including those in the reproductive tract, bone, muscle, skin, liver and kidneys. They also provide cardiovascular protection. 

Let’s talk about two androgens found in women and men.


I know everyone thinks of testosterone as the primary male sex hormone (which it is), but small amounts of testosterone are also produced in a woman’s ovaries. Along with other sex hormones, testosterone helps support the overall health (growth and repair functions) of reproductive tissues as well as bone density, muscle mass, heart health, blood cell production and fat distribution.

When doing lab work I recommend you test for both free and total testosterone (free is important as that represents the amount of testosterone that is actually unbound and active/bioavailable in the plasma; total levels do not provide clarity around how much testosterone is actually available to your body). 

For optimal free testosterone levels I usually look for 4-8 percent in women (and 40-60% in men). For optimal total levels I look at 60-80 in women (it does depend on age and cycle day) and > 400 in men. 

Low levels of testosterone in women

Low levels of testosterone in women may cause a loss of libido, irregular menstrual cycles or even infertility, and are tied to a number of neurological symptoms including moodiness, anxiety, depression, nervousness, irritability and poor cognitive function (memory/ability to concentrate). 

Additionally, given testosterone’s health-protective effects after menopause, low levels can also increase certain health risks including,

  • Obesity
  • Bone loss/osteoporosis
  • Depression
  • Muscle wasting 
  • Heart disease 

Low levels of testosterone can also point to an underlying issue with a woman’s ovaries.

I usually recommend both women and men boost low levels of testosterone by bumping up certain nutrients such as  vitamin D  or zinc. Optimize vitamin D to blood serum levels between 50-100 ng/mL (on the  25-hydroxy vitamin D3 lab test). I find that most people are deficient in vitamin D; it's important for so many other health benefits beyond testosterone levels.

Zinc is another nutrient in which many people are deficient. Zinc supports many important functions including hormone balance, fertility, insulin sensitivity, mood (it is actually supportive of a better mood!) and more. (9) Red meat, shellfish (I love oysters and it is particularly high in zinc), pumpkin and hemp seeds, and cashews are good choices. Reducing the vices (alcohol, smoking, sugar)  is also important, as is reducing stress and  supporting the adrenals.

I also often recommend a supplement called  TestoPlex™ from Xymogen to support healthy levels of testosterone.

Estrogen hormone replacement therapy can also lower a woman’s testosterone level so I often prescribe bioidentical testosterone along with bioidentical estrogen should that be a concern. I’ve had good results prescribing bioidentical testosterone to women. 

High levels of testosterone in women

On the flip side, high levels can cause infertility challenges as well as symptoms that affect a woman’s physical appearance, including, 

  • Greater muscle mass
  •  Excess facial and body hair
  • Male pattern hair loss (front balding)
  • Skin conditions such as acne
  • Deeper sounding voice
  •  Decreased breast size
  •  Enlarged clitoris 

High testosterone levels may increase a woman’s risk for also having insulin resistance, diabetes and  polycystic ovary syndrome (PCOS). PCOS is a hormonal disorder that is common in women of child-bearing age. Those affected are often found to have excess androgen levels.  Check out the podcast I did with my fellow Sexy Younger You founder, Robin Nielsen. Robin talks about all things PCOS and how it has been her lifelong struggle.

Some women may simply have higher than average testosterone levels (but may not have PCOS or other significant symptoms); I always tell these women not to view their higher than normal testosterone labs as a negative thing! Such is the case with what I refer to as “Warrior genes.”

Warrior Genes in Women

So why is it that some people have low or high levels of any given hormone? We know that there is genetic predisposition relating to sexual differentiation (that point at which we become male or female after inception). During prenatal development, sexual hormones further feminize or masculinize us.

Your body then develops, based on a cascade of hormones that occurs leading up to puberty. Again, a bit of this is influenced by genetics (and through your inherited gut microbiome which is passed to you from your mom), but much more is likely influenced by outside factors such as endocrine disruptors and diet during early development (including in breast milk where studies have shown that toxin exposures may influence infant gut microbial function during critical developmental windows). (10) Endocrine disruptors can block hormone processes and create other imbalances. 

So some women just have more testosterone, for example, or more DHEA (like Robin), throughout their lives. These women may also see levels increase even more throughout life due to other factors (which is why knowing your hormone levels and retesting periodically is so important). We all need to monitor our levels as there are always health risks associated with too much – or too little – different hormones. And remember, sometimes the risks are loss of protection of some kind.

Here’s one woman’s story of having  too much testosterone in, “My Shoulders are Huge”. Bigger and stronger than most women (and the men she was dating) Julia had lifelong challenges that she viewed as negative. She also experienced a lot of facial and body hair growth, and acne. It turned out she had high levels of androgens.

When she came to me I told her to embrace the potential she had (women with higher androgen levels often have a stronger ability to gain muscle), and to try and deal with everyday symptoms such as unwanted hair growth with an over-the-counter product.

Additionally, I told Julia to be mindful that higher androgen levels do potentially have negative risk factors as well.

Androgen excess is often associated with belly fat (visceral fat), obesity and metabolic diseases such as diabetes. So I suggested that she would need to stay on top of that by working out and avoiding a sedentary lifestyle (which thankfully she was already doing). Focusing on retaining her  insulin sensitivity was another key strategy, so a Keto-Green® diet along with  intermittent fasting is perfect for her. 

I do find it fascinating (yet not totally surprising) that we’re seeing more women’s androgenization as well as men’s estrogenization over time…so what’s the common thread? As I mentioned earlier, I think it is really the increased exposure we all get via endocrine disruptors! (and our poor diets also cause issues with healthy detox as well). If you haven’t put this health topic on your radar, please do. Go onto sites like  EWG.ORG  and read about common foods you should avoid, or look up your skincare and other personal care products and see how they rate in terms of containing chemicals that are known to cause problems. 

Try not to purchase products that contain: Parabens, phthalates, triclosan (found in antibacterial soaps!), hexane, sulfates, petrochemicals, formaldehyde and other solvents, and synthetic fragrances and colors. Purchase organic foods, especially meats. 

Along with removing endocrine disruptors, a few other natural strategies for lowering testosterone levels in women include,

  • Keto-Green diet and intermittent fasting: fasting the Keto-green way in particular helps to control blood sugar dysregulation and insulin control; too much insulin stimulates the ovaries to produce even more testosterone). Additionally, losing fat mass can help.
  • Naturally increase your Sex Hormone Binding Globulin (SHBG).

SHBG is a protein in the blood that binds itself to androgens (testosterone in particular) and estrogen. It is particularly impactful relating to free testosterone levels. When a hormone is bound it is inactive and not available for use by the body’s cells. If it isn’t bound it is “free” and therefore active and available to the body. 

High levels of SHBG can result in symptoms of excess estrogen, excess thyroid (hyperactive) and low testosterone levels.  Low levels of SHBG can result in symptoms of low estrogen, excess free testosterone and low thyroid levels.

You may be able to increase SHBG levels through regular exercise (like I suggested to Julia). (11-13)  As an added bonus research has shown that higher levels of SHBG are associated with a lower risk of breast cancer. (14) 

Note that SHBG levels are usually reduced in women (and men) who are hypothyroid so working to improve this condition may also help to increase SHBG levels to more normal levels. (15) 

I view low levels of SHBG to be <60 nmol/L and high levels to be >80 nmol/L. 

  • Oddly, drinking two or more cups of caffeinated coffee a day! Research on women over age 60 found that exercise and drinking coffee were associated with having higher SHBG levels.(16) 

Some women may choose to go on the pill which will work to increase SHBG and lower testosterone levels (but may bring with it other concerns). 

Testosterone issues in men (“Low T”) 

One of the reasons men often have “moobs” is because of the estrogen mimickers found in our country’s meat supply, and in other foods men eat. Such hormone disruptors and xenoestrogens are responsible for total testosterone levels in men (the “normal” levels) dropping about 22 percent between 1987 and 2004! Remember that aromatase enzyme activity (found in fat cells)  increases with excess estrogen and fat; this causes testosterone levels to decline further as these enzymes convert testosterone into even more estrogen. (17) 

“Low T” is a common issue for men. After their free testosterone peaks in their 20s there is a natural decline of about 1 percent per year after age 30. 

Many men suffer from “low T”, resulting in “moobs” and erectile dysfunction, among a number of other challenges. Men also go through a type of male menopause, called andropause, due to their declining androgen hormones in particular (their symptoms look a lot like those seen in menopause, including brain fog, fatigue, mood swings and more accumulation of fat!). But with declining testosterone men lose out on a number of a number of health benefits provided by adequate levels of testosterone. I’ve written an entire article about testosterone decline in men and why it occurs; I have included many recommendations as to  how to treat low testosterone in men using natural methods. 

Higher levels of SHBG can be a helpful marker 

I’ve mentioned how higher levels of sex hormone binding globulin (SHBG) can cause a reduction in free testosterone levels. High levels of SHBG can also – less commonly – result in excess estrogen. (18)  

High levels of SHBG in men can also point to hyperthyroidism, liver issues, or problems with the testicles or pituitary gland. Elevated cortisol levels can also increase SHBG. But  SHBG levels  are rarely tested in routine lab work. 

Men typically only have their testosterone levels tested when having Low T or fertility issues (and rarely get their SHBG tested). When I have a man get tested for his sex hormone levels I’ll also include getting his SHBG tested as it can point to issues you might not otherwise see by only looking at testosterone results. 

For testosterone testing, I prefer to see optimized testosterone levels in men at about 600-800 ng/dL although normal lab ranges are 500-1000. “Low T” is diagnosed if a man’s level is less than 300. I’ll include overall sex hormone testing links at the end of this article. 

Mitochondria, sex hormone health and insulin sensitivity

Another root cause relating to low testosterone in men is the health of their mitochondria. Think of the mitochondria as the body’s bank of power cells. Pregnenolone is exported out of the mitochondria and converted into different sex hormones, including testosterone and DHEA. And guess what? The Standard American Diet (SAD) is one of the biggest reasons for mitochondrial dysfunction and resultant deficiencies in these sex hormones! (19)  

I talked to Dr. Anthony Capasso about  how mitochondrial health is frequently involved in sex hormone declines in a recent podcast. He explained that the mitochondria are injured when we eat a lot of carbs and that as many people age, there is a huge drop in mitochondrial number (with fewer mitochondria resulting in reduced function and energy). Along with impacting your sex hormones, mitochondrial dysfunction contributes to conditions such as insulin resistance

Mitochondria health is another reason to eat a Keto-Green diet; it supports sexual function and hormone balance. Low carbs, eating more healthy fats and intermittent fasting are all strategies that support mitochondria health. Research has found that interventions such as diet that improve mitochondrial function can improve insulin sensitivity as well. (20) 

Blood sugar issues and resultant insulin resistance are found to be co-occurring in many sex hormone imbalances. When insulin resistance occurs most of the body tissues start to ignore insulin signals, but the ovaries continue to remain sensitive to insulin. This is what occurs in PCOS in women. Elevated insulin levels stimulate the adrenals to produce more testosterone.

In men, insulin stimulates testosterone and inhibits SHBG. (21) Studies have found that low testosterone levels in men predict an occurrence of higher insulin resistance (than in men with higher levels of testosterone).

Dr. Capasso also suggests higher intensity, short burst types of exercise, along with getting quality sleep, to keep a man’s mitochondria and testosterone at optimal levels. 

A few other quick tips for addressing low testosterone in men would be to bump up zinc (50-60 mg per day) and optimize vitamin D levels (as mentioned earlier for women).  Lowering blood sugar is also important due to the connections between testosterone levels and insulin; a blood test you might want to consider is called the  HgbA1c test, and ideal levels for this would be < 5.3%.

You can  read this article for additional recommendations for addressing “Low T” in men. Remember you want to focus on reducing any excess estrogen as well to be mindful of endocrine disruptors in your foods and environment.

I’ve recommended bioidentical testosterone for men so that is also an option (with some need to monitor this closely and be cautious to be sure there are no unwanted behavioral side-effects).

You can read  this article about how I used bioidentical testosterone, DHEA, adrenal support and a few vital supplements to help my elderly dad reduce his inflammation and get back to his energetic self again. I know you all have a dad, brother, uncle or other men in your lives beyond your mate! Pass the info along! 


Dehydroepiandrosterone (DHEA) is another androgen, like testosterone. It is important to the integrity of bone, muscle and skin (in both females and males) and plays a significant role in maintaining libido.

DHEA is produced mainly in the adrenals but also by the ovaries (and testis in men), brain and skin tissue. As a woman’s estrogen levels naturally decline it is DHEA which continues to produce both estrogens and androgens (at least for a while). 

DHEA declines with aging

DHEA levels by age

As you can see in the chart there is a steady decrease in DHEA starting in the 30s for both women and men. In women, there is an average loss of about 60 percent in DHEA levels by menopause. In the postmenopausal female some 90% of estrogen is derived from DHEA (and most of that from the adrenals). (22,23)

DHEA is converted into DHEA-sulfate (DHEA-s) in your adrenal glands and liver. The DHEA-s lab test measures the amount of DHEA-sulfate in your blood. 

Low levels of DHEA are associated with reduced libido, vaginal atrophy, insulin resistance, immune disease, poor memory, dementia, atherosclerosis (clogged arteries), and a general lack of well-being and vibrancy. DHEA levels can also serve as a means to assess the functioning of your adrenal glands and stress response.

The good news is that we can introduce DHEA into the body with typically good results. Restoration to healthy levels of DHEA is associated with: increased bone density and lean body mass, improved mood (and reduced depression and anxiety), improvements in sexual function, improvements in cognitive function, and improvements in insulin sensitivity. (24) 

Results for your DHEA-s level need to be looked at based on your gender, age, and general health condition. I like to see more optimized DHEA levels of 150-300 mcg/dL in women and 200-560 in men. You can see specific age ranges for women at this previous article on  DHEA-s lab testing. 

If someone tests outside the optimal range they should work with their doctor to determine the best treatment approach, which can be unique depending on their specific health status and symptoms. As an example, if a woman is specifically experiencing vaginal dryness, involuntary leakage or issues with libido, I’d recommend they try my  Julva®anti-aging cream for the vulva, which contains bioidentical DHEA. Better yet, my  hormone harmony bundle includes full-size quantities of both Julva and my beautifully balanced progesterone/pregnenolone cream, Pura Balance PPR. 

DHEA can help with vaginal atrophy (vaginal dryness, irritation, pain during intercourse), diminished libido, involuntary bladder leaking (incontinence) and pelvic health when applied to the vaginal area, without causing a significant release of estrogens systemically in the blood. Note that even younger women can experience these vaginal health challenges! DHEA has also been shown to support  breast health. 

Studies on DHEA supplementation in post-menopausal women report benefits including increased desire, lubrication, arousal, satisfaction, and orgasm. (25) 

I have also prescribed bioidentical DHEA for insertion directly into the vagina for vaginal atrophy and libido related symptoms.

Oral DHEA can also be obtained as a supplement over-the-counter but I do recommend you always start by being tested and work with a doctor as too high of level isn’t healthy either. When women test with low levels of DHEA I may start them on 5 milligrams per day and work up slowly, usually not more than 15 milligrams per day.

For men I generally recommend 25-50 mg per day depending on tested levels (this needs to be monitored by your physician!). I also hear from men in my community who are using Julva because it is working for them! 

I often see low levels of DHEA in clients due to chronic stress. One natural way to influence your DHEA levels positively is to get a handle on your stress. I recommend meditation, deep breathing and other forms of relaxation and stress management. Check out this article for some unique suggestions on  how to improve your stress resilience). 

Let’s talk a bit more about stress as it relates to all of your sex hormones.

How Stress Robs Your Sex Hormones 

Sustained levels of stress result in unhealthy levels of  cortisol (the stress hormone). First your body pumps too much cortisol, then your adrenals burn out and your body goes into a low cortisol state. In addition, overall hormone production and healthy hormone detox are also impacted by stress.

Stress affects sex hormones by disrupting the normal menstrual cycle, fertility and reproductive function. GnRH (LH and FSH) is decreased. (26)  In men there can be decreased sperm count, ejaculatory disorders, impotence and other issues associated with infertility. (27) Sex hormones and cortisol are derived from the same precursor so if cortisol increases there will be corresponding declines in other gonadal hormones such as testosterone. (28) 

Are you producing enough oxytocin?

Oxytocin, the hormone of love, bonding, and connection, is one of my favorite hormones. Your body releases it at childbirth, when cuddling, during sex and when you have an orgasm. It is also released when you laugh, play and simply enjoy your family, friends, and pets.

Although oxytocin counters stress, if you suffer from excessive stress over a period of time, the increased cortisol inhibits the production of oxytocin.  Low levels of oxytocin are associated with a low sex drive, anxiety and other mood problems, and a sense of wanting to simply disconnect from the people around you. 

Do you produce enough oxytocin each day? Take my  free oxytocin quiz to find out! You’ll then get some tips to help you produce even more which will help with your stress response and overall hormone balance.

You can read this article to discover more about how  chronic stress impacts your overall health – and what you can do about it. An  anti-inflammatory alkaline diet and  adrenal support are good starts; take some  progesterone, too.  

Also important for better stress resilience and optimal sex hormone balance is to get a good night’s sleep! 

The Power of Sleep (For Good Sex) 

Sleep is important to many body functions, including the production and balance of your sex hormones, and your ability to desire and enjoy sex. 

In order to get a good night’s sleep people often find they need to reset their circadian clock. Have you ever gone on a long trip, jumping multiple time zones? Did you find it difficult to sleep afterward? That’s because your circadian clock got confused. Your circadian clock provides your body with instructions relating to hormone production (including the sleep hormone melatonin, as well as your sex hormones), digestive and reparative processes, and more. 

Melatonin production decreases as you get older, and particularly affects women during and after menopause. (29) Between low levels of melatonin, and low levels of other sex hormones like progesterone, many women struggle to get a good night’s sleep!

Studies with men who have sleep apnea (a condition when the quality of sleep is interrupted and more fragmented) show that the quantity and quality of sleep can reduce testosterone levels. (30)  

There have been many studies relating to poor sleep and its effects on libido, sex hormone levels, sexual function and sexual distress. (Sexual distress is, for example, fretting about the pain you may experience during sex. Such fretting leads to a decrease in desire and the ability to climax.) Research has found that obtaining sufficient quality sleep is important to sexual desire as well as genital response. (31)   

Postmenopausal women who have insomnia self-report high rates of sexual distress as well as compromised sexual function (low desire along with vaginal pain). (32)  

In one small study just a single week of reduced sleep (5 hours per night) in healthy young men resulted in reduced testosterone levels (10 to 15 percent decreases were seen). Given that the 5 hours per night condition is experienced by some 15% of the US workforce this is a frightening statistic. Even normal aging is only associated with a decrease in testosterone of about 1 to 2 percent per year. (33)   

Poor sleep is also associated with a lack of vibrancy and well-being, a decrease in mental alertness and even depression. A lack of sleep impacts your overall hormone balance, immune system, health, and inflammation (which put you at greater risk for disease and symptoms). 

For women I always recommend starting off with my progesterone based Balance cream, and there are other natural sleep aids as well that will work for women or men. You can take melatonin (I like  Call it a Nite) or try magnesium (I prefer magnesium L-threonate which crosses the blood-brain barrier; it is found in my  Better Brain and Sleep formula).  Many people are deficient in magnesium which is a problem! Magnesium helps regulate cortisol so you can relax; it is also involved in over 200 processes in your body. I take both the Better Brain and Sleep formula and also my progesterone cream as part of my nighttime ritual, especially important when I am traveling, stressed or feeling “off” my normal circadian rhythm. 

See these articles for additional tips on  natural strategies for getting a better night’s sleep and for  resetting your body’s internal clock, and pleasant dreams!

Additional Natural Treatments for Sex Hormone Optimization 

I’ve given you many suggestions in this article, so let’s pull it all together with a few of the basics relating to achieving sex hormone optimization (which I’m sure you want, no matter how old you may be!). You might also want to check out this free ebook on hormones.

Remember that having balanced sex hormones is about more than sex; your sex hormones provide many important preventative health benefits for your bones, brain and body! 

  • Go Keto-Green: This is an anti-inflammatory (alkaline), pro-gut health, pro-detox diet. It helps improve your insulin sensitivity so you can lose the body fat that stores harmful estrogens. It also supports healthy detox (to rid your body of excess hormones and endocrine disruptors). You can learn some of my Keto-Green basics by taking my free  10-day Breeze Through Menopause class
  • Get tested! (“What gets tested gets managed”): I recommend a thorough hormone panel, especially if you are monitoring known issues, starting new lifestyle interventions or starting/changing hormone replacement therapies.  My preferred panel is my Elite Hormone panel and is available through a special discounted package I have arranged with Ultalabs. You may want to additionally test for SHBG should you be concerned about testosterone levels in particular. Read about the four key lab markers I believe everyone should know here. You can order individual tests for different hormones as well, although I suggest you opt for more comprehensive panels if you can afford it.
  • Support your gut: Your microbiome and gut health are vital to optimal hormone balance. Take probiotics and avoid inflammatory foods. 
  • Support your brain, your bones and your breasts: Use progesterone to support these important three B’s (important to women and men). Progesterone helps offset estrogen dominance as well. Check out the this article for more information and research citations relating to  the benefits of progesterone and  watch this podcast. Men may do well with 5-10 mg of a topical progesterone cream at bedtime, but a little goes a long way…so again, use only with your doctor’s supervision. Women use my Balance cream or try that and Julva in my  Hormone Harmony bundle.
  • Reduce your exposure to the endocrine disruptors and estrogen mimickers in your life
  • Manage your stress and take adrenal adaptogens like maca (mental detox is also important). You can  try my Mighty Maca Plus for free.
  • Get more sleep. 
  • Exercise (high intensity/burst training and strength training are best)
  • And if things are “off” in the bedroom: Eat the right foods to  support your libido! And prioritize intimacy.

Let me know what questions you still have. 

I am the Girlfriend Doctor, so you can always ask me anything for yourself or regarding your mate. Just know that by taking your one right next step it can make a difference!


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Dr. Anna Cabeca

Dr. Anna Cabeca

Certified OB/GYN, Anti-Aging and Integrative Medicine expert and founder of The Girlfriend Doctor. During Dr. Anna’s health journey, she turned to research to create products to help thousands of women through menopause, hormones, and sexual health. She is the author of best-selling The Hormone Fix, and Keto-Green 16 and MenuPause.

Learn more about my scientific advisory board.