Hormones in Balance
Testosterone. Estrogen. Progesterone. Cortisol. Why the hormone chaos of our time is not fate, but a signal you can finally understand.
It seems to have become normal these days for men to have low testosterone while women suffer from hormone chaos. That is not normal. It is average. And it reflects something that almost no one really explains.
We live in a time when a large part of the population is chronically stressed. Not dramatically stressed, not collapsed, but persistently, quietly, burned deep into the nervous system. People function. They sleep somehow. They eat somehow. But this constant undertone of pressure, of too much, of never really arriving, can leave biochemical traces. And these can affect the hormone system.
Men under 40 today have on average 25 to 40 percent less testosterone than men of the same age group 30 years ago. Not because of aging. Because of the time in which we live.
At the same time, women suffer from hormonal complaints to an extent that was unknown two generations ago. PMS, taken for granted. Cycle irregularities that surprise no one. Exhaustion, mood swings, acne, weight problems that find no satisfying explanation. And a lab report that says: everything within normal range.
Men: Less testosterone than ever before
Travison et al. (2007) documented an age-independent decline of ~1.2% per year in the US population. More recent analyses show an acceleration. In parallel, the sperm concentration of Western men declined by over 60% between 1973 and 2018. That is not aging. That is a systemic diagnosis of our time.
Women: Estrogen dominance without high estrogen levels
Xenoestrogens from plastics, cosmetics, pesticides and mold toxins can bind to estrogen receptors and activate hormonal cascades without ever appearing as estrogen in the blood. A woman can have perfect lab values and still suffer massively from estrogen-like overload. Because what burdens her is simply not measured.
Chronic stress destroys the hormone system
CRH from the stress system directly suppresses the GnRH pulses that command testosterone and progesterone. Anyone under constant pressure actively suppresses their own hormone production without any stress level ever having been measured. Cortisol is not the enemy here. Chronically wrong cortisol is.
Environmental toxins intervene directly in the hormone system
BPA, phthalates, PFAS, mycotoxins, heavy metals: these substances disrupt hormone receptors, block detoxification enzymes, inhibit thyroid function and sabotage testosterone and progesterone synthesis. In 2023 the EFSA lowered the BPA limit by a factor of 20,000. That shows how seriously regulatory authorities now take the threat.
I have worked for years with men and women who have hormonal complaints. People who have been to the family doctor, the endocrinologist, the gynecologist, and who have always heard the same thing: your blood values are fine. Take this. Come back if it gets worse.
What almost never happens in these conversations: a real engagement with stress patterns, nutritional history, toxin burden, sleep quality, emotional history, gut microbiome, liver capacity. Exactly what I as a physician consider crucial. Not as an alternative to classical medicine. As its necessary extension.
I have used natural approaches to help raise testosterone levels, regulate female hormone systems, resolve years of PMS complaints, stabilize cycles after stopping the pill, and address hormone-related infertility that no classical diagnosis would have explained. It is not an easy process. But if you have a proper plan, individually tailored to the person, and apply the right measures, it is only a matter of time before something changes.
What awaits you in this article
- The biochemical mechanisms behind testosterone, estrogen, progesterone and cortisol
- Why stress sabotages the hormone system directly at the cellular level
- Xenoestrogens and toxins that no standard lab measures
- Diagnoses such as endometriosis, PCOS, luteal phase defect and what may really lie behind them
- Why a simple blood test never gives the complete picture
- My personal approach: lifestyle, detoxification, supplements, infusions, trauma
- Two personal stories, one about me, one about female friends with PMS
- A self-check: could your hormone system be out of balance?
Specialty area at Vivecura: Hormones in Balance
Hormone balance for men and women is one of my four core focus areas, alongside gut reset, mold therapy and heavy metal detoxification. My treatment plan always integrates lifestyle, targeted supplementation, detoxification strategies and, where needed, anthroposophic and complementary remedies. No one-size-fits-all scheme. Rather an individually tailored plan that treats the person as a system.
Before we go into the science, I want to share two personal stories. One about me. And one about female friends whose hormonal complaints first sparked the conversation on this topic.
My own story that changed everything
How 5 minutes a day recalibrated my hormone system.
A few years ago I suffered from persistent back pain. I lay in bed in the morning and sometimes needed more than half an hour just to get up. As someone who otherwise springs into the day full of energy, that was a sobering experience. I searched for alternatives, not for pills, but for something that addresses the actual cause.
I came across cold. I began with cold showers, then with a serious ice-bath protocol. I filled a rain barrel with cold water, set it outside in winter, broke the ice on its surface in the frost and immersed myself. What happened afterwards I had not expected.
What science confirms: cold immersion releases norepinephrine in amounts that exceed anything exercise alone can achieve. Šrámek et al. measured a 530 percent increase in norepinephrine after 14°C immersion. The autonomic nervous system is recalibrated. Chronically high cortisol patterns that represent the classic stress pattern begin to normalize. My testosterone rose. My energy returned. The morning sluggishness disappeared.
I combined cold training with a paleo diet: no processed food, no sugar, plenty of protein and fat as building blocks for steroid hormones, vegetables, real food. The result was not a gradual improvement. It was a transformation.
I wrote a book about it: Your introduction to cold training, with science, guide and morning routine for more vitality. Not because it is a trend, but because I have experienced what a dosed cold stimulus can do to the nervous system, the hormone system and the whole organism. Five minutes a day. No equipment. No cost. And one of the most powerful interventions I know.
In my practice I always integrate this experience: a treatment plan that only includes supplements and lab values, without lifestyle and without an anthroposophic view of the whole person, falls short. The body heals as a system. Not in individual parts.
Almost all my female friends had PMS. That is not normal. That is average.
I remember conversations with female friends where it became clear: nearly all of them had monthly complaints. Mood swings, breast tenderness, exhaustion, skin going crazy. PMS was accepted as the normal state. As part of being a woman.
But in my medical training and in my practice I learned: when something occurs in the majority, it is not automatically normal. It is average. And the average reflects our current living conditions, not what a healthy hormone system is capable of.
The problem: when the actual cause lies in nutrition, in chronic xenoestrogen exposure from plastics and pesticides, in a dysregulated cortisol profile from chronic stress, or in zinc deficiency, the pill reliably suppresses the symptoms. But the body is not healed. It is muted.
And when the pill is stopped after years, the real chaos begins: the body tries to restart a hormone system that did not have to work on its own for years, with depleted nutrient reserves (vitamin B6, zinc, selenium, magnesium), an altered gut microbiome and a body that has never really excreted xenoestrogens.
What I see again and again in patients, and what also worked for friends: stress regulation as the first priority. Then high-dose, targeted supplementation of the depleted micronutrients. Chasteberry as botanical support of the luteal phase. And systematic detoxification of xenoestrogens via gut, liver and dietary change. Not after three days, but after three to six months: everything back to normal. Stable cycle. Calm skin. Balanced mood. Without the pill.
"PMS is not a character weakness and not a female normality. It is a measurable biochemical signal. One that tells us: something here has gone out of balance that we do not have to accept."
Dr. Shukri Jarmoukli, Vivecura BerlinDiagnoses I see in practice, and why conventional medicine often knows only half the story
Many patients come to me with one or more of the following diagnoses. Or they come without a diagnosis, because conventional medicine has not found anything. Both are equally common. And in both cases the same insight often applies: what is measured in the lab does not show the complete picture of what is burdening the body.
I am not attacking conventional medicine. Gynecology, endocrinology, reproductive medicine are irreplaceable specialties. What I add is the question of the causes behind the causes: which environmental burdens come into question here? Which toxins have never been measured? Which stress patterns have been running unnoticed for years? Which nutrient deficiency has been quietly sabotaging the system for months?
Endometriosis
Estrogen-dependent condition in which tissue similar to uterine lining grows outside the uterus. In my view always with the question: which xenoestrogens could be fueling the milieu? Zearalenone, BPA, phthalates and dioxins are associated in studies with an increased risk of endometriosis. Detoxification, liver support and estrobolome optimization are integral parts of the approach.
Xenoestrogens InflammationPCOS (Polycystic Ovary Syndrome)
Androgen excess, cycle disorders, polycystic ovaries on ultrasound. What is often missing: the engagement with insulin resistance as a driver, with mold toxins that may act as mycoestrogens influencing the hypothalamic-pituitary-ovarian axis, and with chronic cortisol that disrupts the GnRH pulse via CRH. Classical treatment targets symptoms. I look for what originally threw the system out of balance.
Insulin Resistance MycotoxinsPMS and PMDD
Premenstrual syndrome up to pronounced dysphoric disorder. The underlying biochemistry: insufficient progesterone in the luteal phase that does not adequately build the allopregnanolone-GABA buffer, often combined with estrobolome imbalance, nutrient deficiencies (especially magnesium, B6, zinc) and a cortisol profile that persistently dampens the HPO axis. All of this can be measured, addressed, changed.
Cortisol/Stress Estrogen DominanceLuteal Phase Defect
Too short or insufficient luteal phase after ovulation, which limits progesterone production. Common causes beyond standard diagnostics: chronic stress (GnRH suppression via CRH), thyroid dysfunction (which is mostly only measured as TSH), prolactin elevations in micronutrient deficiencies, and latent xenoestrogen burden that impairs follicular growth.
Stress ThyroidHormone-Related Infertility
When cycle parameters are within normal range, all hormone levels appear normal, but pregnancy does not occur, I think of the invisible burdens: mycotoxins from molds acting as mycoestrogens, heavy metals blocking selenoproteins and thyroid conversion, xenoestrogens disrupting follicular maturation. Below I share a clinical story that illustrates this.
Mycotoxins/Heavy Metals XenoestrogensPost-Pill Syndrome
After stopping the pill, the body's own hormone system recovers, but with depleted nutrient reserves, an altered gut microbiome and in some cases a body that has not excreted xenoestrogens for years. The androgen rebound, anovulatory first cycles, persistent acne and mood instability are not errors of the body. They are the signal of a system that is recalibrating itself.
Nutrient Deficiencies Estrogen DominanceHypogonadism / Low-T
Clinically diagnosed testosterone deficiency, usually defined by laboratory values below the reference range plus symptoms. Before TRT is discussed: have I found all reversible causes? Chronic stress, sleep deprivation, visceral fat, heavy metals, alcohol, sleep apnea, nutrient deficiencies, thyroid dysfunction. All of these can suppress testosterone levels without any testicular defect.
Lifestyle Heavy MetalsMetabolic Syndrome & Testosterone
Visceral fat and insulin resistance create a vicious circle through elevated aromatase activity: more belly fat, more estradiol, less testosterone, worse insulin sensitivity, even more belly fat. This loop is well known and behavior-sensitive. At the same time, chronic inflammation (TNF-α, IL-6) acts directly on the Leydig cells and reduces testosterone synthesis independently of the HPG axis.
Insulin Resistance AromataseTen years trying to conceive. Normal lab values. And mycotoxins that no doctor had measured.
She came to me initially for an iron infusion. Ferritin at 7. In conversation she mentioned, almost in passing, what lay behind her: ten years trying to conceive. Several reproductive specialists. Two unsuccessful IVF attempts. All hormone values in the lab: unremarkable. Ovulation: detectable. Uterus: structurally normal. The official diagnosis: unexplained infertility.
Then she told me what I had asked and the others had not: in the last seven years she had lived in an old Berlin apartment. Bathroom and bedroom with recurring mold. Repeatedly brushed away, painted over, covered up. Always coming back.
We did a mycotoxin analysis in the urine. The burden of zearalenone, the mold toxin of Fusarium species that is structurally similar to 17-beta-estradiol and competitively binds to estrogen receptors, was clearly elevated. In addition there were other mycotoxins that can generate oxidative stress in follicular cells and directly impair egg quality.
We worked systematically: identified the source of exposure, supported gut and liver detoxification, initiated mycotoxin elimination, switched the diet to low-grain and low-sugar, used selenium and glutathione in a targeted way. Six months after moving into a mold-free apartment and after the detoxification protocol, she became pregnant without further intervention.
I do not claim causality. I document a temporal correlation that is medically significant in its clarity. And I say: when a hormone system persistently does not do what it should despite normal lab values, it is not a defeat to ask one step further.
A dentist with low testosterone. And a cause no one had measured.
He came because of persistent exhaustion and declining performance. 48 years old, dentist, athletic, no obvious risk factors. In the lab: testosterone clearly in the lower normal range, near the clinically relevant threshold. Everything else unremarkable.
In the case history I asked how he worked in his practice. He described decades of daily work with amalgam fillings, placing them, grinding them down, removing them, often without complete protective protocol. The classic picture of someone with cumulative occupational mercury exposure.
According to current research, mercury can block selenoproteins, inhibit thyroid enzymes and possibly act directly on the Leydig cells, which produce testosterone in the testes. It can affect the HPG axis on several levels. Whether that was the sole cause in his case can never be said with certainty. What I can say: after a structured DMPS chelation protocol over several months, accompanied by mineral monitoring, selenium supplementation and lifestyle optimization, his testosterone rose measurably. The exhaustion improved. Performance returned.
This is not an isolated case in my practice. I see this pattern regularly: people who were dentists, dental technicians or dental assistants, whose testosterone values or thyroid parameters were below what was expected, and where a heavy-metal analysis painted a picture that no standard lab could ever have shown.
Why the psyche and the nervous system can also influence the hormone system
I work holistically. I don't say that as a slogan, but as the result of everything I have seen in practice. And one of the most important reasons for this is a phenomenon that does not appear in any hormone consultation, but that makes the picture of some patients more complete than any lab value: the close connection between the nervous system, the emotional history of a person and their hormonal balance.
Cell Danger Response: when cells could be stuck in survival mode
Robert Naviaux describes, with the concept of the Cell Danger Response (CDR), a state in which cells, due to persistent burden, chronic stress or unresolved traumatic experiences, can switch into a biochemical protective state. In this model, mitochondria change their metabolic mode. Cells produce less energy, reduce anabolic processes, and could thus also throttle hormone production. This mechanism is not a flaw of the body. It would be an evolutionary protection.
What this could mean clinically: when someone has lived for years in a burdening environment, whether physical, emotional or through toxins, the cellular system may respond differently, even if the threat is long gone. Chronically low testosterone values, flat cortisol curves, progesterone deficiency despite an otherwise good foundation could in some cases be the expression of a nervous system that is still on alert. That is a possibility I always keep in mind during the case history. Not as a diagnosis, but as another relevant question.
That is why, for certain patients in my practice, body-oriented trauma work is part of the approach. Not talk therapy alone, but approaches that address the nervous system directly. I work with biodynamic psychotherapeutic methods that involve the body and the nervous system. And in selected cases, when classical therapeutic methods have reached their limits, ketamine-assisted therapy can be a meaningful next step. In these cases, ketamine can open a therapeutic window in which the nervous system can re-process deeply anchored stress patterns at a neuronal level, in a way that pure talk therapy and supplements alone cannot always achieve.
I emphasize: not every hormone disorder has a traumatic or psychological component. That would be just as incomplete a statement as saying that it never plays a role. What I do: I ask about it. I take it seriously. And I decide individually.
The hormone system is an orchestra, not a solo
Most people think about hormones in single categories: testosterone for men, estrogen for women, cortisol for stress. That is like describing a symphony orchestra by only talking about the first violin. The truth is more complex and more beautiful: all hormones constantly communicate with each other. They share common precursors, influence each other, and are jointly modulated by lifestyle, nutrition, toxins and stress.
Testosterone
The life hormone. For drive, muscle mass, cognition, mood and vitality, in men and women.
Estrogen & Progesterone
The duo of female balance. Not the absolute value, but the ratio decides everything.
Cortisol
The stress hormone that disrupts all others when chronically elevated. The invisible saboteur.
Each of these systems has its own control center. Cortisol is regulated via the HPA axis (hypothalamus-pituitary-adrenal). Testosterone and the female sex hormones via the HPG axis (hypothalamus-pituitary-gonads). These axes are not separate. They share neurotransmitters, influence the same hypothalamus, and when one axis is permanently overloaded, all the others pay the price.
Cortisol: The silent architect of hormone chaos
Cortisol has an image problem. It is seen as the hormone of stress, as something you want to reduce. The truth is more nuanced and more important: cortisol is essential for life. It regulates energy metabolism, inflammatory response, the immune system, blood pressure and the mobilization of glucose. The problem is not cortisol. The problem is chronically wrong cortisol.
The HPA axis, the conductor of the stress system
Hypothalamus: the first step
In response to stress or a blood sugar crash, the hypothalamus releases CRH (corticotropin-releasing hormone). The starting signal for the entire stress system.
Pituitary: the amplifier
CRH stimulates the pituitary gland to release ACTH (adrenocorticotropin). The signal travels through the bloodstream to the adrenal gland.
Adrenal cortex: the production
ACTH stimulates the zona fasciculata of the adrenal cortex to produce cortisol. Cortisol enters the bloodstream and acts systemically on hundreds of tissues.
Feedback: the self-regulator
Through negative feedback, cortisol inhibits both CRH in the hypothalamus and ACTH in the pituitary. Under chronic stress, this regulator fails.
The cortisol awakening response (CAR): what a healthy system does
Cortisol follows a robust daily rhythm. What is hardly known: within the first 30 to 45 minutes after waking, cortisol rises in a healthy person by 50 to 160 percent. This phenomenon is called the cortisol awakening response (CAR) and was first described by Pruessner et al. (1997). It is not a flaw of the body, but an evolutionary design: the body activates its daily budget and mobilizes energy for the coming hours.
Healthy cortisol daily profile at a glance
A flattened CAR (too little morning rise) is associated with burnout, autoimmune diseases and cardiovascular risk. An evening elevation, when cortisol does not drop, sabotages sleep and the hormone system alike.
How chronic cortisol sabotages all other hormones
Here lies the heart of the problem. Cortisol in continuous operation interacts destructively with every other hormone system. And it does so in ways that remain invisible in standard labs.
The four hormonal acts of sabotage by chronic cortisol
- Testosterone suppressed (CRH inhibits GnRH): Chronically high cortisol levels activate CRH, which directly inhibits the pulsatile release of GnRH in the hypothalamus. Less GnRH means less LH, less LH means less testosterone from the Leydig cells. At the same time, Rivier and Rivest (1991) showed that stress exerts a second, additive inhibition on GnRH via GnIH/RFRP-3 neurons.
- Progesterone declines (HPO axis suppression): At the central nervous level, cortisol inhibits the GnRH-LH pulse that triggers ovulation. No ovulation, no corpus luteum, no progesterone. In addition, glucocorticoids in connective tissue cells stimulate aromatase, which converts androgens to estrogen, further shifting the estrogen-progesterone ratio.
- Thyroid slowed (T4 to rT3): Chronically elevated cortisol inhibits the enzyme type I deiodinase (D1), which converts inactive T4 into active T3. At the same time, it activates type III deiodinase (D3), which converts T4 into inactive reverse T3 (rT3). The result: normal TSH and T4 values in the lab, but insufficient active T3 in the cells. Classic hypothyroidism symptoms with seemingly normal findings.
- Insulin resistance amplified (aromatase loop): Cortisol promotes hepatic gluconeogenesis and inhibits GLUT4 translocation, which chronically raises insulin levels. Hyperinsulinemia upregulates aromatase in adipose tissue via the NF-κB pathway, which converts testosterone to estradiol and promotes further fat storage. A self-reinforcing loop.
Measuring cortisol properly: why the blood test so often lies
A single cortisol value from blood, usually at 8 a.m., tells you about as much about your cortisol profile as a single weather photo tells you about the climate. The standard blood test captures bound cortisol (biologically inactive) plus free cortisol, but cannot show whether the CAR is intact, whether evening levels remain elevated, or whether there is a flat, chronically dysregulated curve over the day.
Testosterone: The life hormone we underestimate
Testosterone is not a muscle hormone. It is the hormone of life. Drive, decisiveness, cognitive sharpness, mood stability, insulin sensitivity, bone and muscle building, cardiovascular health: all depend on adequate testosterone levels. In men. And, often overlooked: just as much in women.
A generation-spanning decline that does not stop at age
The Massachusetts Male Aging Study analyzed testosterone values over three survey waves and nearly two decades. The result: a decline of about 1.2 percent per year, completely independent of the age of the men. A 40-year-old in 2000 had on average lower testosterone values than a 40-year-old in 1970. Not because he was older. But because he lived in a different era.
Travison TG et al. A population-level decline in serum testosterone levels in American men. JCEM. 2007;92(1):196–202.And the parallel finding that is even more alarming: Levine et al. showed in 2017 and 2022, in the most comprehensive meta-analysis of its kind, that the sperm concentration of Western men declined by 52.4 percent between 1973 and 2011. The updated analysis for the period through 2018 shows: the decline is accelerating. And it now affects all regions of the world.
Testosterone in women: the most overlooked topic in women's medicine
The 2019 Global Consensus Statement, signed by leading endocrinologists and gynecologists from twelve countries, put it clearly: women produce testosterone from three sources, from the ovaries (25 percent), the adrenal glands (25 percent) and via peripheral conversion (50 percent). Normal total testosterone level in women: 15 to 70 ng/dL.
Symptoms of low testosterone
- Drive and motivation gradually reduced
- Muscle building harder despite training
- Cognitive sharpness reduced, brain fog
- Body fat increased, especially visceral
- Libido reduced, erectile function changed
- Flatter mood, less liveliness
- Recovery time after exertion prolonged
Symptoms of low testosterone
- Persistent exhaustion that sleep does not fix
- Libido and sexual interest reduced
- Muscles build with more difficulty, slow regeneration
- Mental clarity and focus reduced
- Drive for projects and initiative diminished
- Body sense and self-efficacy changed
- Often after menopause, but also earlier
Islam et al. published a meta-analysis in 2019 in Lancet Diabetes & Endocrinology of 36 randomized controlled trials (8,480 participants). Transdermally administered testosterone significantly improved the number of satisfactory sexual events, desire, arousal and orgasm in postmenopausal women. Non-oral testosterone showed neutral effects on blood lipids. A critical caveat: no EU-approved testosterone preparation for women currently exists. Treatments are off-label.
Islam RM et al. Safety and efficacy of testosterone for women. Lancet Diabetes Endocrinol. 2019;7(10):754–766.Estrogen and progesterone: the ratio decides everything
When I talk about estrogen dominance, I almost never mean too much absolute estrogen. I mean a disturbed ratio. Estrogen is like the violin in a string quartet: loud, brilliant, lively. Progesterone is the cello: warm, grounding, stabilizing. When the cello falls silent, the piece sounds wrong, even if the violin plays perfectly.
Progesterone is far more than a pregnancy hormone
In the brain, progesterone is partly converted into allopregnanolone, a neurosteroid that activates the GABA system, the most important calming system of the nervous system. When progesterone is missing or drops too early, you lose this switch. Sleep becomes shallower. Stimuli feel stronger. Mood swings arise not from weakness, but from neurobiology.
The gut also decides: the estrobolome
One of the most fascinating and clinically most relevant findings of recent years: the gut microbiome actively regulates circulating estrogen levels. The liver packages excess estrogen and releases it via bile into the gut. There it is supposed to be excreted. But certain gut bacteria produce the enzyme beta-glucuronidase, which strips the excretion marker back off the packaged estrogen. The exposed estrogen is reabsorbed. The estrobolome, the term for this hormonal recycling system of the gut, is overly active in dysbiosis. The result: higher free estrogen levels in the blood, even though the ovaries have not changed anything.
Estrogen in men: the underestimated hormone
Men need estrogen. This sounds counterintuitive but is biochemically fundamental. In a landmark NEJM study in 2013, Finkelstein et al. brought young men into simultaneous testosterone and estradiol deficiency and showed: estradiol is the dominant regulator of bone resorption in men, not testosterone. Libido, mood and cognitive function in men depend on adequate estradiol, bones all the more so.
Young healthy men received a GnRH agonist (to suppress both hormones) plus either targeted testosterone replacement, testosterone replacement with an aromatase inhibitor, or placebo. Result: fat mass and sexual function were primarily regulated by estradiol, muscle mass by testosterone. Critical conclusion: aggressive aromatase inhibitor use, increasingly popular in men's health circles, can trigger bone loss, joint pain, mood crashes and paradoxical loss of libido when estradiol is too low.
Finkelstein JS et al. Gonadal steroids and body composition, strength, and sexual function in men. N Engl J Med. 2013;369(11):1011–1022.Xenoestrogens: when the environment hijacks your hormone system
Imagine someone sits down uninvited in your partner's seat and behaves as if they were the partner. The seat is taken. The signaling chain runs through. But the wrong person gives the orders. That is exactly what xenoestrogens do in your body: they can bind to estrogen receptors and activate hormonal cascades without ever appearing as estrogen in the blood test.
BPA & BPS
Plastic bottles, receipts, food cans, dental materials
Phthalates
Plasticizers in cosmetics, perfumes, PVC packaging
Zearalenone (ZEA)
Mold toxin on grains (corn, wheat, oats), heat-stable
Parabens
Preservatives in cosmetics, shampoos, creams
Pesticides
Atrazine, DDT metabolites on conventional fruits and vegetables
PFAS
Coatings, baking paper, Teflon pans, water-repellent textiles
In one of the most striking regulatory decisions of recent decades, in April 2023 the European Food Safety Authority (EFSA) lowered the tolerable daily BPA intake from 4 µg/kg/day to 0.2 ng/kg/day, a factor of 20,000. The basis was, for the first time, not reproductive toxicity but immune system effects (Th17 cells). EFSA found: all European age groups exceed this value by two to three orders of magnitude. That means: current average population exposure is estimated to be 100 times above the new safety value.
EFSA. Re-evaluation of BPA in foodstuffs. EFSA Journal. 2023;21(4):6857.BPA was banned in EU thermal paper (receipts), after which BPS was introduced as a substitute, which ECHA classifies as similarly problematic. The pattern is called "regrettable substitution": a harmful substance is replaced by a structurally similar, barely better studied one. The solution does not lie in regulation alone, but in consciously reducing plastic exposure: glass and stainless steel for food, digital receipts, organic labels for pesticide reduction, PFAS-free cookware.
DHEA: The forgotten mother hormone of hormones
DHEA sulfate (DHEA-S) is the most abundantly circulating steroid hormone in human blood. It is the most important precursor for both testosterone and estrogens, especially in postmenopausal women, where nearly all sex hormones arise via peripheral DHEA conversion. And it is almost never measured.
Orentreich et al. were the first to systematically document the age-dependent profile: DHEA reaches its peak between 20 and 25 years of age, then drops by 2 to 5 percent per year and at age 70 to 80 reaches only 10 to 20 percent of the starting value. This so-called adrenopause affects men and women equally and is independent of menopause or andropause.
Morales et al. (1998) showed sex-specific effects: women over 60 reported improved energy and well-being. Men lost fat mass and gained muscle strength. However, the large Nair et al. NEJM study (2006) found no significant effects on physical performance or quality of life over two years. For systemic DHEA in normal adrenal function, there is currently no clear clinical recommendation. The only FDA-approved indication: intravaginal DHEA (prasterone) for vulvovaginal atrophy after menopause. In my practice, I measure DHEA-S as part of the overall hormonal picture and interpret it in the context of all other markers.
Cold, hormones and the autonomic nervous system
I shared my own cold experience. Now the science behind it, honestly placed in context.
Cold does not boost testosterone. But it rewires the nervous system.
The popular claim that ice bathing raises testosterone is not scientifically supported. Sakamoto et al. (1991) actually showed a short-term decline of 10 percent in testosterone after cold stimulation. This is not an argument against cold therapy, it is an argument for honesty.
Where cold's true strengths lie: norepinephrine rises by up to 530 percent (Šrámek et al., 2000). The autonomic nervous system demonstrably shifts toward the parasympathetic. HRV improves significantly after regular cold exposure (Meta-analysis 2024: RMSSD SMD +0.61). And in a controlled PNAS study (2014), Kox et al. showed that cold-experienced individuals produced significantly fewer pro-inflammatory cytokines (TNF-α, IL-6) after endotoxin injection. The anti-inflammatory effect is real. And inflammation, as I show below, directly suppresses testosterone.
Buijze et al. (RCT, 2016, n=3,018) found that daily cold-shower endings of only 30 to 90 seconds reduced sick days by 29 percent.
Chronic inflammation, the invisible hormone saboteur
This connection is mentioned in hardly any patient conversation, although it is biochemically clear: TNF-α, the pro-inflammatory cytokine that is chronically elevated in obesity, chronic stress and dysbiosis, directly reduces testosterone synthesis in the Leydig cells. Mauduit et al. (1998) demonstrated the dose- and time-dependent suppression of the StAR protein by TNF-α. StAR is the shuttle protein that transports cholesterol into the mitochondrion, where testosterone production begins. Block StAR, and you block testosterone.
The obesity-inflammation-aromatase triangle reinforces everything: visceral fatty tissue recruits M1 macrophages that release IL-1, IL-6 and TNF-α. These cytokines activate the aromatase promoter sites in fatty tissue via NF-κB. More aromatase means more testosterone-to-estradiol conversion. Higher estradiol promotes further fat storage. The loop closes.
Inflammation is not a side phenomenon of hormone disorders. It is often their cause. Diet-induced inflammation from processed foods, omega-6 excess and sugar, combined with visceral fat and dysbiosis, can destabilize the hormone system from within, without ever measuring a single hormone. Anti-inflammatory nutrition and gut restoration are therefore not lifestyle recommendations. They are first-line hormonal intervention.
What I measure and why I do not start with the lab
The first appointment with me never begins with a lab order. It begins with case history. With real listening. I ask about daily rhythm, sleep, nutrition, relationship patterns, living environment, professional history. Only when I have the picture do I see which lab values provide new information and which I already know.
Lab Panel Men
- Total testosterone + free testosterone (morning, 7–11 a.m., 2 measurements)
- SHBG, LH, FSH
- Estradiol (E2), do not omit
- DHEA-S
- 4-point salivary cortisol (daily profile)
- TSH, fT3, fT4, anti-TPO (complete)
- Ferritin, serum iron, transferrin saturation
- Vitamin D, zinc, selenium, magnesium
- Fasting insulin + glucose
- hsCRP (inflammation marker)
Lab Panel Women
- Estradiol (E2) on day 3–5 of the cycle
- Progesterone on day 19–22 (luteal phase!)
- LH, FSH, AMH (ovarian reserve)
- Free testosterone + SHBG
- 4-point salivary cortisol (daily profile)
- TSH, fT3, fT4, anti-TPO
- Ferritin, serum iron, transferrin saturation
- Vitamin D, zinc, selenium, magnesium, B6, B12
- Fasting insulin if insulin resistance is suspected
- DHEA-S + hsCRP
Chasteberry (Vitex agnus-castus): the botanical dopamine brake for the hormone system
Chasteberry does not contain progesterone and does not produce it directly either. That is a widespread misconception. What it does: its diterpenes bind to dopamine D2 receptors on lactotrophs of the pituitary, thereby reducing prolactin release. Normalized prolactin improves LH pulsatility, which strengthens ovulation and corpus luteum quality and thereby improves the body's own progesterone production in the luteal phase. It is an indirect, elegant route.
Schellenberg's RCT in the BMJ (2001, n=170) with the standardized Ze 440 extract showed significant improvements in irritability, mood swings, breast tenderness and headaches before menstruation compared to placebo. Csupor et al. published a 2019 meta-analysis of well-characterized Vitex preparations: women had a 2.57-fold likelihood of complete remission of PMS symptoms (95% CI 1.52–4.35). Milewicz et al. (1993) showed prolactin normalization and an increase in mid-luteal progesterone in women with latent hyperprolactinemia.
Who benefits most: women with PMS (especially breast tenderness, luteal phase complaints), after stopping the pill with an irregular cycle, with cycle irregularities without a structural cause. Effects begin after 3 to 6 months of continuous use. Contraindicated in pregnancy, IVF treatment and dopamine agonist medication. I discuss individual dosing in person after case history and labs.
Supplements: fixing deficiencies, not magic bullets
I am open about the evidence. Supplements can do decisive work when they remove limiting factors. They do not replace sleep, stress regulation or nutritional quality. Here is the current overview:
| Supplement | Core Effect | Evidence | Limitation |
|---|---|---|---|
| Ashwagandha (KSM-66 / Sensoril) | Cortisol reduced by ~27.9%; testosterone +14.7% (men) | Solid RCTs | Cortisol and testosterone effects in separate trials; no single RCT combining both yet |
| Magnesium | HPA axis regulation, cortisol reduction, sleep, free testosterone | Well-established | Magnesium glycinate for sleep/cortisol; no strong effect on testosterone with normal levels |
| Vitamin D3 + K2 | Testosterone +~25% in deficiency; baseline hormonal function | RCT in deficiency | No effect with adequate baseline (Lerchbaum 2017) |
| Zinc | Cortisol suppression via aromatase inhibition, testosterone synthesis | Well-established (deficiency correction) | Prasad 1996: effect in marginal deficiency; normal levels = barely any effect |
| Selenium | T4 to T3 conversion, mercury protection, thyroid | Moderate | Selenate vs. selenomethionine: different bioavailability; organic preferred |
| DIM (Diindolylmethane) | Estrogen metabolism optimization (2-OH instead of 16α-OH pathway) | Pilot studies | Small human studies; clinical relevance still pending larger RCTs |
| Rhodiola rosea (standardized) | Cortisol daily rise reduced, fatigue in burnout improved | Controlled studies | Olsson et al. 2009 Phase III: n=60, burnout population; limited extrapolation |
| Chasteberry (Vitex agnus-castus) | Prolactin reduction, luteal phase improvement, decline in PMS symptoms | Multiple RCTs + meta-analysis | Only for women; effects begin after 3–6 months; not during pregnancy |
| Omega-3 fatty acids | Chronic inflammation reduced; indirect testosterone support | Anti-inflammatory effect well established | Direct testosterone effect not shown in studies; effect via inflammation reduction |
Eight levers. Today. Not next Monday.
I know what it is like. You read something, nod inwardly, and three weeks later nothing has happened. Because everything sounds doable but nothing is really anchored. So: pick two levers right now while reading. Start tomorrow morning.
Sleep rhythm as hormone therapy
- Constant wake time, including on weekends
- Morning light in the first 30 minutes after getting up
- Dim screens after 9 p.m.
- Progesterone and testosterone are produced at night in deep sleep
- JAMA 2011 (Leproult): 1 week of 5h sleep lowers testosterone by 10–15%
Protein first, every morning
- Protein first: eggs, skyr, cottage cheese, nuts
- Blood sugar buffer prevents cortisol peak from glucose crash
- Aromatase activation from insulin spikes reduced
- Paleo principle: real food, sufficient fat as a steroid building block
Cold exposure as a stimulus
- 30–120 seconds cold shower at the end of the shower
- Or 2–5 minutes ice bath at 10–15°C
- 3–5x per week for lasting HRV effect
- 530% norepinephrine increase (Šrámek 2000)
- Not for: heart disease, Raynaud, uncontrolled hypertension
Breath work: the biochemical brake
- 4 seconds in, 6–7 seconds out
- Vagus nerve activation: the strongest parasympathetic switch
- HRV improves measurably after 5–10 minutes a day
- Laborde et al. meta-analysis (223 studies): consistent HRV improvement
Strength training 3x per week
- Heavy compound lifts: squat, deadlift, row
- Large muscle groups, adequate load
- Myokines improve insulin sensitivity and reduce aromatase load
- Not maximal every day: recovery is the hormonal gain
Reduce xenoestrogens
- Replace plastic bottles and containers with glass
- Do not touch receipts with wet fingers
- Check cosmetics for parabens and synthetic fragrances
- Organic foods visibly reduce pesticide residues
- PFAS-free cookware (stainless steel, cast iron)
Support gut and liver
- 30 g of fiber daily for optimal estrogen excretion
- Ground flaxseed (2 tbsp daily) for estrobolome balance
- Cruciferous vegetables (broccoli, cauliflower, arugula) for DIM/I3C
- Daily bowel movement: in a sluggish gut, what should leave gets reabsorbed
Targeted supplementation guided by labs
- Measure first, then supplement
- Priority 1: vitamin D, zinc, magnesium, selenium (often depleted)
- Priority 2: ashwagandha when cortisol dysregulation is documented
- Women: chasteberry for PMS/luteal phase deficit, DIM for estrogen dominance
Could your hormone system be out of balance? A guide for self-assessment.
What follows is not a diagnosis and no replacement for a medical case history. It is an honest invitation to pause. Count how many of these points apply to you. The evaluation is at the end.
Area 1: Energy, drive and mind
- Energy gradually lower: Not suddenly, but imperceptibly less fire, drive, liveliness over recent years.
- Chronic exhaustion despite sleep: You sleep 7–8 hours and wake up already tired.
- Brain fog: Concentration, word-finding, decision speed have declined.
- Motivation missing without explainable reason: Things that used to bring joy attract you less.
- Cold intolerance without thyroid findings: You feel cold often while others find it pleasantly warm.
Area 2: Body and metabolism
- Belly fat despite moderate diet: Especially visceral fat that persists stubbornly.
- Muscles harder to build: The same training intensity brings less result than before.
- Mounting skin problems: Acne, eczema, oily or impure skin without external explanation.
- Weight fluctuations without dietary change: Gained or lost weight without explainable reason.
- Hair loss or changed hair growth: More hair in the brush, hairline changed.
Area 3: Mood, nervous system and sleep
- Mood swings without external trigger: Up and down without a logical reason, especially cyclically in women.
- Inner restlessness or anxiety: The nervous system seems permanently on alert.
- Sleep has become shallower: Falling asleep is fine, staying asleep is not. Or no rest in the morning.
- Increased irritability: Small things trigger a reaction that was not there before.
- Recovery time after strain prolonged: Sport, stress or illness take longer to bounce back from.
Area 4: Specific to women
- PMS symptoms (breast tenderness, mood, bloating): Regular pronounced complaints in the 7–14 days before menstruation.
- Cycle length or rhythm changed: Become shorter, longer, irregular.
- Water retention before menstruation: Noticeably swollen hands, legs, belly in the second half of the cycle.
- Stopped the pill and chaos ensued: The cycle did not normalize for a long time after stopping.
- Libido has been low for some time: Sexual interest has clearly declined, without a relationship problem as the cause.
Area 5: Specific to men
- Testosterone-typical symptoms: Less assertiveness, reduced erection quality, decline in athletic performance.
- Alcohol regularly, even moderately: Alcohol directly suppresses testosterone production in the Leydig cells.
- Sleep under 7 hours regularly: 1 week of sleep deprivation = 10–15% less testosterone (JAMA 2011).
- Snoring or apnea reported: Sleep apnea demonstrably suppresses LH and testosterone at night.
Area 6: Exposure and history
- Amalgam fillings (now or in the past): Mercury accumulates in endocrine organs and disrupts thyroid and hormone synthesis.
- Regular tuna or swordfish consumption: Methylmercury via the food chain.
- Chronic stress for a year or longer: Persistent stress = persistently disrupted HPA axis = disrupted hormone system.
- Antibiotics multiple times in recent years: Gut microbiome disruption affects the estrobolome and nutrient supply.
- Mold exposure in the home: Zearalenone and other mycotoxins act as mycoestrogens.
Your evaluation
These questions do not replace a medical case history or laboratory diagnostics. They are an orientation. Not every symptom has a hormonal cause. And a hormone system out of balance does not automatically explain all complaints. What counts is the overall clinical context. That is exactly what the initial consultation is for.
Hormones in the system: the connection to my other specialty areas
Hormone balance does not exist in a vacuum. A chronically dysregulated gut microbiome recycles estrogen via beta-glucuronidase. Mold toxins bind as mycoestrogens to estrogen receptors. Heavy metals block the selenoproteins that thyroid and testosterone synthesis need. In my practice we look at the whole system.
Hormones in Balance
Testosterone, estrogen, cortisol, holistic
This AreaGut Reset
Estrobolome, nutrient absorption, inflammation axis to the hormone system
Mold
Zearalenone and other mycotoxins as mycoestrogens and HPG axis disruptors
Heavy Metals
Mercury blocks selenoproteins, disrupts T4-T3 conversion and the HPO axis
My treatment approach: why a blood test is never enough
The initial consultation with me never begins with a lab order. It begins with listening. With a detailed case history that asks not only about symptoms, but about the life behind them. Because hormones are not isolated numbers. They are the expression of a system that lives in a particular context.
Alongside complete hormone panels (cycle-appropriate in women, fasting in the morning in men): a 4-point salivary cortisol profile over the day, HRV measurement as an autonomic marker of the stress system, heavy-metal analysis when the case history indicates it (amalgam, fish consumption, occupation), mycotoxin analysis in urine in cases of mold exposure, micronutrient status (selenium, zinc, magnesium, vitamin D, B6, B12, ferritin), complete thyroid (TSH is not enough), inflammation markers, blood sugar and insulin sensitivity. And always: an honest assessment of stress patterns, emotional burden history, sleep quality, dietary habits and living environment.
Why all of this? Because a testosterone value of 8 nmol/L in a man with chronic sleep deprivation, visceral fat, high alcohol consumption, subclinical hypothyroidism and three amalgam fillings describes a different problem than the same value in an otherwise healthy man with normal sleep and good nutrition. Both need different solutions. A single number says nothing if you do not know the context.
My treatment plan: always as a system, never as a single measure
Lifestyle as the indispensable foundation
Without sleep, nutrition and stress regulation, all other measures do not reach deep enough. This is not a wellness appeal, this is biochemistry. Sleep deprivation lowers testosterone measurably. Blood sugar spikes activate aromatase. Chronic stress suppresses GnRH. No supplement, no infusion, no hormone preparation can replace these foundations. That is why I always first work on sleep rhythm, nutritional quality, movement and the stress system before I consider further measures.
Detoxification when toxin loads are present
This is the step that is almost entirely missing in conventional hormone therapy. When heavy metals are present that may block thyroid enzymes, or mycotoxins that may act estrogen-like, or a BPA burden that may influence the estrogen receptor, then hormone supplementation alone can reach its limits. Detoxification of heavy metals via DMPS protocols, mycotoxin elimination via gut, liver and targeted binders, reducing daily xenoestrogen exposure: in my experience this is not an optional add-on but an important foundation.
Targeted supplementation in therapeutically effective doses
I regularly encounter patients who have tried supplements and say: it didn't do anything. When I ask, it turns out they took dietary supplements at prophylactically low doses, designed for a healthy person with sufficient nutrient status, not for someone in need of therapy with a documented deficiency. The difference between supplementation that works and one that does nothing often lies in the dose, which I set individually based on labs and clinical picture. That is why I do not give general dosage recommendations in public formats. That must happen in the personal consultation after diagnostics.
Intravenous infusion therapy
Sometimes oral supplementation is not enough, because the intestinal barrier is compromised, because the body does not absorb certain nutrients adequately despite oral administration, or because a faster systemic effect is needed. In my practice I give infusions, including high-dose vitamin C (antioxidative, supports cortisol regulation and collagen synthesis), glutathione (central detoxification molecule, particularly relevant in heavy metal and mycotoxin burden), B complex (neurotransmitter synthesis, methylation support), intravenous magnesium in pronounced HPA axis dysregulation, and where appropriate phosphatidylcholine in neurotoxic burden. Infusions are not a luxury. They are a medical tool with a clear indication.
Anthroposophic remedies as an integrated component
I work according to an approach that combines classical medicine, functional medicine and anthroposophic medicine. Not as a replacement, but as an extension. Certain plant preparations, minerals and rhythmic remedies from anthroposophic medicine support regulation and self-healing forces at a level that purely biochemical measures do not reach. In practice I find that the combination of lifestyle work, targeted biochemistry and anthroposophic remedies produces results that none of the three levels alone could have achieved.
Someone with testosterone deficiency that may result from a particularly burdensome year could need a different plan than someone whose testosterone has dropped due to visceral fat and sleep deprivation. Someone with estrogen dominance and documented mold exposure could benefit more from a detoxification strategy than from botanicals alone. And someone whose nervous system seems stuck in chronic stress mode could achieve more with nervous-system-oriented therapy than with labs and supplements alone. Recognizing the difference is my task. Developing the right individual plan from it is my standard.
Let's complete the picture together.
In a first conversation I listen. Not with the lab. But with a real case history. Then we decide together which diagnostics will really bring new information and which next step is the right one for you.
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