Puberty is a transitional period marked by hormonal changes that affect physical, emotional, and psychological functioning to reach adult maturation. Because hormones are in a constant state of flux, many adolescents will experience mood swings, stress, and fatigue in addition to physical changes. It can be challenging to identify hormonal imbalances in adolescents, which can negatively impact both physical and emotional well-being and development.

A root cause medicine approach to hormonal imbalances in adolescents incorporates lifestyle, nutrition, and stress-management techniques to create a tailored strategy to transition through puberty with a strong foundation for good health through all stages of life.

[signup]

Understanding Hormonal Imbalances in Adolescents

The reproductive and endocrine systems are the two primary systems involved in puberty and the production of hormones that cause the changes seen in puberty. These hormones act as messengers and affect nearly every organ system within the body. A hormonal imbalance can involve an excess or deficiency of one or more hormones or secretion of hormones at inappropriate times. Issues with sex hormone production can lead to early or delayed puberty. Hormones in the hypothalamus and pituitary gland of the brain trigger the start of puberty: Gonadotropin-releasing hormone (GnRH) is secreted in the hypothalamus and causes the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary cells. FSH and LH then act on the testes and ovaries to make testosterone, estrogen, and progesterone. This connection between the brain and the sex organs is called the hypothalamic-pituitary-gonadal axis (HPG axis). In the adrenal glands, the production of hormones such as DHEA and DHEA-S is increased during puberty, which causes changes in physical appearance, such as increased body hair and odor. Women with polycystic ovary syndrome (PCOS) may have higher levels of DHEA. 

Additionally, the adrenal glands produce cortisol, which is commonly known as the “stress hormone” due to its involvement in the stress response. Most cells have cortisol receptors, as cortisol helps control blood sugar levels, balance blood pressure, regulate metabolism and inflammation, and assist with memory. High cortisol levels can contribute to changes in the menstrual cycle and libido and are also linked with anxiety and depression. The adrenal glands respond to hormones released by the hypothalamus and pituitary gland via a connection known as the hypothalamic-pituitary-adrenal axis (HPA axis).

There are also physiologic changes in glucose metabolism that occur during puberty. Insulin resistance is higher in puberty, partially due to the increase in adipose tissue during puberty. Women with PCOS have insulin resistance, leading to increased glucose levels in the body.

Thyroid hormones are essential for normal growth and development in children and adolescents, as these hormones impact every organ system in the body. Thyroid hormone production is regulated by the hypothalamus and pituitary gland in the brain via a connection known as the hypothalamic-pituitary-thyroid (HPT) axis. Hypothyroidism occurs when thyroid hormone production is too low, and it can delay the onset of puberty and slow metabolism. This can cause short stature, fatigue, weight gain, hair loss, constipation, cold intolerance, and depressed mood. It is often diagnosed in late puberty, signaled by menstrual irregularity. Hyperthyroidism occurs when thyroid hormone production is too high and can cause menstrual irregularities, heart palpitations, weight loss, sleep disturbances, goiter, heat intolerance, and anxiety. (15)

Signs and symptoms of common hormonal imbalances for both girls and boys include hair loss on the scalp, severe fatigue, unexplained weight gain or weight loss, increased sensitivity to heat or cold, and extreme mood swings with persistence of depression or anxiety.

In girls, one of the most common signs of a hormone imbalance is irregular periods. In the first two years after starting menstruation, cycles are expected to be irregular, with fluctuations in cycle length and days of bleeding. However, if menstruation hasn’t started by age 15, the period lasts consistently longer than eight days, several months pass between periods, severe cramping or blood clots occur with menses, or there is coarse hair growth on the face, chest, or abdomen, these all signal a deeper hormonal imbalance.

Causes of Hormonal Imbalances in Adolescents

The transition through puberty is known to have a strong genetic component. That said, recent studies have shown that environmental factors such as lifestyle, diet, exposure to endocrine disruptors, and stress can alter the function of the HPG and HPA axis and, therefore, influence the process of puberty and potentially lead to hormonal imbalances.

Chronic stress can over-activate and overstimulate the HPA axis, leading to dysregulation of the hormones released by the adrenal glands. An overproduction of cortisol is seen in response to chronic stress, leading to an elevated cortisol-to-DHEA ratio associated with more rapid aging, metabolic syndrome, and reduced immunity. Additionally, chronic stress has been associated with gut dysbiosis and increased intestinal permeability.

Exposure to endocrine-disrupting chemicals (EDCs) also contributes to hormonal imbalances. EDCs are often found in receipts, food packaging, plastics, personal care products, and foods and can interfere with many physiologic processes in the body. Exposure to heavy metals, such as lead and mercury, via the environment or contaminated food and water, can also disrupt optimal hormonal function through increased oxidative stress and chronic inflammation. (42)

Circadian rhythms are now recognized as key regulators of many essential physiologic functions. There is a strong association between the circadian clock and optimal hormone functionality. Studies have shown that poor quality sleep has been associated with an increase in endocrine, metabolic, and cardiovascular disease. 

Inadequate nutrition can also contribute to hormonal imbalances. Additionally, consuming heavily processed foods and refined sugars can lead to poor gut health, further exacerbating hormonal imbalances. The gut microbiome and hormonal health are deeply interconnected. The microbiome’s composition can be influenced by sex hormones, leading to dysbiosis, and the estrobolome, within the gut microbiome, can also impact the function of circulating estrogens. The gut microbiome plays an active role in estrogen metabolism, and a healthy gut microbiome will help limit estrogen reabsorption.

Functional Medicine Assessment Tools

Adolescence is a period of rapid and constant hormonal changes, and a thorough history and physical exam are crucial to identifying signs of imbalance versus symptoms due to expected hormonal fluctuations. There are many functional medicine assessment tools to help with a personalized evaluation and targeted treatment plan.

The DUTCH Complete (Dried Urine Test for Comprehensive Hormones) uses dried urine samples to measure both sex hormones and stress hormones. This provides a more complete picture of a person’s hormonal balance and circadian rhythm. This test can be used in older adolescents once hormone levels are not rapidly fluctuating.

A comprehensive thyroid panel is a blood test that assesses thyroid function and identifies a hypothyroid or hyperthyroid state.

Stool testing, such as the GI-MAP, evaluates the gut microbiome and looks for gut pathogens that can cause dysbiosis. Additionally, biomarkers to identify leaky gut, such as zonulin, are assessed as well.

A salivary hormone profile, such as through ZRT labs, tests the sex hormones and adrenal hormones, including cortisol. This can also provide a window into both hormonal balance and circadian rhythm.

[signup]

Dietary Interventions for Hormonal Balance

Dietary strategies for hormonal balance emphasize nutrient-dense whole foods that are predominantly plants. An anti-inflammatory diet, such as the Mediterranean diet, is a great place to start, as it promotes a healthy gut microbiome and lowers chronic inflammation. This approach encourages the consumption of vegetables, fruits, unsaturated fats, whole grains, legumes, herbs, spices, and oily fish. Red meat, processed and ultra-processed foods, refined grains, refined sugars, sugary beverages, and excessive alcohol are excluded, as these are known to promote inflammation.

Micronutrients, such as selenium found in Brazil nuts, iodine found in seafood, and zinc found in nuts, whole grains, and legumes, are important to include for thyroid health and overall hormone balance.

Healthy fats, such as olive oil, avocados, nuts, and seeds, contain anti-inflammatory antioxidants and polyphenols. Omega-3 polyunsaturated fatty acids are vital for cell membrane structure and function (such as in sperm cells) and reduce inflammation. Fish, nuts, and seeds (such as flax and chia) are high in omega-3 fatty acids.

An optimal thyroid-health diet will be similar and include nutrient-dense, plant-predominant meals. A recent study evaluating the association between food and thyroid disorders found that people with autoimmune thyroiditis consumed more processed food and animal fat than healthy patients. The study concluded that a Mediterranean-like diet may be beneficial in preventing thyroid disease.

Managing blood sugar variability by eating adequate fat and protein will help support the adrenal glands and manage insulin resistance. Avoiding caffeine and alcohol will also help to decrease the body’s stress response and improve the circadian rhythm.

Emphasizing intuitive eating, nourishing foods, and involving the whole family in modeling healthy lifestyle behaviors will encourage a healthy relationship with food throughout adolescence and set a positive foundation for adulthood. 

Supplemental Support and Herbal Remedies

Nutritional supplements for hormonal balance in adolescents should be utilized at the recommendation of a healthcare professional, with close attention to safety and weight-based dosing (when appropriate).

Vitamin D deficiency is widespread around the world. Vitamin D is a vital micronutrient that is needed for optimal health. Several studies have reported that Vitamin D deficiency affects insulin regulation and has been shown to play an important role in fertility. Exposure to the sun for 8-10 minutes at noon during the spring and summer can yield the recommended vitamin D levels. In the winter, approximately two hours of sun exposure is needed. As this may be difficult for many people to achieve, UV light therapy or oral supplementation may be required. 

Adding probiotics can help improve gut health by optimizing the microbiome. Ideally, this is incorporated via foods, such as fermented foods, but a probiotic supplement can also be an option for adolescents. Supplementing with fiber may be required to ensure regular bowel movements are occurring, which will optimize estrogen elimination.

Melatonin may also be used to help support sleep, as well as cognitive behavioral therapy and sleep hygiene.

Lifestyle Modifications and Stress Management

Establishing healthy lifestyle habits and a healthy circadian rhythm in adolescence will set the foundation for good health in adulthood. Regular physical activity, adequate sleep, and stress reduction techniques can positively impact hormonal balance.

It is well known that physical activity has numerous health benefits. Exercise also positively impacts hormonal health by improving blood sugar regulation, lowering body fat, and reducing cardiometabolic risk factors.

Adequate and regular sleep helps to establish a healthy circadian rhythm. The circadian rhythm influences the production of sex hormones, and studies have suggested that disrupted circadian rhythms can contribute to hormonal imbalance. Short-term effects of circadian rhythm disruption on hormone health include increased sensitivity to stress, emotional lability, and poor glucose regulation. Chronic circadian rhythm disruption can lead to insulin resistance and irregular menstrual cycles. Emphasizing good sleep hygiene by having consistent sleep and wake times, minimizing artificial light in the bedroom, and sleeping in a cool and dark room will help to regulate the circadian rhythm.

Stress reduction techniques, such as meditation, yoga, and mindfulness, can be very beneficial for managing the hormonal flux of adolescence. Chronic stress can alter the HPA, HPG, and HPT axis and lead to increased cortisol levels, which can also negatively impact gut health. Encouraging regular physical activity in nature, limiting screen time, and promoting good quality sleep will all help with stress reduction. 

Integrating Conventional and Functional Approaches

Integrating different approaches to hormonal imbalances in adolescents will yield the best outcomes. Addressing possible root causes of hormonal imbalances, such as gut health and stress management, via a root cause medicine approach while treating urgent growth and development delays with conventional medicine is a truly holistic approach to patient care. Recognizing the need for nutritional counseling and lifestyle modification coaching will positively impact the whole family’s health. An integrative approach to optimal hormonal health promotes collaboration in healthcare and will provide the patient with the most support to set a good foundation for future health.

[signup]

Key Takeaways

A holistic approach to hormonal imbalances in adolescents includes a personalized and comprehensive approach that focuses on adequate nutrition, lifestyle modifications and the incorporation of regular stress management techniques.

Emphasizing a plant-predominant diet with good-quality fats and sufficient protein will support a healthy gut microbiome.

Promoting consistent sleep and meal timings will optimize circadian rhythm function.

Adopting regular stress management techniques such as yoga or meditation will help maintain lower cortisol levels.

Consistent education and engagement with the whole family will improve all members' health outcomes and quality of life.

Utilizing a root cause medicine approach ensures individualized and tailored management of adolescent hormonal imbalances.