Anxiety disorders are incredibly common, affecting an estimated 31% of US adults at some time during their life. In some cases, anxiety can be attributed to underlying hormonal imbalances. Thus, by addressing the hormonal issues, not only are other potentially negative effects of that imbalance minimized, but the physiologic root of the anxiety may be fixed.

In root cause medicine, it is always preferable to dig a little and find the underlying causes to be able to rely less on simple symptomatic treatment. The possible hormonal contributions to anxiety are a great example of how we can do this.

This article will discuss anxiety, how hormonal imbalances may contribute to it, and how to treat it with a functional medicine approach.

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What is Anxiety?

Anxiety is an emotion characterized by feelings of tension, encouraging the mind to create an excess of concern over real or perceived threats and the body to create physical symptoms such as increased sweating or nausea.

Anxiety is similar to fear but different in that anxiety is often more oriented to the future and more diffuse, whereas fear is in response to a very specific and immediate threat that has been identified in the present. Anxiety persists for a long time without resolution, whereas fear is generally short-lived and resolves after the threat has passed.

Panic is also similar to both fear and anxiety and can be the intensification of either. So one may have a panic attack about a diffuse future threat or may fall into a state of panic when facing a very real and overwhelming threat in the present time.

Anxiety and panic attacks, when they occur regularly over a long period of time, can be symptoms of psychiatric conditions, including Generalized Anxiety Disorder (GAD), Panic Disorder (PD), Post Traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), and others. They can also be symptoms of physical illnesses, as we will discuss more in this article.

What is Hormonal Imbalance?

A hormonal imbalance happens when you have too much or too little of one or more hormones. It's a broad term that can represent many different hormone-related conditions.

What Causes Hormonal Imbalances?

Hormone imbalance can be caused by several different means. These include tumors or growths, damage to an endocrine gland, autoimmune conditions, and endocrine-disrupting environmental chemicals.

Dysbiosis

Our gut microbiome plays a huge role in proper hormone production, elimination of sex hormones, and maintaining appropriate levels of neurotransmitter production. Research suggests there are patterns of altered gut microbiota composition in those with various mental health conditions. When gut bacteria is unbalanced, hormone imbalances can lead to thyroid disorders, estrogen excess and/or a drop in neurotransmitter production, leading to anxiety.

Tumors and Growths

The presence of tumors and other growths in an endocrine gland like the adrenals or thyroid can cause it to produce too much of its hormone. The symptoms resulting from this excess are often how such tumors are discovered. After treatment for the tumor, there will often be no or much less hormone production from the affected gland, creating a known need for replacement hormone therapy.

Brain or Endocrine Gland Damage

Endocrine glands are generally small and susceptible to injury from trauma (even mild brain injury may be associated with damage to the pituitary gland). Damage that occurs to the hypothalamus may also affect hormonal balances. Most cases of hypoparathyroidism are due to damage to the tiny parathyroid glands during neck or thyroid surgery. Damage could also occur due to a loss of blood flow for a time, infectious illness, or radiation therapy.

Autoimmune Conditions

Autoimmune conditions can affect most endocrine glands. When this occurs, the gland is damaged, potentially to the point of no longer producing any effective hormone. By far, the most common reason for low thyroid hormone production is autoimmune damage of the thyroid gland. Some common autoimmune endocrine conditions include Hashimoto's Disease (Thyroid), Graves’ Disease (Thyroid), Type 1 Diabetes (Pancreas), and Addison's Disease (Adrenals).

Endocrine Disrupting Environmental Chemicals

Many human-made chemicals released into the environment or encountered in the daily use of common items (i.e., plastic water bottles) can masquerade as hormones, latching onto the same receptors that the hormones would access and causing havoc to the body's regulatory systems. These commonly affect the estrogen receptors, but many others can also be affected.

Anxiety Symptoms

Anxiety has physical, mental, and emotional aspects and hundreds of possible symptoms. While experiencing some anxiety is a normal part of being human, persistent and life-impacting anxiety is more likely to be classified as a disorder. Some of the common symptoms of anxiety include:

Emotional Symptoms

• Nervousness
• Feelings of unease, fear, or panic
• Feelings of impending doom or danger
• Feelings of being out of control
• Feeling on edge or irritable
• Runaway feelings of worry
• Feelings of self-consciousness

Mental Symptoms

• Inability to concentrate
• Ruminating about a problem
• Avoiding feared situations

Physical Symptoms

• Shortness of breath
• Hyperventilation (breathing too quickly)
• Heart palpitations
• Trembling, blushing, or sweating
• Nausea
• Stomachaches
• Dry mouth
• Dizziness
• Headaches
• Tense muscles
• Unexplained pains
• Cold, sweaty, or tingly hands or feet
• Restlessness
• Sleep difficulties

Hormone Imbalances that Can Contribute to Anxiety

The world of hormones is extremely complicated as each hormone may have receptors throughout the body, and a given hormone (or hormone disruptor, such as BPA) may bind to multiple different receptors, as may the breakdown products of these compounds. That said, some hormone imbalances have clear clinical associations with anxiety and probably many more that are not fully explored.

The main types of hormones strongly linked to anxiety are thyroid (energy regulation), parathyroid (calcium regulation), estrogen (female hormone), oxytocin (the love hormone), testosterone (mostly male hormone), growth hormone (regulation of growth), insulin (blood sugar regulation), vitamin D (gene activator).

Thyroid Hormone Imbalances

Imbalances in thyroid hormones (T4, T3, TSH) are well established to cause anxiety in both hyperthyroidism (too much thyroid hormone) and hypothyroidism (too little thyroid hormone). In addition, the presence of thyroid autoimmunity is also associated with anxiety.

Parathyroid Hormone Imbalances

Various conditions such as obsessive-compulsive disorder, depression, anxiety, and paranoia have been associated with  primary hyperparathyroidism (PHPT). In the elderly the clinical features of the disease are often very difficult to diagnose.

Female Sex Hormone Imbalances

Imbalances in estrogen and testosterone are all associated with anxiety. Generally, situations where estrogen levels quickly drop, such as the postpartum period, perimenopause, and menopause, are more associated with anxiety than too-high levels. For menstruating women, estrogen levels are lowest in the luteal phase of the menstrual cycle (2 weeks before the start of the period). This time is often associated with increased symptoms of anxiety.

Testosterone has a protective effect against anxiety in women as well as men. Administering testosterone has been shown to change behavior in the context of social anxiety.

Despite the protective effect of testosterone on anxiety, PCOS, which often causes high testosterone levels, also correlates strongly with anxiety.

Male Sex Hormone Imbalances

Testosterone, which is naturally significantly higher in male bodies than in female bodies, is typically found to be significantly protective against anxiety, which may, in part, explain the lower rates of anxiety in males than females. When testosterone levels are low, this can increase male anxiety rates. One study also showed that male hormone levels changed and anxiety increased due to learning of one's infertility.

Oxytocin Imbalances

Oxytocin is increased with cuddling, orgasm, childbirth, and nursing. Higher levels are protective from anxiety. Oxytocin levels can be set at a lower level due to childhood trauma, and increasing oxytocin appears to be helpful in healing from traumatic stress.

Stress Hormone Imbalances

In actuality, most hormones are affected by stress, but the ones most directly involved with what we consider a stress response are the mineral and glucocorticoids, such as cortisol, epinephrine, and norepinephrine. The connection between these and anxiety is bi-directional. But if dysregulated or imbalanced, these hormones can contribute to anxiety and panic.

Insulin and Glucagon Imbalances

Insulin and Glucagon are major hormones directly involved in regulating blood sugar levels. As excessively low or high levels of sugar in the blood can be dangerous and even fatal, it would make sense that there may be a connection between these hormones and anxiety, essentially triggering a message to do something to fix the imbalance quickly! High levels can impact the brain and cause mood issues, including anxiety.

Growth Hormone Imbalances

Deficiency in growth hormone is clinically associated with anxiety, although the exact mechanisms remain unknown. The growth hormone/insulin-like growth factor 1 axis seems to exert a regulatory effect on brain function and neurogenesis, especially in the brain region associated with mental and emotional disorders, such as depression and anxiety.Clinical data shows support that mood disorders are often reversed by GH replacement therapy.

Functional Medicine Labs to Test for Root Cause of Anxiety Due to Hormonal Imbalances

Thyroid Labs

Thyroid hormones as well as anti-thyroid antibodies should be checked as both imbalances in hormones (both high and low levels) and the autoimmune process itself can contribute to anxiety.

Parathyroid / Calcium Labs

Parathyroid hormone, calcium and Vitamin D should all be checked due to their interrelationships in the regulation of calcium.

Female Sex Hormone Labs

The DUTCH panel covers all of the female sex hormones through a urine metabolite test. This is good for both initial and follow up testing during treatment.

Male Sex Hormone Labs

Male hormone levels can be tested with the same DUTCH urine test, as well as by checking total testosterone.

Oxytocin Labs

Testing for oxytocin in the cerebrospinal fluid, where it is most active, is not practical and the methods for clinical evaluation are still being developed. However, relatively new tests are available for research that correlate levels in urine, blood (serum) and saliva as a by proxy measure of what is present in the CSF.

Adrenal / Stress Hormone Labs

The Adrenocortex Stress Profile with Cortisol Awakening Response measures diurnal patterns in Cortisol and DHEA as well as providing more detail on the cortisol response first thing in the morning. As these patterns change with adrenal imbalances, this is a useful first test and follow-up for stress hormones. The DUTCH Complete combines sex and stress hormone testing in one test.  

Insulin Labs

Insulin is often tested in the blood as part of testing for diabetes or pre-diabetes screening. Due to the direct interrelationships between insulin and blood sugar levels, it will most often make sense to test both.

GH Labs

Growth hormone can also be tested in the blood. When someone is taking growth hormone, it is possible to develop antibodies to it, so growth hormone antibodies may be tested to monitor for this.

Comprehensive Stool Test

A comprehensive stool test is an excellent start to assessing the gut's health. For patients suffering from GI symptoms, autoimmune diseases, chronic illness, or hormone imbalances, gut health testing may be the key to understanding the root cause of the disease.

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Functional Medicine Treatment for Anxiety Due to Hormonal Imbalances

If a hormonal imbalance has been identified and is suspected of contributing to anxiety, both can be treated simultaneously. As the hormone levels may take time to equilibrate, depending on the causes, it is ideal to have symptomatic support with the anxiety while this is happening so it provides less stress feedback into the system.

Nutrition for Hormonal Imbalances

Nutrition for hormone balance should generally follow a whole food, plant-based, Mediterranean-inspired pattern. Foods to which one has known allergies or sensitivities should be avoided to avoid unnecessary activation of the immune system and stress response. Highly processed foods should also be avoided because the empty calories these provide starve the body of nutrients necessary for optimal hormone levels. In addition, highly processed and high glycemic index foods promote a dysbiotic gut, which then affects the brain and multiple hormones.

If insulin is imbalanced or PCOS is involved, particular care will need to be taken with the glycemic load of foods consumed to put less strain on the glucose management system.

Some foods, like soy, have estrogenic effects, mildly binding to estrogen receptors. If one is estrogen deficient, this may actually be somewhat helpful. If one is estrogen dominant or has too high of estrogen levels, it may be better to limit quantities of phytoestrogens, like in soy. That said, human evidence shows that soy is safe to consume and has numerous other health benefits. There has been concern that soy would negatively impact male hormones, but this is not seen in a recent meta-analysis.

For autoimmune thyroid disease, a trial of gluten avoidance may be worthwhile.

Supplements & Herbs for Anxiety and Hormonal Imbalances

In addition to hormone replacement or suppression therapy that may be indicated, some supplements and herbs may help to restore balance in the endocrine system.

Probiotics for Anxiety

The gut-brain axis provides a route for information to travel from the gut and microbiome throughout the system.

Probiotics for Stress Hormones

One particular probiotic strain that has been studied with hormone imbalances is the ps23 strain. When studied in a group of highly stressed nurses, it reduced cortisol levels significantly over the control.

A study that gave a combination of probiotics (Gasteel Plus) to soccer players and sedentary individuals showed that in the soccer players, there was a significant improvement in anxiety, and in the sedentary group, there was a decreased Corticotropin Releasing Hormone (CRH), an upstream stress hormone.

Another strain of probiotics, Lactobacillus planetarum DR7, was studied in stressed adults. After the treatment, they showed reduced anxiety levels, clearer thinking, and lower cortisol levels.

Probiotics for Thyroid

There is also a strong association between microbiome health and thyroid disease. Probiotics can help restore a healthier microbiome and reduce disease.

Probiotics Oxytocin

Certain strains of probiotics can increase the production of oxytocin.

Probiotics should be taken by mouth as powder or capsules once daily. One must be aware that too high of a dose too soon may cause GI distress, so it may be better to start with a somewhat lower dose and see how it goes.

Vitamin D, Omega-3 Fatty Acids, and CoQ10 For Anxiety

Low Vitamin D levels are associated with thyroid disease, especially autoimmune types, so supplementation to replete levels to optimal can be helpful. This is often accomplished with oral dosing at ~4000 IU daily and follow-up Vitamin D labs drawn in about 3-month intervals.

In women with PCOS, supplementation with Vitamin D and Omega-3 fatty acids together significantly decreased testosterone levels and improved mood scores. A different study of Coenzyme Q10 supplementation on women with PCOS also showed improvement in anxiety indices and a significant decrease in testosterone levels.

Selenium For Anxiety

Selenium supplementation has been shown to affect Hashimoto's Thyroiditis positively.

A study on selenium and probiotic supplementation in women with PCOS showed significant improvements in anxiety scores and reduced testosterone in the group receiving the supplements, as well as other benefits.

Herbs For Anxiety

Black Cohosh has a long history of use in female conditions characterized by low estrogen levels, including menopause. It is shown to be effective and safe for use to treat menopausal symptoms.

Lion’s Mane (Hericium erinaceous) mushrooms, when taken for only 4 weeks, were associated with improvement in anxiety in menopausal women.

Complementary and Alternative Medicine for Anxiety and Hormonal Imbalances

As supportive measures for anxiety, High-Intensity Interval Training (HIIT) has been shown to significantly and rapidly alleviate anxiety. Yoga and meditation have also been shown effective in reducing anxiety, reducing stress hormones, and improving sleep many times. Breathing exercises can also directly reduce anxiety.

Testosterone can be increased in both males and females through intensive exercise, especially resistance exercise, and participation in competitive sports. Endurance exercise beyond a certain point may actually decrease testosterone in men. This is known as the Exercise Hypogonadal Male Condition (EHMC).

Insulin sensitivity can be improved, and thus average insulin levels reduced, through engaging in physical exercise and cold water winter swimming.

Growth hormone is increased by sauna bathing and prolonged water-only fasting.

A 60-min session of music therapy can reduce cortisol levels and perceived anxiety in patients with early Alzheimer's Disease. A study found that listening to music, but to an even larger degree, singing reduced cortisol and perceived stress and increased oxytocin in expecting mothers. In addition to cortisol and oxytocin, listening to music also modulates testosterone levels, tending to decrease them in males and increase them in females, a similar pattern to falling in love.

Oxytocin is also fairly widely known for being increased by physical touch and eye gazing.

Mind-body practices like yoga and meditation can be helpful tools in finding anxiety relief as the underlying hormonal imbalances are healed.

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Summary

As we have seen, a struggle with anxiety should trigger an inquiry into hormonal status. That may lead to additional lab testing. Many options exist for complementary treatment of anxiety in addition to the correction of hormonal imbalances.