"It's all in your head."
Maybe one of the most irritating, disempowering, hope-stealing remarks to hear after sharing the details of your very real symptoms. Fatigue. Hair loss. Low libido. Hot-flashes. The list goes on. BUT, the truth is... there is a very high likelihood that what you are dealing with does indeed have roots in your head--well, your brain to be exact.
These hormonally linked manifestations of imbalance follow a hierarchy, and the beginning of the chain lies in the brain. This chain is known as the HPATG axis: hypothalamic-pituitary-adrenal-thyroid-gonadal axis. These endocrine, or hormone, systems operate within an intricate web. Each location affecting the next with a series of feedback loops.
The first link, sits in the hypothalamus. This is where the endocrine system meets the nervous system. The hypothalamus is located just above the brainstem. When it is activated by stress (physical, chemical, or emotional), it secretes releasing hormones that stimulate the pituitary gland (corticotropin-relasing hormone: CRH, for example).
Just below the hypothalamus, situated at the base of the brain is the pituitary gland. When directed by releasing hormones of the hypothalamus, CRH in this example, the pituitary gland secretes hormones to act on the endocrine glands of the body, adrenocorticotropic hormone, or ACTH in this example.
The ACTH acts on the adrenal glands, which are situated atop of the kidneys. The adrenal glands secrete glucocorticoids, cortisol in this situation. Cortisol receptors are on most cells of your body. Depending on the location, the effect will vary. In general, though, cortisol will act to shut down "unnecessary" systems in order to priorities those required more for survival in a fight-or-flee situation (reproduction, for example). This is one reason fertility will struggle in a stressed-out body.
It doesn't stop there though. The CRH released by the hypothalamus also acts to inhibit the release of thyroid-stimulating hormone from the pituitary gland. As does cortisol. Furthermore, cortisol inhibits the conversion of T4 to T3 and promotes the conversion of T4 to reverse T3, which further antagonizes T3 at the receptor level. T3 is the metabolically active form of thyroid hormones, adding thyroid dysfunction to the list of imbalances.
Our genius bodies have feedback loops in place to help balance our bodies. For instance, excess levels of cortisol will trigger the hypothalamus to decrease production of CRH. This is an example of negative feedback. It is a beautiful bi-directional cascade when everything is flowing at ease. However, it can be quite the headache (literally) when one area is struggling because this tight-knit group doesn't let any one system fall alone--when they go down, they often times go down together. So although you might think it to be an obvious link of hot-flashes to your gonadal (sex hormone) imbalance, it might not be that straight-forward. You might be surprised to learn that the key to living life at room temperature may lie in balancing your thyroid, or nourishing your adrenals.
From a Functional Medicine standpoint, it is the person being cared for. Not the symptom or diagnosis being treated. When care is patient-centered, the person is treated as a whole. All systems are evaluated and addressed. And, the hormone hierarchy is taken into consideration. Meaning that when a sex hormone imbalance is discovered, we look further upstream to the thyroid and the adrenal glands because true, long-lasting health is achieved when the root-cause is healed. It may be multi-systems oriented, it may be complex, even complicated. But you should never be left to think your problem is made up. May you be seen, may you be heard, may you be held as a whole.