Is Your Thyroid Actually The Problem? The Hormonal Imbalance You Need To Know

Added: 2026-05-31

[00:00:00]One in five women over the age of 40 will develop a thyroid issue. And the problem is most of these women will be told that their TSH is normal and that their thyroid is normal. Unfortunately, there are two sex hormones, specifically estradiol and progesterone, that strongly influence thyroid function that I have seen that very few doctors are talking about. So, in today's video, I'm going to uncover the mechanisms behind estradiol and progesterone and how they positively influence thyroid function.

[00:00:34]So, any woman watching in that perimenopausal range or anyone that's any woman above 40, I encourage you to follow through on this video and take some notes. I want to arm you with knowledge that you can take this information back to your provider and have a a smarter conversation and get to the root cause of your thyroid dysfunction. If we're meeting for the first time, my name is Dan. I'm the pharmacist here at MD Custom RX.

[00:01:00]And I truly believe at getting to the root cause of problems. When I used to work a traditional pharmacy, I seen over and over again women were prescribed either antidepressants or some type of other medication that was essentially just masking their symptoms of hypothyroidism. So, in today's video, let's get to the root cause of this problem and let's just unpack this step by step. Before we get specifically into the estradiol, progesterone, and thyroid connection, I want to take a step back and just lay the foundation on three key areas that I think are important to understand for any perimenopausal woman.

[00:01:36]The importance here is that there are other endocrine uh players. There's other hormones involved that are influencing both the sex hormones and our thyroid function.

[00:01:46]So, let's just go through those one by one. So, the first thing here that's been identified as insulin. We know of insulin as the fat storage hormone. And this is this is a really important to understand, especially in perimenopausal women.

[00:02:01]We want to make sure we have a balanced insulin level. And so if we have too much insulin or even too little, if we go on a ketogenic diet, that can be very problematic. So we want to make sure it's a story of Goldilocks that we have the right amount of insulin in our system to manage not only our glucose levels, but also to manage the fat storage of our body. And so we want to make sure we're actually measuring insulin levels. If you've seen me before, I've talked about this in other videos where we want to get a fasting insulin level. The second thing that strongly influences thyroid function is cortisol. We've seen this over and over again where if cortisol levels are elevated, it slows down the conversion of T4 into T3. So this is something that we need to understand as well. We have to have a proper functioning adrenal system >> [snorts] >> pushing out enough cortisol, but again not too much and not too little. So low cortisol and high cortisol can both negatively influence our body's ability to convert T4 into T3, which is inactive to active. We'll get a little bit more into that in just a few minutes.

[00:03:07]And then the third thing is just thyroid in general. We need to understand that our thyroid gland is the thermostat of our body. It regulates again our metabolism, our mood, our energy levels, our hair growth. We have a lot of women that come into the pharmacy, my hair is falling out. And right away I'm going to ask them, "Hey, has your doctor assessed your thyroid function? Have they done a complete thyroid panel? Have they done a four-point cortisol test? And have they looked at your sex hormones?"

[00:03:34]And unfortunately, most most often the response that I get is they might have just looked at a TSH and a progesterone level and said that you're fine.

[00:03:43]And then again left the office with an antidepressant or an anti-anxiety medication, which I feel is unfortunately largely inadequate. Now a lot of times between the insulin levels, the cortisol levels, and the thyroid levels, they're all connected. So, if one of these systems fails, they end up all collapsing in on each other, and then our sex hormones take a dive as well.

[00:04:07]And so, again, this is where that perimenopausal woman where their levels are fluctuating up and down, again, tends to wreak a lot of havoc on, again, insulin, cortisol, and thyroid. So, we have to make sure that we know we we want to be able to control what we can, right? So, we want to control our diet and control the amount of of carbohydrates that are coming into our diet. We want to make sure we're able to control the our stress and that we're managing that effectively and getting enough sleep. And then we want to make sure that we're, you know, the biggest two disruptors for thyroid that I have seen is stress and environmental toxins.

[00:04:43]So, most women are thinking of estradiol, they're thinking about their menstrual cycle, they're thinking about the reproductive hormone. And that is certainly true in the conventional sense. But I want you I want women out there to take and think of estradiol as a potent anti-inflammatory agent. So, let me kind of walk you through this.

[00:05:01]So, estradiol has been shown in studies to turn on NF-kappaB, which in turn helps to downregulate tumor necrosis factor alpha. So, a lot of terms there, but essentially what it's doing is estradiol is coming in and helping to reduce inflammation in the body.

[00:05:19]So, the other thing that is interesting is estradiol, we have a lot of women that come into the pharmacy and complain about this. Estradiol is dropping during that perimenopausal time of their lives, and it creates a lot of brain fog, it creates a lot of just cognitive decline, they're not as sharp as they used to be. And the problem there is that estradiol in the brain helps to control glucose regulation. And so, when these nerves are firing, uh they need a lot of glucose to do that. And so now estradiol is dropping and the brain's ability to to manage glucose and blood sugar to these neurons that use this for fuel, this you're kind of choking off the fuel supply to the neurons and that cognitive decline ensues. So, estradiol levels are critically important for cognitive function, just for for memory and to even to ward off things like Alzheimer's disease. So, we want to make sure that estradiol levels remain steady, that if they are low, if we're deficient in estradiol, these women should be looking at again appropriate ways to improve that level so that their their cognition improves.

[00:06:29]We see this over and over again at our pharmacy where doctors are prescribing bioidentical hormones and for the first time in many years women come back and report finally ah they can think again that brain fog has lifted where maybe we attribute that to low thyroid function and stress, which certainly do play a part, but estrogen as well is critically important for brain health and brain function. The other thing I want you to understand about estradiol is athletic performance. So, I see this as well, too. Patients come into the pharmacy and they have dropped off pace, their their exercise tolerance has dropped and that is because estradiol has a profound impact on fast twitch muscle fibers. So, as estradiol levels drop, their muscles don't respond as well as they used to. You know, these runners that come in that are on hormone therapy or maybe they're not on hormone therapy yet, they are struggling to maintain pace because again their hormone levels are dropping. And again, I'm not saying that everything here is related back to estradiol. My point here is that estradiol does have a a positive influence on muscle tissue and if if estradiol levels are again in the tank and we we just don't have the appropriate amount. We see a profound impact on women's exercise performance.

[00:07:48]The third thing that we see on labs that that patients come in into the pharmacy, estradiol levels drop and their LDL levels go up. So, estradiol again has a great influence on liver function and cholesterol management. And so, again, women will come in, "Nothing's changed in my diet.

[00:08:07]My lipids have been steady for years."

[00:08:09]And then all of a sudden they hit they they hit around age 40, 45, they come back into the pharmacy and they show me their labs and all of a sudden their LDLs through the through the roof, their cholesterol's through the through the roof, and their doctor wants to put them put them on some type of cholesterol-lowering agent.

[00:08:26]Where again, if we get to the root cause of the problem here and we fix that perimenopausal woman's hormones, we can see that these lipid levels improve because we we reestablish physiological levels of their sex hormones.

[00:08:41]So, let's jump into the next section here where I want to tie together estradiol, progesterone, and thyroid.

[00:08:48]Something that's really important to understand, especially with progesterone and thyroid, is that as a woman's progesterone level drops, their conversion of inactive to active thyroid hormone drops. So, let me just kind of unpack this a little bit here. When we talk about thyroid production, we need to understand that T4 is a prohormone.

[00:09:08]It doesn't have activity.

[00:09:11]And so, unfortunately, a lot of times doctors are going to be testing the TSH and the T4.

[00:09:16]And what they really need to be looking at, in my opinion and that of the research, is T3. And so, progesterone, going back to this sex hormone as it drops, the conversion of inactive T4 converting to T3 is diminished when progesterone levels drop. And we actually see this a little bit too with estradiol. Not so much in the conversion, but in uh thyroid binding globulin. When estradiol levels swing up and down, we see that thyroid binding globulin swings with it.

[00:09:48]So, when uh actually inversely. So, when estradiol levels drop, we can actually see an increase in thyroid binding globulin, and now there's less uh T4 and T3 circulating. So, we've got all these keys that need to open up the metabolic door on the metabolism door.

[00:10:06]And now, with estradiol levels jumping up and down, we get a binding protein that is also swinging with it in in the opposite directions, and this can have a negative influence on the amount of T3 that's available for the woman's body to use uh with properly functioning metabolism. Now, let me just stop for a second here and take a step back. We understand that TSH is released from the pituitary. So, thyroid stimulating hormone.

[00:10:34]The issue with this, though, is that just because the TSH is normal, doesn't mean we're getting the adequate amount of T3 into the cells to have action. I always like to use the analogy of a car here. Think of the TSH as just the fuel in the gas tank, and just making the assumption because there's fuel in the tank that the engine is running properly. We all know that if we have a a tank full of fuel, it doesn't necessarily mean that our engine is working properly. There could be issues with the spark plug, the carburetor, I mean, a multitude of different things.

[00:11:06]We all know this. But yet, when it comes to thyroid function and thyroid testing, we want to look at a hormone released from the pituitary gland, you know, a proxy, and use that to say, "Yep, thyroid function is normal."

[00:11:21]Uh again, I just think this does a huge disservice to so many women out there.

[00:11:25]>> [snorts] >> The other issue, though, too, is we're not doing a complete thyroid panel.

[00:11:30]Okay, we need to look at TSH, but we need to dig deeper and look at T4, T3, thyroid binding globulin, which I just talked about, and something else called TPO, thyroid antibodies to TPO, thyroid peroxidase enzyme. And the reason that this is important, and this is where it ties into women in perimenopause, is estradiol is a can be a very important hormone to help reduce autoimmune issues, autoimmune diseases.

[00:11:59]I just want to stop for a moment and I want to make sure women understand this.

[00:12:05]Estradiol has a profound impact on the thyroid as it relates to our autoimmune issues, specifically Hashimoto's. Women are seven times more likely than men to get Hashimoto's thyroid conditions because the problem here is that estradiol has a profound impact on the immune system. When estradiol levels drop, a woman's body has less of an ability to distinguish its cells from other invaders. So, what I mean by this is So, now the thyroid tissue, the body thinks of it as a foreign substance, essentially, like a bacteria, a virus, and so now these antibodies, these TPO antibodies, will go and attack the thyroid tissue and create more thyroid dysregulation.

[00:12:56]And so, again, here we go.

[00:12:58]Unfortunately, a lot of patients are coming into our pharmacy and they don't have a TPO level. They say they've been diagnosed with hypothyroidism, and I ask them, "Well, well, why? What's the cause?" "Well, my thyroid's not working that well."

[00:13:12]Okay. Well, is that because you aren't getting enough selenium or iodine or tyrosine? Are you Is it a deficiency of building blocks? Or is your immune system attacking its own tissues? And so, we never really we never get to the root cause of the problem here. So, if you're a woman out there that is struggling with thyroid issues, or if your doctor is just testing the TSH, again, I would strongly have your doctor do a complete panel and start checking your thyroid antibody levels cuz that where that's where the issue could lie.

[00:13:47]And again, your estradiol level could be low and that's contributing to these antibodies being elevated in your system. So, here's where compounding pharmacy comes in. We are able to, upon a prescription from your doctor, of course, make a a product of estradiol and progesterone that fits your exact needs based on your exact levels. Now, this is so important because with traditional pharmacy with traditional pharmaceuticals, it tends to be this one-size-fits-all or as I've said before, maybe it's three or four different doses and you we we silo patients, especially women, into a couple of different categories and says, "Okay, you need this dose or that dose."

[00:14:26]And that's all you've got. With compounded pharmacy, we can adjust the dose again an infinite amount of ways based on your specific labs.

[00:14:35]And let's take that one step further with thyroid, we can combine T3 and T4 in, again, any strength that your doctor wishes so that we can match up the exact dose that you need based on your labs and adjust from there. Cuz again, there are a lot of different doses of levothyroxine that are out there.

[00:14:55]Uh they do an okay job, but the the deficiency there is we don't have T3 combined with that levothyroxine.

[00:15:03]And again, as I mentioned before, levothyroxine is inactive. It has to be converted in the liver and other tissues in the body into T3.

[00:15:12]And if we don't have that proper conversion because of whether it's too much cortisol, not enough progesterone, then we go back to the doctor and we they're saying, "Oh, we're fine because the TSH is in the normal range, but we don't have the proper amount of T3." And again, this is where compounding comes in. If your doctor is actually testing your T4 and your T3 levels, and we see where those deficiencies are, we can match up a dose that meets your exact labs.

[00:15:44]Okay.

[00:15:45]So, let's just tie this all together here and wrap this up. So, we need to understand that estradiol, progesterone, and thyroid are related. If we don't have the proper amount of estradiol, we're going to have thyroid binding globulin proteins either too much or too little, and that's going to negative negatively influence uh the amount of of free hormone that our body has to use. The other issue is with the progesterone that we just described.

[00:16:14]If we become deficient in progesterone, what ends up happening in the woman's physiology, in their bodies, is that they're they lose the ability to convert T4 into T3. So, that conversion diminishes as progesterone levels decline.

[00:16:30]And then lastly, I want to make sure that we understand precision dosing with compounded medication. We are able to make, again, any dose that your doctor wishes based on your labs uh of estradiol, which we often combine with estriol. That was in my video from 2 weeks ago.

[00:16:49]Uh we can use progesterone. And then with thyroid compounding medication, we can combine it again whichever strength your doctor wants of both T3 and T4.

[00:17:01]And we can also put that into a slow-release capsule if they like, uh which helps for all the different reasons as well. And that's tailored specifically to you.

[00:17:11]So, I hope you found value in today's video. I know this was a lot of information to cover, but just understand that if you have a thyroid issue to get a complete thyroid panel and to also look at your estradiol and progesterone levels as well cuz they have a profound influence on how your thyroid gland works.

[00:17:29]So, I hope you found value in today's video. Again, if you haven't yet subscribed to our channel, please do so and I will see you next week. Stay well.