“If you’re dragging, not sleeping well, feeling stressed, and even depressed,” notes Dr. Jennifer Burch, of Central Compounding Center in Durham, “a likely cause is hormonal imbalance—and even more likely a problem with cortisol levels.”

Dr. Burch—who is among the area’s leading experts in designing and overseeing bio-identical hormone replacement (BHRT) programs for both women and men—speaks with both personal and professional authority on this subject.

“Understanding, as I do, the power of hormonal imbalances,” she says with a smile, “I look back on my college days and wish I had known then what I know now—about cortisol, about hormone testing, and about the benefit of supplements. I remember the first time I ever checked my cortisol, it was low, low, low—almost a flat line—low in the morning, low at lunch, low at supper, low at bedtime. I was tired all the time. And when I started using supplements to address the problem, the benefits were amazing. I thought: ‘This is what it’s like to feel good!’

“Hormone balance is the foundation of good health,” explains Dr. Burch. “Our many hormones are catalysts for chemical changes at the cellular level that are critical for growth, development, and energy—and for maintaining homeostasis—balance. Not too much, not too little.

“They regulate and control just about every aspect of human function. So, when out of balance, their impact can be significant—affecting sleep, weight, fertility, mental function, energy, even healing.

“And while an imbalance,” she explains, “can be simply that there is too much or too little of a given hormone, it rarely is that simple. Hormones work together—so imbalances are complex, what I would describe as ‘hormone symphonies.’ For example, too little of one might also impair the effectiveness of another. So, it’s essential to tease out the precise nature of the imbalance in order to treat it effectively.”

Too Much Stress, Too Little Cortisol:
Major Imbalance, Major Problems

Cortisol imbalances, says Dr. Burch, are a good example of that complexity. “In proper quantities,” she explains, “cortisol helps regulate many bodily functions, including energy levels, blood pressure, blood sugar, and sleep cycles. And it’s perhaps best known as the ‘stress hormone,’ because it regulates the body’s stress response.

“As your body perceives a threat, the adrenal glands release cortisol into the bloodstream, causing an increase in your heart rate and blood pressure. That’s the natural ‘flight or fight’ response that gives us a burst of intense energy and heightened senses. In isolated moments of danger, it can be quite helpful.

“Problems arise, however, when the flight or fight response becomes chronic. Prolonged, unrelieved periods of stress can cause severe cortisol imbalances, with profound negative effects on our health. These range from unpleasant to dangerous—from fatigue, headaches, and irritability to anxiety, depression, and increased blood pressure. This is a significant health issue.

“Relieving stress and restoring cortisol balance,” asserts Dr. Burch, “is an essential foundation to good health.”

Restoring Hormonal Balance

“Restoring hormonal balance,” emphasizes Dr. Burch, “begins with testing. The symptoms for such imbalances are many and varied, and often only tell you that something is out of whack—but not what. For example, similar symptoms signal too much or too little of a given hormone, or simply that one hormone is not in sync with another. The hormonal changes that come with menopause might include not only changes in levels of sex hormones but could include shifts in cortisol levels as well.”

Furthermore, she explains, one hormone affects another. “That’s the ‘hormone symphony’ I referred to. There’s an important relationship between thyroid and adrenal hormones, for example. Cortisol and T-3, the active component in the thyroid, both need the other to be balanced for each to work. If cortisol is not in the right range, thyroid doesn’t work as well. And, if cortisol is balanced, but thyroid’s not, the cortisol doesn’t work as well either.

“Similarly, cortisol levels affect the balance of sexual hormones. So, if we are running on high cortisol all the time, often progesterone will be low. Low progesterone may result in estrogen dominance, even though estrogen levels are normal. Everything’s connected!”

Testing: A Process, Not an Event

“So, before you can address an imbalance,” says Dr. Burch, “you need to test. You simply don’t know what the problem is until you do. And you don’t test for one hormone, you test them all. Because you can’t know if your sleep problem is coming from an elevated cortisol level for some other reason.

“The standard panel we use at Central Compounding Center,” she says, “tests levels of eight different hormones, including estradiol, progesterone, testosterone, DHEA, and cortisol. And the cortisol levels are tested throughout the day—morning, lunch, suppertime, bedtime. That’s essential. Because, when cortisol is at normal, optimal levels, there is a fluctuating cycle of hormone production. In the morning, more cortisol is produced to give our bodies a boost to start the day. By midnight, cortisol production drops to its lowest levels to allow for restful sleep. We need to know how an individual’s cortisol levels fit that normal cycle.

“The method we use for evaluating hormone levels is saliva testing,” says Dr. Burch. “It’s not only a simple, accurate, noninvasive method of measuring hormones, but unlike blood-based tests, saliva diagnostics can measure the amount of free, unbound hormone that is available.

“Accurate testing for the purpose of addressing hormonal imbalances is a process rather than a one-time event,” emphasizes Dr. Burch. “The initial comprehensive panel allows us to recommend adjustments—using bioidentical hormone replacement therapy (BHRT) or supplements. Typically, we’ll make gradual adjustments, monitoring the patient’s experience, and will retest periodically to be sure the desired balance is achieved.”

Treating Cortisol Imbalances

“Addressing the problem of low cortisol levels is most often a matter of stress reduction,” says Dr. Burch, “and effective treatment has several parts. Based on test results, adjustments may be necessary for other hormones out of balance, so BHRT may be necessary.

“Lifestyle adjustments play an important role as well,” she notes. “Simple adjustments, such as meditation or turning off screens well before bedtime, are helpful. Gentle exercise (don’t train for Iron Man!), provides movement without over-stressing the adrenals. A healthy, non-inflammatory diet—including multi-vitamins—will help reduce stress, as may herbs such as ashwagandha.”

In addition, Dr. Burch notes that there are supplements that provide significant relief and aid in maintaining balanced cortisol and DHEA levels. “One that we recommend is Adren-All®, which provides targeted amounts of vitamin A and C, pantothenic acid, and other B vitamins that are critical to adrenal gland function. It includes all the essential vitamins, so you don’t need multiple products, and the dosage—between one and four capsules a day—can be adjusted according to each individual’s needs.”