A Brief Blurb about Hormone Optimization
“There is no such thing as optimizing hormones” - a comment I once received from an obesity and cardiometabolic specialist
Throughout my years of practicing, reviewing thousands of research papers, & treating countless patients, I have heard this skepticism many times. It usually comes from a misunderstanding of what medical "normal" actually represents vs what is physiologically required for health and disease prevention.
To anyone who says "hormone optimization doesn't exist," this is for you:
"Normal" is a Statistical Average, Not a Definition of Health
When a doctor tells you your levels are "normal," they are comparing you to a reference range derived from the average population of your age. In our current society, that population is often overweight, sick, and heavily medicated. If you are 60 years old and have "normal" hormone levels for your age, you have the physiology of a declining 60-year-old who is at risk for heart disease, osteoporosis, and dementia.
Optimization means restoring your hormones not to the "normal" of a declining senior, but to the levels of a healthy young adult. We do this because the medical literature consistently shows that higher, "optimal" levels are associated with reduced all-cause mortality and better quality of life.
Treating the Patient, Not the Number
The idea that optimization doesn't exist implies that a lab number defines your health. However, the literature shows that there is no specific biological parameter (lab number) that accurately reflects androgen or thyroid activity at the cellular level. You can have "normal" blood levels but suffer from cellular resistance or loss of signal transduction.
Thyroid: A "normal" TSH does not mean your tissues are getting enough active thyroid hormone (T3). Optimizing means giving enough T3 to resolve symptoms like fatigue and metabolic dysfunction, even if that suppresses the TSH, because TSH is not the best biomarker for tissue euthyroidism.
Testosterone: The FDA defines hypogonadism as a level below 300 ng/dL, but studies show men with "normal" levels (e.g., 350-400 ng/dL) still suffer from symptoms like insulin resistance and visceral fat accumulation. When we optimize them to higher levels, we see reversal of diabetes and metabolic syndrome.
The "Do No Harm" Fallacy
Critics often argue that optimizing hormones carries risk. I ask them to look at the other side of the coin. What is the risk of not optimizing?
Estrogen: We know that estrogen deprivation accelerates aging, coronary artery disease, and dementia. By optimizing estrogen (specifically oral estradiol), we can actually reverse atherosclerotic plaque—something statins generally fail to do.
Testosterone: Low or low-normal testosterone predicts heart disease and death. Optimizing levels is protective against all-cause mortality.
It is Evidence-Based Preventive Medicine
Ultimately, hormone optimization is about augmenting the levels that naturally decline with age to prevent the diseases associated with aging. We aren't just trying to make you feel good (though that happens); we are using evidence-based medicine to protect your bones, brain, and heart.
