Midlife Hormone Health: Optimize Your Wellbeing

Resistance Training > Cardio (After 35)

Too much cardio can stress the HPA axis and worsen hormone imbalance. Instead, focus on:

Compound lifts (deadlifts, squats, presses)
3–4x/week strength training
Prioritizing recovery and sleep

📚 Journal of Applied Physiology: Protein and Aging
📚 Nature Reviews Endocrinology: Muscle as a Metabolic Organ

PCOS, Insulin Resistance & Weight Gain: A Metabolic Puzzle

Polycystic Ovary Syndrome (PCOS) is often misunderstood—and underdiagnosed in women over 35. While typically associated with younger women, PCOS can persist or present later in life, especially when driven by insulin resistance and inflammation.

PCOS in Midlife

PCOS is not just about cysts. It’s a metabolic and hormonal condition characterized by:

Irregular cycles or anovulation
Elevated androgens (like testosterone, DHEA)
Acne, hair loss, or unwanted hair growth
Weight gain and insulin resistance
Mood disorders, anxiety, and fatigue

Midlife women with unresolved PCOS may struggle more with:

Perimenopausal hormone shifts
Belly fat that resists all diet/exercise
Blood sugar crashes and cravings
Fertility issFeeling off lately? Energy crashing, sleep struggling, weight sticking—despite doing “everything right”?

You’re not alone. Hormone shifts in midlife impact how both women and men feel, perform, and age. From metabolism to muscle, mood to motivation, hormones play a central role—and the rules change after 35.

In this in-depth guide, based on insights from Dr. Ashley Dwyer on the 1st Optimal Podcast, we’ll explore the science of hormone health, practical strategies for real-life application, and cutting-edge tests and treatments used in functional medicine today.

🎧 Listen now:
Spotify Episode
YouTube Episode

This article is designed for high-performing adults (ages 35–55), especially those interested in:

Weight loss and body recomposition
Hormone therapy and functional lab testing
Perimenopause, menopause, and low testosterone (TRT)
Performance, recovery, and metabolic health
Evidence-based, personalized protocols

The Root Causes of Hormone Disruption in Midlife
Perimenopause & Menopause: What Every Woman Over 35 Should Know
Testosterone & Andropause: The Quiet Decline in Men’s Health
The Gut-Hormone Connection
Protein, Muscle & Metabolism: The Underrated Trio
PCOS, Insulin Resistance & Weight Gain: A Metabolic Puzzle
Top Hormone Health Myths—Debunked
Functional Lab Testing: What to Ask For & Why
Case Study: From Overtrained & Undereating to Optimal Function
FAQs: Hormone Health Questions Answered
Conclusion & Next Steps

The Root Causes of Hormone Disruption in Midlife

Hormonal changes don’t happen in a vacuum. By midlife, many adults—especially high achievers—are dealing with decades of stress, poor sleep, blood sugar swings, yo-yo dieting, under-eating, and overtraining. The result? Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, disrupted cortisol rhythms, thyroid dysfunction, and impaired sex hormone production.

Key contributors to hormonal imbalances in your 30s, 40s, and 50s include:

Chronic stress and cortisol dysregulation
Inadequate protein and micronutrient intake
Insulin resistance and blood sugar instability
Poor sleep quality or sleep apnea
Environmental toxins and endocrine disruptors
Gut dysbiosis and inflammation
Low muscle mass and overtraining

Many clients who come to 1st Optimal have been training hard, eating “clean,” and still feel stuck. That’s not a discipline problem—it’s a physiology problem.

Optimizing hormones means shifting from a symptom-suppression model to one that identifies and addresses root causes. Functional lab testing (like GI-MAP, DUTCH hormone testing, and advanced blood panels) allows providers to personalize interventions instead of guessing.

📚 Related sources:

Perimenopause & Menopause: What Every Woman Over 35 Should Know

For many women, midlife begins with a whisper, not a scream.

Sleep gets lighter. Cycles get irregular. Weight creeps up, especially around the belly. And despite healthy habits, motivation dips and anxiety rises. That’s often the start of perimenopause—the transitional period leading up to menopause.

What Is Perimenopause?

Perimenopause typically begins in a woman’s late 30s to early 40s and can last up to 10 years. Hormones like estradiol (E2) and progesterone begin fluctuating, and eventually, ovulation stops altogether.

Unlike menopause (which is defined as 12 months without a menstrual period), perimenopause is chaotic and unpredictable. One month your hormones are sky-high; the next, they crash.

Common signs of perimenopause:

Irregular periods
Night sweats and hot flashes
Anxiety and irritability
Insomnia and early waking
Brain fog or forgetfulness
Weight gain despite regular exercise
Vaginal dryness and low libido

These symptoms are driven by erratic or declining levels of estradiol, progesterone, and sometimes testosterone—all of which play roles in brain health, metabolism, sleep, and mood.

How Functional Medicine Approaches Perimenopause

At 1st Optimal, we don’t “wait until menopause” to intervene.

Instead, we support hormone transitions early by identifying root causes like:

HPA axis dysfunction
Low progesterone from chronic stress or overtraining
Estrogen dominance (too much estrogen relative to low progesterone)
Thyroid underfunction (often worsens during this time)

By using advanced labs—like DUTCH testing, full thyroid panels (including reverse T3), and blood tests for estradiol/progesterone ratios—we’re able to personalize support using:

Bioidentical hormone therapy (BHRT)
Targeted adaptogens (like ashwagandha, rhodiola)
Lifestyle interventions (resistance training, protein prioritization, blood sugar stability)

🧠 Did You Know?

Estrogen plays a key role in protecting the brain. Declines in estradiol are linked to increased Alzheimer’s risk and affect serotonin levels—contributing to depression and anxiety in perimenopausal women.

📚 NIH: Estrogen and Brain Health in Menopause

Testosterone & Andropause: The Quiet Decline in Men’s Health

While women experience dramatic hormonal shifts during perimenopause and menopause, men undergo a slower, more subtle decline called andropause. Most men won’t notice a “crash,” but rather a gradual fade in energy, strength, focus, and libido that often begins in their 30s or early 40s.

What Is Andropause?

Andropause refers to the age-related decline in testosterone and other key hormones in men—especially free testosterone and DHEA-S (dehydroepiandrosterone sulfate). Unlike menopause, it doesn’t happen overnight.

Testosterone levels in men drop an average of 1–2% per year after age 30, but factors like poor sleep, obesity, insulin resistance, chronic stress, and environmental toxin exposure can accelerate this decline.

Symptoms of Low Testosterone (Low T)

Decreased morning erections and libido
Increased belly fat and reduced muscle mass
Fatigue, low motivation, and brain fog
Mood swings, anxiety, or depressive symptoms
Poor recovery from workouts
Loss of confidence or drive
Trouble sleeping

Many men chalk this up to “getting older”—but these symptoms can often be reversed or dramatically improved with a combination of lifestyle interventions, functional testing, and when appropriate, testosterone replacement therapy (TRT).

Functional Medicine Approach to Men’s Hormone Health

At 1st Optimal, we never guess. Before considering TRT, we evaluate:

Total and free testosterone
SHBG (sex hormone-binding globulin)
Estradiol and DHT
LH/FSH (pituitary hormones)
Insulin sensitivity and blood sugar
Inflammatory markers and liver enzymes

For men not ready or eligible for TRT, natural support includes:

Resistance training + increased protein intake
Sleep optimization + blue light hygiene
Stress management via HRV training or breathwork
Nutrients like zinc, magnesium, boron, and vitamin D
Peptides like Kisspeptin or Gonadorelin (under physician guidance)

For men with clinically low testosterone and symptoms, properly managed TRT has shown benefits including:

Improved mood and energy
Increased lean muscle mass
Decreased visceral fat
Enhanced insulin sensitivity
Better bone density and cardiovascular health

📚 JAMA: TRT and Cardiometabolic Health in Men
📚 NEJM: Effects of Testosterone on Physical Function

The Gut-Hormone Connection

Your gut isn’t just about digestion—it’s a central player in hormone balance. More and more research confirms what functional medicine has said for years: if your gut is off, your hormones will be too.

Meet the Estrobolome

The estrobolome is a collection of gut bacteria that help metabolize estrogen. When these microbes are healthy, estrogen is properly broken down and eliminated. When dysbiosis (gut imbalance) occurs, an enzyme called beta-glucuronidase gets overactive—causing estrogen to recirculate instead of being cleared.

This can lead to estrogen dominance, PMS, irregular cycles, fibroids, weight gain, and mood swings in women—and contribute to fat gain, low libido, and low T in men.

Gut Health and Hormone Disruption

Key gut-related causes of hormonal issues include:

Leaky gut (intestinal permeability) → leads to inflammation and immune activation
Low stomach acid → poor absorption of hormone-building nutrients like zinc and B12
SIBO (small intestinal bacterial overgrowth) → disrupts nutrient metabolism
Constipation → slows estrogen detox and raises toxic burden
Food sensitivities → drive systemic inflammation and cortisol spikes

Functional Testing for the Gut-Hormone Axis

1st Optimal uses tests like:

GI-MAP (stool analysis for pathogens, dysbiosis, and beta-glucuronidase)
Zonulin (marker of gut permeability)
Comprehensive food sensitivity testing
Organic acids tests (for yeast, mold, and nutrient pathways)

We’ve seen clients dramatically improve hormone balance just by healing their gut. One woman with fibroids and painful periods resolved her symptoms in 4 months—without HRT—by addressing gut dysbiosis and estrogen detox.

Gut-Healing Hormone Support

High-quality digestive enzymes and probiotics
Cruciferous vegetables and DIM to support estrogen clearance
Magnesium citrate or glycinate to support bowel motility
Bone broth, collagen, and glutamine for gut lining repair
Elimination of ultra-processed foods, artificial sweeteners, and alcohol

📚 NIH: Gut Microbiota and Estrogen Metabolism
📚 JAMA: Microbiome Disruption and Endocrine Disease

Protein, Muscle & Metabolism: The Underrated Trio

Muscle is more than just “tone”—it’s metabolic currency, and it becomes increasingly valuable as we age. After 35, most adults lose muscle mass unless they actively work to preserve it. That muscle loss is directly tied to:

Slower metabolism
Blood sugar dysregulation
Poor thyroid conversion
Increased insulin resistance
Fat gain, especially visceral fat

Why Protein Matters More in Midlife

Due to anabolic resistance (a normal part of aging), the body becomes less efficient at using dietary protein for muscle repair and hormone production. That means midlife adults actually need more protein—not less.

Recommended intake for optimization:

Women: 0.8–1.0 grams per pound of goal body weight
Men: 1.0–1.2 grams per pound of goal body weight

This supports muscle retention, hormone synthesis, neurotransmitter production, and blood sugar control.

Muscle and Hormone Interplay

Muscle improves insulin sensitivity and lowers cortisol
Strength training stimulates growth hormone and testosterone

Higher protein dietsues or early menopause

Insulin Resistance: The Hidden Driver

PCOS is closely linked to high fasting insulin—even if fasting glucose looks “normal.” Chronically elevated insulin:

Disrupts ovulation
Increases androgen production
Worsens inflammation
Promotes visceral fat accumulation

Functional Medicine for PCOS

At 1st Optimal, we take a comprehensive approach using:

Blood sugar mapping (glucose + insulin + HbA1c)
Hormone panels including DHEA, free testosterone, SHBG
Cortisol rhythm analysis
Personalized nutrition and GLP-1 peptides (where appropriate)

Our protocols often include:

Lower glycemic load meals
High protein + strength training
Inositol, NAC, and berberine
Continuous glucose monitoring (CGM)

📚 NIH: Insulin Resistance and PCOS
📚 Fertility and Sterility: PCOS Beyond Fertility

Top Hormone Health Myths—Debunked

With the rise of social media “hormone hacks,” misinformation is rampant. Let’s separate fact from fiction with science-backed corrections to the most persistent myths.

❌ Myth 1: Bioidentical Hormones Are Dangerous

✅ Fact: Bioidentical hormones (e.g., estradiol, progesterone, testosterone) have the same molecular structure as hormones your body makes. When properly prescribed and monitored, they’re safe and effective for symptom relief and long-term health.

📚 NAMS: Safety of Bioidentical Hormone Therapy

❌ Myth 2: Hormone Therapy Increases Cancer Risk

✅ Fact: The Women’s Health Initiative (WHI) study from 2002 caused widespread panic, but its findings have since been revised and clarified. For many women, estrogen therapy actually lowers risk of colon cancer and all-cause mortality—especially when started early in menopause.

📚 NEJM: Re-analysis of WHI Data

❌ Myth 3: Only Women Have Hormone Problems

✅ Fact: Testosterone in men has dropped by 25–30% over the past two decades. Men are just as susceptible to hormone imbalances, often driven by obesity, lack of sleep, and insulin resistance.

📚 JAMA: Declining Testosterone in Men

❌ Myth 4: Weight Gain Is Just “Aging”

✅ Fact: Weight gain after 40 is not inevitable—but it is more complicated. Shifts in estrogen, testosterone, insulin sensitivity, cortisol, and thyroid function all make fat loss harder. A root-cause strategy (not calorie slashing) works best.

❌ Myth 5: Thyroid Panels Only Need TSH

✅ Fact: TSH alone misses many issues. Full thyroid panels should include:

Free T3
Free T4
Reverse T3
Thyroid antibodies (TPO, TGab)

📚 Journal of Clinical Endocrinology & Metabolism: Functional Thyroid Testing

Functional Lab Testing: Going Beyond the Basics

At 1st Optimal, we believe data drives better decisions. Many midlife symptoms are dismissed because traditional labs fall “within range.” But optimal health isn’t about normal—it’s about what’s ideal for you.

Conventional vs. Functional Labs

Conventional ranges are based on population averages—including people with chronic disease. Functional medicine narrows those ranges to identify suboptimal trends before full-blown dysfunction sets in.

Core Labs We Use for Midlife Hormone Health

🧪 Comprehensive Hormone Panel

Estradiol, progesterone, testosterone (total & free)
DHEA-S, SHBG
LH/FSH
Pregnenolone and cortisol (diurnal curve)

🧪 Metabolic & Inflammatory Markers

Fasting glucose, insulin, HbA1c
hsCRP, homocysteine, ferritin
Lipids (including particle size and ApoB)
Vitamin D, B12, magnesium, zinc

🧪 Thyroid Panel

TSH, Free T3, Free T4
Reverse T3
TPO & TGab antibodies

🧪 GI-MAP + Beta-Glucuronidase

Tests for pathogens, gut inflammation, leaky gut
Measures detox and estrogen reactivation risk

🧪 DUTCH Test (Urine Hormones)

Tracks hormone metabolites, cortisol rhythm, and detox pathways

Why We Test This Deeply

To validate symptoms that aren’t “in your head”
To reveal patterns behind fatigue, fat gain, low libido, mood issues
To personalize treatment: HRT, supplements, lifestyle, peptides
To track progress and objective outcomes

Want to know where you stand?
👉 Book a lab review + consult here.

📚 PubMed: Importance of Comprehensive Lab Evaluation
📚 NIH: Beyond TSH - Functional Thyroid Diagnosis

The Rise of Peptides & GLP-1 Medications

Over the past few years, peptides and GLP-1 receptor agonists have become some of the most powerful tools in the functional medicine arsenal—especially for hormone support, weight loss, metabolic health, and healthy aging.

What Are Peptides?

Peptides are short chains of amino acids that signal specific processes in the body—think of them as targeted messengers. They can influence:

Hormone production
Fat metabolism
Muscle growth
Sleep and recovery
Immune regulation
Cognitive function

Because they mimic natural signaling, peptides are both effective and generally well tolerated under medical supervision.

Top Peptides Used at 1st Optimal

🧬 CJC-1295 + Ipamorelin
Stimulates growth hormone release → improves body composition, sleep, recovery.

🧬 Kisspeptin-10 or Gonadorelin
Stimulates natural testosterone production in men with low T.

🧬 BPC-157 & TB-500
Enhance injury recovery, gut healing, and tissue regeneration.

🧬 AOD-9604
Fat loss peptide that mimics the lipolytic region of HGH.

GLP-1s: A Game Changer for Weight & Hormones

Drugs like semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro) are GLP-1 agonists originally developed for type 2 diabetes—but now FDA-approved for obesity and widely used in functional medicine.

They work by:

Slowing gastric emptying → better fullness/satiety
Reducing cravings and binge episodes
Improving blood sugar control and insulin sensitivity
Promoting 5–15% body weight loss in clinical trials

But the real power? When combined with:

High-protein nutrition
Resistance training
Functional lab monitoring
Supportive therapies like B12, electrolytes, and thyroid tuning

Responsible Use Is Critical

At 1st Optimal, we never offer GLP-1s without:

✅ Full lab workup
✅ Health history and lifestyle analysis
✅ Ongoing provider support
✅ Education on muscle maintenance and hormone impact

📚 NEJM: Efficacy of Semaglutide in Weight Loss
📚 Nature Medicine: Tirzepatide Outcomes

Emotional Health, Burnout & Hormones

Hormone health isn’t just about labs—it’s deeply intertwined with your emotional state, nervous system, and daily stressors. Burnout is a biochemical condition, not just a mindset problem.

The HPA Axis and Stress Response

The hypothalamic-pituitary-adrenal (HPA) axis is your body’s stress command center. Chronic stress triggers:

Elevated cortisol → disrupts sleep, blood sugar, estrogen, and thyroid
Suppressed DHEA → weakens immune response and resilience
Disrupted circadian rhythm → lowers melatonin and growth hormone
Impaired neurotransmitters (serotonin, dopamine) → mood swings, cravings, anxiety

In other words, the more chronically stressed you are, the more likely your hormones are off.

Burnout in Midlife Professionals

Dr. Ashley Dwyer highlights a common pattern in high performers:

“They’ve spent 20 years overdelivering—career, family, health perfectionism—and suddenly they crash in their 40s. They think they’re just tired, but their labs show burnout physiology.”

Signs of biochemical burnout:

Trouble waking up
Afternoon crashes
Sleep disruption at 2–4 a.m.
Anxiety, brain fog, apathy
Poor recovery from workouts

Restoring Resilience

Healing the nervous system is just as important as hormone replacement or supplements. Tools we use:

🧘‍♀️ HRV training + breathwork
📱 Parasympathetic support: vagus nerve stimulation, meditation apps
🌞 Morning light exposure: resets cortisol and melatonin rhythm
💤 Sleep hygiene: magnesium, low EMF, no screens after 9pm
📋 Lab tracking: DHEA, cortisol, serotonin, GABA, B6, magnesium

Burnout recovery often requires pulling back to push forward—especially for high achievers. In some cases, we begin with nervous system repair before adding hormone therapy or fat loss goals.

📚 Frontiers in Neuroendocrinology: Stress, Burnout & the HPA Axis
📚 PubMed: Hormonal Profiles in Burnout Patients

FAQs: Midlife Hormone Health

Here are the most common questions we get at 1st Optimal about hormones, weight loss, and functional medicine.

1. When should I get my hormones tested?

If you’re experiencing fatigue, weight gain, low libido, poor recovery, mood swings, or irregular periods—now is the time. Testing proactively can prevent years of frustration.

2. Do I need HRT even if I’m “normal” on labs?

“Normal” doesn’t always mean optimal. If you have symptoms and labs on the low end of normal, you may still benefit from therapy. Functional medicine focuses on the whole picture—symptoms, history, and labs.

3. Are peptides or GLP-1 meds right for me?

We evaluate candidates based on lab markers, goals, and readiness. GLP-1s are powerful tools, but they work best when paired with muscle-building and mindset coaching.

4. What kind of doctor do I need for hormone optimization?

Ideally, a functional medicine-trained provider who understands hormones, gut health, and metabolic lab work. All 1st Optimal clinicians are trained in hormone health, peptides, and performance medicine.

5. Will I have to be on hormones forever?

Not necessarily. Some therapies are supportive during transitions (like menopause), while others may be long-term for optimal health and disease prevention. The goal is personalized care that adapts as your life evolves.

If you’re ready to stop guessing and start optimizing, we can help.

🎧 Listen to the full episode with Dr. Ashley Dwyer:
📺 Watch on YouTube
🎧 Listen on Spotify

Midlife Hormone Health: How to Optimize Energy, Metabolism, and Mood After 35