How to Handle Hormone Changes

Exhausted all the time? Here are the meds and other moves that can help.

By Hallie Levine

Your hormones—molecules that help govern metabolism, energy, and other key processes—can fluctuate as you age. These changing levels can cause a number of health issues.

But there are solutions. Here’s a rundown of key hormones, how they can change with age, what to do (and not do) to ease negative effects, and what your doctor can do to help.

Vitamin D

Possible problems: The so-called sunshine vitamin is actually a hormone that your body makes, says E. Michael Lewiecki, director of the New Mexico Clinical Research & Osteoporosis Center in Albuquerque. But the ability to produce vitamin D decreases significantly with age, and low blood levels (under 20 nanograms per deciliter) have been associated with an increased risk of falls and fractures in older adults.

The fix: Adults over age 70 need 800 IU of vitamin D daily, according to the Endocrine Society. Because it’s hard to get enough from food (though fortified dairy and orange juice have moderate amounts), you may need a daily supplement. Talk to your doctor about what’s right for you.

Thyroid Hormones

Possible problems: You normally produce more thyroid stimulating hormone (TSH)—which tells your body to pump out more of several other thyroid hormones—as you age, says Salila Kurra, MD, an endocrinologist at Columbia University in New York City. In some instances, this can lead to hypothyroidism, or an underactive thyroid. This, in turn, can cause issues like fatigue, drowsiness, depression, and constipation.

The fix: If routine blood work shows elevated TSH levels, have it checked again three months later, says Anne Cappola, MD, an endocrinologist at the University of Pennsylvania in Philadelphia. In a number of instances, a high TSH returns to normal within that time. Not among that group? Your doctor should check levels of a thyroid hormone called free T4. If your free T4 levels are abnormal and/or your TSH is high (generally over 10 milli-international units per liter), your doctor may prescribe synthetic thyroid hormones to take long-term.

Parathyroid Hormone

Possible problems: Some people, especially postmenopausal women, may make too much of this hormone, which is important for the regulation of blood calcium levels. This can lead to osteoporosis.

The fix: Hyperparathyroidism is usually picked up via routine blood work, often long before any symptoms appear. It’s treated with surgery to remove the parathyroid gland. "Bone density often improves following successful surgery," says Lewiecki.

DHEA

Possible problems: DHEA, which helps make hormones like testosterone and estrogen, declines by 2 to 3 percent per year after about age 30. As DHEA decreases, so may muscle mass, bone density, and endurance. Body fat and risks of heart disease may increase.

The fix: Get moving regularly, says Cappola. One small study published in the journal Age found that about 24 minutes of vigorous exercise increased DHEA levels temporarily in older adults. But don’t bother with a supplement, Cappola says. According to a 2023 Endocrine Society report, while a few studies found that a daily 25 to 50 mg DHEA supplement helped increase levels of the hormone in older adults, that didn’t improve muscle strength or overall quality of life.

Human Growth Hormone

Possible problems: Research has found that a true growth hormone deficiency in your older years reduces strength and raises your risk of heart disease. But while growth hormone production declines with age, a "complete" deficiency is very rare, according to Richard Auchus, MD, chief of the endocrinology & metabolism section at the Ann Arbor VA Medical Center in Michigan.

The fix: Physical activity. The Mayo Clinic report found that older adults had a temporary increase in growth hormone after resistance exercise or high-intensity aerobics. The more strenuous the exercise, the more that growth hormone increased. Also, because growth hormone is released during sleep, it’s important to get 7 to 8 hours of slumber a night, says Cappola. Skip supplements and other over-the-counter products that promise to increase your levels of HGH, she says. HGH therapy is available by prescription, but it’s approved only for a few conditions for adults and "can cause significant side effects, like swelling, carpal tunnel syndrome, and breast development in men," says Cappola.

Adrenal Hormones

Possible problems: Older adults may make too much aldosterone and cortisol, two of the hormones that the adrenal glands produce, says Auchus. High levels of aldosterone can raise blood pressure. (In fact, it’s estimated that up to one-quarter of people with treatment-resistant hypertension may have this.) High cortisol levels can make it harder to control high blood pressure and type 2 diabetes.

The fix: Levels of these hormones aren’t routinely tested. But if you have high blood pressure or type 2 diabetes that hasn’t responded sufficiently to medication, Auchus recommends asking your doctor to check your aldosterone and cortisol levels with a blood or urine test. High aldosterone levels are treated with medications such as spironolactone (Aldactone), eplerenone (Inspra), or amiloride (Midamor). For elevated cortisol levels, which may be caused by a benign tumor in the adrenal gland, you’ll usually be advised to have surgery to remove the tumor. If that’s not possible, you may be prescribed a medication such as mifepristone (Korlym) or osilodrostat (Isturisa), says Auchus.

Too Little Estrogen or Testosterone?

Estrogen: For women, the dramatic decrease in the hormone estrogen after menopause can increase the likelihood of illnesses like heart disease and issues like vaginal dryness. Maintaining a healthy weight is important, says endocrinologist Cynthia Stuenkel, MD, of the University of California, San Diego School of Medicine; it can keep your heart (and other organs) healthier. For vaginal dryness and long-lingering hot flashes, starting oral hormone replacement isn’t generally recommended after age 60 because it can make you more vulnerable to blood clots and, after more than five years of use, to diseases such as breast cancer. Low-dose vaginal estrogen is considered safer at any age and for any amount of time.

Testosterone: Men produce less testosterone with age, which may contribute to reduced strength and muscle mass. But for most men, testosterone replacement therapy isn’t the answer, Auchus says. What does help is a balanced diet, a full night’s sleep, and regular exercise. For instance, a single strength-building workout training temporarily raises testosterone production in older men, according to a report from the Mayo Clinic.

Managing Your Blood Sugar

About a quarter of American adults ages 65 and older have type 2 diabetes, while more than 50 percent may have prediabetes. The hormone insulin is at the root of the problem. "As you get older, your body becomes less sensitive to insulin—you need to produce more to manage your blood glucose (sugar) levels," Cappola says. But with age, your pancreas may have a hard time making enough insulin, which can cause prediabetes and, eventually, full-blown diabetes. The best way to prevent this is to maintain a healthy weight and to exercise regularly, both of which make your cells more receptive to insulin, says Cappola. It’s also important to know your blood sugar level, so talk with your doctors about the testing schedule that’s right for you.

Editor’s Note: A version of this article also appeared in the October 2024 issue of Consumer Reports On Health.

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