What causes hormonal imbalance?

Hormone imbalance implies that the levels of certain hormones are too high or too low. This can involve any of the different hormones (e.g. thyroid hormone, female/male hormones, steroid hormones, growth hormones, and insulin).

I will discuss the conditions that are more frequently encountered below. In women, a good sign of normal hormonal balance is regular menstrual periods.

Thyroid hormones

Hyperthyroidism occurs when the body produces too much thyroid hormones. The symptoms are akin to everything “speeding up”. 

Your metabolism speeds up and you lose weight, feel hot and perspire a lot, you heart rate speeds up, your bowels move more frequently, you tend to be fidgety and some people have difficulty sleeping because your mind is constantly active.

The commonest cause is Grave’s disease (caused by antibodies, tends to run in the family). Other causes include a functioning nodule (when there is a thyroid nodule producing too much thyroid hormones. There may be more than 1 nodule present) and thyroiditis (inflammation of the thyroid gland).

Hypothyroidism occurs when the body does not produce enough thyroid hormones. The symptoms are opposite to that mentioned above. Everything tends to slow down. Y

our metabolism slows down so you gain weight and tend to feel cold, heart rate slows down, bowels move more slowly so there is a tendency to constipation, as well as feel more forgetful and tired.

The commonest cause is Hashimoto’s thyroiditis (caused by antibodies and tends to run in the family).

Female/Male hormones

In women, low female hormones will result in irregular or lack of periods and cause symptoms of hot flushes, tiredness and mood changes, and is a cause of infertility. This may be due to early menopause, when the ovary stops producing oestrogen.

This can also be due to eating disorders, stress or disorders of the pituitary gland. If this is present for a long time, the bones can get affected, increasing the risk of osteoporosis and fracture.

In most cases, women seek help when they notice that their periods have stopped or become irregular, and only notice their subtle symptoms of tiredness, mood swings, etc on hindsight when they get treated and feel significantly better.

Some women have excess male hormones and this may cause symptoms such as lack of or irregular periods, acne, increased facial hair, and in severe situations, deepening of the voice and shrinking of the breasts.

Polycystic ovarian syndrome (PCOS) is a common cause of acne and increased facial hair, but will not cause the latter 2 symptoms where a search for a testosterone-producing tumour is indicated.

In men, low male hormones can cause symptoms of tiredness, low sex drive, erectile dysfunction and reduced shaving frequency. Some men may notice increased breast size.

Locally, some young men get picked up during the NS pre-enlistment check up and are brought to medical attention when they are noticed to not complete pubertal development.

In the older age group, difficulty conceiving, erectile dysfunction and reduced sex drive usually leads one to seek medical attention.

Steroid hormones

The symptoms of excess hormones include weight gain (especially around the tummy area), thin skin, easy bruising, thick and dark stretch marks as well as an increase in blood pressure and blood sugar levels.

The most common cause for this would be if you’re taking steroid tablets/creams/sprays. Otherwise, other causes are rare. If there are any concerns, simple blood/urine tests can be done to exclude this as a cause of weight gain.

Insulin

Insulin resistance or deficiency leads to diabetes. Symptoms of diabetes include feeling thirsty, passing a lot of urine and blur vision, as the sugar causes the lens of the eyes to swell. Many people with diabetes have no symptoms and are only detected on routine health screens.

The vast majority of people with diabetes have type 2 diabetes, and many people with type 2 diabetes (insulin resistance) have a genetic susceptibility, and it’s quite common to have a family member with diabetes. Being overweight/obese will increase your risk of developing diabetes.