Discover the impact of bioidentical HRT with integrative endocrinology on your health journey and improve your quality of life.

Abstract

Welcome. In this educational post, I will guide you through the intricate world of hormone replacement therapy (HRT). As a practitioner with decades of experience spanning multiple disciplines, from chiropractic to functional medicine, I have dedicated my career to understanding the intricate web of systems that govern our health. This isn’t just about managing menopause or “low T”; it’s about reclaiming your vitality, protecting your long-term health, and understanding the profound connections between your hormones, your brain, your heart, and even your gut. We will explore the critical difference between merely treating symptoms and truly healing the body, dispelling common myths perpetuated by outdated studies, and showcasing how optimizing hormones is a cornerstone of proactive, root-cause medicine.

I’ll break down the roles of key hormones like testosterone, estrogen, and progesterone for both men and women, backed by the latest evidence-based research from leading experts. We’ll examine why conventional approaches often fall short, leaving patients with persistent symptoms despite “normal” lab results. We will delve into why cardiovascular disease is the number one killer of women, the misunderstood link between hormones and breast cancer, the crucial role hormones play in bone and brain health, and the most effective, modern treatment options available. Furthermore, I will explain how integrative chiropractic care complements hormone optimization by supporting the body’s structural and neurological integrity, creating a synergistic effect that enhances overall wellness and accelerates healing. This post is designed to be an easy-to-understand journey, empowering you with the knowledge to take control of your health through real-world patient stories that highlight the life-altering power of a comprehensive, root-cause approach.

Understanding the Difference Between Treating and Healing

In my years of clinical practice, I’ve seen countless frustrated patients. They’ve been taking medications for years, yet they never seem to feel truly well. This brings me to a foundational principle I share with my patients, a timeless piece of wisdom from Hippocrates: “The greatest medicine of all is teaching people how not to need it.”

This statement is the very essence of what we do. Our goal is not just to prescribe another pill but to teach you how to foster a state of health where medications become unnecessary. So many of the prescriptions people rely on daily are merely Band-Aids for symptoms. They might temporarily silence a headache or calm anxiety, but they do nothing to address the underlying reason those symptoms appeared in the first place.

This is the critical distinction between treating and healing:

• Treating: When you treat a condition, the context remains the same. You have a headache, you take an ibuprofen, and the pain subsides. But what caused the headache? Was it dehydration, a nutritional deficiency, stress, or a structural misalignment in your neck? The ibuprofen doesn’t answer that question; it only masks the symptom.
• Healing: Healing occurs when we identify and remove the condition’s root cause. It’s a permanent solution. Imagine you have a sharp pain in your toe every time you wear a specific pair of shoes. Would you keep taking pain medicine, or would you take off the shoe and look for the pebble inside? Healing is about finding and removing that pebble.

Hormones are often the “pebble in the shoe”—a hidden driver of numerous chronic symptoms and diseases. Understanding their role is a giant leap toward genuine, long-lasting health.

The Problem with Synthetic Hormones: The Lock and Key Analogy

A common misconception is that all hormones are created equal. This couldn’t be further from the truth. Your body is incredibly intelligent. Over millennia, it has evolved highly specific cell-membrane receptors for the natural hormones it produces. Think of this relationship as a perfectly matched lock and key.

• The Lock: The receptor on your cell.
• The Key: The natural, bioidentical hormone.

When the correct key (a natural hormone) fits into the lock (the receptor), it doesn’t just open the door; it triggers a cascade of beneficial cellular activities. It unlocks the full spectrum of functions that hormone was designed to perform, from protecting your brain and heart to maintaining bone density and regulating your mood.

Now, consider a synthetic hormone. It’s like a poorly copied key. It might fit into the lock well enough to jiggle it and stop one primary symptom, like a hot flash. However, it fails to turn the mechanism fully. It doesn’t unlock the hundreds of other protective and health-promoting benefits that the natural hormone provides. This is why natural, bioidentical hormones are not just for symptom relief; they are crucial for restoring optimal health and preventing chronic illness. Injured tissue heals with nutrients and proper biological signals, not with foreign drugs.

Understanding the Gut-Brain-Hormone Connection

Before we dive into the specifics of hormone therapy, we must address the foundation of our health: the gut. When the delicate balance of bacteria in your digestive system is disrupted—a condition known as gut dysbiosis—it can trigger a cascade of systemic problems. I often see patients presenting with what they believe are hormonal or even psychiatric issues, but the root cause is hidden within their gut.

The gut-brain axis is a well-established bidirectional communication pathway. We now understand that intestinal permeability, or “leaky gut”, is a significant contributor to neurological and psychological conditions, including depression, anxiety, and ADD/ADHD. This is because a compromised gut lining allows toxins and undigested food particles to enter the bloodstream, triggering systemic inflammation that directly impacts brain function. Furthermore, the gut plays a pivotal role in hormone metabolism, particularly in the processing and elimination of estrogen. If the gut isn’t functioning optimally, it can lead to a buildup of harmful estrogen metabolites, further disrupting hormonal balance.

As an integrative practitioner, I always assess the whole person. This is why my clinical approach, incorporating functional medicine and integrative chiropractic care, always considers the gut. We can optimize hormones all day long, but if the underlying gut issues are not addressed, you will only achieve a fraction of the potential benefits.

The Faces of Hormone Decline

Do any of these feelings sound familiar? Bloated, depressed, moody, anxious, irritable, unable to sleep or focus. Perhaps you’re experiencing unexplained weight gain, especially around your midsection, despite your best efforts with diet and exercise. These are not just signs of “getting older”; they are classic symptoms of hormonal decline.

For women, this can manifest as intense mood swings—happy one minute, then inexplicably angry the next. For men, it often appears as a loss of motivation, a feeling that their “get up and go has got up and gone.” This is not a personal failing; it’s a physiological problem.

The conventional response is often a prescription for an antidepressant, an anti-anxiety medication, or a sleeping pill. But in my clinical experience, I firmly believe that anxiety, depression, sleeplessness, and an inability to focus are not deficiencies of Zoloft, Xanax, or Ambien. More often than not, they are symptoms of a hormonal deficiency. By addressing the root hormonal cause, we can often eliminate the need for these medications and restore true vitality.

The Widespread Impact of Hormones: From Brain Fog to Bone Loss

Hormone receptors are present on nearly every cell in the human body, from your brain to your bones. This means that a decline in hormones affects every single organ system. Let’s look at the symptoms of menopause (in women) and andropause (in men).

Shared Symptoms for Men & Women:

• Mood swings, depression, and anxiety
• Insomnia and night sweats
• Weight gain (particularly abdominal fat)
• Brain fog and difficulty concentrating
• Bone loss (osteoporosis)
• Joint pain and achiness

Female-Specific Symptoms:

• Hot flashes and heart palpitations
• Vaginal dryness and recurrent UTIs
• Irregular menstrual cycles
• Nausea

Male-Specific Symptoms:

• Loss of motivation and drive
• Muscle loss (sarcopenia) and increased body fat
• Mild to moderate erectile dysfunction
• Reduced stamina

In my practice, I often observe a pattern in men called sarcopenia, where declining androgen levels lead to a visible change in body composition: the belly gets larger while the arms and legs become thinner due to muscle wasting. This is not an inevitable part of aging; it’s a sign of hormonal imbalance that we can reverse.

Debunking Hormone Myths: A Look at the Evidence

For years, the conversation around hormone therapy has been clouded by fear and misinformation, largely stemming from the flawed Women’s Health Initiative (WHI) trial. As a clinician, I feel it’s my duty to present the current, evidence-based research that paints a very different, more accurate picture.

Hormones and Cardiovascular Health: The Real Story

Cardiovascular disease is the number one killer of women, claiming five times more lives than breast cancer. Yet, heart health in women remains an under-researched area. This is partly because women present with heart attacks very differently than men. From my background in emergency medicine, I have seen this firsthand. Women often experience vague symptoms like nausea, fatigue, and general malaise, which are tragically dismissed until it’s too late.

Here is what modern research tells us:

• Estrogen is Cardioprotective: As shown in research by Mendelsohn and Karas (1999), when initiated early in postmenopause, estrogen therapy has been shown to cause up to a 50% reduction in cardiovascular disease. Estrogen helps maintain the elasticity of blood vessels, manage cholesterol levels, and reduce inflammation.
• Testosterone is Protective: Hundreds of studies, including a position statement by Goodman et al. (2015), confirm that optimal testosterone levels are protective for the heart in both men and women. The leading theory is that testosterone’s conversion to estrogen is a key mechanism behind this protective effect.
• Outdated Guidelines Are Harmful: The old mantra of using the “lowest dose for the shortest time” is no longer supported by evidence. In 2017, the North American Menopause Society and others updated their guidelines to emphasize an individualized approach, stating there is no good data to support arbitrarily stopping hormones at age 60 or 65. In fact, one study showed that stopping hormone therapy has been linked to nearly 94,000 excess deaths since 2012.

Hormones and Breast Issues: Separating Fact from Fiction

A woman’s greatest fear when considering hormone therapy is often potential long-term health risks. This fear is a direct result of the WHI trial, which incorrectly led the public to believe that all hormones cause serious health issues.

Let’s clarify the facts:

• The Culprit is Synthetic Progestin: The only hormone shown to increase risks is synthetic oral progestin (e.g., medroxyprogesterone acetate), which was used in the combination drug PremPro in the WHI study (Manson et al., 2013). This is a chemically different molecule from the natural progesterone our bodies produce.
• Natural Progesterone is Protective: Bioidentical progesterone, which is molecularly identical to the progesterone your body produces, supports balanced hormone signaling and promotes overall cellular health.
• Estrogen Does Not Cause Serious Issues: No credible data supports the claim that bioidentical estradiol increases health risks. In fact, the estrogen-only arm of the WHI trial (using Premarin, a conjugated equine estrogen) showed a decrease in certain risks and mortality. Logically, this makes sense. Serious health issues are extremely rare in young women in their teens and twenties when their estrogen levels are at their peak.
• Testosterone is Highly Protective: A wealth of research, much of it compiled by Dr. Rebecca Glaser (Glaser & Dimitrakakis, 2013), demonstrates that testosterone plays a significant role in supporting women’s health and tissue balance.

We must shift the blame away from hormones and look at the true drivers of chronic conditions: sugar, inflammation, and toxicity. Many conditions thrive in an acidic, inflammatory environment and feed on sugar. Let’s focus on prevention and addressing the metabolic roots of dysfunction, rather than on unfounded fears about beneficial, natural hormones.

Optimizing diet, fasting insulin, vitamin D, sleep, and detoxification pathways, and incorporating chiropractic care—which supports spinal alignment and nervous system function and can help reduce systemic inflammation—is fundamental when using physiologic hormone therapy thoughtfully.

Finding Hormonal Harmony- Video

A Deeper Look at the Key Hormones

When we talk about hormone optimization, we focus on a few key players that profoundly impact your overall health.

• Estrogen: With over 400 functions in the female body, it is essential for brain, bone, and cardiovascular health. Its decline is linked not only to hot flashes but also to a higher risk of colorectal cancer, heart disease, Alzheimer’s disease, and osteoporosis. Because up to 80% of our serotonin (the “feel-good” neurotransmitter) is produced in the gut, the decline in estrogen can disrupt gut health and significantly contribute to depression and mood disorders. Men also require a small amount of estrogen for similar protective benefits, which they produce by converting a portion of their testosterone. This estrogen is what provides many of the protective benefits to the brain and heart that are often attributed solely to testosterone.
• Testosterone: A powerful hormone that is vital for both men and women. For women, it is often the missing piece for energy, mood, and cognitive function. Here’s a fascinating fact: over their lifetime, women actually produce more testosterone than estrogen. It is an absolutely vital hormone for female health, yet it is so often overlooked. Why? A primary reason is the lack of an FDA-approved testosterone product specifically for women. Much of the medical education that providers receive is sponsored by pharmaceutical companies. With no drug to market, there is little financial incentive to teach doctors about the critical importance of testosterone for women. This is why many of my colleagues in functional medicine and I have sought specialized training outside conventional institutions to learn this vital information.
• Progesterone: Often called the “calming” hormone, it is crucial for sleep, metabolism, and balancing the effects of estrogen in women. In their 40s, women’s progesterone levels often plummet, leading to symptoms like heavy menstrual cycles, anxiety, and insomnia. Progesterone promotes normal sleep patterns, protects the uterus and breasts, acts as a natural diuretic, increases metabolism, prevents cyclic migraines, and enhances the action of thyroid hormones.
• Thyroid Hormone: The master of your metabolism. Imbalances can affect every single cell in your body, yet it is one of the most undertreated conditions I see in my practice.
• Vitamin D: While we call it a vitamin, its molecular structure and function in the body are that of a steroid hormone, as noted by Holick (2007). It is critically important for immune function, bone health, and mood regulation.

The System-Wide Impact of Hormone Optimization

Hormones are chemical messengers that regulate every system in the body. When they decline, the effects are felt everywhere, from our bones to our brains.

Building Stronger Bones and Preventing Fractures

Osteoporosis is not an inevitable part of aging; it is a preventable disease. Both estrogen and testosterone are critical for maintaining bone density. Studies consistently show that while each hormone is helpful individually, they work synergistically to build bone more effectively together. Hormone replacement therapy is a powerful tool for preventing osteopenia and osteoporosis. In my clinical experience, I’ve seen it halt and even reverse bone loss, significantly reducing the risk of debilitating fractures. This stands in stark contrast to many pharmaceutical drugs for osteoporosis, which are now being shown to create more brittle bone without significantly reducing fracture rates, and they often come with a host of side effects. Restoring the body’s foundational building blocks—hormones, minerals, and nutrients—is the most logical and effective approach.

Protecting the Brain and Enhancing Cognitive Function

One of my favorite areas to discuss is the profound impact of hormones on the brain. The data is overwhelming and exciting.

• Stroke Prevention and Treatment: Estrogen is a potent anti-inflammatory and immunomodulator. Fascinating new research, such as the study by Abbott et al. (2003) on older men, shows that estrogen plays a protective role. In fact, after a stroke, the brain produces a surge of local estrogen at the site of the injury to protect the tissue. This has led to clinical trials where administering natural estrogen immediately after a stroke is showing promise in completely reversing the damage.
• Memory and Mood: Both estrogen and testosterone are vital for memory, focus, and mood regulation. The “brain fog,” memory lapses, and depression that many experience during perimenopause and andropause are directly linked to declining hormone levels. Optimizing testosterone has been shown in countless studies to be a highly effective treatment for depression.
• Alzheimer’s Prevention: The hallmark of Alzheimer’s disease is the accumulation of beta-amyloid plaques in the brain. Both estrogen and testosterone have been shown to slow or even stop the deposition of these plaques. There is a direct correlation between low testosterone and an increased risk of Alzheimer’s disease, heart disease, and all-cause mortality.

The Relationship Between Testosterone and Overall Vitality

When patients ask me about the most tangible benefit of testosterone optimization, my answer is always the same: relationship health. When you are exhausted, irritable, anxious, and can’t sleep, who bears the brunt of it? Your loved ones. Restoring your hormonal balance brings back your energy, your patience, and your zest for life, which in turn restores your most important relationships.

Benefits of Optimized Testosterone (Men and Women):

• Increased energy, stamina, and motivation
• Improved mood and sense of well-being
• Enhanced mental focus and clarity (goodbye, brain fog!)
• Increased muscle mass and decreased body fat
• Better sleep quality
• Protection for the brain, heart, and bones

A common fear among women is that testosterone therapy will cause masculinization—a deep voice or a beard. This is a myth. Research from pioneers like Dr. Rebecca Glaser has shown conclusively that when dosed appropriately, testosterone does not cause these effects. We aim to bring women’s levels to the optimal range for a female (e.g., 100-200 ng/dL), not to male levels. The result is not masculinity, but a return to vitality.

For men, it’s crucial to understand that a “normal” lab value is not the same as an optimal one. A man with a testosterone level of 320 might be told he is “in the normal range,” yet he feels terrible and is at a higher risk for disease. Our goal is to optimize levels to where you feel your best (around 1,000 ng/dL), not just to fall within an arbitrary range.

The Role of Integrative Chiropractic Care in Hormonal Health

Hormone optimization does not happen in a vacuum. As a Doctor of Chiropractic, I know that structure dictates function. The nervous system, which is housed and protected by the spine, is the master control system for the entire body—including the endocrine (hormone) system. If there are structural misalignments in the spine, known as vertebral subluxations, they can create interference in the nerve signals traveling between the brain and the glands that produce your hormones (like the adrenals, thyroid, and ovaries). This neurological stress can disrupt hormone production and signaling, making it much harder to achieve balance.

This is how integrative chiropractic care fits perfectly into our treatment model:

1. Restoring Nervous System Integrity: Through gentle, precise chiropractic adjustments, we correct spinal misalignments. This removes nerve interference, allowing the brain to communicate more effectively with the body’s hormonal glands. A properly functioning nervous system can better regulate hormone production and response. For example, spinal misalignments can affect the nerve supply to the digestive organs, impairing their function. By performing specific spinal adjustments, we can help restore proper nerve flow, supporting better gut motility and function, which is a crucial part of a holistic hormone and gut health protocol.
2. Reducing Physiological Stress: Chronic pain and structural imbalances are major stressors on the body. This stress elevates cortisol, the primary stress hormone. High cortisol can disrupt the entire hormonal cascade, suppressing thyroid function and stealing the building blocks needed to produce other crucial hormones, such as testosterone and progesterone. Chiropractic care helps reduce this physical stress, thereby normalizing cortisol levels. Both estrogen and testosterone play a direct role in pain processing. As Tennant (2015) notes, chronic opioid use decimates testosterone levels, creating a vicious cycle. I have seen countless patients find relief from chronic joint pain once their hormones are optimized, and their healing is accelerated.
3. Enhancing Cellular Health: By improving nerve function, we enhance the body’s overall ability to heal and regulate itself. This creates an internal environment where hormone therapy can be more effective. When your cells are receiving clear signals from the nervous system, they are better able to utilize the hormones we are working to optimize.

In my clinical observation, patients who combine hormone optimization with regular chiropractic care achieve faster, more profound results. They not only feel the benefits of balanced hormones but also experience improved mobility, reduced pain, and a greater sense of overall well-being. It is a truly synergistic approach to healing from the inside out.

Finding the Best Treatment Option for You

Now that you understand why hormones are so important, let’s discuss the how. Not all therapies are created equal, and choosing the right method is key to achieving optimal results.

• Oral Hormones: Natural oral estrogen and progesterone can be beneficial. Rapid-dissolve tablets for testosterone, which are absorbed under the tongue, are also a good option. We generally avoid oral synthetic hormones, especially synthetic testosterone and progestins, due to risks shown in studies.
• Creams and Patches: These are acceptable options, but absorption can be inconsistent. Absorption of creams is often better when applied to the genital area in both men and women due to the high vascularity of the tissue. Estradiol patches for women can be effective but require frequent changes.
• Injections: Testosterone shots for men are widely used and can be effective for disease prevention. However, they can create a “roller coaster” effect of hormone levels and have a higher side effect profile, especially for women. A significant concern is that many men on long-term injection therapy are also prescribed estrogen blockers, which are extremely dangerous and increase the risk of heart disease, Alzheimer’s, osteoporosis, and prostate cancer. Estrogen is crucial for men’s health, and blocking it is a harmful practice.
• Hormone Pellets: This is my preferred method and the one I have specialized in for over a decade. Hormone pellets have been used since the 1930s and are derived from plant sources like wild yam. These tiny pellets, about the size of a grain of rice, are implanted in the fatty tissue and release a steady stream of hormones for 3 to 6 months. The release is based on cardiac output, meaning you get more hormone when you are active and less when you are at rest, mimicking the body’s natural rhythm. This method allows for highly individualized and stable dosing, and in my clinics, we have performed over 30,000 procedures with exceptional safety and patient satisfaction.

Real-Life Stories: The Power of an Integrative Approach

Data and studies are essential, but the true impact is seen in people’s lives.

From Deficiency to Vitality: The Young Man’s Story

An 18-year-old man was brought to me by his mother. She was convinced he had low testosterone. He was depressed, anxious, on medication for ADD, and had no interest in life. To my surprise, his lab work showed a testosterone level of nearly 1,000—very high. He had plenty of “gas in the tank,” but it wasn’t getting to the “engine.” His hormone receptors were not functioning correctly.

The solution wasn’t more hormones. I placed him on a simple protocol of Vitamin D (critical for hormone receptor sensitivity), iodine to support his thyroid, and a methylated B-complex. Two months later, his mom returned, overjoyed. He was off all his medications, his anxiety and depression were gone, and he was thriving. He was a prime example of how a functional, root-cause approach can change everything.

Reclaiming a Life: Bobby’s Story

Bobby, a 65-year-old woman, came to me in a state of deep depression and apathy. Her husband, a retired gynecologist, had followed the old guidelines and taken her off hormones at age 60. Her daughter, a patient of mine, insisted she come in. We discovered she was profoundly deficient in all her hormones. We started her on pellet therapy.

About six weeks later, I saw her in the office, and she was crying. “I realize I haven’t liked my husband for 25 years,” she confessed. “But now I know it was me, not him.” She was mourning the time lost to hormonal imbalance. A few weeks after that, her husband came in. He thanked me for giving him his wife back and said that if he had known about this therapy during his practice, he would have recommended it to every one of his patients. They are still my patients today, living their lives to the fullest.

Conclusion

Your symptoms are real, but they are not your destiny. Conditions like chronic fatigue, fibromyalgia, anxiety, and depression are not just diagnoses to be managed with drugs; they are often signs of deeper imbalances in your hormones, nutrition, and structural health.

If you’ve been told your labs are “normal” yet you still feel unwell, it’s time to look deeper. It’s time to find a practitioner who will listen to your symptoms, go beyond standard lab ranges, and partner with you to uncover the root cause. A comprehensive approach that includes gut health, targeted supplementation (such as iodine and B vitamins), and integrative chiropractic care is vital for success. “Normal” lab results are not always optimal. Aim for levels that promote disease prevention and vitality, such as a Vitamin D level above 60 ng/mL.

My goal is to help you do more than exist—it’s to help you live fully. By combining evidence-based hormone optimization with foundational support such as integrative chiropractic care, you can move beyond simply treating symptoms and begin the journey toward true, lasting healing.

References

• Abbott, R. D., Launer, L. J., Rodriguez, B. L., Ross, G. W., Wilson, P. W., Masaki, K. H., & White, L. R. (2003). Serum estradiol and risk of stroke in elderly men. Neurology, 60(12), 1907–1911.
• Glaser, R., & Dimitrakakis, C. (2013). Testosterone therapy in women: myths and misconceptions. Maturitas, 74(3), 230–234.
• Goodman, N. F., Cobin, R. H., Ginzburg, S. B., Katz, I. A., & Woode, D. E. (2015). American Association of Clinical Endocrinologists and American College of Endocrinology position statement on the association of testosterone and cardiovascular risk. Endocrine Practice, 21(9), 1066–1073.
• Holick, M. F. (2007). Vitamin D deficiency. The New England Journal of Medicine, 357(3), 266–281.
• Manson, J. E., Chlebowski, R. T., Stefanick, M. L., Aragaki, A. K., Rossouw, J. E., Prentice, R. L., … & Women’s Health Initiative Investigators. (2013). Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA, 310(13), 1353–1368.
• Mendelsohn, M. E., & Karas, R. H. (1999). The protective effects of estrogen on the cardiovascular system. The New England Journal of Medicine, 340(23), 1801–1811.
• Stuenkel, C. A., Davis, S. R., Gompel, A., Lumsden, M. A., Murad, M. H., Pinkerton, J. V., & Santen, R. J. (2015). Treatment of symptoms of the menopause: An endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 100(11), 3975–4011.
• Tennant, F. (2015). The intractable pain patient who has failed therapy. In Pain-2nd Edition (pp. 53- 61). Practical Pain Management.
• The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. (2017). The 2017 hormone therapy position statement of The North American Menopause Society. Menopause, 24(7), 728–753.

SEO Tags: Hormone Replacement Therapy, Bioidentical Hormones, Dr. Alexander Jimenez, Testosterone for Women, Menopause, Andropause, Integrative Chiropractic Care, Functional Medicine, Root Cause Medicine, Progesterone Benefits, Estrogen Dominance, Thyroid Health, Chronic Fatigue, Fibromyalgia, Anti-Aging, Wellness, El Paso TX Chiropractor, hormone optimization, hormone pellets, estrogen therapy, gut health, gut-brain axis, leaky gut, dysbiosis, cardiovascular health, breast cancer myths, osteoporosis prevention, brain health, Alzheimer’s prevention, chronic pain relief, chiropractic care, hormone imbalance, vitamin D