I'm a hormone specialist — Here's important things you should be doing for your hormone health

Carla Moran is a consultant endocrinologist at the Beacon Hospital, Dublin

Dr Carla Moran, endocrinologist. Picture: Moya Nolan

I grew up in Dublin, and then we moved to Kildare when I was about 14. There were no doctors in the family; I was the first to go to university.

I was always very academic. I loved school, loved information, loved books. I was lucky enough to get into UCD and studied medicine there.

I chose endocrinology fairly early on. One of the reasons is that you develop a really nice relationship with patients. We look after mostly chronic diseases that can all be treated very well, and people tend to have a very good quality of life with the medication we give them.

You build up a strong rapport and relationship with patients, and often look after them for many years.

The other bit of endocrinology that attracted me is that it is very much based on understanding how the body works as a whole system. A liver specialist, for example, just looks after the liver, whereas I’m looking after lots of different glands that work together to make sure the whole body system is working well.

The really important things for hormone health are the things we should all be doing, things that are good for our body — good sleep, a healthy diet, and exercise.

1. Getting basics right will help your hormones:

Sleep is really important for general health, and also for some hormones and the rhythm of hormones. Hormone regulation is much better if you get good sleep and if the sleep happens at the expected time: overnight.

A healthy, varied diet is really important. Specific micronutrients in food are vital for hormone health. For example, iodine (which is found in seafood, dairy products, and seaweed) is the building block for thyroid hormone.

If people are very deficient in iodine, their thyroid gland doesn’t work very well, and they can get a goitre — an enlargement of the thyroid gland — or severe thyroid disease, while, in pregnancy, [iodine deficiency] can affect a baby’s growth and brain development.

Exercise is really important because it helps us maintain our weight. Being overweight or obese really increases the risk for multiple conditions. Some endocrine conditions, including diabetes and polycystic ovarian syndrome (PCOS), are worsened by weight gain. Ideally, a person’s BMI should be under 25. Between 25 and 30 is overweight; over 30 is obese.

2. Condition you may have without knowing it:

The unfortunate thing about type-2 diabetes, which is the most common form, is that many people will have it for years before it’s diagnosed.

As doctors, we really like to pick it up as early as possible [so we can] prevent damage from high blood sugars.

As the blood sugars are rising, people might start to notice symptoms — tiredness, blurred vision, passing a lot of urine, they might be very thirsty. When the blood sugars are only mildly raised, a person still has diabetes, but might not have symptoms.

People who are at risk of diabetes should get a blood test once a year with their GP to check for diabetes before the onset of symptoms.

Type-2 diabetes can [go into remission] through diet, exercise and weight loss.

3. The drugs that have transformed diabetes treatment:

As endocrinologists, it’s wonderful to have these medications to give to patients. GLP-1 medications have completely changed the way we manage diabetes.

When I trained, we just had a couple of tablets and insulin. But now, if the tablet medications aren’t working, we use GLP-1 medications, or sometimes we use them as a first-line treatment.

They’re wonderful medications because they control the blood sugar and often can help people lose weight. If people are carrying weight, sometimes they can carry some fat within their liver, and these medications can help with liver health as well.

4. Is it anxiety, is it menopause — or is it your thyroid?

Thyroid disease is very common in women, and women are eight times more likely to get thyroid disease than men.

Hypothyroidism is more common; about 3% of women will get an underactive thyroid gland. About 1% will get an overactive thyroid gland, also known as thyrotoxicosis or hyperthyroidism. Both are very effectively managed through medication.

With an underactive thyroid, it’s like everything slows down. People usually notice they become lethargic, they have low energy, and their mood can get low. They can get constipation and dry skin. They might notice their hair is falling out all over their scalp. They can gain weight.

With an overactive thyroid, it’s the opposite. Everything speeds up. They feel anxious, on edge. They can sweat a lot. They can be very tremulous. They get a lot of palpitations. They can get anxious. Some people lose weight, but not everybody.

It’s no harm to say to the GP, ‘please, can you check my thyroid as well?’ [when doing routine bloods]. Thyroid blood tests are really accurate, so if they’re normal, then it’s not a thyroid problem [you have].

5. The thyroid factor in fertility:

[Untreated thyroid disease] can affect the regularity of the menstrual cycle, so women might not ovulate with each cycle, and they might not conceive.

If they do conceive, there’s an increased risk of miscarriage for both underactive and overactive thyroid conditions.

If [the thyroid issue] is treated, fertility should go back to normal, and treatment very significantly reduces the miscarriage rate. Treatment is really effective at restoring fertility to where it should be.

6. Going on HRT is up to you:

There are lots of women who go through menopause and are fine. If that’s the case, and if menopause is happening at an expected age [around 51], then there’s no need to go on HRT. It’s an individual decision.

But if women have symptoms of perimenopause or the menopause and they’d like help with that, then HRT is an option. It’s not the only option, but it’s an option.

The only time that we really encourage women to use HRT is if they go through a very early menopause — under 40 and probably under 45 — as they would be at risk of thinned bones [due to the early loss of oestrogen].

7. Heavy drinking can affect testosterone:

Alcohol has a negative effect on hormones. Heavy consumption of alcohol can affect how the testicles make testosterone. Men can develop a condition called hypogonadism, where they’re not making enough testosterone because of damage from alcohol.

It’s reversible if they stop drinking alcohol. Obviously, excess alcohol can cause liver disease, but if we’re thinking specifically about hormones, men [and women] tend to hold on to more weight if they’re drinking too much alcohol, and that in turn increases the risk of diabetes, for example.

It also pushes up blood pressure and affects sleep, so it has multiple negative impacts.

If I could tell patients one thing...

It’s difficult because there are so many different hormones and they all need slightly different things, [but] diet and exercise are so important.

It doesn’t matter what endocrine disease I see; people won’t feel optimal if they don’t have a good diet and if they’re sedentary.

A healthy diet and 30 minutes of exercise five days a week really helps a person’s overall quality of life. It will help their hormones in the long term, help prevent some hormonal diseases, and help with longevity.

If I had a tablet that did all the good that a healthy diet and lifestyle did, it would be the number-one prescribed tablet in the world.