If you’re wondering how to naturally increase fertility, the most important thing you should know is that fertility isn’t just about the reproductive organs—it’s a whole-body indicator of health. As a functional medicine doctor, I’ve helped countless patients learn how to naturally increase fertility by addressing imbalances across all systems of the body. If you’re trying to conceive without resorting to pharmaceuticals or IVF, this guide will give you the strategic, root-cause roadmap to reclaim your fertility naturally.

Why Increase Fertility Naturally?

Natural fertility optimization isn’t just about conception—it’s about creating the healthiest possible environment for you and your future child. Couples choose to increase fertility naturally because they want to avoid synthetic hormones, invasive procedures, or expensive treatments that ignore the real cause of the issue. They want to heal, not override, their bodies. IUI, IVF and other fertility treatments can alo be extremely costly, which is another important reason to consider learning how to naturally increase fertility. However, even when pursuing fertility treatments, or perhaps undergoing a process of egg retrieval for egg freezing or a sperm harvesting for sperm freezing, it’s still a good idea to take all possible measures to increase fertility naturally so that the eggs have the best possible chance of success.

Conventional medicine often reduces fertility to a hormone problem. But infertility is a signal—your body is telling you something is off. When we listen, investigate, and treat the underlying dysfunction, the result isn’t just fertility—it’s vitality, balance, and lasting health.

Lifestyle Practices That Harm Fertility

Before we can build fertility, we need to stop destroying it. The modern lifestyle is fertility-toxic. Here’s how:

• Chronic Stress: Activates the HPA axis and shuts down reproductive hormones. Cortisol hijacks your cycle, suppressing ovulation and libido. It also significantly suppresses testosterone production and sperm quality in men.
• Poor Sleep: Disrupts circadian rhythms and hormone production—especially melatonin and progesterone, as well as testosterone in men.
• Toxin Exposure: Pesticides, BPA, phthalates, and heavy metals mimic hormones and disrupt endocrine balance. There is also data out there that exposure to plastics in clothing also act as fertility disruptors, creating changes in electrical and magnetic signaling that negatively impact ovarian function and sperm quality. Look for clothing that is free of plastics, PUFAs, and other synthetics.
• Nutrient-Deficient Diets: Low-fat, high-sugar, or overly restrictive diets destroy hormone production and egg quality. Our ultra-processed modern diet is void of nutrients despite being rich in processed carbohydrates and seed oils. In fact, both simple carbs and seed oils have been proven to negatively impact fertility. Aim to include high-quality animal proteins and fats as well as organic, darkly colored fruits and vegetables like berries and leafy greens. I also recommend a daily carrot salad for hormone balance.
• Overtraining/Under-Eating: Particularly common in driven, Type A women, this leads to hypothalamic amenorrhea, where the brain shuts down ovulation entirely.
• Alcohol, Caffeine, and Smoking: All three impair egg quality, sperm health, and hormone balance. I recommend avoiding all three if you’re TTC.

A note about these lifestyle factors: These foundational elements are pretty universal amongst articles describing methods for how to naturally increase fertility. Because they’re so ubiquitous, it may seem tempting to overlook them in search of something more direct, more exclusive, or more granular. While I do offer such recommendations below, I want you to know that lifestyle is the single most important factor in fertility as well as in health as a whole. It will do you no good to look to supplements or anything else for how to naturally increase fertility while overlooking the lifestyle. There is no supplements, and honestly no drug, that can undo the effects of poor sleep, high stress, toxin exposure, calorie deficits, substance abuse, and a poor diet.

How to Naturally Increase Fertility by Identifying the Root Cause of Fertility Disorders

To truly increase fertility naturally, you must identify why your body isn’t conceiving. Here are the most common root-cause conditions that sabotage fertility:

1. Thyroid Disorders

Low thyroid function (hypothyroidism) decreases progesterone, disrupts ovulation, and increases miscarriage risk. If your TSH is “normal” but you’re still tired, cold, or constipated—get a full thyroid panel. Subclinical hypothyroidism often flies under the radar. Hyperthyroidism, such as seen in Graves’ disease, also negatively impacts fertility. If you’re wondering how to increase fertility naturally, you should start by getting your thyroid thoroughly checked out.

2. PCOS (Polycystic Ovary Syndrome)

PCOS is an insulin-resistance and androgen-dominance issue. It impairs ovulation, leads to cystic ovaries, and causes irregular cycles. You must correct blood sugar dysregulation, reduce inflammation, and support hormone detoxification to restore ovulation.

3. Endometriosis

This inflammatory, estrogen-driven condition causes pelvic pain and infertility by distorting reproductive anatomy and disrupting implantation. Gut health, immune balance, and estrogen metabolism must be addressed aggressively.

4. Hypothalamic Amenorrhea

This is the brain pulling the emergency brake on fertility due to perceived stress or lack of energy availability. It’s common in athletes, perfectionists, and under-eaters. Recovery requires restoring adequate caloric intake, body fat, and nervous system calm.

5. HPA Axis Dysfunction (Adrenal Fatigue)

The hypothalamic-pituitary-adrenal axis controls the stress response. When it’s dysregulated, it suppresses reproductive hormones. You must rewire the stress response through nervous system regulation, sleep, and adrenal support to restore fertility.

How to Naturally Increase Fertility with Supplements

Certain nutrients powerfully support reproductive function. Many of these are key players in my practice for optimizing fertility:

• Myo-Inositol: Improves insulin sensitivity and ovulatory function—especially critical for PCOS.
• CoQ10 (Ubiquinol): Enhances mitochondrial function in eggs and sperm, improving quality and developmental potential.
• Omega-3 Fatty Acids: Reduce inflammation and support hormone production.
• Methylated B Vitamins (especially B9/Folate): Crucial for methylation, egg health, and preventing neural tube defects.
• Magnesium: Calms the nervous system, supports adrenal function, and improves sleep—all essential for fertility.
• Vitamin D3: Regulates hormone production and immune balance. Low levels are directly linked to infertility and miscarriage.

How to Naturally Increase Fertility by Looking at the Whole Body

Your uterus does not operate in a vacuum. Fertility is the result of systemic harmony, not isolated hormonal tweaks. Here’s how the entire body affects your ability to conceive:

Brain & Nervous System

The hypothalamus and pituitary gland orchestrate your reproductive cycle. Chronic stress rewires your brain to shut down reproduction. Nervous system regulation—via breathwork, somatic practices, and trauma healing—is fertility medicine.

Gut Health

The gut regulates nutrient absorption, immune response, and estrogen metabolism. Dysbiosis, leaky gut, or SIBO drive inflammation and hormone imbalance. Heal the gut, and you lay the groundwork for conception.

Liver Function

The liver detoxifies excess estrogen and metabolizes hormones. A sluggish liver leads to estrogen dominance, PMS, and ovulatory issues. Support with cruciferous vegetables, dandelion root, NAC, and targeted herbs.

Blood Flow

Pelvic blood flow is essential for ovarian and uterine health. Sedentary lifestyle, poor circulation, and inflammation impair oxygen and nutrient delivery to reproductive organs. Movement, dry brushing, acupuncture, and castor oil packs all enhance circulation.

Musculoskeletal System

Tension in the pelvis, scar tissue, or misalignment in the spine can block blood flow and nerve signaling. Bodywork (chiropractic, craniosacral therapy, pelvic floor therapy) helps clear the path for conception.

Lymphatic System

The lymphatic system clears cellular waste and toxins. A stagnant lymph system clogs hormone pathways and raises inflammation. Rebounding, sauna, hydration, and manual lymph drainage support this overlooked detox pathway.

Final Thoughts: Fertility Is a Barometer of Health

To naturally increase fertility, you must stop chasing hormones and start chasing health. When your body feels safe, nourished, and in balance—it will create life. This isn’t theory. I’ve seen it happen over and over with patients who were told their only option was IVF.

Natural fertility is not luck. It’s the result of uncovering root causes, supporting the body as a whole, and restoring biological wisdom. Your body is not broken. It’s communicating.

You just need to learn how to listen—and how to heal.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post How to Naturally Increase Fertility appeared first on Dr. Alexandra MacKillop.

For women in particular, one of the biggest reasons for hair loss on the top of the head relates to hormonal imbalances attributed to a condition called PCOS, which has four different subtypes. When I am working with a woman in a clinical setting, PCOS hair loss is often one of the most frustrating symptoms that she wants addressed as quickly as possible.

In this article, we will be discussing reasons for hair loss, how I evaluate for the causes of hair loss in my functional medicine practice, and how I help my patients reverse PCOS hair loss with natural treatment. We will also cover additional topics, such as how long it takes to reverse PCOS hair loss and whether or not the condition is likely to come back.

Diagnosing PCOS Hair Loss

The condition of hair loss itself is not hard to diagnose. In fact, it’s usually one of the easiest things to identify when a woman is experiencing it because you can see the evidence of it stuck t oyour clothing, clogging your vacuum or your shower drain, and strewn around your house. However, PCOS hair loss can also be insidious because it doesn’t always appear like patchy clumps of hair falling out. In fact, patchy hair loss of that nature is less likely to be related to PCOS and more likely to be related to another condition, like autoimmunity, nutritional deficiencies, or toxin exposure. Instead, PCOS hair loss tends to look more like thinning along the hair line and increased shedding overall.

One of the biggest challenges in diagnosing PCOS hair loss is differentiating the hair loss as specifically PCOS hair los as opposed to hair loss from other conditions. Keep in mind that not all women who have PCOS experience hair loss as a symptom. At the same time, a woman may have PCOS and also be experiencing hair loss due to other factors. Finally, a woman experiencing hair loss (and her doctor) may have suspicions of PCOS because of the hair loss, even though she might not have PCOS at all.

Treating PCOS hair loss means that a couple of things need to first be true: for one, she needs to have diagnosed PCOS and two, the hair loss needs to be because of the PCOS and not the result of other factors. Therefore, it’s important to conduct a thorough workup to make sure that other health conditions are not also at play. If those other health conditions are missed, treating the hair loss through the PCOS paradigm will result in the patient not getting better and maybe even worsening because of delayed diagnosis.

Reasons for hair loss apart from PCOS hair loss:

Here are some other common reasons that I see hair loss in my practice. Please keep in mind that this is not an exhaustive list, and it’s possible for a person to have more than one condition:

1. Hypothyroidism: Hormonal reasons are a big driver of hair loss, but those reasons are not always exclusive to reproductive hormones, such as PCOS hair loss. In fact, when I see a patient experiencing hair loss, my first thought actually is not PCOS, but rather a thyroid conditions. Hypothyroidism is more common among women with PCOS that among thos without it, and the thyroid is actually a big reason that my PCOS patients experience “PCOS hair loss” even though it’s truly driven by the thyroid.
2. Hashimoto’s and other autoimmunity: Hashimoto’s is one type of autoimmune condition, which is commonly responsible for causing hypothyroidism. However, I include it separately on this list because not all cases of hypothyroidism are caused by Hashimoto’s, and not all cases of Hashimoto’s end in hypothyroidism. Because Hashimoto’s involves an autoimmunt inflammatory response agains the thyroid and resultant thyroid damage, many people do end up developing hypothyroidism as a result of Hashimoto’s. However, the inflammation and self-reactivity associated with Hashimoto’s can also result in hair loss, even with normal thyroid function. Other autoimmune diseases such as inflammatory bowel disease (IBD), lupus, Sjogren’s syndrome, rheumatoid arthritis and others can also cause hair loss. Grave’s disease, which is an autoimmune thyroid condition associated with hyperthyroidism can also cause hair loss, all of which should be differentiated from PCOS hair loss.
3. Low Estrogen: Hair follicles don’t last forever. Instead, they experience a growth phase that can last several years and then they transition to a state of dormancy called the telogen phase, which lasts a few months before the follicle atrophies, dies and the hair falls out. Periods of low estrogen in women, such as those seen with hypothalamic amenorrhea, menopause, breastfeeding, and other health conditions shortens the growth phase of the hair, moving it into the telogen stage more quickly. PCOS is classically associated with excess estrogen, particularly when testosterone levels are very high, but other women experience low estrogen for other reasons, despite PCOS. In this case, the PCOS hair loss would be due to low estrogen levels rather than the high androgen levels.
4. Perimenopause: PCOS hair loss is classically understood to be caused by elevated testosterone levels, which cause atrophy of the hair follicles and shorten the growth phase. However, transient elevations in testosterone can also be caused by the early stages of perimenopause. While the causitive factor in the hair loss is the same (testosterone), high androgens in perimenopause that cause hair loss are not the same thing as true PCOS hair loss.
5. Nutrient deficiencies and restrictive dieting: Nutrient deficiencies cause hair loss because multiple micronutrients, like B vitamins, zinc, iron, vitamin C and countless others are essential for creating new hair (along with skin, nails, and maintaining function of the body’s organ systems.) In cases of significant nutrient deprivation, such as extreme dieting or chronic illness, nutrient deficiencies can develop which result in hair loss. (The nutrient deficiencies can also cause other health problems, like hypothyroidism, which contribute to hair loss as well.) It is also not uncommon for the ketogenic diet, vegan diets, and use of semaglutides like Ozempic to cause hair loss.
6. Post-COVID: Severe illness such as that seen from extreme cases of COVID-19 can also contribute to hair loss. The inflammation associated with the inflammatory response, or use of steroids in treatment, contribute to a shortening of the growth phase and resultant hair loss.
7. Inflammation: Apart from COVID-19, infections may trigger widespread inflammatory responses in the body that bring about similar changes to the hair follicles. These too need to be differentiated from PCOS hair loss, though keep in mind that blood sugar disorders including the insulin resistance seen in PCOS also contribute to hair loss.
8. Heavy metals and other toxicity: Heavy metals like arsenic, thallium, cadmium and mercury all contribute to hair loss by interfering with the mechanisms of hair growth. This causes weakening of the hairs themselves, increased breakage and early shedding. Thallium exposure is the most common heavy metal implicated in hair loss. Thallium exposure most typically comes from coal smelters, which release this toxin into the air, and it also becomes deposited in the soil and water. For this reason, it is essential to wash fruits and vegetables and use a high-quality water filter to ensure that what you are drinking is safe.
9. Hormonal birth control: Hormonal birth control is made from artificial progesterone, which tricks the body into not ovulating. This means that the body then is unable to produce natural progesterone, and progesterone deficiency also contributes to hair loss through a similar mechanism to low estrogen. At the same time, some types of these artificial progesterones are derived from testosterone and share characteristics to the hormone testosterone. In PCOS hair loss, testosterone receptors in the hair follicles respond to signaling from testosterone and cause atrophy of the follicles and resultant hair shedding. The artifical progesterones, derived from testosterone in the hormonal ocntraceptives, have a similar effect when they bind to testosterone receptors, causing a similar mechanism of hair loss as seen in PCOS hair loss.
10. Stress: High stress increases adrenal responses, which affect blood flow to the hair follicles. They also result in increased production of androgenic stress hormones which affect hair follicles similarly to high testosterone levels in PCOS hair loss. High stress can also induce an adrenal form of PCOS and contribute to PCOS hair loss through that mechanism.
11. Certain medications: like chemotherapy drugs which notoriously cause hair loss, use of steroid medications, antidepressants such as fluoxetine (Prozac) and lithium, blood pressure medications like ACE inhibitors, blood thinners, seizure medications, and Accutane can cause hair loss on the top of hte head, which need to be distinguished from PCOS hair loss. Many women with PCOS are taking these medications and don’t realize that their hair loss results from the medications instead of being the specific symptom of PCOS hair loss.
12. Eczema, fungal infections and other skin disorders: Inflammatory and infectious skin conditions can create inflamation that is pervasive enough to reach the hair follicles themselves. This inflammation and reactivity damages hair follicles and can cause weakness, breakage, shedding and hair loss. PCOS and the accompanying blood sugar imbalances increase risk of developing fungal infections like candida, including infections on the scalp, which can contribute to hair loss but should be differentiated from true PCOS hair loss.
13. Childbirth: During pregnancy, the body lengthens the telogen stage of hairs. This means that hairs which would ordinarily reach the end of the growth and telogen stages and fall out instead do not. They remain in the telogen stage, not growing necessarily but not falling out either. Then, after the baby is born and the hormone and immune system shift, the hairs finally fall out, all at once. For some women, this effect is delayed until breastfeeding ceases, or until periods return. In women with PCOS, return to menstruation can take much longer and women may incorrectly believe the hair loss is due to PCOS hair loss because so much time has elapsed since childbirth. This is why accurate testing and clinical workup are important for making a diganosis.
14. Hair treatments: Use of hair dye, particularly hair treatments containing bleach, chemical straightening products, and heat treatments like hair dryers, flat irons, curling irons, and even washing hair in very hot water all cause dryness and damage to the hair itself. This weakens the hairs, increasing breakage and making it more difficult for hair to grow long. This can look like hair loss, especially when the breakage occurs close to the scalp. Hair breakage can also be increased with aggressive hair brushing techniques, tight ponytails and hair styles involving the hair pulled back, frequently wearing hats and barrets, sticky elastics or clips can also pull and snap hairs.

PCOS Hair Loss

The “true form” of PCOS hair loss results from elevated androgen levels. However, keep in mind that the condition of PCOS can also contribute to hair loss as mediated through inflammatory changes, blood sugar problems, and changes in other hormone levels. However, when we are talking about the effect of PCOS in causing hair loss, we are referring to the form of PCOS hair loss that is caused by elevated androgen levels.

As I touched on earlier, elevated androgen levels induce a process called “follicular miniaturization,” in which the high androgens bind to testosterone receptors in the hair follicles, causing them the atrophy and break down. The result is thinner hairs, weaker hairs, and eventual death of hte hair follicles. This leads to not only increased hair shedding but fewer healthy and functional hair follicles in general.

Treatment for PCOS Hair Loss

When the hair loss has been proven to be truly the result of high androgens in PCOS, treatment is necessary in order to slow the progression of the condition. Because of the mechanism of testosterone in PCOS hair loss, treatment necessitates strategies for reducing androgens, increasing blood flow to the scalp to restore follicle function, and providing increased nutrients to allow the hair follicles to remain healthy and grow health hair.

In my functional medicine practice, I treat the different types of PCOS differently. Understanding what is driving the high testosterone levels is imperative for lowering them. So, we always start there. However, there is good evidence that the following strategies are also implicated in reversing the testosterone-associated changes that take place in PCOS hair loss:

1. Spearmint Tea: In PCOS hair loss, testosterone converts into a highly androgenic hormone derivative called DHT. Spearmint tea, particularly when enough is consumed, reduces the conversion of testosterone into this highly androgenic form which damages hair follicles. The research shows that drinking at least two cups of tea daily is needed to see effects. I recommend always drinking organic, looseleaf tea to reduce exposure to toxins.
2. Zinc: Similar to spearmint, zinc has been shown to reduce converstion of testosterone to DHT. It also reduces the responsiveness of testosterone receptors in the hair follicles of themselves so that the androgens have less of an effect in causing PCOS hair loss. It’s important to note that the effects of zinc supplementation in PCOS hair loss are not simply the result of correcting zinc deficiency, though many people are unknowingly deficient in zinc. Instead, the supplementation improves PCOS hair loss regardless of deficiency. However, it is possible to overdose on zinc, so it is important not to exceed supplementation past 80 mg daily, and to be mindful of the fact that excess zinc supplementation can create copper deficiency, which may also cause hair loss. In my practice, I recommend starting with 30 mg of zinc bisglycinate or zinc picolinate which are superiorly absorbed compared to other forms.
3. Saw Palmetto: Like spearmint, saw palmetto reduces the conversion of testosterone into DHT via the enzyme 5-alpha reductase. For this reason, it’s not necessary to supplement with both of them in order to control hair loss. Instead, I usually start my patients on one or the other. However, different people respond differently to them, so sometimes we prefer to use multiple strategies on the front end and cut back. Because of the timeline required to control PCOS hair loss, this solution is appealing to some patients.
4. Green Tea: Whereas saw palmetto and spearmint reduce conversion of testosterone to DHT, green tea reduces androgen levels in general. This is important because hair follicles are not the only part of the body impacted by the high androgen levels. Green tea is therefore a good solution because of its ability to treat PCOS, instead of focusing primarily on PCOS hair loss.
5. Red Reishi: This adaptogen funcitons similarly to saw palmetto and spearmint in blocking the 5-alpha reductase enzyme. However, being an adaptogen, it also provides other benefits to the body, particularly in improving the stress response, supporting the immune system, and reducing inflammation. I am inclined to prescribe this to patients when they are dealing with an inflammatory or adrenal form of PCOS, or if they have co-occurring health conditions such as those listed earlier.
6. Topical Rosemary Oil: Rosemary oil has components that block DHT, like many of the herbs listed above. However, the difference is that rosemary oil is applied topically to the scalp and massaged in, instead of taken orally. This allows more direct access to the hair follicles. It also contains compounds that stimulate the hair follicles to increase growth, and antioxidants that reduce the effects of other factors on causing damage to the hair follicles, in addition to the androgens in PCOS hair loss. Finally, topicaly application and massage stimulate blood flow which brings nutrition and oxygen, supporting the health of the follicles. I recommend applying a small amount of rosemary oil directly to the scalp, massaging for about 15 minutes, resting for another 15 minutes to absorb and then washing out. Be mindful that oils such as these may cause the hair to appear greasy, so be mindful when washing.
7. Red Light Therapy: Near infrared and red light laser therapy have excellent research to back up use for promoting hair growtih and slowing hair loss, regardless of cause. This form of light stimulates cells called fibroblasts, which produce hair growth factors and increase blood flow. The result is thicker hairs that grow more quickly, and even reversal of some of the atrophy-related changes in PCOS hair loss. Red light therapy is a great option for PCOS hair loss because it doesn’t require you to take a pill, and the devices used to administer red light therapy can be used for other applications as well. I personally use the NovaaLab red light laser, and this is what I recommend as well. If you want to use the NovaaLab laser and save 10%, use the following code(s) to get started:
   • NovaaLab Red Light Laser for targeted laser spot treatment (more potent)
   • NovaaLab Deep Healing Pad which can more easily be used to apply red light treatment to the whole head at once

How long does it take to heal PCOS hair loss?

Because PCOS hair loss so profoundly affects a person’s quality of life, one of the most pressing quesitons my patients have is how long it will take to heal the condition. PCOS itself is complicated, but the nature of how hair grows and falls out in the first place is even more so. Recall from our discussion above that PCOS hair loss comes from the effects of androgens, which cause atrophy of hair follicles that weaken the strands and death of the follciles themselves. The hormons also shorten the growth phase, and send the hair follicles into the telogen phase more quickly. The telogen stage lasts several months (often around 3) before the hairs fall out.

Treating PCOS hair loss at the root cause itself takes several months. Lowering androgens and lowering production of DHT can take several months, sometimes up to 6, to even start to see changes. Then, once the androgen levels change, the hair follicles themselves take time to heal. Once that happens, there’s still then a delay because of the telogen stage, of around 3 months. After that, we then need even more time to start to see hair regrowth.

Because of these complexities, starting to see changes in PCOS hair loss sometimes take up to a year or more. This will happen more quickly if PCOS has not been a problem for as long, because the longer the hair follicles have been exposed to the testosterone, the more time they will need to heal. It’s also going to take longer if other problems are also at play, such as those seen in the first list, like nutrient deficiencies, toxin exposure, or inflammatory conditions.

Among all the treatments outlined above for PCOS hair loss, I want to share that red light laser therapy produces changes the fastest. This is because rather than waiting for hormone levels to drop, the high-intensity laser directly reverses the effects of testosterone at the level of the hair follicles. This leads to faster healing while the additional time is taken to address the hormonal imbalances that cause PCOS hair loss. Remember, however, that because of the telogen stage of hair, even with red light laser therapy, it will require a minimum of 3 months to start to see changes in hair loss. Hair loss you’re experiencing right now is the result of the chemical state of your body at least three months in the past.

Overall, PCOS hair loss treatment is challenging and takes a long time, but that doesn’t mean it’s impossible, and it doesn’t mean you should give up hope. The fastest and most effective way to help PCOS hair loss is to make sure that you have the right diagnosis (and aren’t missing anything), and to treat the underlying root cause of the PCOS hair loss (high androgens) so that it doesn’t return in the future.

Healing takes time, and there are no quick fixes. Because of the time requirements, remember that there are no drugs or medications that can produce changes faster, so natural treatment really is your best bet. Be patient, have grace on yourself, and do the next right thing!

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Understanding and Reversing PCOS Hair Loss appeared first on Dr. Alexandra MacKillop.

My patients share this nearly famous quote from their primary care providers all the time. That’s how they end up in my office, of course. Because they’re not fine. They feel terrible, with their hair falling out, gaining weight for no reason, freezing all the time, debilitating fatigue, brain fog. They look and act like a walking, breathing hypothyroidism textbook and yet…their other doctors say they’re “normal.”

What gives?

As a functional medicine doctor, thyroid disease is one of the main problems I treat in my office. While some patients walk in already knowing they have a problem and what it is (they’re looking to slow progression of their condition, or treat it without prescription medication), the majority have never gotten a diagnosis to finally explain their symptoms and start treating them at the root cause.

Why do thyroid problems so frequently go undiagnosed?

In my experience, there are typically three (categories of) reasons that my patients fail to receive an accurate diagnosis for their symptoms when they see other doctors. These are the three reasons that they might get told they’re fine when, in reality, they are struggling with thyroid disease. They might be told it’s in their head or (gasp!) probably perimenopause because, as if they didn’t realize it already, “You’re in your 40’s now…”

In my opinion, making an accurate diagnosis is not hard. Sure, the years of schooling that teach healthcare providers how to screen for all these different conditions and what they mean can be very challenging indeed. But, once you know the information, you just need to do the thing.

So, without further ado, here are the three reasons that my patients receive a misdiagnosis or have a missed diagnosis of a thyroid condition:

1. They’re not running comprehensive enough tests

This might sound obvious, but if you don’t test your thyroid you’re never going to accurately confirm a thyroid problem.

Unfortunately, most doctors don’t actually test thyroid function on screening labs. Sure, they run Thyroid-Stimulating Hormone (TSH) but fail to acknowledge that TSH does not actually test thyroid function.

TSH is a hormone the brain makes to tell the thyroid what to do. The thyroid is then, in turn, supposed to produce T3 and T4, which are the main thyroid hormones. The liver is supposed to make proteins called thyroid-binding globulins to carry these hormones through the blood stream to tissues, acting as a reservoir for these important hormones. The tissues themselves (gut, liver) are supposed to conver T4 into T3 as needed, per-diem to run metabolic functions in cells.

All of these functions are testable. Yet, most healthcare providers don’t test them.

Why?

They fail to recognize that TSH isn’t the full picture. Our brains are smart, but they’re even smarter than we give them credit for. Meaning, on account of other cellular processes going on in the body, the brain might be perfectly fine with an underfunctioning thyroid, thank-you-very-much, and carry on its normative signaling despite underfunctioning of our main metabolic regulator.

If you don’t test the full thyroid panel, you don’t get the full information. And if you don’t have full information, you can’t rightfully rule in, or out, a thyroid condition.

There are seven different main patterns for hypothyroidism, and I explain them all in my post titled: The Root Cause of Hypothyroidism. Check if out if you are curious what might be going on behind the scenes.

If you aren’t working with a functional medicine doctor, I’d encourage you to ask your PCP to run the full list of tests for you.

2. They don’t test frequently enough

You don’t need a medical degree to know that our metabolic needs when we’re sleeping differ dramatically form when we’re running a marathon. We also have different metabolic needs when we are resting versus when we are stressed. Our thyroid needs likewise differ when we’re sick, when we’re tired, when it’s winter versus summer, and according to the menstrual cycle. In fact, TSH levels on blood work even differ throughout the day! (They’re typically highest in the morning.)

If you’re concerned you have hypothyroidism, your doctor is going to be looking for an elevated TSH level. Remember that TSH is thyroid-stimulating hormone, meaning it’s released in order to stimulate the thyroid’s production of thyroid hormone. If the thyroid is under functioning, the brain will send a stronger and stronger signal to get the thyroid to pick up the pace, akin to an angry boss yelling at a lazy employee.

In many cases of hypothyroidism, the deficiency is subtle, with the TSH level only sometimes exceeding the reference range, typically only in the morning when TSH levels are highest. (That is, not to mention, that many labs and subseqently, many physicians, use a reference range that is far too broad; but that’s a different post for a different time.)

So, if you only test TSH (which most physicians do) and only test it once per year (which is the current standard “screen”) and don’t remind patients to remain off biotin supplements (which many physicians forget about) and don’t require a morning, fasted draw (which most don’t) then there is a good chance you will miss the elevated TSH level and your doctor will wrongly tell you that your thyroid is “normal” when it ism in fact, not.

But of course, you knew that, because your symptoms and intuition are hard to ignore.

3. They forget about the immune system

The most common cause of hypothyroidism is an autoimmune condition called Hashimoto’s Disease. But, here’s the thing: you can have Hashimoto’s and not yet have hypothyroidism.

Hashimoto’s as an autoimmune disease means that a person’s immune system is wrongly attacking their thyroid. The immune system is supposed to produce antibodies aimed at fighting off infections, like COVID or Epstein-Barr virus, or strep throat. But, with Hashimoto’s, the immune system instead starts making antibodies against thyroid tissue, called anti-thyroperoxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies.

The result is thyroid inflammation and evnetual thyroid tissue destruction, accompanied by all the immune symptoms that make you feel sick, like fatigue, brain fog, joint pain, hair loss, depression and…do I sound like I’m describing hypothyoridism yet?

Remember that TSH does not screen for Hashimoto’s Disease, yet Hashimoto’s Disease is the number one cause of hypothyroidism. Also keep in mind that while Hashimoto’s Disease often leads to destruction of the thyroid gland and eventual resulting hypothyoridism, it doesn’t always; but it still produces symptoms of its own accord that notoriously accompany hypothyroidism. Because of these symptoms, Hashimoto’s sufferers often feel too unwell to exercise, or eat well and likewise gain weight just as they would with full blown Hashimoto’s hypothyroidism.

Maybe you’ve already been tested for Hashimoto’s and told you don’t have it, but your symptoms are so suspicious that you’re not sure you believe the diagnosis. Of course, it’s possible that you don’t have Hashimoto’s or other thyroid disease, and you need to keep advocating for yourself and digging to find that answer.

But then again, remember this: most people with Hashimoto’s weren’t born with it. Rather, they were born with a genetic predisposition that was triggered by something, such as Epstein-Barr virus, COVID, gluten sensitivity, or, notoriously, hormonal and immune shifts such as those seen in puberty, pregnancy, postpartum and perimenopause. This means that even if you were previously tested for Hashimoto’s and the result was negative, that may have changed at some point throughout your life. My own doctor even incorrectly told me that if the antibodies are negative, they’re negative and there’s no point in retesting. I’m grateful that I had the knowledge to advocate for myself and get the appropriate lab work.

I want that for you, too.

So, friends, remember that you are the one who knows your health best. If something feels off, it definitely is; it’s just a matter of testing for it. (And that means running the right tests, running them frequently enough, and remembering to be comprehensive!)

I hope this helps you to get the best posible healthcare. You deserve it!

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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The post Did Your Doctor Say Your Thyroid Is Fine (Three Reasons for a Missed Diagnosis) appeared first on Dr. Alexandra MacKillop.

It wasn’t the usual type of sore throat, on the inside by my tonsils and tongue. Instead, it felt like a big sore lump at the front of my neck. It was tender to the touch (especially when his little meandering hand would accidentally bump it when we were nursing.) The sides of my neck were painful too, and when I’d tuck my chin at night, there was a sense of uncomfortable pressure. 

Looking in the mirror, the change was subtle. I don’t think I’d have noticed it otherwise because having a baby made it difficult to spend much time examining my reflection. I honestly thought it was just residual soreness in my neck from being hunched over while rocking my son to sleep. But one night, I was so frustrated by the discomfort that I flipped on the light in the bathroom and took a closer look. The bottom of my neck, under my cricoid cartilage (or as I jokingly call it, my “Eve’s apple”), there was some swelling. Where I normally could see my neck tendons extend all the way from my chin to my chest, their outline was obscured partly at the base of my throat from my inflamed thyroid. 

I knew right away what was going on. I had thyroiditis, an increasingly common postpartum health issue. 

The thing is, none of my healthcare providers had ever warned me about it. Instead, I knew what was going on because I’d learned about it in school and had actually treated a number of my own patients for it. In fact, it affects up to 8 out of every 100 pregnancies. 

Identifying Thyroid Disorders

Conventional medicine likes to break up our health into different systems. We see cardiologists for heart problems and GI doctors for poor digestion. We have endocrinologists and gynecologists and urologists. In some ways this is a good thing, because we end up with providers who really know their respective systems well. But on the downside, we lose sight of the fact that the systems of our bodies are all closely connected to each other. This is especially true with hormones, including reproductive hormones, thyroid hormones, and stress hormones. We even have a special name for this connection called the hypothalamic-pituitary-adrenal-thyroid-gonadal axis, or HPATG axis for short. The main takeaway of all this (for the purpose of our current conversation) is the fact that when one category of hormones changes, it affects all the other hormones too.

I often liken pregnancy to going through puberty in 10 months, and childbirth to going through puberty overnight. The hormonal shifts are enormous and extremely fast. For some reason, the body sometimes has a hard time leveling off after the rapid changes along one axis of the HPATG web (reproductive hormones), and the thyroid or adrenal glands end up suffering as a result. Some women even end up developing autoimmune problems because of this, if they have a genetic predisposition. 

Fortunately, I already had the anti-inflammatory herbs and supplements I knew I needed on hand and started taking them right away. Then, I hurried off to get my labs drawn as soon as the order was placed. I was extremely relieved that there were no signs of Hashimoto’s, an autoimmune condition which happens to be the #1 cause of hypothyroidism in women. I’m grateful that my thyroiditis quickly resolved and didn’t become a chronic issue, as is the case with autoimmunity, and that it responded well to postpartum thyroiditis natural treatment.

How I Treated My Postpartum Thyroiditis

Thyroiditis in pregnant and breastfeeding women should be treated differently than thyroiditis in the general population for two key reasons:

• The root cause is different (in most cases, hormonal and immunological shifts drive thyroiditis in the perinatal period, which isn’t always the case in other populations)
• The herbs and supplements that may be used to ordinarily treat thyroiditis aren’t all safe in pregnant or breastfeeding women. (I tend to observe pregnancy-safe guidelines for breastfeeding women)

Here’s the Postpartum Thyroiditis Natural Treatment Strategy that I used:

1. Fish Oil

I was already taking 2,000 mg of cod liver oil daily and for 1 week, I increased the amount I was taking to 4,000 mg. The omega-3 fatty acids in cod liver oil are very anti-inflammatory, which is a key factor in moderating the inflammation that drives thyroiditis.

It’s important to note that not all fish oils are safe during pregnancy due to vitamin A content and risk for contamination with heavy metals. Fish oil can also increase risk of bleeding disorders and can interact with some medications, so check with your doctor before changing your fish oil routine or starting any of the other supplements I describe.

2. Probiotics

The liver and GI system are responsible for detoxifying hormones, and there’s a lot of detox that goes on in the postpartum period. In the third trimester, estrogen levels are six times higher than pre-pregnancy levels, and they dip even lower for breastfeeding women. That’s a lot of transition in a short time, which means a lot of work for the GI system.

The ability of the body to detoxify these old, ‘used’ hormones depends largely on the microbiome. This subset of bacteria is appropriately termed the ‘estrobolome’ for its function in clearing out old estrogen compounds. A buildup of estrogen byproducts can contribute the the hormonal storm that drives thyroiditis, so I started taking a probiotics with a wide variety of strains in addition to my prenatal probiotic to help support the diversity of my gut and its ability to detoxify estrogen.

3. N-Acetyl Cysteine

A chemical called glutathione is one of the body’s main weapons against oxidative stress and inflammation, and supplementing with it is very effective in treating conditions related to oxidative stress such as thyroiditis. However, there isn’t a lot of data regarding its use in pregnancy or during breastfeeding.

N-Acetyl Cysteine, on the other hand, has the effect of bolstering up the body’s own stores of glutathione, creating the same antioxidant effect without the potential risks of taking oral glutathione. NAC has been shown to be both safe and effective during pregnancy/breastfeeding. I took a dose of 1,200 mg for 14 days, then reduced the dosage to 600 mg.

4. Vitamin C

Vitamin C plays an important role in helping the body recycle its glutathione stores. I took 2,000 mg of Vitamin C daily in the form of chewable tablets for 1 month.

5. Rest, water, calories, nutrients…

Possibly the most important of all was getting back to the basics of self-care. During this time, I cut back on my daily walking and spent more time resting in bed with my baby, focusing on conserving energy and allowing my body to heal. I also paid extra attention to my water intake, focused on getting plenty of meals and snacks to keep my calories up (and avoid putting my body under even more stress) and made sure to eat plenty of nutrient-dense foods like organic butter, grass fed red meat, berries and leafy greens.

I count myself very lucky not only because I recovered quickly, but because I had access to the information I needed to start taking steps right away. So many providers never talk to their patients about the risk of thyroid problems after childbirth, so they end up going undiagnosed for a long time. That’s because not every case of thyroiditis presents with neck pain like mine did. Other symptoms can include weight gain (which gets blamed on pregnancy or “baby weight”), hair loss (again, blamed on “postpartum hormones”), extreme fatigue (“it’s just because you aren’t getting as much sleep”), constipation (“here, take a stool softener…”), depression (postpartum depression is a thing, but so is hypothyroidism), dry skin, feeling cold, a puffy face, muscle weakness, joint pain, brain fog and more. 

Other Strategies for Postpartum Thyroiditis Natural Treatment

There are more strategies available for treating postpartum thyroiditis than just what I used. Here are some other, breastfeeding-safe postpartum thyroiditis natural treatment strategies that I often use in my practice when treating postpartum mamas.

Selenium

Selenium supplementation (200 μg daily) during pregnancy and postpartum in thyroid peroxidase antibody-positive women significantly reduces the incidence of postpartum thyroid dysfunction. My go-to prescription for patients is in the form of selenomethionine.

Vitamin D

In women with established postpartum thyroiditis receiving levothyroxine, vitamin D supplementation (2000-4000 IU daily based on baseline levels) reduces thyroid peroxidase antibody titers over 3 months, with stronger effects in those with vitamin D deficiency

Gluten-Free Diet

If a patient tests positive for thyroid antibodies, the research shows strong support for following a gluten-free diet as as a treatment strategy. Many, if not most, cases of postpartum thyroiditis include an autoimmune component, demonstrated by positive results for anti-thyroglobulin and/or anti-thyroperoxidase antibodies. In these cases, the recommendation would be to follow a gluten-free diet strictly, and for the rest of the patient’s life.

What to Do if You Think You Have Postpartum Thyroiditis

If you suspect that something is running amok with your thyroid, get tested! The sooner a diagnosis is made, the sooner you can start doing something to improve your health. However, keep in mind that it’s not a good idea to just assume you have a problem with your thyroid and treat it on your own. Even if you are 100% correct that your thyroid isn’t functioning well, it’s important to discern whether or not there’s an underlying autoimmune problem because the problem should be addressed differently if there is. Failing to acknowledge autoimmunity can make the problem even worse. (Autoimmune thyroiditis is the most common type of thyroid problem. Click here to learn more about the different types of hypothyroidism.)

• Ask your doctor for a comprehensive blood test including the following: TSH, free and total T3, free and total T4, reverse T3, throxine-binding globulin, anti-Tg antibodies, and anti-TPO antibodies. Ask for nutrient panels too, including vitamin D, zinc, selenium, iodine, and omega-3’s
• Support your microbiome by consuming 30 different types of plants weekly (remember that nuts, whole grains, seeds, legumes, fruits and vegetables all ‘count’ as plants)
• Regularly consume wild-caught fatty fish like salmon to maintain healthy omega-3 levels
• Make sure you get enough sleep, ideally 8-10 hours per night in the winter
• For personalized care, make an appointment with a functional medicine physician who can help you in identifying the root cause of your health concerns and support the optimal function of all your body’s systems. If it’s not your thyroid, it’s something else, and you deserve to have it addressed so you can feel your best!

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Postpartum Thyroiditis Natural Treatment appeared first on Dr. Alexandra MacKillop.

“Okay, okay, hypothalamo-whatta-whatta?“

If that’s what you’re thinking, you’re in good company. The hypothalamic-pituitary-adrenal-thyroid-gonadal axis is quite the tongue twister. But don’t worry, it sounds more confusing and overwhelming than it is. In short, the HPATG-Axis is the system of hormone balance in our bodies. To understand how to balance hormones naturally, we need to first understand what hormone balance looks like through this great, big web of connections.

In a nutshell, the HPATG-Axis phrase refers to is the fact that a part of our brain called the hypothalamus communicates with our adrenal glands, thyroid, and ovaries (aka gonads) through a series of hormones produced by the pituitary gland (also located in our brain). In physiology, we often talk about those interactions separately, referring to them as the hypothalamic-pituitary-adrenal axis, or the hypothalamic-pituitary-thyroid axis. But in reality, they’re all connected, and this post will explain everything you ever wanted to know about how and why. (Okay, maybe not everything, but the basics…)

The HPATG Axis (AKA Endocrine Axis)

HPATG physiology can basically be summed up like this: the hypothalamus talks to our pituitary gland using hormonal signals, telling the pituitary gland when and how to stimulate our thyroid, our adrenal glands, and our ovaries. All of those glands send hormonal messages back to our brain with information about how much activity is going on, and whether or not there are any problems. In response, the brain tells the body to amp up activity in each of those sites, or tone it down. This is called a negative feedback loop.

When we face periods of stress (or rather, when we face too much stress for too long), our HPATG axis is completely intercepted. This is where we can run into imbalances in our thyroid hormones (such as hyperthyroidism or hypothyroidism), adrenal hormones (such as “adrenal fatigue”), or fertility problems, (such as hypothalamic amenorrhea). These problems can occur one at a time, or all at once, leading someone to feel really sick, and probably also really confused! Stress is a biggie when it comes to a properly functioning HPATG axis. In most cases, if you’re wondering how to balance hormones naturally, we need to start by addressing stress because stress is the single most powerful influence over the HPATG axis.

Stress and Stress Management

When we think about stress, we typically think about the psychological or emotional—deadlines at work, an overly packed schedule, a bad breakup, or a death in the family. But stress comes in many forms, and can even be triggered by good life events…

• Under eating (not enough calories or carbs)
• Nutritional deficiencies
• A significant/sudden change in diet/eating habits (especially yo-yo dieting)
• Over exercising (or a sudden change in the type of exercise)
• Lack of sleep or change in sleep schedule (i.e. night shift)
• Illness or injury (including surgery)
• Travel (even if it’s fun!)
• Moving
• Starting a new job or educational program
• Getting married
• Certain medications, or drug use
• Depression or anxiety
• Emotional distress (like the loss of a loved one)
• Psychological distress (like work deadlines or studying for exams)

Many of these things are normal parts of life, and when we are following a pattern of self care, our bodies are able to accommodate the stressors without falling into dysfunction. But when our self-care routine falls out of balance (or we begin struggling with disordered eating) we detract from the foundation of health. When that happens, everything else starts to crumble. One of my favorite ways to explain this relationship between stress and self-care is the bucket analogy:

Self-care fills our bucket, but stress drains our resources. When the bucket gets low, we start to notice symptoms of burnout. When the bucket gets empty, it leads to hormonal disaster, interrupting our whole HPATG axis at a biochemical level in our brains (big red stress arrow on the infographic at the top of this post). Ultimately, learning how to balance hormones naturally means learning how to identify and cope with the small, daily stressors in our lives.

Dysfunction, one axis at a time

The reason we often talk about the HPATG axis in terms of its separate components (HPA, HPT, HPG axes) is because unilateral dysfunction is common. For example, an autoimmune disease called Hashimoto’s Thyroiditis can lead to destruction of the tissue of the thyroid gland and subsequent hypothyroidism. When this happens, the thyroid loses its ability to produce thyroid hormone. When the pituitary gland realizes that thyroid hormone levels are so low, it amps up its secretion of thyroid-stimulating hormone in an attempt to tell the thyroid to do a better job. The problem is, the thyroid itself has been damaged—it can’t do its job until the autoimmune reaction is addressed. (Here’s where stress pops up again: if you’re wondering how to balance hormones naturally in terms of your thyroid hormones, you still need to pay attention to the stress piece because stress is one of the primary drivers of autoimmune disease.)

Low levels of thyroid hormone create a further stress response in the body, signaling back to the brain that something’s off. This consequently affects the signaling between the pituitary gland and the adrenals/ovaries as the body tries to balance things out. Low levels of thyroid hormone, for example, creates a dangerous environment for a growing baby, and so the reproductive system is one of the first to get shut down (via the HPATG axis). On the other hand, pregnancy causes the body to re-prioritize its hormonal resources. When a woman is pregnant, the body needs different levels of thyroid hormone, cortisol, and other hormones to carry the pregnancy to full-term. These body signals these changes through the same negative feedback loop. (All of this takes place without us ever having to think about it. You’ve got to admit, God’s design is pretty amazing!)

The HPATG Axis and Healthcare

When a patient complains of problems like fatigue, weight gain or weight loss, thinning hair, or irregular periods (just to name a few), the solution is never as simple as writing a prescription for birth control pills or Synthroid. There’s always more to the story, and that’s why its so important to identify the root cause of the problem when considering how to balance hormones naturally. In my practice, I do this primarily by talking with my patients in detail about their health history, and taking a closer look at the lab work. From a functional medicine perspective, it’s never safe to assume that the other components of the HPATG axis are functioning properly, even if we’ve already identified that one of them is out of sync. That’s why holistic healthcare means addressing the whole person, and not just using a symptom-by-symptom, band-aid approach.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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The post How to Balance Hormones Naturally (Understanding the HPATG Axis) appeared first on Dr. Alexandra MacKillop.

One of the most common questions I get as a functional medicine doctor is how to treat hypothyroidism naturally. This question is understandable because for one, hypothyroidism is becoming extremely common. And for those affected by it, unfortunately the only option offered from a primary care doctor is synthetic thyroid hormone replacement therapy, levothyroxine (Synthroid). But what this generic prescription misses is the fact that no two cases of hypothyroidism are exactly the same. Therefore, there’s no straightforward answer for how to treat hypothyroidism naturally. In order to treat it, you need to first understand the root cause of hypothyroidism.

In the world of functional medicine, we categorize “hypothyroidism” in seven different ways. In a traditional doctor’s office, that isn’t the case, which leads to the multitude of diverse and unique patient cases getting treated exactly the same. (Read: hormone replacement therapy) For those with primary hypothyroidism, AKA “underactive thyroid,” or a thyroid that just isn’t doing its job of producing adequate hormone, replacement therapy is appropriate. But what if the reason someone has low thyroid function doesn’t begin and end with the thyroid In fact, most of the time, the diagnosis and solution aren’t so linear. In functional medicine, understanding the root cause of hypothyroidism means exploring each individual thyroid case through the lens of seven different subtypes.

The Seven Root Causes of Hypothyroidism

1. Primary Hypothyroidism (Underactive Thyroid)

The first root cause of hypothyroidism is the classic subtype: Primary Hypothyroidism. Primary hypothyroidism basically boils down to a thyroid gland that isn’t doing its job of manufacturing thyroid hormone. If thyroid hormone isn’t being made, it can’t carry out its function in the body. Thyroid hormones come in two basic forms, T3 (triiodothyronine) and T4 (tetraiodothyronine). Both of these hormones basically consist of an amino acid molecule (tyrosine) attached to three (T3) or four (T4) molecules of iodine. T3 is considered the “active” form of thyroid hormone, which floats around in the blood, doing its job. T4 has some direct effects on the body, but it’s most known for acting as a reserve for T3. When T3 start to drop, rather than simply making more T3 right away (this might take too long), an enzyme removes one of the four iodine molecules from T4, thereby converting it to T3, the “active form.” The thyroid produces these hormones in proportions roughly equal to 5% T3 and 95% T4, give or take.

Underactivity of the thyroid can result from two things. One, the thyroid might not have access to the raw materials needed to manufacture thyroid hormones (namely, tyrosine and iodine) or two, the machinery just might not work. To effectively treat an underactive thyroid, we would need to substitute either thyroid hormone or tyrosine/iodine, depending on which is needed.

2. Hypothalamic Hypothyroidism (Stress-Induced)

The second root cause of hypothyroidism is hypothalamic hypothyroidism, a type of stress-induced thyroid problem. Although thyroid hormones are made by the thyroid, the thyroid gland itself isn’t the control center. Rather, an area of the brain called the hypothalamus calls the shots. The hypothalamus secretes a hormone called TRH, thyrotropin-releasing hormone, which in turn signals to the pituitary gland to increase or decrease TSH, thyroid stimulating hormone, which is the hormone that directly tells the thyroid what to do. This whole process is referred to as the Hypothalamic Pituitary Thyroid Axis.

To make things more complicated, thyroid hormone production doesn’t quite begin and end at the hypothalamus, either. Although the hypothalamus acts as the control center for thyroid hormone regulation, other processes in the body can suppress the activity of the hypothalamus–namely, stress.

Stress comes in many forms (too much exercise, too little sleep, not eating enough, overworking ourselves, relationship problems, illness etc…) but they all affect the hypothalamus (and thyroid) the same way. If a patient’s hypothyroidism results from stress, hormone replacement therapy would help, yes. But is it the best way to help this patient heal No. The obvious answer would be stress reduction, and supporting the body in overcoming the dangerous effects of stress.

3. Hashimoto’s Thyroiditis (Autoimmune)

The third root cause of hypothyroidism is Hashimoto’s Thyroiditis. Autoimmune hypothyroidism is a subset of primary hypothyroidism in that the thyroid-hormone-making-machinery is malfunctioning. But the difference between Hashimoto’s thyroiditis and the type of hypothyroidism described in #1 is that the cause of the thyroid dysfunction is known: autoimmunity. In this case, the body mistakes the thyroid gland for a pathogen, and the immune system begins attacking and destroying the thyroid tissue, affecting its ability to produce thyroid hormone. Once again, hormone replacement therapy would help the situation, but the best solution would be to treat the autoimmune process and help prevent it from getting out of control.

Hashimoto’s thyroiditis, like other autoimmune conditions, has a genetic predisposition that can be triggered by factors in the environment. Sometimes stress can trigger the autoimmunity, as can nutritional problems, environmental exposure to toxins, viral infections, and more. Either way, the best solution is to treat the autoimmunity and teach the patient how to manage their condition.

4. Peripheral Conversion Defect (Thyroid Hormone Metabolism)

The fourth root cause of hypothyroidism is Peripheral Conversion Defect. As a quick refresher on what we’ve already discussed, T3 is the “active” form thyroid hormone, produced in small amounts. The thyroid produces T4, the “inactive” form at rates nearly 20x higher, which floats around in the blood stream to be converted to T3 as needed.

Mainly, the conversion of T4 to T3 takes place in the liver, but the digestive system, heart, muscle, and nerve cells all also are involved in the conversion process. However, sometimes this conversion process gets interrupted, leading to blood levels of T3 that are too low. The reason for this can be complicated, but some of the main drivers of this so-called peripheral conversion defect (or problem with thyroid hormone metabolism) include oxidative stress and nutritional deficiencies. Correcting nutritional deficiencies is pretty straightforward (change the diet, supplement, correct absorption problems) but oxidative stress is a whole other animal. Oxidative stress results from inflammation, which can be triggered by anything from chronic disease, to infections, to a high-stress lifestyle. Once again, this form of hypothyroidism is highly individual.

5. Hormone Receptor Competition (Toxins)

The fifth root cause of hypothyroidism is Hormone Receptor Competition. Once T4 has been converted into its active form of T3, it’s time for the hormone to do its job. Thyroid hormone is responsible for regulating body temperature, metabolism heart rate, digestion, cognitive function, fertility…you name it, thyroid hormone affects it. Thyroid hormone acts like an on/off switch in the body. When it binds to its receptors, it either amplifies or suppresses the ongoing response. If no T3 is around, the switch can’t get flipped.

But of course, nothing is quite as simple as flipping a switch (except, you know…flipping a switch.) Really, the relationship between the T3 hormone and our bodily systems is more like a lock and key mechanism. T3 is like the key, and the receptor is like a lock, which is only supposed to be accessed by its specially designated key. Unfortunately, there are quite a few molecules in the world that look a lot like T3, and can fit into the T3 receptor (like a keyhole). Unlike thyroid hormone, these molecules can’t actually turn on or off the switch, but they do fit nicely into the receptor, preventing T3 from accessing it.

These “look alike” molecules obviously aren’t supposed to be in our bodies. Typically, they’re toxins that result from contaminated food and water, poor quality air, exposure to mold/fungus, or hazardous chemicals. Unlike some of the other types of hypothyroidism we’ve already discussed, supplementing with thyroid hormone won’t correct the problem. The body already has plenty of T3 floating around, and adding more hormone isn’t going to have much effect. Sure, it might crowd out the toxins, out competing them for the receptor site, but typically the therapeutic dose used for patients isn’t sufficient to have an effect. The only solution is to remove the source of the exposure and support the body’s detoxification efforts, especially gut health.

6. Binding Globulin Availability (Sex Hormone Imbalances)

The sixth root cause of hypothyroidism is Binding Globulin Availability problems. Remember all those details about TRH, TSH, T3, and T4 Well, there are three more hormones to add to the list to make things just a little more confusing: rT3 (reverse T3), free T3, and free T4.

When thyroid hormones travel through the blood stream, they aren’t just floating around willy-nilly, waiting to find their receptor. Instead, they’re bound to carrier proteins, called globulins, which help protect them from damage and shuttle them to where they need to go. While on the bus (attached to the hormone binding globulin), the thyroid hormone is inactive. Only when it detaches from the globulin, metaphorically getting off the bus, can it do its job of binding to the receptor. Sometimes, the ratio of globulin to thyroid hormone becomes distorted, with too much globulin. The result of this is that the thyroid hormone gets all bound up, making it inactive by preventing it from accessing the receptor site. In order to truly be “active,” thyroid hormone needs to be unattached from globulin. In this situation, we call the thyroid hormone “free T3” and “free T4.” As you might guess, a person might have normal and healthy levels of total T3 and T4, but the amount of free T3 and free T4 are too low because the amounts of hormone binding globulin are too high.

What causes elevated levels of hormone binding globulins Lots of things, but most often excess amounts of estrogen (from birth control pills, pregnancy, or other reasons) and estrogen “look alike” molecules, such as plastics, soy products, and other toxins. The best way to treat a patient in this situation is to uncover the cause of the excess globulins, remove the source, and support the body’s detoxification as it returns to a functional baseline.

7. Nutrient Deficiencies

If we circle back to point #1, we remember that thyroid hormones (T4 and T3) are named as such because of the number of iodine molecules they contain. So, what happens when a person needs to synthesize more thyroid hormone but they don’t have enough iodine in order to do so?

The seventh root cause of hypothyroidism is—you guessed it—thyroid hormone deficiency. However, iodine isn’t the only nutrient which, when depleted, can induce a state of hypothyroidism. Zinc, selenium, vitamin D and magnesium are all necessary for thyroid hormone production, and low levels mean bad news for thyroid health. (Additionally, hypothyroid patients also tend to be low on vitamin B12, though that isn’t necessarily something that causes hypothyroidism.)

If that sounds complicated, it’s because it is! What makes it even more complicated is the fact that you can’t possible know whether or not you have vitamin deficiencies that predispose you to hypothyroidism, or what type of hypothyroidism you actually have (if you have it at all) unless you have a thorough lab workup done by your doctor.

In conclusion…

The root causes of hypothyroidism are complicated and multi-faceted, even more so than I’ve been able to cover in this blog post! But the main takeaway is that you shouldn’t settle for a simple diagnosis if your doctor simply tells you you have hypothyroidism. There’s always more to the picture, and there are likewise a lot more options for education and management. Many people don’t need a lifelong prescription for Synthroid. In some cases, it’s possible to completely reverse the hypothyroidism, prevent it from worsening, and even heal related conditions (like sex hormone imbalances, toxin exposure, or autoimmune disease.) If you’re concerned that you may have a thyroid imbalance, check out The Hormone Hacker, my expert guide for decoding lab results so you can get to the root cause of your symptoms once and for all.

If you’re suffering with thyroid disease, first of all, I’m so sorry. But more importantly, there’s hope for you! Ask your doctor to dig a little deeper, or find a new healthcare provider who will help get to the bottom of your symptoms and empower you to manage your health according to your values.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

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