36 Hours Before The Leadville 100

I’ve been training for most of the past year for the Leadville 100, a 105-mile mountain bike race across the mountains of Leadville, Colorado, starting at 10,000+ feet elevation. The race this year was on Saturday August 15, and I was ready to hit the line at my start time of 6:42 AM.

On Thursday evening before the race, I was in a store picking up some last minute supplies and extra clothing with my partner, Ryan, in case of bad weather for the race (we had gotten caught in a crazy mountain storm on shakeout ride earlier in the week and I realized I had to be REALLY prepared for all circumstances). For those of you unfamiliar with the race, it takes an amateur roughly 10-12 hours to complete and you never quite know what weather will be thrown at you along the way.

After nearly a year of relentless training, adjusting my health routines and nutrition, and dialing in every variable I could think of as a new-to-endurance athlete to race the Leadville 100, my mind was entirely locked on the start line. I was even a little bit excited to give it a shot, and really proud of all of the time and energy I had dedicated towards getting really good at a new sport in my late 30s.

While Ryan and I were driving back to the house, my phone lit up with a text from my mom: my dad had taken a hard fall on his mountain bike when he was out with her and my nephew. They thought he had maybe broken his collarbone or dislocated his shoulder, and were going to a nearby health clinic for x-rays.

A short while later, the second call came. Turns out it wasn’t his shoulder - it was a severe upper cervical spine fracture, and he was being transported to a hospital in Denver for urgent stabilization surgery. Surgery was slated tentatively for Friday, as they needed more advanced imaging first to really understand the extent of the situation.

We didn’t know what his neurological outcome would look like until he woke up post-op on Saturday morning. With upper cervical (C2) fractures, there’s so much instability that a slight shift in the broken fragments could put pressure on the spinal cord and lead to motor and neurological deficits, so the focus was on keeping him still and calm until they were ready to operate.

So…I didn’t go to the start line. I went to Denver.

Holding Two Realities At Once

When an acute, unexpected emergency happens, your internal landscape can get messy. Your nervous system has a lot to handle, and depending on your ability to navigate regulation of that nervous system, things can either get frenetic or really, crystal clear.

Thinking back on this a week later as I write this, there was never a real question in my mind about where I needed to be. If, God forbid, something had gone sideways in that operating room, being anywhere else would have been unthinkable. But something I’ve learned in the last few years of really going deep with nervous system work is that humans are capable of holding dual realities simultaneously. I knew with total clarity that I was making the right decision for me, and I was also aware that I had a sinking feeling of disappoint that I wouldn’t be making it the starting line of a race that I had been spending a long time preparing for.

It was really interesting to observe people’s reactions in real time. A few people reached out to wish me luck and, upon finding out that I wouldn’t be racing, shared that a year of training is too much to throw away, or that he would have wanted me on the course and I wasn’t doing what I should be doing. I think a lot of the times when we don’t know what to say to other humans going through a tough experience, we can project our own thoughts and lived experience without really thinking about the impact of those words on another. I don’t think anyone meant anything inherently negative, but it was definitely interesting to be on the receiving end of some of this.

Ryan said something in the middle of all of that tension that cut straight through the noise:

“How amazing is it that you have the kind of relationship with your dad where being there is an absolute given? So many people don’t have that, and so it’s really hard to understand why you’d make that choice when it probably was never an option for them.”

That moment of being seen by my person was one of the most grounding moments in a really chaotic 72 hours, and was a reminder to me of how important it is to have those kind of supportive relationships - how people show up when things aren’t all shiny and perfect is the true test of any relationship or friendship.

If you’ve been in my world for awhile, you know that my day job is an integrative-health based high performance coach. This experience reminded me something important. High performance isn’t just about rigid execution and finishing what you started at all costs. It’s not about sacrificing your own needs, wants, and well-being for an outcome.

True psychological resilience is cognitive flexibility - the ability to hold deep gratitude alongside real disappointment, to pivot without an identity crisis, and to recognize when the metric that matters has changed.

True physical resilience - shown by my dad in this scenario - is being able to weather an unexpected injury or illness and bounce back in a way that shows you all of the hard work did pay off.

The Physical Dividend

My dad is 67 years old. He fractured his C2, underwent an emergency C1–C3 fusion, and is currently monitoring additional fractures through the cervicothoracic junction. He’s in a hard collar for the next 12 weeks and will have imaging every 3 months for the next year to ensure he doesn’t need to go through another surgeyr.

By all standard clinical metrics, a traumatic cervical fracture at 67 for many individuals is a catastrophic event.

Yet, when he woke up Saturday morning, he had zero motor or neurological deficits. He was discharged home 48 hours post-surgery. He is up, moving, and walking. The nursing staff on his floor were visibly shocked by how fast his baseline returned.

That isn’t just good luck. It is physiological reserve.

My dad has spent decades prioritizing an active, strong, functional life. Because he had muscle mass, joint stability, vascular integrity, and metabolic capacity banked ahead of time, his body possessed the structural armor to withstand acute physical trauma and the metabolic reserve to recover from complex surgery without a systemic downward spiral. He also has always cultivated a healthy relationship with stress - my dad had a very successful career and certainly experienced high stress levels, but has always had a mindset that allowed him to not have that stress derail his health and daily life.

In my industry, we often talk to women about lifting heavy, protecting bone density, and eating enough protein through the lens of body composition or daily energy. We talk about “reducing stress” or, more important, working on your relationship with stress. I coach women on how to build resilience by leveraging the physical body to impact the mind - that’s why we do things that are uncomfortable, like hard training, cold plunges, infrared sauna use, personal development work, and other tools.

This is the real why: you build biological capacity so that when an unscripted physical or emotional crisis happens, your body has the raw materials and the learned capacity to deal with discomfort to handle this.

A Highlight for Many Women: The Caregiver’s Unseen Load

While my dad is by all accounts crushing his recovery after just a week, I’m also watching my mom step into caregiving mode. I remember her doing this for months with my grandma when her mom was sick towards the end of her life.

She and I have talked a lot over the years about the impact that had on her and my aunts, and how it’s common in general for women to end up in caregiving roles that can be detrimental to their own health and well-being. We’ve wondered if some of her struggles with autoimmunity now stem from the stress of those years caring for her parents. As she is navigating her own health question marks right now, watching her miss some sleep and having to adjust her own routines has been a profound reminder or how high-performing, nurturing women operate in times of emergencies. The sleep takes a hit first, the nervous system is running on adrenaline, and it takes a lot of intention to hold boundaries with yourself to still pocket some time for you.

For those of you who are taking care of those in need, whether it’s children or parents, remember that caregiving is an endurance event in its own right. But you cannot run a high-demand support role from an empty cup without eventually having your biology pay a tax on that. It’s the opposite of what we’re taught in society - the best thing anyone in a caretaking role can do is actually be a little self-full and take care of themselves first.

Part of building a work-life alignment and business architecture as an entrepreneur is creating the structural freedom to show up for the people you love. I am heading back out to Colorado in a few weeks specifically to step into that seat, relieve my mom, spend time with my dad, and make sure they both have the space, rest, and time to protect their own baselines. This has been such a reminder of another reason why I don’t regret the risks and stress that came early on with running my own business - the freedom is something you just can’t trade in once you have it. I’ll take the uncertainty of a small business owner year to year to have the ability to be present in these moments.

So…Here’s What the Training Was Actually For, It Turns Out

Over the last twelve months, I got into the best shape of my life. I’ve been into fitness for the better part of the last 15 years, and always played sports growing up, but this past year I have been training, not just working out. My biological age is ten years less than my actual age, and my strength and cardiovascular health have never been better. I’m also more regulated and resilient than I have ever been. This has been a different type of fitness journey, and I’ve learned so much (and have an insane amount of respect for any endurance athlete that fits this into daily life because the time commitment is on another level).

When I was doing the long training rides on my Wahoo Kicker in our back yard in the Arizona heat, testing my hormones daily to make sure I didn’t lose my cycle health, and doing the deep metabolic work of figuring out how to recover better from a new type of training, I thought the objective was singular: to complete 100 miles across the high country of Leadville and get the notorious “Belt Buckle” gifted to each finisher.

I was wrong.

That physical foundation is was what allowed me to navigate back-to-back high-stress seasons - from supporting my partner through his mother’s serious health scare throughout June, to running my companies and all of the changes currently happening in the online health space with the explosion of AI and huge telehealth companies, to dropping everything for my dad in an intensive care unit - without my own health, nervous system, or business collapsing under the weight.

We build physiological capacity so we can endure the unexpected. I talk about this to my private health clients a lot - I firmly believe that people don’t cold plunge and do uncomfortable things because they are “fun.” They do them because they understand the long-term ROI - regular, controlled doses of discomfort translate to the ability to weather stress and unexpected events without having deleterious impacts to your own health and well-being.

We build strong foundations and a healthy nervous system tone so that when life demands a pivot we didn’t expect, we have the strength, the clarity, and the freedom to be fully present in the moments that actually matter, with those who matter most.

So…e, and now I have a whole year to deepen into this sport, training, and building a deeper resilience tank for whatever is coming next. Mostly, I’m proud of myself for putting in the work. I’m proud of my parents for doing the hard work of staying active and fit into their later years, and proud of how they show up for each other when things aren’t easy by any means. And I’m really freakin’ proud of my nervous system and how I’ve navigated this…sometimes it’s nice to see the hard work you put in pay off, isn’t it?

Deepen the Work

If you are looking to build a resilient, high-capacity life that supports your health, your career, and your longevity:

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According to a recent Gallup poll, women in leadership positions are reporting record-high levels of engagement and ambition. They are driven, highly capable, and executing at elite levels. Yet simultaneously, burnout rates among senior female leaders in particular have hit an all-time peak…which is impressive given how much the rate of burnout skyrocketed immediately post-Covid a few years ago.

This creates an interesting paradox clinically speaking: high capability often masks physiological deterioration.

Because your output remains high and you have no problem getting sh*t done, your exhaustion is often dismissed as “just a busy season” or “just being a busy mom.” Because you can still hit your metrics in the workplace, lead your team, and show up, your body physiology is assumed to be intact and working just fine (after all, how else would you be able to get it all done?). The very trait we praise - a high self-override - is the exact mechanism that delays diagnostic intervention until the system flatlines. By then, it’s a heck of a lot more difficult to reset the physiology.

When a high-performing woman finally steps away from her desk to get lab work done, she is usually seeking validation for what she feels internally. Instead, she gets handed a standard blood panel with a series of green checkmarks and a polite note saying, “Everything looks fine.”

Individual markers rarely trip diagnostic alarms on their own in women’s health. Burnout isn’t a single broken lab value; it is a multi-system biological signature. There is no diagnostic test that says “hey you’re in burnout” - but there are patterns, and patterns are often what give us clues as to how to actually support women.

Inside the Burnout Signature: A Case Study

Consider this client who came to my practice: a 40-year-old executive who had recently stepped into a high-travel role. On the surface, she was thriving. Professionally, she was hitting every milestone.

Physiologically, she was running on 3 to 4 hours of fragmented sleep, relying on caffeine to get started every day, and honestly relying on sheer willpower and mental drive to finish it.

When we ran a comprehensive functional blood panel, no single marker pointed to a catastrophic disease state. But when you mapped her biological systems together, the multi-system adaptation was unmistakable:

• The Adrenal Curve: Her diurnal cortisol was completely inverted - flat and low all morning when she needed get-up-and-go energy, then climbing late at night when her system should have been settling into sleep.

• The Thyroid & Metabolic Axis: Her TSH was modestly elevated (still “lab normal”) while her Free T3 was sitting near the floor (2.6 - for reference, I like to see this closer to a 3.5 or above). Her body was blunting active thyroid conversion to dial down cellular metabolic expenditure.

• Sex Hormones: Her progesterone, DHEA, and testosterone were all depressed. Her body had intentionally down-regulated reproductive hormone production to conserve substrate for survival.

• Micronutrient Depletion: Her RBC selenium, magnesium, B12 and vitamin D were depleted - all important cofactors required for cellular energy, mitochondrial function, and neurotransmitter synthesis.

• The Digestive Environment: Her stool panel revealed low pancreatic elastase, depleted short-chain fatty acids, low Lactobacillus and Bifidobacterium, and elevated zonulin—a signature of gut barrier permeability and compromised digestive capacity under chronic stress.

If you evaluate any of those systems in isolation, you miss the story.

If a clinician looks only at her thyroid, they might prescribe a low-dose thyroid medication. If they look only at her progesterone, they hand her a prescription for sleep or tell her it’s “probably perimenopause”. If they look only at her gut, they may suggest a probiotic.

Treating those systems individually fails because the body doesn’t just randomly stop working; it makes multi-system compensations.

Her biology was making a series of highly logical, protective down-regulations to match an unsustainable total load. It was actually doing…exactly what it was supposed to be doing. The thyroid down-regulated to save energy; the sex hormones dropped because reproduction wasn’t a priority. As for the gut barrier, it’s well-known that the gut lining become more permeable (or ‘leaky’) under prolonged stress. With chronic stress, the downstream impact on the gut is reduced blood flow to digestion (because if you need to run away from a bear, you don’t need to eat), shifts in gut bacteria, and a weakening of the tiny proteins that keep the barrier to entry and exit across the gut lining intact.

The end result? You’re tired, bloated, your cycle is off, and all of the sudden your digestion and brain just aren’t working like they used to.

The 6-Month Reversal

Real recovery in high-performing systems does not happen through a 6-week aggressive protocol or a weekend at a spa (but boy does that one sure feel good!); it happens by restoring physiological safety and substrate availability over time. It takes time to develop these physiological shifts, and it takes time to restore them

For this client, we didn’t throw twenty supplements at her or tell her that quitting her job was the only path to healing. We systematically addressed the architectural foundations so that the supply to her systems matched the demand she was placing on them:

1. Restoring the Circadian Signal: We anchored strict morning light exposure and strategic meal timing to rebuild her Cortisol Awakening Response, giving her brain a clear signal that the day had begun. This helps cut down caffeine reliance, leads to more stable energy throughout the day, and builds strong sleep hygiene - the key to body recovery.

2. Substrate Replenishment: We targeted her micronutrient gaps, rebuilding her magnesium, selenium, and and other micros to give her mitochondria the raw materials for cellular energy.

3. Digestive & Barrier Support: We supported pancreatic enzyme output, restored SCFA production, and brought down intestinal inflammation to ensure she was actually absorbing nutrients from her food.

4. Gradual Load Management: We adjusted her training volume from high-intensity chronic cardio to targeted strength work paired with low-threshold movement, removing the secondary stressor of under-recovered exercise. Movement shifts are often temporary to allow the body to recognize safety and encourage recovery, before ramping up into more intensity once the foundations can actually handle it again.

By month three, her morning cortisol began to show a distinct rise, her gut barrier markers were normalizing, and her sleep architecture stabilized.

By month six, her follow-up panels showed a complete multi-system reversal: her Free T3 returned to an optimal functional range, her DHEA and progesterone recovered naturally without exogenously forcing the system, and her daytime energy was steady, reliable, and unforced.

She didn’t need a single isolated hormone “fixed.” She needed her total systemic load brought into balance so her body could stop playing defense. Now, when she does need hormone support as she eventually moves through perimenopause, she has a strong foundation and will be able to move through that experience in a different way.

Rebuilding the Baseline

Capable women can execute on empty for years before the physiological bill comes around. The ability to push through fatigue, override hunger signals, and manage immense responsibility is a skill, but when used continuously without recovery, it limits your long-term output.

If you want your body to keep up with what you’re building, you have to give it the raw materials, the rhythm, and the recovery architecture it needs to sustain that vision.

Your output isn’t proving that your foundation is solid - your baseline health and mental well-being are actually what shows the receipts.

Deepen the Work

If you’re wanting to do a full system performance evaluation to set yourself up for success, I’m opening my consulting calendar again starting in September - apply below and let’s talk.

1. Private Health & Performance Strategy Comprehensive functional testing, metabolic mapping, and personalized health architecture tailored to your career demands, workload, and longevity.

• Apply for Private Consulting

2. The Health Practitioner Mentorship (HPM) For clinicians, coaches, and practitioners who want to master advanced lab interpretation, understand multi-system HPA-axis dynamics, and deliver root-cause clinical transformations.

• Let’s talk about mentorship

There’s just one problem: Cortisol isn’t the enemy.

Cortisol is your get-up-and-go hormone. It’s what wakes you up in the morning, sharpens your focus, mobilizes glucose when you need to perform, and gets you moving. Without a healthy cortisol peak, you wouldn’t feel calm…you’d feel completely unable to get out of bed and pretty darn tired, to be honest.

For high-performing women, the problem isn’t usually “too much cortisol.” The real issue is timing, rhythm, and clearance.

My Own Adrenal Curve (And What “Real-Time Adaptation” Looks Like)

I’m currently one month out from a 100-mile mountain bike race. When you layer heavy endurance training on top of running two businesses, managing a clinical practice, and navigating daily life, your biology leaves obvious clues. For the record.. I am NOT and have never been an endurance athlete, so I sure have learned a lot from this new challenge!

I decided to run a comprehensive functional panel on myself to check my baseline before race day, and the data provided a fascinating snapshot of a body making real-time adaptations to total load:

• HPA Axis Down-Regulation: My overall cortisol production was low, with a sluggish morning rise in free (available) cortisol. My system was actively down-regulating output to protect itself from chronic high demand.

• Slow Clearance Rate: My body was holding onto the small amount of cortisol I was making for dear life. When your liver and tissues have a slow clearance rate, your body isn’t clearing out cortisol efficiently. In daily life, this creates a weird, heavy sensation: you wake up dragging because you didn’t produce a sharp morning rise, but by mid-afternoon, you feel “sluggishly wired” because your system can’t clear out what little you did make.

• Upstream Biomarker Depletion: My B vitamins were drained, my serum free T3 was sitting at 2.8, and my ferritin came back at 25.

Now, if I looked at those numbers through a traditional medical lens... I’d be told everything is completely normal, because technically these numbers are “in range” in a conventional workup.

I know so many of you have experienced the same. Your lab portal gives you a green checkmark. A standard clinical visit ends with, “Labs look great, see you next year!”

Except a Ferritin of 25 is nowhere near the 70–100 range needed for optimal oxygen delivery during a 100-mile mountain bike race (or for optimal thyroid function, or athletic performance in general). And a Free T3 of 2.8 is “lab normal,” but functionally dragging for high-level metabolic drive and recovery (for the record, I like to see mine coming in at least at a 3.5).

This is why “not sick” isn’t the same thing as thriving.

Through a systems-biology lens, these labs aren’t a mystery..they’re a protective adaptation. When total stress exceeds recovery capacity, the body intentionally down-regulates thyroid conversion (free T3), conserves iron, and alters the cortisol curve to keep you from burning through your reserves. In theory, my body is doing exactly what it should - downregulating in response to ongoing stress load.

What you are actually chasing in this state isn’t just “more rest” or trying to lower stress. You are chasing rhythm, substrate replenishment, and physiological safety.

The Morning Levers: Raise It on Purpose

You actually want a sharp cortisol peak shortly after waking. This is called your Cortisol Awakening Response (CAR). Here is how you cue it naturally:

• Get outside in the first 30 minutes, without sunglasses. Morning light entering the retina is the master circadian switch. It tells the brain the day has started, triggering your CAR so it has somewhere to fall from later.

• Protein before or with caffeine. So many women get stuck in a classic caffeine trap: they wake up dragging due to a sluggish morning curve, so they immediately reach for black coffee on an empty stomach to force an artificial peak. This triggers a sharp, synthetic stress spike and blood sugar crash, which further dysregulates your natural morning curve and ruins your appetite for real food. Eating 30+ grams of protein first blunts that spike. If you feel like you have to have coffee to get moving…this one is for you.

• Move early. A walk or a lifting session in the AM lets cortisol do its job when your body is biologically primed for it.

The Evening Levers: Let It Fall

To get deep, restorative sleep, cortisol needs to drop off a cliff as the sun goes down.

• Dim the lights after sunset. Bright overhead lighting tricks your brain into thinking it’s noon, keeping cortisol propped up when it should be plummeting.

• Stretch your exhales. Make your out-breath longer than your in-breath (e.g., inhale for 4 seconds, exhale for 6). It is a direct signal to your parasympathetic nervous system, the exact “stand down” command cortisol listens to.

• Put the day’s stress down. The stressor doesn’t have to be real for the curve to react..the thought is enough. When you lay in bed at 9:00 PM reviewing tomorrow’s calendar, drafting a tough email in your head, or replaying a confrontation, your adrenals don’t know the difference between those mental loops and an actual physical threat. The biochemical cascade is identical. Consider a brain dump, some fun reading, or connection time with your loved ones before bed.

If you change one thing: Move your hard workouts and your last cup of coffee earlier in the day. Both send cortisol climbing right when you want it winding down, which is the fastest way to flatten the evening drop you’re working so hard for.

Cortisol Never Acts Alone: The Gas Pedal and the Shock Absorbers

Cortisol doesn’t operate in a vacuum. It lives in constant conversation with DHEA—your adrenal buffer and anabolic reserve.

Think of Cortisol as the gas pedal (catabolic / breakdown) and DHEA as the shock absorbers (anabolic / repair). The ratio between them is what decides whether a busy season is just a hard Tuesday or the beginning of systemic burnout:

• High Cortisol / Normal DHEA: High demand, but your body still has the shock absorbers to adapt.

• High Cortisol / Low DHEA: High demand with zero shock absorbers. You’re driving 90 mph over speed bumps. This is where muscle loss, brain fog, and severe fatigue set in.

• Low Cortisol / Low DHEA: The classic “flatline.” The adrenal response has down-regulated to protect you from chronic over-drive.

  

^Guess what my DHEA was doing? Whoops! (for reference, it should be in that nice green zone of the graph above)

When we run deep functional testing, we aren’t just looking for “high” or “low.” We are reading the relationship between demand (cortisol) and reserve (DHEA) to see how your body is actually handling its workload.

The Takeaway

Am I a little bit extra about my cortisol curve? Yes.

Do my days flow infinitely easier when I honor it? Absolutely.

Am I going to be supporting these systems with strategic supplementation and nutrition between now and race day (and afterwards)? You betcha!

Stop trying to crush your cortisol. Start giving it the inputs it needs to peak when you need performance, and fall when you need rest.

Deepen the Work

If you are ready to look under the hood of your own biochemistry and assess YOUR cortisol dynamics, or if you’re a practitioner looking to elevate how you interpret these markers for your clients, here is how we can connect:

1. Private Executive Health & Performance Consulting

We look past surface-level bloodwork and generic wellness advice. We run comprehensive diurnal testing, map your cortisol-to-DHEA dynamics, and build a custom, foundation-first architecture tailored to your life and performance.

• Learn How To Get Your Cortisol Tested

2. The Health Practitioner Mentorship (HPM)

For clinicians, coaches, and practitioners who want to master advanced hormone analytics, understand true HPA-axis mechanics, and move beyond basic supplement protocols to deliver real clinical transformations. You know how to run a business; now it’s time to be the go-to in your niche by getting your clients the best, lasting results.

• Learn More About Mentorship

I consider myself a big cheerleader when it comes to women’s health innovation, femtech, and seeing more female founders step into the spotlight.

I want more money flowing into female-specific research, which still lags far behind male-specific research in the health space. I want female founders scaling massive companies, because I believe that when women win, communities win. I get genuinely excited when a technology company steps up and says, “We are building this specifically around female biology” - because it is, in fact, fundamentally different than male biology.

For decades, women have been handed products, research, and operating systems that were designed for men and painted pink. The “shrink it and pink it” effect is real. The growth of femtech isn’t just a business trend; it’s a necessary, long-overdue response to a medical paradigm that has historically viewed the fluctuating nature of female physiology as an inconvenience in study design and product development.

Which is exactly why we need to talk about a subtle, uncomfortable trend playing out in the market.

Lately, I’ve noticed a pattern in how I evaluate health technology. When a product is pitched to me as designed for women, by women, my initial impulse isn’t just curiosity—it’s an immediate, emotional desire for the product to succeed. I want to believe.

And that realization has made me pause.

When does “built for women” represent genuine, breakthrough innovation… and when does female-centric branding start doing more work than the product itself?

I have fallen for brilliant marketing in the women’s health space, only to be disappointed by generic services and cookie-cutter information disguised as “highly personalized” and “synced to a woman’s body.” We see this playing out constantly with big-box telemedicine companies promising HRT prescriptions to fix everything from weight resistance to hair loss to mood under the banner of personalization—only for the consumer to experience a standard 5-minute visit and a basic prescription that immediately sets to auto-renew every 90 days.

Supporting female innovation shouldn’t require suspending our standards for evidence, transparency, and clinical accuracy. In fact, I believe the most pro-woman thing we can do is stay deeply excited about the future while continuing to ask the hardest questions.

The Hype Around “Continuous Hormone Monitoring”

I’ve been closely tracking the growing conversation around companies like Clair Health, a female-founded startup developing a wearable positioned around “continuous hormone monitoring.”

On the surface, the concept sounds great. A continuous picture of your hormonal landscape - tracked passively in real-time from a wearable device - could fundamentally change how women understand their baseline physiology.

But as a clinician, when you look past the headlines and examine the actual mechanism, a critical distinction emerges: the device does not directly measure hormones.

There is no micro-sampling of blood, saliva, or interstitial fluid. It isn’t directly detecting estrogen, progesterone, luteinizing hormone (LH), or follicle-stimulating hormone (FSH). This is fundamentally different from products like the Mira hormone monitor, which actually tests urine metabolites directly.

Instead, the device measures downstream physiological signals - things like body temperature, heart rate variability (HRV), and resting heart rate - and uses algorithmic machine learning to infer what your hormones might be doing based on those inputs.

Inferring a hormonal trend from physiological data is not the same thing as measuring a hormone. Which is OK - but I hope that marketing by these companies will make this concept very clear to the consumer.

Can an algorithmic trend still have value? Absolutely. But I find that the marketing efforts frequently outshine what the technology itself can actually promise. When a product is marketed as a “continuous hormone monitor,” it creates an immediate perception of clinical precision. Average consumers assume they are getting a direct window into their biochemistry when they are actually getting a sophisticated mathematical estimation.

That distinction matters. When data is presented as authority rather than an input, women lose the ability to accurately interpret their own bodies.

The Clinical Paradox: What Happens When Physiology Is Irregular?

Algorithmic inference works best when the underlying system behaves predictably.

If a woman has a textbook, 28-day ovulatory cycle, her body temperature, HRV, and resting heart rate follow a relatively predictable cadence relative to her estrogen and progesterone shifts. An algorithm can map those physiological markers against expected norms with a reasonable degree of correlation.

Which brings us to the ultimate paradox: What about the women who actually need hormonal clarity the most?

Consider what happens when a woman is navigating:

• Polycystic Ovary Syndrome (PCOS)

• Anovulatory cycles

• High-stress systemic depletion

• Perimenopause

In perimenopause, for example, estrogen doesn’t follow a clean curve; it spikes and drops unpredictably. Progesterone production becomes sporadic. Cycles lengthen, shorten, or skip entirely. Downstream physiological signals become noisy and chaotic. Throw dysregulation in the body’s stress response into the picture, and things get complicated quickly. The body doesn’t work in silos; it functions as an integrated whole, with dysfunction in one system directly impacting the others.

If an algorithm relies on predictable physiological correlations to infer hormonal states, how confidently can it tell a woman what her body is doing when her underlying physiology stops following the rules?

If a technology cannot offer true accuracy when the body shifts off-script, we aren’t giving women clarity…we are giving them another layer of expensive guesswork. My hope is that future iterations of these wearables will account for these complex scenarios, but I haven’t seen one yet that can reliably pull it off.

The Emotional Appeal of the Form Factor

I’ve caught myself falling into this exact mental trap.

About two years ago, I saw an announcement for smart earrings engineered specifically to track women’s health metrics. The concept was brilliant: female-founded, an elegant form factor, and designed from the ground up around female biology rather than a clunky, repurposed wristband. I was ready to sign up for the waitlist on the spot.

It was a great reminder of my own biases.

My initial excitement wasn’t built on years of published clinical data or proven accuracy; it was built on what the product represented. It represented a future where women’s health technology is thoughtful, beautiful, and backed by real development resources. It was a product designed for women, by women.

Because women’s health has been historically underfunded and overlooked, the phrase “built for women” carries immense emotional weight. It signals safety, validation, and long-overdue progress.

Consciously or unconsciously, health technology marketing relies on this. “Built for women” can easily become a powerful positioning tool, one that causes us to evaluate a company’s intentions far more favorably than its actual clinical utility.

(And by the way... I’m still waiting on those earrings to actually go live!)

Pro-Woman Means Raising the Bar

Let me be clear: this is not a takedown of femtech, Clair Health, wearable tech companies, or female founders. I want these companies to succeed. I want them to push the industry forward.

But we do not support female founders by lowering our standards for evidence. An algorithm is not revolutionary simply because it targets female physiology. It has to hold up to what it promises, and that clinical reliability remains to be seen.

When we accept algorithmic inferences as definitive answers, or when we buy into form factors before they prove their utility, we reinforce the exact cycle we are trying to break: we encourage women to trust the wearable, the lab, or the protocol before trusting their own lived experience.

Data matters. Testing matters. Technology matters. But they are inputs, not authority.

Women don’t just need products marketed to them. They need products held to the highest standard of technical rigor, clinical validation, and radical transparency.

Women’s health has been underserved for too long. We should absolutely demand more products built specifically for us. But more than anything, we need to start demanding far more from the products built for us.

Building Agency Past the Marketing

At the end of the day, no wearable, algorithm, or 5-minute virtual prescription can replace a deeply understood, foundation-first health strategy. Whether you are navigating your own high-performance health or guiding others through theirs, true progress happens when we stop outsourcing our authority to shiny tools and start building real systems that honor female biology.

If you are ready to cut through the noise, shift away from generic protocols, and build a high-level operating system that actually works, here is how we can work together:

1. Private Executive Health & Performance Consulting

• For high-achieving women, entrepreneurs, and leaders who are tired of relying on external wearables, generic lab interpretations, or conflicting wellness trends to manage their energy, health, and longevity.

• We look past the marketing, audit your true biological baseline, and construct a custom, foundation-first health architecture designed for sustainable performance.

• Apply Here

2. The Health Practitioner Mentorship (HPM)

• For clinicians, coaches, and integrative practitioners who want to move beyond automated checklists, high-priced supplement stacks, and surface-level data.

• The High Performance Mentorship is designed to refine your clinical reasoning, master true root-cause sequencing, and elevate the standard of care you deliver to the women you serve.

• Join the Mentorship Waitlist

My last piece on advanced peptides and the optimization infrastructure generated an incredible amount of clinical data discussion. We talked about signaling molecules, cellular text messages, and the precise biomarkers required to ensure your body can actually handle a high-level intervention. More to come on the peptide series, of course!

But today, we are going to pivot. This piece is going to sit with the deeper conversation underneath the whole functional hormone moment. It stems from conversations I’ve been having with the women I work with, from coaching my practitioner mentees, and from discussions held at various integrative health summits and entrepreneur events alike.

When women enter my world, they often arrive armed with spreadsheets of lab work, questions about peptides/HRT/supplements, and a vocabulary completely saturated with functional medicine jargon. They can track their luteal phases, talk about their cortisol curves, and debate the merits of different workout programs.

Yet, when we look past the charts, the underlying reality hasn’t changed. They are still running on empty.

This isn't another guide on what markers to test. I want to look at the deeper mismatch happening right now. Too many women are treating their health like a compliance checklist - believing that if they just have more discipline, more supplements, or more perfect labs, they will finally feel better. But the goal was never just to achieve perfect numbers on a page. Let's talk about what happens when we stop trying to endlessly optimize the data, and start looking at what it actually takes to get your life back.

The Eleven-Word Truth

Let’s skip the clinical pleasantries and name the core reality of the modern women’s health movement: Women don’t want their hormones optimized. They want their life back.

Every single week, a familiar scene plays out in high-end functional medicine practices across the country. A brilliant, capable woman - she could be an executive, an entrepreneur, a mother holding a massive matrix of responsibility together - walks out of a gorgeous clinic holding a brown paper bag full of specialty tinctures, thyroid medication, and estrogen creams.

Her lab report has little green checkmarks next to numbers that used to be printed in red. By every metric of the clinical intake form, her biomarkers are moving toward an ideal statistical range. Her practitioner is thrilled. Her charts look perfect.

But as she sits in her car in the parking lot, staring at the steering wheel, a quiet, frustrating question tracks through her mind: If my numbers are so beautiful, why do I still feel like something is not quite right?

She did not schedule that initial clinical visit because she had a passionate intellectual curiosity about her free T3 levels or her morning DHEA output. She scheduled it because she woke up one morning and realized her world had quietly become very small, and she wanted her vitality back. She wanted to feel like herself again.

Somewhere in the explosion of the wellness industry, we confused the tool with the destination. We built a vast, high-priced ecosystem dedicated to optimizing biological levers, while completely forgetting about the woman who has to pull them.

What You Are Actually Asking For

When you are exhausted, suffering from brain fog, or watching your sleep architecture collapse, your initial reflex is to treat it as a mechanical failure. You assume a gear has slipped inside your endocrine system, and you hire an expert to fix the machinery.

But if you look closely at what happens when your health drifts, the true loss isn’t structural. It’s relational, emotional, and behavioral. You don’t just lose hormonal output; you lose parts of who you are.

When a high-performing woman says she wants her progesterone optimized, what she is actually asking for is a reclamation of the things that got smaller while she wasn’t feeling well:

• The creativity that got quiet: The capacity to look at a complex business problem, an artistic project, or a strategic vision and feel a sudden surge of inspired clarity, rather than a wave of cognitive fatigue.

• The playfulness that disappeared: The spontaneous energy to laugh, to mess around with her kids, to date her husband, to be deeply silly, or to enjoy a completely unproductive Saturday without a voice in her head calculating how much recovery capacity she is burning.

• The big dreams she used to chase: The space to think five years down the line with genuine ambition, rather than just trying to survive the next forty-eight hours of her calendar.

• The intimacy she misses: The desire to be truly seen and to see her partner, moving past the transactional co-parenting or co-existing schedule that takes over when her body feels like an unsafe house.

• True presence in her relationships: Sitting at the dinner table or across from a friend and actually hearing them, rather than dissociating into a fog of physical exhaustion while nodding on cue.

• The version of herself that shows up to work fully: Walking into a boardroom or onto a stage with unshakeable authority, rooted in a nervous system that feels settled, steady, and dangerous in the best way possible.

• Her sense of humor: The sharp, quick wit that naturally bubbles up when a brain isn’t entirely consumed by managing systemic inflammation and low-grade survival physiology.

These are not soft, abstract concepts; they are the actual metrics of human health and hormonal well-being. When your health declines, your world shrinks to the size of your symptoms. It’s hard to see past that or around that. The uncomfortable reality of the current medical landscape is that we have trained women to accept statistical optimization in place of actual personal reclamation.

The Disconnect of “Optimal Labs”

Let’s look directly at the data density because this is where the current wellness frame breaks down. There is a profound difference between a well-titrated hormone protocol and a restored life.

Clinical research evaluating quality-of-life outcomes following menopausal hormone therapy or thyroid management regularly demonstrates a fascinating trend: while initial biomarker optimization reliably improves acute physical symptoms like hot flashes, night sweats, or gross metabolic parameters, it frequently falls short of restoring comprehensive life satisfaction, cognitive resilience, or emotional vitality.

This is not a failure of the medicine. It is a failure of the frame.

A traditional or boutique hormone protocol is explicitly designed to do one job: change the concentration of a specific molecule floating through your bloodstream. If your serum estradiol reads at 20 pg/mL and a practitioner uses a transdermal gel to bring you to 90 pg/mL, the protocol has achieved its mechanical goal. The biomarker is optimized.

But that protocol is entirely blind to the life underneath the molecule. If that same woman returns to a high-stress lifestyle, sleeps five hours a night, keeps her nervous system in a state of chronic sympathetic dominance, and carries the unaddressed weight of a life that no longer fits her values, those optimized hormones have nowhere to land.

Your cellular receptors don’t operate in a vacuum. A hormone is an instruction manual. If the building site of your life is completely chaotic, giving the workers a more elegant set of blueprints won’t build the house any faster. It just creates an expensive, high-leverage disconnect.

The Analogy: Tuning an Engine with Nowhere to Drive

To make this explicit, I want you to think about your endocrine system (aka your hormone-producing organs and their communication networks) like a finely engineered performance vehicle. Optimizing your hormones without addressing the life underneath is exactly like bringing a high-performance car into the shop, spending thousands of dollars tuning the engine, balancing the tires, and upgrading the fuel lines - and then leaving the shop without ever asking where you are actually trying to drive.

Optimal labs are simply the ignition. They are not the destination. They give you the spark, the mechanical capability, and the baseline clearance to move. But you did not come into the office just to hear the engine idle cleanly in the garage. You came in because you want to drive across the country. You want to see the scenery. You want the vehicle to carry you safely to a destination that matters to you…you want the experience.

You can have every single marker on your blood panel sitting perfectly within a green reference range and still be running the wrong engine for the life you actually want to lead.

Naming the Elephant in the Room

We need to look at what's happening within the functional medicine space right now. Too often, women leave conventional medicine because they are tired of being dismissed, only to find the exact same model waiting for them under a different name. Instead of a fifteen-minute visit and a pharmaceutical prescription, they get a longer appointment, a massive panel of advanced testing, and a highly complex protocol of supplements. The underlying paradigm remains completely unchanged: your body is failing, the answer is outside of you, and this external input will fix it.

This is not an attack on the brilliant practitioners doing the deep work of hormone restoration and true integrative, functional care. Bioidentical hormones are life-altering, necessary, and elegant tools when used correctly. Supplements absolutely can make a difference and are often needed as a bridge during healing. Rather, this is a necessary observation of a systemic pattern.

I want this field to be more than a premium prescription pipeline. It is capable of so much more. The women who write the checks and trust us with their bodies deserve a version of medicine that is genuinely different - one that treats the lifestyle foundation as the primary medicine.

The Doorway and the Destination

The reason this conversation isn’t really about hormones is because a hormone imbalance is rarely a primary root cause. It is usually a biological consequence.

Your endocrine system is an incredibly sensitive environmental sensor. It is constantly listening to the cadence of your life, the state of your relationships, the quality of your rest, and the safety of your mind. When your life is characterized by relentless hustle, deferred boundaries, and systemic depletion, your hormones shift to protect you. They downregulate non-essential functions like deep recovery and optimal metabolic output because your body thinks it’s navigating a prolonged war.

When we look at it through this lens, balancing your labs stops being the ultimate cure and becomes the doorway. The life on the other side of that door is the actual work.

I know this dynamic intimately because I have had to walk through that exact doorway myself. At several points in my life, I have had to manage my health through multiple, competing identities: as a clinician running a complex practice, as an athlete asking my body to perform under heavy mechanical stress, as an entrepreneur scaling businesses, and simply as an ambitious woman trying to remain whole in a culture that glorifies the grind and tries to pressure women to fit into one mold or another at any given point in time.

Every time my own biology has drifted into a state of depletion or burnout, the solution has never been an external fix or a more complex supplement stack. Did I use those tools en route to healing? Of course. However, the real turning point has always been a ruthless, honest confrontation with my lifestyle architecture:

• Am I self-sacrificing in order to people please?

• Am I giving up my self-care in order to work more?

• Am I not being honest with myself about my nutrition, training, recovery (aka am I skipping though because I’m “busy” or “stressed”?)

When I restored my own foundations - rebuilding my sleep boundaries, stepping back into the routines and training that make me feel anchored, changing the structure of my businesses to protect my creative space, honoring my own boundaries and being firm in communicating my needs, prioritizing connection - my physiology followed my life. The foundational tools gave my body the initial clearance to move, but reclaiming my daily operating system was what actually brought me back online.

The Five Questions I’d Love For You to Sit With

If you want to move past the superficial layer of hormone tracking and step into genuine health optimization, you have to be willing to ask better questions. These are not soft, lifestyle-magazine prompts. They are rigorous, diagnostic tools designed to audit the system underneath your biochemistry.

These are the exact questions you should sit with honestly, and they are the questions you should expect a truly comprehensive practitioner to be willing to ask you across a clinical desk:

1. Who might you become if you actually felt good in your body again? If the baseline friction of fatigue, brain fog, and physical discomfort was entirely removed from your morning, what version of your personality would step into the room? What is actually being impacted by the way you currently feel?

2. What parts of your identity have you quietly allowed to get smaller while you weren’t feeling well? Look at your creative projects, your relationships, your professional risks, and your hobbies. What did you cross off the list simply because you lacked the physical capacity to hold it?

3. Where do you need to take your personal agency back? Where are you currently outsourcing your well-being to an external protocol, a doctor, or a supplement stack while avoiding a hard choice about your boundaries, your workload, or your environment?

4. What conversations does your body want your current healthcare provider to be having with you that they are completely missing? If your body could speak past your blood panels, what lifestyle truth would it tell your practitioner?

5. What would you go do tomorrow morning if your hormones weren’t running the show? If you had total confidence that your body would show up for you with stable energy, clear cognition, and structural resilience, what would you immediately change about your life?

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What A Functional Medicine Approach to Hormone Well-Being Can Look Like

In my consulting practice, and in the practices of the practitioners I mentor, we don’t treat labs and life as two separate conversations. We treat them as a singular, integrated ecosystem.

When a woman partners with me, we order the advanced testing. We look at the hormones, the gut microbiome, the metabolic markers, and the nutrient status with intense clinical precision. But we overlay that data directly onto her life blueprint. We build a double-layered strategy: we use the clinical data to stabilize her biological baseline, and simultaneously use her life goals to design her daily habits.

I regularly watch this translation play out in the women I work with.

• We had an executive who came in demanding a higher dose of thyroid medication because her morning focus had tanked. By the time we finished our engagement, her medication stayed exactly where it was, but she had reclaimed her morning light exposure, re-sequenced her protein intake, and stepped back into a creative writing project she had abandoned five years ago. Her focus returned because her mind had something compelling to focus on.

• We had an entrepreneur who thought she needed a complex cortisol protocol to manage her severe evening fatigue. It turned out she simply needed to stop skipping lunch, build an unshakeable boundary around her evening email habits, and re-introduce heavy lifting into her week.

The labs settled because the life settled. The clinical work met the reclamation work, and these women left the container not just with a prettier PDF of lab results, but with agency intact.

A Call to the Practitioners in the Room

If you are a clinician, a health coach, or a functional medicine practitioner reading this, I want to speak directly to you for a moment.

The women walking into our offices are looking for leaders, not just prescribers. They are looking for practitioners who are brave enough to look past the blood panels and ask the big, uncomfortable questions about how they are living. They want to be seen as whole, complex human beings, not just a collection of endocrine feedback loops.

If you feel a growing fatigue with the “labs plus HRT” conveyor belt model, please recognize that instinct for what it is: a call to raise the standard of care. This deep, relational, system-based approach to functional medicine is the future of our field, but it is not being taught in traditional certifications or automated weekend seminars. It requires developing a sophisticated clinical lens that honors both the molecule and the life.

If this is the kind of practitioner you want to become, and you are ready to build a practice that delivers true, sustainable reclamation to the women you serve, take a look at our frameworks within the Women’s Health and High Performance Specialist certification track, where you learn how to do exactly what this article describes.

One More Thing

As you close this page and head back into the momentum of your week, I want you to carry one thought with you: The hormones are simply the doorway. You are the destination.

Never let a medical protocol, a health trend, or a complex stack of supplements become the centerpiece of your identity. You are not a project to be endlessly optimized; you are a wholly wonderful human who has the capacity within to live the exact life you want. The tools exist to serve your life, not the other way around.

This post is an exploration of a core chapter I am currently writing for my first book, which focuses entirely on how high-performing women can build deep performance that actually holds without destroying their health in the process.

References

1. Santoro N, et al. Menopausal Hormone Therapy and Quality of Life: Outcomes from Long-term Clinical Trials. Journal of Clinical Endocrinology & Metabolism, 2016.

2. Pan HA, et al. Comparisons of Quality of Life and Menopausal Symptoms Among Women Using Different Hormone Therapy Regimens. Climacteric, 2018.

3. Chrousos GP. Stress and Disorders of the Stress System. Nature Reviews Endocrinology, 2009.

Join the Conversation

What have you reclaimed - or what are you actively trying to reclaim - alongside your health journey this season? What parts of your identity got quiet that you are ready to bring back online?

Tell me in the comments below. I read and respond to every single one.

A Note Before We Begin

My last two articles on stress, the HPA axis, and how to reset your body’s stress management register brought a wave of questions about peptides. Which ones help with burnout? Which should I steer clear of? Where do I get them? Are the risks worth it?

I want to approach this carefully, because the perspective I want to give you is likely different from what you’ve already heard.

Let’s clear the air: I am not anti-peptide. I use them. I track the clinical research closely because the molecular science is genuinely brilliant, and this category is going to keep producing tools we simply did not have ten years ago.

What I do not love is the current narrative. Right now, there is deep contention among medical providers on the topic. Anytime the conventional establishment tells people “don’t do this,” the resulting trend is that people find a backdoor way to do it anyway. Instead of leaning into their roles as educators - helping people understand their biology and where these tools actually fit - too many professionals let ego steer the conversation. They resort to scare tactics to dissuade the public. It never works, yet we repeat the pattern.

That being said, some of the multi-peptide “stacks” I am seeing women run right now are wild. Women on six, seven, ten compounds at once, who cannot tell me what a single one is actually doing inside their body.

That is the part I want to talk about to you. Consider this part 1 of a series on peptides with the ultimate goal of helping you understand how these tools work, and how to know what questions to ask your providers and practitioners should you be curious about using them. If you understand your body, and you understand the tools in question, you claim total agency over your healthcare. Let’s look at how to approach this like an investor, not a gambler.

The Framework: Cellular Text Messages vs. Raw Materials

To understand why a peptide works - or fails - we have to define what they actually are. For the wellness-savvy reader who just wants the language clean: peptides are short chains of amino acids that act as precise signaling molecules. Your body naturally produces thousands of them to tell tissues exactly what to do: Build this. Repair that. Release insulin. Calm inflammation.

But here is the clarification that matters clinically: Peptides are not super-powered supplements. Treating them like a trendy new multivitamin is exactly why so many women run their protocols poorly.

• Supplements are raw construction materials. Imagine dumping bricks, lumber, and drywall into your driveway. If your body lacks the blueprint or the workers, those materials just sit there in the rain.

• Peptides are the foreman with the megaphone. They are precise cellular text messages. They do not provide raw materials; they forcefully change cellular behavior by binding to specific receptors on your cells and triggering an immediate cascade of biological action.

Because they are active signaling instructions, their timelines and mechanisms look entirely different from a vitamin you take with breakfast.

• Molecular Lock-and-Key: When you inject a peptide like BPC-157, it doesn’t float around hoping to be useful. It binds to specific receptors and accelerates angiogenesis (the creation of new blood vessels) to intentionally flood an injured area with oxygen and nutrients. The action is targeted, not diffuse.

• A Shifted Timeline: Supplements can take months of biochemical stacking to subtly shift a baseline. Peptides act on a timeline of days to weeks because they hijack existing cellular machinery. Growth hormone secretagogues like Ipamorelin trigger a pulse of growth hormone from your pituitary within 30 to 45 minutes of injection. You are not gradually building up a deficiency; you are commanding a physiological response.

The market is moving fast. We have FDA-approved GLP-1 receptor agonists like semaglutide and tirzepatide moving alongside (as of the time of publication of this article) unapproved, highly compelling compounds like BPC-157, TB-500, Retatrutide, Ipamorelin, CJC-1295, and MOTS-c (an exercise-mimetic that essentially text messages your cells to build more mitochondrial power plants).

The biology is real. This is real medicine. But a molecule can only ever be as good as the system it lands on.

The Three Archetypes

To understand the variable underneath the molecule, consider these three patterns I keep watching with women in my private health and performance consulting business. The names are composites, but the biological math is real.

Archetype 1: The Clean Signal

The Setup: Sandy* is in her early 40s, highly athletic, and has spent the better part of a year dialing in her foundation. Her sleep is consistent, her protein intake is locked in, her cortisol curve is clean and optimal, and her baseline blood panels look good. Her GI Map stool analysis showed some mild inflammation as well as depletion of secretory IgA, an important component of the immune system that can get depleted with stress, training, chronic infections, or other root causes.

The Protocol: She had a chronic Achilles issue and some low-grade gut inflammation that had always accompanied her training as a marathon runner. She decided to run an eight-week course of BPC-157.

The Result: The Achilles resolved within four weeks; the gut symptoms quieted by week six. A year later, she has had zero recurrence. The tool worked perfectly because the system was prepared to receive the instruction.

Archetype 2: The Hidden Tax

The Setup: Tanya* is a high-performing corporate executive in her late 40s. On a friend’s recommendation, she started tirzepatide through an online portal. The weight came off rapidly, and she was thrilled.

The Protocol: Eight months of continuous use, monitored only by body weight.

The Result: When we sat down to look at her broader picture, her DEXA scan showed a severe drop in lean muscle mass and bone density. Her hair was thinning at the temples, her ferritin (stored iron) had tanked down to a 19 (for reference, I like this to be closer to 60-70), and her daily energy was spent. The drug did exactly what it was designed to do, but because no one told her she needed a minimum of 120 grams of protein a day to protect her tissue, the system paid a massive hidden tax for the quick lever.

Archetype 3: The Credit Thief

The Setup: *Jane is running a complex, four-peptide stack prescribed by a practitioner she trusts, costing her roughly $900 a month. She feels noticeably better than she did last quarter.

The Protocol: Concurrent with starting the peptides, she also finally hired a trainer, started lifting weights three times a week, prioritized an eight-hour sleep window, and stopped skipping lunch.

The Result: She feels incredible. However, the expensive peptides are getting 100% of the credit in her mind, while the unsexy, foundational habit shifts are doing 80% of the actual physiological heavy lifting.

Why This is a Business Systems Problem

A peptide is a lever, not a foundation. When the foundation holds, the lever works beautifully. When the foundation is absent, the lever underperforms, and the underlying biology keeps paying the bill for whatever you skipped.

Think about your body the exact same way you think about your business. You would never hire a high-priced senior executive to fix a problem that is actually a fundamental systems error. You would build the infrastructure first, then bring the executive in to do the hyper-specific work they are uniquely brilliant at. The executive thrives on top of a working system; they flounder on top of a broken one.

Peptides are your senior executives.

The pattern of reaching for a high-tech lever before holding the foundation is one of the defining instincts of the high-performing woman. You learned early in your career that the difference between average results and excellent results was a tool, a software integration, a strategic hire. You scaled your business on this instinct, and your professional life is full of moments where writing a check for the right lever was the correct move.

But the body does not respond to leverage the way a career does.

The body responds to inputs, repetition, and consistency. It does not care that you are time-poor and would prefer to write a check. It cares about whether the fundamental inputs it requires are being delivered.

The Optimization Audit: A Framework for Readiness

If you are thinking about starting a peptide, or you are already on one and wondering if it’s returning on your investment, here is your readiness check. These are not gatekeeping barriers; they are setup requirements to ensure the molecule lands cleanly.

• [ ] Sleep: Are you sleeping 7.5 to 8 hours in a dark room on a consistent schedule? Sleep is when the actual tissue repair and signaling pathways the peptide initiates take place.

• [ ] Protein: Are you hitting at least 100 grams of bioavailable protein daily across 3–4 meals? (If you are on a GLP-1, this number jumps to 120–140 grams to aggressively defend your muscle and bone mass. If you’re postmenopausal and on a GLp-1, it jump higher).

• [ ] Resistance Training: Are you lifting weights 2–3 times a week? Mechanical tension is the primary signal that tells your body to preserve structural tissue while signaling molecules speed up repair.

• [ ] Nervous System Regulation: Do you have a daily, active practice that shifts you out of sympathetic (fight-or-flight) dominance? Every metabolic signal you send lands in whatever autonomic state your nervous system is currently holding.

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The Diagnostic Blueprint

You cannot optimize what you are not objectively tracking. If you are going to use real medicine, you need real data. Here is the exact clinical framework I recommend running before starting a protocol, and again 8 to 12 weeks in, to audit your system’s response:

1. The Growth Hormone Axis

• Specific Markers to Order: IGF-1, IGFBP-3

• Why It Matters: Crucial if you are using growth hormone secretagogues like CJC-1295 or Ipamorelin. The pre-test establishes your baseline cellular growth activity. The post-test acts as a vital safety check to ensure the protocol hasn’t pushed your body into unsafe, hyperphysiological ranges.

2. Metabolic & Glucose Control

• Specific Markers to Order: HbA1c, Fasting Insulin, Fasting Glucose

• Why It Matters: Absolute non-negotiables for GLP-1 protocols like tirzepatide or semaglutide. The pre-test catches hidden insulin resistance that scales with stress. The post-test tracks real metabolic optimization and ensures your protocol isn’t causing severe glucose crashes.

3. Systemic Inflammation

• Specific Markers to Order: hs-CRP, ESR

• If taking for gut optimization: GI-Map

• Why It Matters: The primary metrics for tissue-repair peptides like BPC-157 or TB-500. This tracks systemic fire; seeing your hs-CRP drop post-cycle gives you objective proof that the cellular signaling text message successfully delivered its instructions. GI Mapping can help assess inflammation at the gut level and track pre/post protocol progress.

4. Organ Safety & Lipids

• Specific Markers to Order: ApoB, Full Lipid Panel, ALT/AST (Liver Enzymes), eGFR (Kidney Function)

• Why It Matters: Your clinical safety anchor. Complex peptide stacks can place an unmapped metabolic tax on liver clearance pathways or subtly shift lipid particles. This ensures your baseline organs aren’t paying a hidden price for your optimization protocol.

What True Health Agency Looks Like

In my own life, my daily non-negotiables remain entirely unsexy:

• Protein intake + carb intake scaled to my training load (more cardio = more carbs)

• Lifting heavy three to four times a week

• A fiercely protected sleep window to the best of my abilities

• Morning sunlight, and

• Daily breathwork before I look at my phone.

• Continual personal development to check in on my relationship with stress, perception of stress, and opportunities for a growth mindset shift

Because that foundation is held, when I do choose to, for example, run a short course of BPC-157 for an acute training injury, my recovery timeline drops by half. I treat the compound like an upgrade, not a rescue mission.

Imagine what becomes possible when you stop outsourcing your protocols and start understanding your internal operating system. You stop spending money on inputs that are wrong for your body’s current season. You gain the ability to push the levers when your biology needs support - like the progesterone-dominant luteal phase of your cycle or a high-stress professional launch - and pull them back when you are resilient.

That is agency. You can have the leverage, but you have to build the system capable of holding it first.

This article is an initial deep dive into peptides following the very popular “Peptides in Practice” workshop I held recently, which focuses entirely on how high-performing women and the practitioners who serve them can integrate this knowledge into their wellness routines. There will be a series of follow-ups focusing on specific classes of peptides and their uses - be sure to subscribe to catch the series!

If this article resonated with you and you you are ready to stop guessing at your inputs, look at the options below to step into my ecosystem:

1. If you are wanting to deeply understand peptides, how to utilize them, and protocols for specific goals, the replay of “Peptides in Practice” is now available to the general public:

Access the Peptides in Practice Workshop

2. Are you a clinician or health coach who wants to move away from rigid, generic and learn how to navigate complex, nuanced cases and trending modalities like this with your own clients?

   Learn About Practitioner Mentorship

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References

• Wilding JPH, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. New England Journal of Medicine, 2021.

• Jastreboff AM, et al. Tirzepatide Once Weekly for the Treatment of Obesity. NEJM, 2022.

• Sikiric P, et al. Brain-gut Axis and Pentadecapeptide BPC 157: Theoretical and Practical Implications. Current Neuropharmacology, 2020.

• Lee C, et al. The Mitochondrial-Derived Peptide MOTS-c Promotes Metabolic Homeostasis and Prevents Diet-Induced Insulin Resistance. Cell Metabolism, 2015.

A week or so ago I published a post called You Probably Don’t Have High Cortisol. If you haven’t read that yet, start there - I had to split this topic into two parts because we go DEEP on a topic that’s quite misunderstood in the health and wellness arena these days.

Once women understood that there are four different things that can be going on with their cortisol, and that three of them get mislabeled as “high cortisol” all the time, the next question I received in my DMs was almost unanimous:

“Okay. So now what?”

This is that post. This is the “now what.” Last time I helped you figure out what your stress hormones are actually doing. This time I’m going to tell you why - even with the right answer - what you’ve been trying probably still hasn’t worked.

It’s another long one, but another free one :) Enjoy!

Let me start by telling you what I already know about you.

You’re not the woman who needs to be convinced that cortisol or stress matters. You’re already tracking your sleep. You’re eating your protein. You’ve done a DUTCH test or perhaps another form of hormone testing. You’ve taken the supplements. You’ve made the adrenal cocktail. You’ve tried the cold plunge thing someone on Instagram told you to do. You’ve spent the money. You’ve done the reading.

And six, twelve, however many months in… you’re still waking up at 3 a.m. Still tired by 2 p.m. Still anxious for reasons that don’t quite have a name. Still wondering what is wrong with you, because everyone else seems to be sustaining what you can’t.

And somewhere quieter than you’d ever say out loud, you’ve started to wonder if maybe it’s you. Maybe you’re somehow defective. Maybe you should be able to do this. Maybe other women are sustaining the unsustainable and you’re just not trying as hard.

I want to tell you the same thing I tell every woman who sits across from me with that look on her face.

You aren’t doing anything wrong. You were handed the wrong model. And the wrong model fails every time - not because the tools were wrong, but because of the order you ran them in.

Why nothing you’ve tried has actually worked

A lot of what’s being sold to you as “the answer” lives at the top of a stack of layers, and the layers underneath it were never built.

Picture regulating yourself and normalizing your cortisol/stress rhythm like a pyramid. Four layers:

• The bottom layer, the biggest one, is your daily life. How you sleep. How much real sunlight you get. What your blood sugar is doing all day. How wound up your nervous system is from the moment you wake up. This layer does almost all of the work of fixing your cortisol. None of it can be put in a bottle.

• The second layer up is the calming or energizing herbs - things like ashwagandha, holy basil, rhodiola. Useful when the bottom layer is solid. Useless or worse when it isn’t.

• The third layer is nutrients - the actual raw materials your body uses to make and clear hormones. Vitamin C, B vitamins, magnesium, the basics. Important. Won’t do much alone.

• The top layer, the smallest one, is the prescriptions and the precursor hormones - things like DHEA, pregnenolone, glandular supplements. Useful for women who are genuinely depleted. Useless if the rest of the pyramid is missing. Nuanced as women move into perimenopause because we’re bringing the conversation about lower production of some of these hormones into the picture.

But.. look at where almost every cortisol product on the market lives. The top. Because that’s where the marketing dollars are. Nobody can sell you a consistent wake-up time. There is no affiliate code for morning sunlight. So the layer that does the most work has the least attention behind it, and the layer that does the least without a base gets all your money.

This is true of conventional medicine. It is also true - and this part hurts to say because it’s my own field - of a lot of what’s being sold to you as “functional medicine” right now. Same gland-level approach. Same supplement-stack logic. Just in nicer packaging.

I include myself in that. We’re all guilty of it. The pressure to hand someone something concrete to take home - a list, a stack, a thing - is real. The harder work, the foundation work, doesn’t feel like a thing. Which is exactly why nobody is selling it to you.

So what do you actually do?

You build it from the bottom up.

I train for endurance mountain bike racing. And in that world there is one rule you do not break - you build a base before you do the hard stuff. Months of easy, kind of boring aerobic work that builds the engine. If you skip the base and go straight to the hard intervals, you don’t get faster. You get hurt. Because the hard work only produces results when there’s a foundation underneath it to absorb the load.

Your cortisol and stress response works the exact same way. The supplements, the herbs, the cocktail, the cold plunge, the DHEA - those are the intervals. Sleep, light, food, nervous system - that’s the base.

The reason your “tried everything” has been failing you is almost never that you tried the wrong things. It’s that you tried them on no base. And without a base, none of the rest works quite as well as we expect. You may have had an initial surge of feeling better, then it plateau’d - or you may just not really have noticed a difference one way or another.

Here’s roughly how the order looks if you map it on a calendar.

The first month: get your foundation in

This is the part everyone wants to skip. Don’t. Most of your healing is going to come from this.

Pick a wake time and hold it. Same wake time every day. Ideally within about a thirty-minute window…weekends included. Your body’s cortisol rhythm is anchored to the consistency of your sleep-wake schedule, moreso than the total duration of time spent in bed.

Get sunlight in your eyes within the first hour. Outside, with no sunglasses, even on a cloudy day. Ten to thirty minutes. This single thing rebuilds a broken cortisol curve more than anything you can buy, because morning light is the actual signal that tells your body the day has started.

Stop having coffee on an empty stomach as your breakfast. Eat protein within an hour of waking. About thirty grams. Every time your blood sugar crashes, your body fires off cortisol to pull it back up. If you’re crashing four or five times a day, you’ve built a stress response out of your own meals.

Do the actual stress audit. Sit down. Write out what is currently pulling on you. Work. Relationships. Money. The open loops you keep avoiding. Inflammation in your body. The hard conversation you’ve been postponing. You do not have to fix all of it. You do have to be honest about what’s there. Nothing in a bottle can put out a fire that’s still being fueled.

Pull back the intensity for a few weeks. No fasted high-intensity workouts. No training to exhaustion. Walks. Easier rides. Gentle strength. Restorative movement. You are not losing fitness. You’re removing one of the inputs that’s been keeping your system in alarm.

Notice how much of this is taking things away, not adding them. That is the point. More is not better. Less, in the right order, is.

[I will say that in some cases, we want to simultaneously bring in direct hormone support and work on the foundational base. Where sone women tend to get into trouble is when they just jump to direct hormone replacement and ignore the foundations.]

Weeks four through eight: now you can start adding things in

Once you have a few weeks of the foundation under you, you can start using the actual tools.

The calming or energizing herbs become an option, depending on what your body is doing. If your cortisol is genuinely high in the evening, calming herbs at night can really help. If your cortisol is genuinely low, gentle support in the morning may be appropriate. If you don’t know yet which one you are - that’s fine. A lot of women in this phase do best on just nervous system work and movement until they get a clearer picture. Proper testing of your cortisol curve can help streamline the best options for you and takes out the guesswork.

One specific warning, because I see this every week. Ashwagandha is not for everyone, and timing matters more than the label tells you. Taken in the morning by a woman whose cortisol already spikes too hard at dawn, it amplifies the spike instead of softening it. So if you started ashwagandha and felt MORE anxious, more wired, more on edge - it isn’t that the herb is wrong. It’s that the timing was wrong for your body. This herb is added to a lot of adrenal support blends, so be sure to read your labels!

Real nervous system work goes deeper here, and I do not mean the bath-and-candle version. I mean actual practice. Daily breathwork. Real wind-down time between hard things. Somatic work or vagal work if you have access to it. And - this is the part most high-achieving women try to skip - actually saying out loud what you need instead of holding it inside and dealing with it alone. Stress you don’t deal with does not evaporate. It moves into your body and waits.

You also start letting the intensity back in. Real strength training. Zone 2 cardio. Harder workouts kept genuinely occasional until your recovery is trending up. If you track HRV, use the WEEKLY trend, not any single morning’s number.

The part most cortisol content forgets - your cycle

This is where most of what you’ve read about cortisol stops being true for you specifically.

If you are still cycling, your stress tolerance is not the same on day six as it is on day twenty-four. The first half of your cycle, when estrogen is rising, can handle more intensity, more output, more stimulation. The second half, when progesterone is rising, wants more calm, more recovery, more support.

Most cortisol-healing content out there was written for men. Or for women treated as if they were small men. Which is most of medicine, most of wellness, and most of biohacking. Ultimately, the same stress-recovery rules can’t be applied to every day of your month - because your month is not the same on every day.

If you’re in perimenopause and your cycle is irregular or unpredictable, the same logic applies. You’re not going to track phases. You’re going to track your own energy patterns and notice the windows when you can push and the windows when you need to pull back.

The point is not to be perfect at tracking. The point is to stop applying the same recovery to every day of a body that isn’t the same on every day. Your cycle is not the inconvenience you work around; it’s the operating manual.

Weeks eight and beyond: now you can refill

By now your foundation is solid and your nervous system is being actively supported. This is when the nutrient work finally gets to do what it’s supposed to:

• Vitamin C, which is concentrated in your adrenals at a higher level than almost anywhere else in your body.

• B vitamins, especially B5, which is what your body needs to actually make the precursor for all of your stress hormones.

• Magnesium, which stress burns through faster than almost anything.

• Plus the supporting cast - a B-complex, zinc, vitamin D, omega-3s. This phase is restocking, not pushing.

This is also the point where, if you’re genuinely depleted, things like DHEA, pregnenolone, or glandular supplements may be useful. These are tools, not magic. They work because everything underneath them got built first. They do nothing - or worse than nothing - when the foundation is missing.

And, this is finally the moment to address the rest of the hormone picture. Thyroid. Sex hormones. Gut. Here is why the order really, really matters. When your cortisol is high, it literally blocks the place progesterone is supposed to bind. Not metaphorically. Physically. I have watched plan after plan try to fix progesterone first, fail, and conclude that “progesterone doesn’t work for her.” The progesterone wasn’t the problem. Cortisol was sitting on the docking station, refusing to let it land. Calm the cortisol first, and the same support that did nothing three months ago suddenly starts working.

Again, will there be times you intro hormones earlier? Absolutely. Understand that as you work through the foundational support stages, your response to those hormones may change, dosage may need to be adjusted, etc.

How long until you actually feel better?

Realistically? Eight to sixteen weeks for most women to feel something clearly shift. Longer if you’ve been pushed into real depletion - that often takes six to twelve months to fully rebuild. I want to say that honestly because impatience is one of the main reasons healing falls apart.

Two places impatience shows up especially hard:

• The first is quitting in the first month. The foundation doesn’t feel like treatment. So around week three, right before it would have paid off, a lot of women decide it isn’t working, get frustrated, and jump to the supplement aisle. They quit the thing that works for the thing that doesn’t. Please don’t be that woman - The boring weeks are the working weeks. I understand the allure of a quick fix, really I do!

• The second is retesting too early. If you go back to your DUTCH at four weeks, the numbers will look mostly the same as before. Not because nothing is working, but because adrenal healing is slow. That isn’t a failed plan; that’s an unrealistic timeline. Retest at eight to twelve weeks. Earlier than that and you’ll just talk yourself out of the thing that was actually fixing you.

The biggest predictor of how fast you heal isn’t what’s in your supplement cabinet. It’s whether the things that pushed you into this state have actually changed. Same hours, same relationship and perception of stress, same training/recovery mismatch, same overcommitment and “yes”-ing, plus some new capsules - that is not a healing plan.

How do you know it’s actually working?

Mostly you feel it before you see it.

Your afternoons start getting through without a hard crash and without three cups of coffee just to function. You fall asleep easier, you stay asleep, the 3 a.m. wake-ups get less frequent. Your mood steadies. The anxiety eases. The brain fog lifts. And the one I tell women to watch for most - your resilience comes back. A small annoyance that would have wrecked your whole day a few months ago becomes just a thing that happened. That is your nervous system, repaired. You’re able to pause and reset before reacting.

If you’re tracking, the numbers eventually move too. Your HRV starts climbing over weeks. Mornings start with real energy instead of dread. And if you retest at the right time, your cortisol curve regains its shape - higher in the morning, low at night - and DHEA moves back up.

Use these as your green light for when to step further into the work. Don’t add the herbs until the foundation is holding. Don’t reach for the deeper repletion until your nervous system is genuinely calmer. The signs your body gives you tell you it’s ready for the next layer. Healing is not a thirty-day countdown. It’s a path you advance through as your body shows you it can take the next step.

What I actually do

I am not going to teach you a system I don’t run myself. So here is what this actually looks like in my life. Not the polished version, but the real one.

The foundation never ended for me. It just became my life. It is the floor I live on. I wake between five and six, earlier in the Arizona summer. I don’t reach for my phone. I get outside, sun in my eyes. Sometimes I journal if I’m feeling like I have a lot on my plate, sometimes I read for a few minutes, sometimes I (gasp) grab my phone and play Wordle. My wake time barely moves, even on weekends - consistency is king.

I let my body set the day. Before I look at my wearable data (I currently use Whoop), before I decide what training the day gets, I do a body scan. I ask what my body actually needs that day - more output, or more recovery. If it’s an output day, I get on the bike or get a lift in. If it’s a recovery day, I run sauna with red light, maybe cold therapy, and time on my vibration plate, and I don’t argue with it. Sometimes on those days all I have time for is a walk with the dog instead. The data is one input; it’s not the verdict. The most accurate signal I have is me. I USED to just force myself to do whatever workout I had planned for the week, and somewhere around 35-ish I found I really had to shift that mentality because it wasn’t getting me the results I wanted, it was leaving me feeling not so great, and it was really just me being in autopilot vs. being intentional about exercise.

I do the deeper nervous system work, and it is the unsexy part. I work with a practitioner doing dry needling and nervous system regulation, and it has surfaced things I didn’t know I was still holding. It is tiring. It has also been the most genuinely useful work I’ve done for my own physiology. Going deep on a few real things beats going broad across twenty. I also do some sort of breathwork daily, even if it’s 5 minutes. I hate it, my mind always wanders, and I’m still waiting for it to get easier…yet I also see how much it benefits my capacity day to day. Just keeping it real for you!

I say what I need out loud. To my partner, friends, etc., i nstead of absorbing it and “handling it.” I treated that as optional for years. It is not. Unspoken stress doesn’t disappear. It moves into your body and waits.

None of this is exotic. None of it is the top of the pyramid. And it is why - training for a hundred-mile bike race, running two businesses, writing my first book - my own cortisol sits somewhere I am genuinely happy with.

Do I dive into strategic supplements? Of course. But I find when I’m really consistent with the aforementioned things, supplements are just amplifiers; they don’t really replace the other stuff. Right now my stress support looks like:

• Magnesium + glycine/taurine before bed

• Hydrating with trace minerals

• The Detox Patch and The Testosterone Patch from The Patch Method [they also have a “Cortisol Fix” patch, though I wouldn’t recommend that unless you’ve tested and are aware your cortisol is trending high.

  ---

One more thing, and the part I most want you to hear

If you have been “trying everything” and have started to quietly conclude the problem must be you - please hear me.

The problem is not you. The problem was the model.

You were handed a healing plan built for someone else, sold by an industry that profits from the plan failing, on a schedule that was never going to match your biology. The fact that it didn’t work for you is not evidence of personal failure. It is evidence that the model is wrong.

You do not have to keep blaming yourself. You do not have to keep adding. You do not have to keep buying.

You have to start from the bottom of the pyramid. Work with your biology instead of against it. Give the foundation the time it needs, and trust the signal coming from your own body more than the score on your wrist.

This post is part of a chapter I’m writing for my first book - on what it actually takes for high-performing women to feel well and perform through every season of life. The order of healing, and why almost nobody talks about it, gets its own section. More on the book soon!

If this was useful, the most useful thing you can do is send it to the woman in your life who is three supplement bottles deep and quietly losing hope. Show her the pyramid. Tell her to start at the bottom. She probably never had the order.

And tell me in the comments - which part of the foundation are you skipping? What’s the thing you keep meaning to do and never quite get to? I read every reply, and they decide what I write next. This series exists because of what you’re asking for.

Everything I publish here stays free while I am building this community. A paid subscription supports the deeper breakdowns as they come, but the core education will always be free. That matters to me.

Until next time - when in doubt, zoom out.

- Dr. Laura

References

1. Lightman, S. L., Birnie, M. T., & Conway-Campbell, B. L. (2020). Dynamics of ACTH and cortisol secretion and implications for disease. Endocrine Reviews.

2. Oster, H., et al. (2017). The functional and clinical significance of the 24-hour rhythm of circulating glucocorticoids. Endocrine Reviews.

3. Stalder, T., et al. (2016). Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology.

4. Chrousos, G. P. (2009). Stress and disorders of the stress system. Nature Reviews Endocrinology.

5. Leproult, R., & Van Cauter, E. (2010). Role of sleep and sleep loss in hormonal release and metabolism. Endocrine Development.

6. Sims, S. T. (2022). Roar and subsequent published work on female-specific endurance physiology.

7. Panossian, A., & Wikman, G. (2010). Effects of adaptogens on the central nervous system and the molecular mechanisms associated with their stress-protective activity. Pharmaceuticals.

8. Lopresti, A. L., Smith, S. J., et al. (2019). An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract. Medicine.

9. Russell, G., & Lightman, S. (2019). The human stress response. Nature Reviews Endocrinology.

10. Precision Analytical (DUTCH Test). Cortisol metabolism and recovery interpretation guides.

Last week I published a post called What Most Hormone Protocols Get Wrong. The core idea was simple: we keep treating the gland when the actual dysfunction is upstream. It reached more women than I expected - and the emails/DMs I received from it told me something specific. Of everything in that post, one topic generated the most questions by a wide margin.

Cortisol.

Women wanted to know: how do I actually know what my cortisol is doing? Why didn’t my protocol/supplement/changes to my workout routing make me feel better? What am I missing?

This is that post. It’s long, it’s detailed, and it’s free - because right now I care more about you actually understanding your own physiology than about anything else. Pour a coffee, & let’s get into it.

If you’re reading this, I bet you’ve been doing the work.

You track your cycle. You wear an Oura ring. You added magnesium glycinate at night, phosphatidylserine before bed, holy basil in the morning. You’re on the ashwagandha protocol that everyone in your feed has been recommending. You spent $500 on a DUTCH so you’d actually know what was going on in your body.

And here you are, six months in. Still waking up many nights at 3 AM. Still exhausted by mid-afternoon. Still can’t lose the last 10 pounds despite tracking macros and lifting four days a week. Still anxious for reasons you can’t quite name.

You’ve been told this is what “high cortisol” looks like in women your age. You’ve been put on the protocol your favorite functional medicine creator recommends. You’re doing all the things.

So why aren’t you better?

You’re not doing those things wrong. You’ve been treating the wrong pattern.

Cortisol isn’t a single number - even on a DUTCH test. It’s a four-dimensional pattern. And even women who’ve spent the money on advanced testing often have their results read incorrectly by whoever interpreted them. Once you’re working from a wrong read, every protocol that follows underperforms.

There are four cortisol patterns I see most often in practice. Only one of them is actually “high cortisol.” The other three get diagnosed as high cortisol all the time - and that’s where the work you’ve already done stops paying off.

Let me walk you through what your cortisol pattern is actually telling you.

The mistake hiding inside your cortisol results

Conventional medicine - and much to my dismay, a lot of functional medicine - treats cortisol like a thermostat. The number is high? Lower it. The number is low? Boost it. That’s the logic behind almost every cortisol protocol you’ve been handed.

But cortisol isn’t a thermostat. It’s a four-dimensional signal.

There’s the output (how much your adrenal glands are making). There’s the free fraction (how much is biologically active at any given time). There’s the clearance rate (how fast your body is metabolizing it). And there’s the rhythm (the curve it follows across the day - high at waking, dropping toward evening).

A single cortisol number - especially one measured at a single point in time - tells you about one of these dimensions. Maybe two if you’re lucky. And depending on which dimension is off, the right intervention can be the exact opposite of what the lab suggests.

Here’s a better way to picture it:

• Think of your cortisol like a bank account. A single cortisol test tells you the balance on one particular day. It tells you nothing about your income - how much your body is producing. Nothing about your spending rate - how fast you’re clearing it. Nothing about your cash flow pattern across the month - the rhythm.

• Two women can have the exact same balance on the day of the test and be in completely different financial situations. One is earning well and spending normally. The other is earning nothing and quietly living off her reserves. The balance alone cannot tell them apart.

That’s cortisol. The single number is the balance. The pattern is the financial picture. And you cannot make a good decision from the balance alone.

This is what gets missed. And it’s why two women with “high cortisol” on the same lab report can need completely opposite protocols - and why one of them ends up worse.

What is a normal cortisol pattern?

A normal cortisol pattern is rhythmic. It peaks within the first 30 to 45 minutes of waking - this is called the cortisol awakening response, or CAR - and then declines steadily across the day, reaching its lowest point around midnight. That curve is what keeps you alert in the morning, gradually winds you down through the afternoon, and lets melatonin take over at night.

That rhythm is the most important thing. Not the number at any single moment - the shape of the curve.

A few things to know about normal cortisol output:

• Free cortisol is only about 1% of your total cortisol production. When a lab runs a salivary cortisol or a basic “cortisol level,” it’s usually measuring free cortisol. That’s a useful piece - but it doesn’t tell you what your adrenals are actually producing overall.

• Metabolized cortisol - what you see on only a DUTCH test - reflects your total cortisol output. This is the marker that tells you whether you’re making a lot or a little.

• The relationship between free and metabolized cortisol tells you about clearance. If you’re producing a normal amount but clearing it fast, your free cortisol can look low. If you’re producing a normal amount but clearing it slowly, your free cortisol can look high. Same production, different patterns.

This is why the best approach at actually evaluating cortisol is not just a blood test. You can’t see the pattern in a snapshot.

How do you tell if your cortisol is actually high?

Here are the four cortisol patterns I see most often. Two of them get diagnosed as “high cortisol.” Only one of them actually is. As you read, see which one sounds like your life.

Pattern 1: True high output.

This is the classic stress pattern. Metabolized cortisol is high - meaning your body’s production of it is up. Free cortisol is high - it’s active in your circulation. And clearance is normal. You’re making a lot of cortisol and dealing with all of it. If this is you, you’re the woman who’s wired, anxious, can’t sit still, doing too much, sleeping poorly, gaining weight despite doing everything right. It can feel REALLY hard to relax, and you may find yourself feeling really reactive towards even smaller things.

This is the pattern most people picture when they hear “high cortisol.” It is real, and it’s fixable - by addressing the stress drivers underneath it, not by suppressing the cortisol directly. However, supplementation and tools to reduce it can be helpful in managing symptom load while working on those underlying drivers!

Pattern 2: Elevated clearance - the most misread pattern.

Metabolized cortisol is high - your production is robust or even elevated - but free cortisol looks low or normal. Your body is making plenty of cortisol and clearing it fast.

This one shows up most often in women carrying extra adipose tissue, particularly belly fat. Adipose tissue pulls cortisol off its binding protein and speeds up clearance. It also shows up in hyperthyroidism, in chronic stress states where the body has compensated by clearing faster, and sometimes in the postpartum period as hormones are trying to re-adjust.

Here’s the trap: If your testing only looked at free cortisol - a single morning salivary, a one-off blood draw - this pattern looks like low cortisol. So you get told you have “adrenal fatigue.” You get put on adaptogens or licorice or glandulars to “raise” a cortisol level that was never actually low. And you feel worse - because you didn’t have a low cortisol problem in the first place. You had a clearance problem, and it needed completely different support.

Pattern 3: Sluggish clearance.

Your production is normal-to-low, but free cortisol is hanging high. The cortisol is getting made and not cleared efficiently. You feel every symptom of “high cortisol” - anxious, wired, poor sleep - even though your overall output isn’t actually elevated.

This pattern usually traces back to liver function, thyroid status, bile acid production, or mitochondrial issues affecting how you metabolize cortisol. The fix is upstream of cortisol entirely.

Pattern 4: True low output - HPA exhaustion.

Metabolized cortisol is low. Free cortisol is low. DHEA is often low too. This is the classic burnout pattern - the woman who’s run on stress for years and whose system has finally downshifted into conservation mode.

If this is you, lowering cortisol is the last thing you need. Grabbing that “cortisol fixer” off of TikTok shop is not going to do you any favors here, unfortunately.

Your whole system needs to be nourished back up. Adaptogens can play a role here - but they get reached for too aggressively and too early, before minerals, blood sugar, and the nervous system are stable. That overshoot is exactly why so many women in this pattern feel worse on the protocol they were handed.

Every one of these four will get labeled a “cortisol problem” on a conventional test. Every one of them needs a different approach. This is why your pattern matters more than your number.

What does HPA axis dysregulation feel like?

This is the part that gets women dismissed. The symptoms of cortisol imbalance don’t always match what people expect, and they vary depending on which of the four patterns is at play.

Some of the most common symptoms across all patterns:

• Waking between 2 and 4 a.m. consistently (especially when paired with mind racing)

• The “wired but tired” feeling - exhausted but unable to wind down

• Afternoon energy crashes that no amount of caffeine fixes

• Sugar cravings around 3 p.m. or after dinner

• Anxiety that has no obvious trigger

• Weight gain centered on the belly that won’t respond to diet or exercise

• Hair thinning, especially around the temples

• Cycle changes - irregular periods, worse PMS, anovulatory cycles

• Hot flashes or temperature dysregulation that aren’t strictly perimenopausal

• Brain fog by midmorning

• Recovery from workouts taking longer than it used to

• Catching every cold that goes around

What’s tricky is that these same symptoms can show up in a woman with high cortisol production and in a woman whose cortisol has crashed. Your body is bad at telling you which direction the imbalance is going - it just tells you it’s struggling. This is exactly why your pattern matters more than your symptom list. Assuming that “anxious + can’t sleep + belly fat” automatically means high cortisol is the single most common reason women end up on the wrong protocol.

What causes high cortisol in women?

The list is longer than most articles will tell you. The most common drivers I see in the high-performing women I’ve worked with for over a decade:

Chronic stress. The obvious one. Work, parenting, relationships, financial strain, ongoing health issues. But also subtler chronic stressors - perfectionism, people-pleasing, lack of boundaries, not communicating needs, hypervigilance from past trauma.

Blood sugar instability. One of the biggest drivers. When your blood sugar crashes, cortisol rises to bring it back up. If your blood sugar is crashing four or five times a day - which happens with high-sugar breakfasts, long gaps between meals, or excessive caffeine on an empty stomach - your cortisol is responding every time. Over years, this rewires the entire HPA axis.

Poor sleep. Not just total hours - sleep architecture. Fragmented sleep, late bedtimes, no consistent wake time, blue light at night. The cortisol curve is anchored to your wake time. Inconsistent wake times produce a chaotic cortisol curve regardless of how many hours you slept.

Over-training or under-fueling. Endurance training, high-intensity work, and chronic caloric deficits all signal the body to produce cortisol. Fasted morning workouts in already-stressed women are one of the more common mistakes I see.

Gut inflammation. Inflammation from the gut signals the HPA axis to mobilize cortisol as part of the immune response. Chronic gut dysbiosis can drive cortisol independently of any psychological stress.

Perimenopause. As ovarian hormone production declines, estrogen and progesterone - which both buffer cortisol - drop. The same level of stress that was manageable five years ago now feels overwhelming because the buffering capacity is gone.

Medications. Steroids obviously. But also some birth control formulations, some thyroid replacement when dosing is off, and certain stimulants.

Underlying medical conditions. Cushing’s syndrome (rare, but real) is the most extreme. Subclinical hyperthyroidism also raises cortisol clearance.

Most women have two, three, or four of these stacked at once. The fix isn’t to “eliminate stress” in some vague way - it’s to identify which of these inputs are actually driving your cortisol up, and address those.

The cortisol panic - and what the internet is getting wrong

I have to name the elephant in the room, because it’s changing how women show up to me.

Cortisol is having a moment. Your feed is full of it. The “cortisol cocktail” - orange juice, coconut water, salt, a splash of cream of tartar. The “cortisol face” before-and-afters. The supplement brands that have repackaged the same three adaptogens as a “cortisol detox.” Every symptom a woman has - belly weight, bad sleep, anxiety, fatigue - is getting funneled into one explanation. High cortisol. Lower your cortisol. Buy this to lower your cortisol.

Here’s the problem: Almost all of it assumes Pattern 1. It assumes everyone with symptoms has true high output, and that the fix is to suppress.

But if you’ve read this far, you now know there are four patterns. You know that Patterns 2, 3, and 4 will all get worse with a blanket “lower your cortisol” approach. The woman with HPA exhaustion who drinks a cortisol-lowering mocktail every afternoon and stacks ashwaghanda on top isn’t fixing anything - she’s pushing an already-depleted system further down.

I’m not anti-cortisol-content. I’m glad women are paying attention to their stress physiology - that’s genuinely a good thing! But “lower your cortisol” as a universal prescription is the exact same flat thinking as conventional medicine’s “your labs are normal.” It’s a single answer applied to a four-dimensional problem.

The cortisol cocktail probably won’t hurt you. It also won’t fix a pattern you haven’t identified. And I know how precious your time and resources are, so I want you to make sure that the habits and products you’re being consistent with are actually doing something for you1

What you can do right now: a 7-day cortisol self-assessment

You can’t run your own DUTCH test…but you can gather real data on your own pattern this week - and it’ll tell you more than you’d think, and may help you decide if you want to pursue further functional testing. Here’s what to track for 7 days:

1. Your wake-ups. Every time you wake in the night, note the time and whether your mind was racing. Consistent 2-4 AM wake-ups with a racing mind point toward a cortisol rhythm problem - cortisol rising too early and too sharply.

2. Your energy curve. Rate your energy 1-10 at four points each day: on waking, mid-morning (around 11), mid-afternoon (around 3), and evening (around 8). After 7 days you’ll see your actual curve. A healthy one is highest in the morning and tapers gently. A crash at 11, or a hard 3 PM dive, is telling you something.

3. The caffeine test. When your afternoon crash hits, notice - does caffeine actually fix it, or just paper over it for an hour? Caffeine that doesn’t really work points to a crash that’s cortisol and blood-sugar driven, not a true need for stimulation.

4. Protein at breakfast. Estimate the grams of protein in your first meal. Under 30 grams, with no fat or fiber to anchor it, and your blood sugar - and therefore your cortisol - is on a rollercoaster from the first hour of your day.

5. Your morning light. Are you getting outside, eyes to the sky, within 30-60 minutes of waking? Or is your first input a screen? Morning light is the single strongest anchor for your cortisol rhythm, and most women miss it entirely.

6. Where you are in your cycle. If you’re still cycling, note your cycle day alongside your symptoms. Cortisol-sensitive women often feel their worst in the late luteal phase - and that’s information, not coincidence.

None of this replaces testing. But at the end of 7 days you’ll have a real picture of your rhythm, your crashes, and your inputs - and you’ll walk into any conversation with a practitioner with actual data instead of a vague “I feel off.”

How do you actually lower cortisol levels?

This is the question I see most. And it’s the wrong question.

You don’t always want to lower cortisol. You want to fix the pattern.

If you have Pattern 1 (true high output), then yes - you want to bring cortisol down. But you do that by addressing the inputs (stress, blood sugar, sleep, training load) more than by suppressing the output. Cortisol-lowering supplements like ashwagandha, phosphatidylserine, and magnesium can help. But they’re tools layered on top of foundation work, not replacements for it.

If you have Pattern 2 (elevated clearance), you don’t want to lower cortisol - your output is already normal. You want to slow the clearance, which means addressing whatever is driving it: belly adiposity, thyroid function, liver capacity. Stacking ashwagandha here can backfire.

If you have Pattern 3 (sluggish clearance), the goal is to improve clearance, not lower output. That’s liver support, thyroid optimization (check those free T3 levels), bile acid production (if you’re reading this and don’t have a gall bladder…hi this is you!), mitochondrial work.

If you have Pattern 4 (HPA exhaustion / low output), lowering cortisol is the last thing you want. This system needs nourishment - minerals, blood sugar stability, gentle adaptogens later (not first), real rest, real food, real sleep.

So when someone asks “how do I lower my cortisol?” - my real answer is: it depends which pattern you’re in, and lowering may not be what you need.

How long does it take to recover from HPA dysfunction?

The realistic answer: 8 to 16 weeks of consistent foundation work, longer if there’s deep HPA exhaustion.

The first 4 to 6 weeks of meaningful cortisol pattern shift usually come from lifestyle inputs - consistent wake time, morning light, blood sugar stability, sleep prioritization, reducing training load if needed, nervous system regulation work. This is where the biggest gains live, and where most women quit, because the changes feel boring next to a supplement protocol.

The next 8 to 12 weeks are about layering - appropriate supplementation for the specific pattern, addressing upstream drivers (gut, thyroid, blood sugar at a deeper level), and rebuilding capacity.

True HPA exhaustion - Pattern 4 - often takes 6 to 12 months of consistent work to fully recover. Not because the work is exotic, but because the system has been depleted for years and rebuilds slowly.

The biggest predictor of how fast cortisol recovers isn’t the supplement stack. It’s whether the inputs that drove the dysregulation in the first place have actually changed.

How to fix a dysregulated HPA axis

If you’ve read my work for any length of time, you’ve heard me say foundation first, the roof comes last. This is what that means in the context of cortisol.

The four-step priority order I use with the women I work with:

Step 1: Brain. Circadian rhythm support. Same wake time every day regardless of bedtime. Morning sun within 30 minutes of waking. Light reduced in the evening. Sleep quality prioritized. Nervous system regulation work - breathwork, somatic tools, real connection with safe people. Your relationship with stress, not just exposure to it.

Step 2: Filter. Identify what’s blocking the system from working. Inflammatory load - gut, food sensitivities, environmental toxins. Blood sugar - what’s your fasting insulin doing, what does your day look like meal-to-meal, are you crashing? These are upstream of cortisol and have to be addressed before supplementation can do its job.

Step 3: Hierarchy. Once foundation is stable, sequence interventions correctly. Adrenals and insulin (and gut optimization) first. Thyroid second. Sex hormones third. Skipping this order is where most “cortisol protocols” stall.

Step 4: Adapt. Build resilience after the foundation is in place. Strategic adaptogens matched to the pattern (not a generic stack). Hormetic stress - cold, heat, exercise - at appropriate doses for your specific physiology. Strategic supplementation, not maintenance baseline.

That sequence is non-negotiable. The right intervention at the wrong time makes things worse - which is why so many “cortisol protocols” stall before they get to work.

What I do

I’m not going to teach you a framework I don’t run myself. So here’s exactly what I do to support my own cortisol. Not the polished version that’s Instagram-shiny, but the actual one.

I protect the first hour of the morning. I wake between 5 and 6, earlier in the Arizona summer when the sun comes up early. I don’t grab my phone. The first thing I do is get outside, get sun in my eyes, and read for a few minutes - right now I’m working through the Daily Stoic. It’s a small thing that does an enormous amount for cortisol rhythm.

I do a body scan before anything else. Before I look at my Oura or Whoop data, before I decide what kind of workout I’m doing, I check in - what does my body actually need today? More movement, or more recovery? That question, asked before the data instead of after it, is the whole game. If you’re a woman who finds yourself in your head often, and might have a harder time connecting with your body…this morning tool would be perfect for you.

I let my body lead, not my wearable. This is a real discipline. Some mornings my wearable data says I recovered beautifully and I feel crushed. Some mornings the score is bad and I feel great. I use the data as one input, not the verdict. If you let the data run the show, you stop listening to the most accurate signal you have, which is you!

Movement or recovery - never both maxed out. On a good day, I get a workout in: the bike, or a lift. On a day my body asks for recovery, I run sauna with red light, cold therapy, and time on my vibration plate instead. I don’t force a hard workout onto a system that’s asking for something else. That used to be hard for me, because working out is always a great mental stress relief tool!

I do the deeper nervous system work. This is the unglamorous part. I’ve been working with a practitioner doing dry needling and nervous system regulation, and it has surfaced stored patterns I didn’t know I was carrying. It’s exhausting. It’s also been some of the most transformative work I’ve done for my own stress physiology. Going deeper on a few things beats going broad on twenty. It’s ok to have a season where you do some “hard” work on an area of your health and well-being, knowing it’s going to benefit you longterm (and the hard doesn’t last forever!)

I verbalize what I need. Out loud. To my partner, my friends, my clients. Instead of holding it all in and “handling it.” For a long time I treated that as optional. It’s not. Unspoken stress doesn’t disappear; it just relocates into your physiology and waits.

None of this is exotic. None of it requires a supplement budget. All of it is upstream. And it’s why - even training for a 100-mile mountain bike race, even running two businesses - my own cortisol pattern stays in a place I’m genuinely happy with.

Your body didn’t “stop working” for you

If you’ve been pushing hard for years, here’s what I most want you to take from this post. Your body is doing exactly what it’s designed to do - adapt to ongoing stress in the only way it knows how. Cortisol dysregulation is your nervous system’s reasonable response to the demands you’ve placed on it. The fact that you can still get up, go to work, and care for the people in your life is not evidence that nothing is wrong - it’s evidence that your system has compensated impressively, for a long time.

The fix isn’t to “slow down” in some vague way you have no intention of actually doing. It’s to get strategic about how you support yourself. To know which cortisol pattern you’re actually in - which usually means a DUTCH test, not a single blood draw. To stop treating “high cortisol” as one universal problem with one universal solution, and start asking what your specific pattern is telling you. And to do the upstream work before you reach for the next supplement, not after the supplement fails.

And if you’re anywhere from your late 30s through your 50s, please don’t dismiss what’s happening to you as “just stress.” Perimenopause changes the cortisol picture significantly. Estrogen and progesterone both buffer cortisol, and as they decline, you become more cortisol-sensitive. The same stress that was manageable five years ago genuinely feels worse now. That’s biology, not weakness!

One more thing

This post is part of a chapter I’m writing for my first book - on women’s health, hormones, and what it actually takes to feel well and perform through every season of life. Cortisol gets a whole section, because it’s the pattern underneath almost everything else. More on the book soon.

If you found this useful, the best thing you can do is send it to one woman who’s been told she has “high cortisol” and put on a protocol that isn’t working. She’s exactly who I wrote it for.

And tell me in the comments - which of the four patterns do you think you are? What’s your 3 AM situation? What has your cortisol journey looked like so far? I read every response, and they shape what I write next. This post exists because of what you asked for last time.

Everything I publish here stays free while I’m building this community. If you want to support the work and get the deeper clinical breakdowns as they come, a paid subscription is the way - but the core education will always be free. That part matters to me.

And if you happen to be a practitioner reading this - the clinical, case-based version of these four patterns is what I teach inside my certification. But this post was written for the woman trying to understand her own body. That’s who I hope it reaches.

Until next time - when in doubt, zoom out.

• Dr. Laura

References

1. Hannibal, K. E., & Bishop, M. D. (2014). Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Physical Therapy.

2. Russell, G., & Lightman, S. (2019). The human stress response. Nature Reviews Endocrinology.

3. Lightman, S. L., et al. (2020). Dynamics of ACTH and cortisol secretion and implications for disease. Endocrine Reviews.

4. Stalder, T., et al. (2016). Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology.

5. Anderson, T., & Lane, A. R. (2024). Cortisol dynamics in women: emerging considerations across the lifespan. Endocrine Practice.

6. Precision Analytical (DUTCH Test). Cortisol metabolism interpretation guides. precisionanalytical.com

7. Chrousos, G. P. (2009). Stress and disorders of the stress system. Nature Reviews Endocrinology.

8. Karatsoreos, I. N., et al. (2010). Endocrine and physiological changes in response to chronic corticosterone. Endocrinology.

9. Joseph, J. J., & Golden, S. H. (2017). Cortisol dysregulation: the bidirectional link between stress, depression, and type 2 diabetes. Annals of the New York Academy of Sciences.

10. Stephens, M. A., & Wand, G. (2012). Stress and the HPA axis: role of glucocorticoids in alcohol dependence. Alcohol Research: Current Reviews.

The 38-year old on a thyroid medication whose fatigue wouldn’t life. The 42-year old in early stages of perimenopause who’d been put on progesterone for eight months, yet still couldn’t sleep through the night. The 35-year old with cystic acne and “perfect” labs whose practitioner kept adding supplements, watching nothing change.

Every single one of these women had been told their labs were normal. Every single one of them was still suffering. And every single one of them had been treated through the lens of “which gland isn’t working?”… when the actual answer was that none of the glands were broken at all.

This is THE most common mistake I see in functional medicine - both in clients who I work with directly on their health goals coming from other practitioners, or with the functional practitioners I mentor inside of my practitioner community. It’s also the most expensive mistake your practitioner can make.

Let me explain.

The mistake everyone makes

For decades, conventional and even much of the functional medicine world has been organized around the idea that if a hormone is low, you give more of it. If a gland seems sluggish, you support that gland. Got a thyroid problem? Thyroid medication or supplements to support the thyroid. Signs of poor adrenal output? Adaptogens and glandulars. Low progesterone? Progesterone cream, Vitex, wild yam.

This works some of the time. Especially in the short term. The problem is that most chronic hormone cases don’t actually start at the gland.

They start with the brain.

I know that sounds dramatic, but let me walk you through it.

Pattern Zero: Where Dysfunction Actually Starts

Your hormones are regulated by what we call the HPATG axis - hypothalamus, pituitary, adrenals, thyroid, gonads (ovaries and testes). Stick with me while we review some physiology for those of you who are practitioners (and maybe introduce these concepts to you if you’re here learning for yourself!).

The corporate metaphor I use with my practitioner mentees is this:

• The hypothalamus is the CEO. It senses everything happening in your body - stress, light, temperature, inflammation, sleep, blood sugar - and makes the executive decisions about what needs to happen physiologically in response to those signals.

• The pituitary is the manager. It translates the CEO’s decisions into specific memos, which go out to the glands.

• The glands - the adrenals, thyroid, ovaries, etc. - are the factories. They produce the actual products: cortisol, thyroid hormone, estrogen, testosterone.

When you have chronic hormone symptoms, most practitioners focus on the factory output. Not enough thyroid hormone? Let’s add some more. But here’s the thing - if the factory is producing exactly what the manager told it to produce, and the manager is doing what the CEO told it to do, then changing the factory’s output without addressing the upstream signals is really just fixing symptoms while ignoring the cause.

The clinical pearl I want you to remember is this: the glands can often be innocent bystanders when the brain is in alarm mode.

What puts the brain in alarm mode? Chronic stress. Trauma. Poor sleep. Undereating. Overtraining (or not prioritizing recovery with your high workout load). Inflammatory load from your gut. Blood sugar instability. Even the way you’ve been talking to yourself for the past ten or twenty years!

When your amygdala - the brain’s thread detection center - stays in a state of low-level alarm long enough, it sends a continuous “danger” signal to the hypothalamus. The hypothalamus responds the only way it knows how: it tells the pituitary to keep the tress system on. The pituitary tells the adrenals to make cortisol. And cortisol, being the master signaling molecule it is, starts disrupting every other axis.

What this looks like in your body

Here’s where it gets clinically real. When the brain is in chronic alarm mode, it doesn’t just affect your stress response. It creates a cascade that impacts a whole bunch of different things, that you may not realize are actually related.

• Ongoing elevated cortisol impairs T4 to T3 conversion. Even if your thyroid is making plenty of T4, your liver and peripheral tissues can’t convert it into the active T3 your cells actually use. Your TSH looks fine. Your T4 looks fine. Your free T3 (if it’s even being tested) is at the bottom of the range. You feel exhausted, cold, and foggy and your doctor tells you your thyroid is fine. It is.. but its downstream signaling isn’t.

• Cortisol may disrupt ovulation. Your brain has decided this isn’t a safe time to reproduce, so it suppresses LH pulsatility. You start having anovulatory cycles (aka..you don’t ovulate). No ovulation, no corpus luteum formed, which means no progesterone is made. You blame “estrogen dominance,” but the real story is that progesterone is missing because your brain decided survival was a higher priority than reproduction.

• Chronic cortisol elevation drives insulin resistance. Cortisol is a glucocorticoid, meaning its job is literally to raise blood glucose. Chronically high cortisol means chronically high blood sugar means chronically high insulin. Insulin resistance follows. You start craving carbs at 3pm and gaining weight you can’t lose, and again, your fasting glucose looks “fine.”

• Eventually, the system flips. When the adrenals get tired of running cortisol production at full volume, they downshift. Now your morning cortisol is low. You can’t get out of bed. Your body has dropped into conservation mode and your thyroid downregulates further to slow your metabolism.

This is the picture most practitioners see and call “adrenal fatigue” or “thyroid failure” or “estrogen dominance.” All three labels are looking at downstream effects of the same upstream problem.

The brain is still in alarm mode. The glands are still innocent. If anything, the glands are trying to adapt to the memos being sent their way!

A quick note on mechanism, because I’m correcting something the functional medicine world has been teaching for years

If you’ve been around functional medicine for any length of time, you’ve probably heard the “pregnenolone steal” hypothesis. The idea goes like this: under chronic stress, your body steals pregnenolone - the master precursor of the steroid hormone pathways - away from sex hormone production and shunts it toward cortisol production instead. The result is depletion of progesterone, estrogen, and testosterone. It’s a tidy story. It’s also been taught in functional medicine for decades.

The clinical observation behind it is real. Chronically stressed women do have low sex hormones; I see this in serum testing and DUTCH testing again and again. But the mechanism the hypothesis describes has been updated, and I want to be honest about that with you because I’d rather you be in on the loop as the science evolves, rather than use terminology that’s familiar only because it’s, well, familiar.

Modern endocrinology has shown that steroidogenesis is compartmentalized. Pregnenolone is synthesized locally inside each tissue (the adrenals make their own from cholesterol, the ovaries make their own, the brain makes its own) and each tissue runs on its own regulatory signals - ACTH for the adrenals, LH and FSH for the ovaries - using its own enzyme systems. There’s no shared circulating pool to “steal from.”

So if it’s not literal substrate competition, what is happening?

Brain-level signaling disruption. Specifically:

• CRH (Corticotropin releasing hormone, the hypothalamic stress hormone - remember, the executive!) directly inhibits GnRH (gonadotropic releasing hormone), the signal that drives ovarian function

• Cortisol suppresses LH pulsatility at the pituitary level

• Chronic stress affects ovarian responsiveness to LH and FSH

• Receptor sensitivity downstream is also affected

The pattern looks identical from the outside: high cortisol, low sex hormones, not ovulating regularly, “where did my libido go?” The clinical takeaway is also identical: address the upstream stress signal and the sex hormones recover. But the actual mechanism is communication disruption between the brain and the gonads, not a literal pregnenolone shortage due to “stealing” raw materials.

I’m spending time on this because I think how we explain physiology to ourselves and to our clients matters. If you’ve been told “your body is stealing pregnenolone to make cortisol,” the spirit of that is correct; your sex hormones are suffering because of stress. The literal mechanism is more nuanced. Same takeaway, more accurate physiology.

Why this matters whether you’re a patient or a practitioner

If you’re reading this as a woman who’s been told your labs are normal but you still feel like garbage, I want you to take a breath. The most likely reason your protocol isn’t working is not that you need a different supplement, a different doctor, or another lab. The most likely reason is that the upstream driver of your symptoms hasn’t been addressed yet.

If you’re reading this as a practitioner - like those of you in my mentorship - you’ve probably watched this play out a hundred times. The client whose DUTCH looks great after gut work but whose symptoms haven’t shifted. The client who responds for a few weeks or months to thyroid medication and then plateaus. The client whose progesterone “doesn’t work.”

The principle is the same. Fix the foundation first. The roof comes last.

When the glands really aren’t innocent

I have to be direct about something here, because if I leave this out I’ll have left out a really important piece of this whole conversation.

Pattern Zero applies to functional hormone cases. It does not describe every clinical scenario, and pretending it does is its own form of error.

There are three categories where the gland is, in fact, the primary driver, and where treating only upstream isn’t going to be enough.

Perimenopause and menopause.* This is the one I want to spend time on, because it’s where I see the most confusion right now. As ovarian follicular reserve depletes - somewhere in a woman’s late 30s through her 50s - the gland is no longer producing what it once did. The brain is actually signaling appropriately. The pituitary is shouting (your FSH and LH are climbing for a reason). The ovaries simply don’t have the raw material left to respond.

This is not Pattern Zero. This is not a brain-in-alarm-mode story. This is a real, physiological hormone deficiency, and in that scenario, doing endless upstream foundation work without ever considering hormone replacement is not honoring the biology. It’s withholding what the body is actually asking for.

I’m firmly pro hormone replacement therapy in the right context, with the right woman, at optimized doses. I think the cultural pendulum has swung too far away from HRT for women in peri and post-menopause, and too many of you are suffering needlessly because someone told you to “just lean into your feminine energy” or “support your adrenals” while your brain, bones, and cardiovascular system lose their estrogen protection year after year. That’s not functional medicine. That’s neglect dressed up as natural. On the flip side, I’m not a fan of big-box telemedicine companies that promise “personalized” hormone care and really are just delivering generic, minimal HRT dosages to women based on algorithmic output, without any level of personalization or consideration of the bigger shifts in physiology outside of just sex hormones that happens in perimenopause.

If you’re in your 40s or 50s and your symptoms have a clear hormonal-decline pattern, with symptoms like hot flashes, night sweats, vaginal dryness, sleep disruption that started around the same time as cycle changes, joint pain that came out of nowhere.. please get serum hormone testing or saliva testing alongside whatever functional workup you’re doing, and please have a real conversation about HRT with a provider who actually understands it. Foundation work matters here too (I’ll come back to that) but it isn’t a substitute for replacement when replacement is what’s needed.

Primary gland pathology.* Hashimoto’s. Graves’. Primary adrenal insufficiency. Premature ovarian insufficiency. Structural ovarian changes in PCOS. These are real diseases of the gland itself. They require diagnosis, often replacement, and sometimes surgical or medication-based intervention. Pattern Zero doesn’t override that; we work alongside it.

Iatrogenic causes.* Surgical menopause. Post-thyroidectomy. Long-term medication-induced suppression. The gland in these cases isn’t “innocent” - it isn’t there, or it’s been pharmaceutically silenced. Replacement isn’t optional in these scenarios. It’s the standard of care.

So the more nuanced framing is this: the glands are often innocent in functional cases. They aren’t always in every case. Your job - whether you’re treating yourself or your client - is to know which scenario you’re in.

How do you know? You take a thorough history. You run appropriate testing - DUTCH alongside serum/saliva, full thyroid panels, antibody testing, cycle mapping, HRV evaluation, family history, prior medical events. You consider age, life stage, surgical history, and how the symptom pattern actually maps to physiology. You listen to your clients or patients and don’t dismiss them just because their story doesn’t “match” your data points. You don’t apply one framework to every body.

And here’s the part I want to make sure no one misses: this is a both-and situation, not an either-or.

Even when hormone replacement is absolutely the right answer - and in peri and post-menopause, it often is - the upstream work still has to happen. Replacement on top of an unaddressed foundation is a recipe for poor outcomes, and I see this play out clinically all the time.

A perimenopausal woman starting HRT without addressing her HPA axis won’t respond the same way as one whose nervous system has been brought back online. Cortisol-cleared hormones don’t reach receptors. An inflamed gut metabolizes oral progesterone differently and you get unpredictable serum levels. A blood-sugar-dysregulated body amplifies estrogen signaling at the tissue level, which can make symptoms worse instead of better. A woman whose mineral status is depleted will have a harder time using thyroid hormone even at optimized replacement doses.

So the framework stays the same: brain first, filter second, hierarchy third, adapt fourth. The difference in peri and post-menopause is that within “hierarchy,” sex hormone replacement has now earned its place at the table… alongside, not instead of, the foundation work.

Foundation first does not mean foundation only. And replacement is not a shortcut around the foundation. Both are required. Both matter. The patients who do best are the ones whose practitioners refuse to choose between them.

What to do instead: the Four-Step Priority Order

Here’s the sequence I teach in the Women’s Health and High Performance Specialist Certification, and it’s the same sequence I run with my private clients.

Step 1: Brain first.* Address the top of the axis before you touch anything else. This means circadian rhythm support, sleep quality, light exposure, nervous system regulation, and your relationship with stress. There is no supplement fix for a brain that won’t stand down. Lifestyle and nervous system work are not the soft, optional add-ons most people think they are. They’re the foundation.

Step 2: Filter.* Remove the interference before you add anything. Inflammatory load from your gut. Toxin burden. Poor sleep. Crappy relationships and toxic work environments (to the best of your ability). Blood sugar instability. Before you add hormones or supplements, identify what’s blocking them.

Step 3: Hierarchy.* Fix in order: adrenals and insulin first, then thyroid, then sex hormones. This sequence isn’t arbitrary. It’s physiological. You can’t build a roof on a shaky foundation.

Step 4: Adapt.* Once the foundation is stable, you build resilience. Adaptogens, hormetic stress (cold, heat, exercise), strategic supplementation. Don’t just add; subtract first, then build back.

→ The takeaway: in functional hormone cases, the issue is rarely the hormone you’re targeting; it’s almost always something upstream that hasn’t been addressed yet. In peri/menopause and primary gland pathology, the gland itself* may need direct support and replacement. Knowing which scenario you’re in is half the battle. When in doubt, zoom out, and then look closely at age, life stage, and history before deciding what to treat.

One last thing, for my high-performing women specifically:

If you’re in your 20s or 30s or 40s and pushing hard, please hear me on this: your biology isn’t inherently “messed up”. It’s responding rationally to the demands you’re placing on it. The fix for everyone isn’t “rest more” or “lean into your feminine energy” or whatever the wellness internet is selling this week, though I understand the shift to that mentality after gears of the hustle and grind. In reality, the fix is to get strategic about how you support yourself so the brain perceives less threat and the rest of the system can come back online.

If you’re in your late 30s through your 50s and you’ve been doing the foundation work for a while and your symptoms still won’t fully resolve.. you may be in early peri, and the conversation needs to expand to include real hormone testing and an honest discussion about replacement. That’s not a failure of your foundation work. It’s just biology shifting under you, and it deserves a different layer of support.

You don’t have to slow down. You have to support better, and you have to know what season of biology you’re actually in.

That’s a conversation I want to keep having here on Substack, on the podcast, and through my work. If you want me to go deeper on any of the four steps above, or if you have a specific pattern you’re trying to figure out.. drop it in the comments. I read every one and let it shape what I write next.

If you’re a practitioner and want to learn the systems-biology framework I use with cases like these, the Women’s Health and High Performance Specialist Certification is currently open for enrollment. Comment CERT below and I’ll send you the details.

Hope this deep dive was helpful - Until next time!

- Laura

References

1. Tsigos, C., & Chrousos, G. P. (2002). Hypothalamic–pituitary–adrenal axis, neuroendocrine factors and stress. Journal of Psychosomatic Research.

2. Geva-Zatorsky, N., et al. (2020). A new model for the HPA axis explains dysregulation of stress hormones. Molecular Systems Biology.

3. Russell, G., & Lightman, S. (2019). The human stress response. Nature Reviews Endocrinology.

4. Charmandari, E., Tsigos, C., & Chrousos, G. (2005). Endocrinology of the stress response. Annual Review of Physiology.

5. Ranabir, S., & Reetu, K. (2011). Stress and hormones. Indian Journal of Endocrinology and Metabolism.

6. Stephens, M. A., & Wand, G. (2012). Stress and the HPA axis: role of glucocorticoids in alcohol dependence. Alcohol Research: Current Reviews.

Feels strange to write that, but here we are.

I’m not brand new to cycling, but I’m also not the kind of person who has been MTB for years, especially not endurance riding. I have family and friends who love it, which is how I was first introduced to Leadville a few years ago.

The Leadville 100 is one of those races that lives in the back of your mind as “something other people do.” High altitude, brutal climbs, 10+ hours in the saddle (I mean..not for the pros, but for the rest of us) - it has a reputation for testing every ounce of grit an athlete has.

So why did I sign up? Many reasons, to be honest:

• Part of me knew I needed something that would stretch me in a way day-to-day training never could. I wanted a challenge beyond business challenges, which have really taken up most of my mental space over the past 5 years.

• I wanted to take everything I teach about high performance - from recovery and nervous system regulation to nutrition and biohacking - and apply it to myself in real time, while bringing clients and my platforms along for the ride.

• If you’re an entrepreneur, you may be able to understand the constant need today for feeding the content machine. To be honest, it’s not my favorite part of running a business. However, I think by making it fun and immersive, it’s actually going to be so much more valuable for my platforms to see application of these tools in real time, while also allowing ME to have some fun in the process.

• Something fun to do with my boyfriend, who’s also training for

  the race with me. Couples who take on challenges together, grow together.

Why does this challenge matter?

For me, Leadville isn’t just about completing a 100-mile race. It’s about intentionally stepping into discomfort.

In his book The Comfort Crisis, Michael Easter talks about how modern life makes it easy to avoid anything truly hard. We live in climate-controlled homes, eat whenever we’re hungry, and rarely face situations that push us beyond what feels safe or convenient. The problem? Comfort doesn’t make us stronger in the long run (in fact, it often has the opposite effect). Discomfort does.

Easter shares the idea of a misogi: taking on a challenge so difficult there’s a real chance you won’t succeed. The point isn’t the outcome; it’s who you become in the process. That’s exactly what Leadville represents for me. It’s not guaranteed. There’s a chance I might not finish. But training for it forces me to grow in ways that sitting in my comfort zone never could.

As a high-performance coach, I often ask clients to lean into challenges that stretch them. Leadville is my way of walking that out in real time. It’s not just about endurance on the bike, it’s about endurance in life: discipline, resilience, and a willingness to meet discomfort head-on. Committing to training even on days I don’t want to. Pushing past the soreness and achiness and thoughts of “Can I actually do this?” in order to grow as a person and as a coach.

Maybe your “Leadville” isn’t on two wheels. Maybe it’s building a business, committing to healing your health, losing weight, or having the courage to start over in a new season of life. Whatever it looks like, the lesson is the same: growth lives on the other side of discomfort.

Early Lessons in Training

I’m one month into training so far, and here’s what I’m learning:

• I know nothing about bike repairs and have a lot to learn there to make sure I can handle a potential flat or other issues that may come up

• While I consider myself a pretty fit, athletic woman..learning a new “sport” is humbling and I have had a lot of days where I’ve felt sore and have had to adjust how I’m recovery, how I’m warming up, what mobility training I need, and more

• Padded biking shorts are not optional

• Surprisingly, going downhill is a steeper (no pun intended) learning curve for me than attacking uphills

• I need to buy higher socks if I want to have shins that aren’t constantly cut up by rocks and bike pedals

• My weight training is going to need to change a lot to reflect the areas I need to strengthen and balance out. I’m an experienced lifter, but having to transition to a ton of single-leg work, explosive movements, and intentional “rehab” style lifts to balance out differences in leg power side to side has been a new challenge (and I have to admit, I’m having a lot of fun with that)

• Adding more endurance work into my life improves my HRV, resting heart rate, and overnight respiratory rate…as long as I do it earlier in the day. Evening long rides tend to impact me in the opposite way

• There is DEFINITELY something to cycle-aligned training and recovery for women, I don’t care if studies aren’t “showing” it yet. I’m experiencing it in real time, even though I’m pretty good at mentally pushing through low energy/poor recovery days.

• Having an accountability buddy is so helpful. I’m so much more likely to commit to rides - even an indoor Peleton hill climb - if my boyfriend is also up for it. Such a good reminder that you are who you surround yourself with, so choose your circle and your relationships wisely

• Last…riding a mountain bike down a hill in the sunshine is pure joy and restores that sense of play that we often lose when we enter adulthood. More play, please

OK, let’s talk health and performance strategy.

One of the biggest advantages I have going into this race is that I get to bring my background in functional medicine and performance coaching with me. I’m not just riding more miles; I’m layering in the strategies I teach every day to help me accomplish those miles.

1. Physiology: Stress + Recovery Cycles

• I’m training with recovery in mind, not just mileage.

• Women’s physiology isn’t built on the same 24-hour rhythm that most training programs assume. I’ve been tailoring my long rides and heavier efforts around my infradian rhythm, and respecting the weeks when my body does better with more recovery, mobility, or strength/sprint work over sheer volume.

• Women also tend to do better with sprint interval training even when pursuing endurance sports. Dr. Stacy Sims has done some incredible research in this arena, and I’m fully leveraging this concept to translate sprint cycling workouts to endurance gains.

  👉 Takeaway for my female athletes: Notice when your body feels strongest (or most depleted) during the month. Align your harder efforts with those peaks, and amp up your recovery efforts when you’re not feeling as strong. Learn to leverage female-specific training to your advantage instead of blinding assuming you should or need to train the exact same way as men.

2. Biohacking Tools

• I’m using data to guide me, not overwhelm me.

• Sleep tracking, HRV, training in specific HR zones, and even continuous glucose monitoring help me see when I’m truly recovered, or when I need to pull back/adjust my routines and nutritional support.

• Supplements like magnesium, creatine, glutathione, nitric oxide and mitochondrial support stack the deck in my favor, while tools like red light therapy and breathwork keep my nervous system steady.

• I’m strategically using infrared sauna and cold exposure as well to influence my nervous system balance, circadian rhythm/cortisol output, and mental stamina. I’m aligning all of these tools to my cycle and hormones, mapping out training and recovery with what I need on a biological basis throughout the month. It’s easier than it sounds (but this is also what I do for my career so…you know I might be biased!)

• I’m digging into peptide stacks. Some that I’m trialing or planning to trial include:

  • MOTS-C for muscle and mitochondrial support

  • BPC157 for recovery and body strain

  • SS31 for mitochondrial love

  • Pancragen for blood sugar reg, as I’m now consuming more carbohydrates that I’m used to for trainings purposes, and I know that blood sugar regulation is a weak point from a biology standpoint for me. Knowledge is power, you know?

  • Pinealon for intermittent sleep support and improving restorative sleep duration

    
    👉 Takeaway: Pick one metric to track (like sleep quality or resting heart rate) and actually use it to adjust how you train or recover. Then add in another. Slowly stacking in interventions one a time and having metrics to evaluate their efficacy is how you run an n of 1 experiment on yourself to improve performance - don’t just blindly do what someone else is doing and expect it to work perfectly for you.

3. Fueling & Metabolism

Nutrition has been one of the biggest shifts. I’m thankful that part of my own health optimization journey in the past has included making sure my body is metabolically flexible - meaning I’m able to tap into carbs or fat for energy pretty seamlessly. This was NOT the case 7 or 8 years ago for me..I used to really struggle getting into fat burn and achieving any level of ketosis. Now, that part of my journey has served me really well since I’m dialing up carb intake to match my rides.

I’m starting to play around with peri-workout nutrition. This means dialing in pre-ride meals, experimenting with mid-ride fueling, and recovering with protein and electrolytes as soon as I’m off the bike. For me, I’m finding the longer cardio workouts tend to suppress my appetite, so I”m having to be super intentional about meal planning compared to my norm. I can *definitely* feel when I’m on a ride if I haven’t fueled properly, so this is an area I’ll continue to be working on.

👉 Takeaway: Pay attention to how your meals affect your energy a few hours later. Steady energy = balanced fuel. Big dips = something to adjust.

4. Mindset & Nervous System Regulation
Every long ride is a chance to practice mindset. When the legs burn and the climb feels endless, I shift from “I can’t” to “this is where adaptation happens.” Nervous system regulation tools - breathwork, cold exposure, meditation - aren’t just recovery hacks; they’re training my brain to stay calm under stress.

A few weeks ago, my boyfriend and I and one of our friends did a 20+ ride up in Flagstaff Arizona to get in some miles at elevation. We ran into a sudden thunderstorm where the temps plummeted about 30-40 degrees, with pouring rain and a little hail, while riding downhill for the last 45 min or so. I wasn’t prepared with warmer clothes or gloves, and pretty soon my hands were numb, my teeth were chattering, and my bike shoes were filling with water. All I could think was “thank goodness I do cold plunges or this would literally be unbearable right now” while we raced down the mountain.

👉 Takeaway: Next time you hit resistance - in a workout, at work, or in life - pause and ask, “What if this discomfort is actually the doorway to growth? What’s the lesson?”

What’s Your Leadville?

Leadville is my big, uncomfortable goal this year. Yours doesn’t have to be a bike race. It might be building a business, committing to your health, starting a creative project, or making a change you’ve been putting off.

I’d love to know: what’s your version of a 100-mile race?

Hit reply or share it in the comments! I read every response, and I may highlight a few in a future post (with your permission). One of the best parts of this community is seeing how each of us chooses to step outside our comfort zones. I’ve found this one of the best parts of Substack - real people looking to connect over our writing and storytelling.

And if you want to follow along as I share more of the training, lessons, and high-performance strategies I’m using along the way, make sure you’re subscribed. This is just the beginning!

I’ll be honest, I hate being cold. I live in the desert for a reason, and I’m pretty sure I was a lizard in a past life. However, I’m a firm believer that the things we avoid tend to be the things that we need the most (or at least can benefit from investigating and trying out).

Most women think of sauna sessions and cold plunges as extreme biohacks reserved for athletes or hardcore biohackers. But the truth? Strategic use of heat and cold is one of the most powerful longevity tools available to high-performing women…if we do it right! It’s not just about extending lifespan; it’s also about sharpening focus, boosting resilience, and regulating hormones so you can thrive in business and life right now. If you’re juggling work, training, and the pursuit of feeling (and looking) your best, these simple rituals are worth a second look.

Cold Exposure: Brain, Body, and Boldness

• Focus On Demand
  Ever notice how a splash of cold water wakes you up fast? There’s real science behind that buzz. Brief cold exposure kicks up dopamine and norepinephrine—think sharper concentration and real “get-it-done” energy. Sure, the wild 250% dopamine spike comes from long cold plunges, but even a minute of cold in the shower can noticeably lift your focus and mood. This dopamine release stems from cold triggering the sympathetic nervous system’s ‘fight or flight’ response, stimulating pathways in the brain that elevate mood and motivation for hours after you step out of the cold. It’s nature’s built-in reward system encouraging alertness and resilience, honed over generations of human adaptation to cold environments.

• Resilience Boost
  Cold isn’t just about grit. You’re teaching your nervous system how to handle stress, so next time work throws curveballs (or you’re up against a killer deadline), you hold center more easily.

• Metabolic Momentum
  Cold activates brown fat—your body’s energy furnace—helping smooth out blood sugar and stabilize energy. This can be especially helpful during hormone shifts or when “midday crash” is the enemy.

I started adding cold finishes to my showers more out of curiosity than confidence. It was awkward at first, but over time, the extra focus lasted longer than my favorite coffee. Then, I moved on to plunges - starting around 50 degrees, even if just for 30 sec-a minute, slowly increasing my duration over time. For me, I found I do better with plunges in the follicular phase of my cycle than in the late luteal phase (right before my period). Every woman will have a different experience, but this is what I discovered was best for my body.

Heat Therapy: Not Just Spa Pampering

Sauna sessions are powerful: think recovery, hormone harmony, and cardiovascular benefits:

• Heart and Vascular Perks
  Sauna gets your heart rate up, supporting blood flow and long-term health. The data is especially solid out of Finland: regular sauna use is linked with lower heart disease risk.

• Sleep and Hormone Support
  Heat helps your body relax, calms stress hormones, and supports faster recovery through short spikes in growth hormone. Women especially find their sleep deeper and mood steadier when sauna is built into evening routines.

• Detox?

  • While you may have heard that saunas ‘sweat out toxins,’ the real science clarifies that the liver and kidneys remain your body’s main detox champions.

  • The rapid cycling between vasodilation (from heat) and vasoconstriction (from cold) creates a powerful 'vascular pump' effect, dramatically enhancing circulation and lymphatic drainage to accelerate recovery and helping these organs transport metabolic waste and environmental compounds more efficiently.

  • This circulation boost supports the body’s natural detoxification processes, creating a foundation for hormonal balance and overall well-being.

When work gets wild, I’ll carve out time for sauna at the end of the day. Even 15 minutes makes the next morning easier. Plus, it’s the kind of self-care that feels earned. Some other things I noticed? I do better with longer sessions (which can transiently increase stress hormone output and activate your sympathetic nervous system) in my follicular phase, while keeping my sessions to 20 min or less in luteal helps me feel calmer, more grounded, and supports better sleep quality (Thanks, Oura ring!).

Contrast Therapy: Dynamic Recovery

Mix hot and cold for an extra edge—think turbocharged circulation, clarity, and smoother recovery between workouts and big meetings:

• Synergy You Can Feel
  Alternating heat and cold pumps nutrients into muscles and helps you reset mentally, especially when life is non-stop.

• Cycle-Smart Approach
  Take notice: cold can feel energizing after your period (follicular phase), while heat soothes and restores before and during PMS (luteal phase). Tweak your protocol based on what your body’s asking for. Be curious, try protocols out, ask questions, and don’t mimic what your husband or guy friends are doing “just because”!

  • You might notice your tolerance for cold plunges and saunas shifts throughout your menstrual cycle, and there’s science behind that!

  • After ovulation (the luteal phase), rising progesterone levels cause your basal body temperature to increase by about 0.3–0.5°C (0.5–1°F). That means you may feel warmer overall, and find hot sauna sessions more taxing or cold exposure less refreshing.

  • In your follicular phase (after your period, with lower core temps), you might feel more resilient and comfortable with cold therapy.

  • That being said, this isn’t a rule - it’s an invitation. Pay attention to your own body’s signals: if heat feels soothing before your period or cold plunges are energizing after, honor those preferences. No protocol fits all; your cycle is your guide for bio-individual experimentation and tuning these rituals to what feels best. That is the definition of biohacking for women.

Safety and Success Tips

Push yourself, but not past your limits. Avoid these if you’re pregnant, have unstable heart issues, Raynaud’s, major stress overload, or medical contraindications. When in doubt, start slow and listen—increasing challenge should feel empowering, not punishing

Protocol Highlights

Here’s what I currently do that is working really well for me and many of my private health clients:

• Cold plunge in AM 1-3 minutes at 45-50 degrees, focusing on slow breath. I do this 2-3x per week. In my late luteal phase (days 25-28 ish), I’ll stick with just 30 sec-1 min, or will just opt for a cold shower in the morning.

• Sauna use 2-3x per week. I aim for 40-60 minutes in my follicular phase, and combine with red light exposure. This is my quiet time, where I enjoy breathwork, catching up with my boyfriend if he’s sharing the sauna with me, or listening to relaxing music. In my luteal phase, I’ll stick with 20 min or less, and will often combine with a quick plunge after as a contrast therapy, always finishing with cold. I’ll typically do these later in the day, though sometimes morning times are all I have!

• This may seem like a big time commitment, but to be honest I show up so much more effectively the rest of the day if I carve these times out for myself. Some days aren’t perfect, and that’s ok.

Real Longevity Is Showing Up for Yourself, Every Day

Cold and heat protocols are about more than biohacking trends. They’re about giving yourself every advantage to think sharply, recover faster, and feel your absolute best in the midst of work, training, and life. Resilience doesn’t occur by change; it’s built bit by bit via your daily actions and choices.

—

Curious about personalizing these routines? Or want a more detailed explanation of the “why” behind the protocol recs above? Drop a comment or reach out - I love helping high-performing women discover their own optimal rhythm!

References

1. Šrámek, P., Šimečková, M., Janský, L., Šavlíková, J., & Vybíral, S. (2000). Human physiological responses to immersion into water of different temperatures. European Journal of Applied Physiology.

2. Huberman, A. (n.d.). The Science & Use of Cold Exposure for Health & Performance. Huberman Lab.

3. Shevchuk, N. A. (2008). Adapted cold shower as a potential treatment for depression. Medical Hypotheses.

4. Kurniasari, M. D., et al. (2022). Short-Term Head-Out Whole-Body Cold-Water Immersion Facilitates Positive Affect. Biology.

5. LeBlanc, J., & Dulac, S. (1975). Autonomic nervous system and adaptation to cold in man. Physiology.

6. Tipton, M. J., et al. (2021). Habituation to cold in humans. Temperature.

7. Wells, G. (n.d.). Cold Exposure and the Parasympathetic Nervous System. Dr. Greg Wells.

8. Maliszewska, K., & Kretowski, A. (2021). Brown Adipose Tissue and Its Role in Insulin and Glucose Homeostasis. International Journal of Molecular Science.

9. Hanssen, M. J., et al. (2015). Cold-Induced Brown Adipose Tissue Activity Alters Plasma Fatty Acids and Improves Glucose Metabolism in Men. The Journal of Clinical Endocrinology & Metabolism.

10. Laukkanen, T., Khan, H., Zaccardi, F., & Laukkanen, J. A. (2015). Association Between Sauna Bathing and Fatal Cardiovascular and All-Cause Mortality Events. JAMA Internal Medicine.

11. Crinnion, W. J. (2011). Sauna as a valuable clinical tool for cardiovascular, autoimmune, toxicant- induced and other chronic health problems. Alternative Medicine Review.

12. Laukkanen, J. A., & Laukkanen, T. (2015). The Link Between Sauna Bathing and Mortality May Be Noncausal. JAMA Internal Medicine.

13. Leppäluoto, J., et al. (1986). Endocrine effects of repeated sauna bathing. Acta Physiologica Scandinavica.

14. Leppäluoto, J., Tapanainen, P., & Knip, M. (1987). Heat exposure elevates plasma immunoreactive growth hormone-releasing hormone levels in man. The Journal of Clinical Endocrinology & Metabolism.

15. Sunlighten. (n.d.). Hormone Balance and Infrared Sauna. Sunlighten.

16. Peake, J. M., et al. (2020). The Use of Contrast Therapy in Musculoskeletal Painful Conditions. Journal of Functional Morphology and Kinesiology.

17. SweatHouz. (n.d.). Contrast Therapy Benefits for Your Body and Mind. SweatHouz.

18. Nagashima, K. (2016). Thermoregulation and menstrual cycle. Journal of Physical Fitness and Sports Medicine.

19. Harding, J., et al. (2023). Cold water swimming as a potential therapy for menstrual and perimenopausal symptoms. Post Reproductive Health.

20. Wójcik, M., et al. (2023). Various forms of heat therapy in relieving dysmenorrhea. Environmental Medicine.

21. American Lung Association. (2025). Sauna, Cold Plunges: Health Impacts. American Lung Association.

22. Geva-Zatorsky, N., et al. (2020). A new model for the HPA axis explains dysregulation of stress hormones. Molecular Systems Biology.

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