The Connection Between Hormones and Mental Health

A Quick Note on What This Is (and What It Isn't) ...

I’m not a doctor, and this isn’t medical advice. I’m a therapist who cares deeply about how your body and brain work together. Through my work in the therapy room, ongoing trainings, and continued education, I see every day how hormones, mental health, relationships, and sexual wellbeing are deeply connected. This is me sharing what I’ve learned from clients, clinical experience, and education, so you can start asking better questions at the doctor’s office, feel less alone in what you’re experiencing, and advocate for yourself like the badass you are. What this isn’t: Medical advice, a substitute for care with your own providers, or a promise that hormones are the answer to everything.

When Your Body and Brain Aren’t on the Same Page

If you’ve ever thought, “I’m doing the therapy, the breathing, the journaling, the gratitude lists, so why do I still feel off?” you’re very much not alone.

We tend to talk about mental health as if it lives entirely in our thoughts. But the brain does not float around independently. It lives in a body that sleeps (or doesn’t), digests (or doesn’t), cycles hormones, responds to stress, and has opinions about sex and connection. When one system gets loud, the others usually chime in.

Research consistently shows that hormones influence mood regulation, anxiety thresholds, sleep quality, focus, and emotional resilience. That does not mean every difficult feeling is hormonal. Sometimes life is just life. But when symptoms persist, intensify, or do not respond the way you would expect, it is worth zooming out and asking a bigger question.

The goal here is not to turn everything into a hormone problem. It is to stop pretending hormones do not exist.

So let’s zoom out and look at a few key players, not as miracle fixes but as context. From thyroid health to menopause to testosterone to desire, we’ll talk about what hormone optimization can support, where it has limits, and why one-size-fits-all solutions rarely work.

The Thyroid: The Quiet Drama Queen of Mood

(with a personal note from me, because this one hits close to home)

Your thyroid is that quiet friend who seems low key but actually runs the entire group chat. It regulates metabolism, energy, temperature, heart rate, and yes, mood and cognition. Thyroid hormones interact directly with neurotransmitters like serotonin and dopamine, which is why thyroid issues so often masquerade as depression, anxiety, or brain fog.

Research published in JAMA Psychiatry shows that people with hypothyroidism are significantly more likely to experience depressive symptoms, even when thyroid levels are only mildly off. Autoimmune thyroid conditions like Hashimoto’s raise that risk even further.

And yet, thyroid symptoms are often brushed off as stress, burnout, postpartum emotions, or “just life.”

After having my third child, I kept thinking, “something is wrong, but I can’t put my finger on it.”  I assumed I was dealing with postpartum anxiety or depression, which would have made total sense. But the symptoms did not quite line up. There was a heaviness and fog that felt different. My energy tanked. My body felt unfamiliar.

Luckily, my midwife pushed for more answers when I shared my symptoms, rather than chalking them up to life with three kids under five. At eight weeks postpartum, I was diagnosed with Hashimoto’s, and later with thyroid cancer, which ultimately led to my thyroid being removed.

The good news is that when thyroid conditions are treated properly, mood often improves, sometimes dramatically. I can vouch for that through my own journey. Once I had answers and the right treatment, it felt like someone turned the lights back on. My energy returned. My brain felt clearer. I recognized myself again.

The takeaway isn’t that thyroid medication fixes everything. It’s that persistent mood symptoms deserve a wider lens, and thyroid health belongs in the conversation. For many people, medication helps, but things like nutrition, sleep, movement, and stress support can matter too, depending on the person and guided by their provider.

Perimenopause and Menopause: The Season That Sneaks Up on You

If you have ever found yourself crying at a diaper commercial (ahem, not that I would know anything about that) or wondering why everyone suddenly feels irritating, hello perimenopause.

During this transition, estrogen and progesterone fluctuate unpredictably and directly affect serotonin, sleep, stress tolerance, and emotional regulation. Longitudinal research shows women are two to four times more likely to experience new or worsening depressive symptoms during perimenopause, even without a prior mental health diagnosis. Additionally, Menopause does not just happen in your body. It shows up in your relationships. Sleep loss, irritability, anxiety, body changes, and desire shifts can strain even strong partnerships.

Research suggests marital satisfaction often dips during this phase but rebounds when symptoms are treated and partners understand what is happening. Peri/Menopause does not cause divorce. Feeling unseen, misunderstood, and unsupported sometimes does.

This is often where hormone replacement therapy (HRT) enters the conversation.

According to menopause experts and clinical research from organizations such as the American College of Obstetricians and Gynecologists (ACOG), The Menopause Society (formerly the North American Menopause Society), and major medical centers like the Mayo Clinic, hormone replacement therapy (HRT) remains the most effective treatment for hot flashes and night sweats. Research also shows that, for many people, HRT can improve sleep, ease vaginal dryness and discomfort, support bone density, and enhance overall quality of life. When disruptive symptoms like night sweats and poor sleep improve, mood and emotional wellbeing often improve as well.

But HRT is not risk free. Large studies like the Women’s Health Initiative highlighted increased risks of blood clots, stroke, and depending on formulation, breast cancer. Later analyses clarified that risk varies significantly based on timing, route, dose, and individual health history. As Dr. Peter Attia emphasizes, HRT is not a yes or no decision. It is a personalized one. Timing matters. Transdermal routes matter. Ongoing reassessment matters.

This is where thoughtful, collaborative care makes a difference. For some women, HRT can be incredibly supportive. For others, different approaches may make more sense, or HRT may not be the right fit at all. There isn’t one correct path through this season. What does matter is that your symptoms are taken seriously and not brushed aside as “just anxiety” or “just stress.” Research shows that mood changes, irritability, sleep disruption, and emotional fluctuations during perimenopause are real biological phenomena tied to hormonal shifts, yet they are frequently misattributed to primary psychiatric issues when hormones are not evaluated. (Studies in Menopause and other clinical journals note this pattern of under-recognition in clinical practice.) When this happens, people can end up on medications or therapies that help some symptoms but don’t address the underlying contributor.

One of the most important things you can do is ask the right questions and find a medical provider who listens. Someone who will assess hormones, take your experiences seriously, and help you navigate options rather than dismiss your symptoms or automatically attribute them to stress or personality. A simple place to start is asking:

“Could hormones be playing a role in what I’m experiencing, and can we look at that alongside my mental health rather than assuming it’s just anxiety or stress?”

Testosterone: More Than a Libido Conversation

When most people hear “testosterone,” they think libido. But that’s only part of the picture, and for many women, it’s not even the first thing that shows up.

Testosterone plays a role in mood regulation, motivation, energy, confidence, cognitive sharpness, and overall vitality. Levels tend to decline gradually with age and more noticeably during perimenopause and menopause, but even subtle shifts can feel significant long before anyone thinks to check hormones.

Research published in The Journal of Sexual Medicine supports this broader understanding. While early studies focused heavily on sexual desire, more recent reviews note associations between testosterone levels and overall wellbeing, mood stability, energy, motivation, and quality of life, particularly when low levels align with persistent symptoms. These effects tend to be modest and individualized, rather than dramatic, and are most meaningful when treatment is carefully dosed and medically supervised.

Clinically, women with lower testosterone levels may describe feeling emotionally flatter, more fatigued, less motivated, or less confident, even when they’re functioning well on the outside. Some notice cognitive dullness or a reduced sense of engagement with life. Sexual desire may change too, but it’s often a secondary concern rather than the main complaint.

Because these symptoms overlap so closely with anxiety, depression, burnout, and stress responses, they are frequently treated as purely psychological before hormones are considered. That doesn’t mean those diagnoses are wrong, but for some women, they are incomplete. When testosterone and other hormones are evaluated alongside mental health, the picture often becomes clearer and treatment more effective.

There is growing evidence that carefully dosed, physiologic testosterone can support mood stability, energy, motivation, confidence, cognitive clarity, and overall sense of wellbeing in selected women, especially when low levels and symptoms align. Improvements in sexual desire and responsiveness may occur, but they are not the primary goal.

It’s also worth noting why testosterone isn’t currently FDA-approved for women. Despite evidence that testosterone may benefit things like mood, energy, and sexual function in some cases, no testosterone product has been approved specifically for women in the United States. Over the years, formulations have been evaluated, including a patch designed for women, but FDA advisory panels have historically declined approval citing insufficient long-term safety and efficacy data, particularly around cardiovascular risk and other outcomes. Researchers and clinicians continue to publish evidence and clinical guidance, and some experts hope that more robust research will eventually support clearer regulatory pathways and potentially FDA-approved options for women in the future.

Sex and Desire: More Than a Hormone Issue

Desire is sensitive. To hormones, to stress, to relationships, and to how safe your body feels.

Hormones matter. Estrogen supports tissue health, natural lubrication, and physical comfort. Testosterone supports energy, motivation, and emotional engagement, which are closely tied to arousal. Thyroid balance fuels overall drive and the capacity to want anything at all.

Large longitudinal studies following women through the menopausal transition show that sexual desire often declines during perimenopause and early post menopause, and that these changes are strongly associated with shifts in estrogen and testosterone levels. According to this research, women with relatively higher levels of these hormones during the transition tend to report greater sexual interest and responsiveness than those with lower levels.

But hormones don’t tell the whole story.

Research published in menopause-focused medical journals consistently shows that stress, anxiety, sleep disruption, depressed mood, and relationship strain are just as influential on desire as hormone levels themselves. In fact, several studies note that perceived stress and emotional wellbeing predict sexual desire as strongly as hormonal measures during perimenopause and menopause.

In other words, desire isn’t just biological. It’s biopsychosocial.

Hormone therapy can help some aspects of sexual wellbeing. According to large reviews, including Cochrane analyses, estrogen therapy can modestly improve sexual function for some women, particularly by improving vaginal comfort and reducing pain or dryness. When physical discomfort improves, desire sometimes follows.

Clinical guidelines and reviews published in The Journal of Sexual Medicine also note that carefully dosed testosterone may improve sexual desire and responsiveness in select postmenopausal women when low desire causes significant distress. However, these benefits are typically modest, individualized, and most effective when combined with attention to emotional and relational factors, not when hormones are treated as a standalone fix.

And this is where the cultural lie sneaks in.

We’re often told that if desire is low, something must be “wrong” with us, or that fixing the hormones alone should fix the problem. But no hormone can override a nervous system stuck in survival mode or a relationship carrying unspoken resentment, exhaustion, or emotional disconnection.

This is where sex therapy becomes incredibly helpful.

A sex therapist doesn’t treat desire as a performance issue or a hormone problem alone. We look at the full context: hormones, nervous system regulation, relationship dynamics, stress load, body image, past experiences, and the meaning sex has taken on over time.

Sex therapy can help you:

• understand why desire changed, rather than trying to force it back

• distinguish hormonal shifts from emotional or relational blocks

• reduce pressure, guilt, or anxiety around sex

• rebuild intimacy in ways that feel safe and sustainable, not performative

  
  

According to research on sexual satisfaction and mental health, sexual wellbeing is strongly associated with lower depression and better overall wellbeing, but only when sex feels wanted, not obligatory. When sex becomes something to manage, endure, or “fix,” the nervous system shuts it down, regardless of hormone levels.

That’s why hormone optimization can be supportive some of the time, especially when it reduces physical barriers like pain, dryness, or fatigue. But it’s rarely the whole answer.

Pleasure isn’t dessert. It’s one of the food groups.

But it’s not a prescription pad either.

So What Can You Do This Week?

You don’t have to overhaul your life or solve everything at once. Small, thoughtful steps matter. Start by asking better questions and noticing how your body responds when it’s supported instead of pushed.

Five Questions Worth Bringing to Your Next Appointment

1. “Could hormones be playing a role in what I’m experiencing, and can we look at that alongside my mental health?”

2. “Which labs would give us the most useful information, not just what’s ‘routine’?”

3. “If my labs are technically normal but I still feel off, what else should we consider?”

4. “What non-medication supports might help my symptoms alongside or before changing prescriptions?”

5. “How do we reassess and adjust if what we try doesn’t help?”

   
   

A Few Small Shifts That Make a Real Difference

Think of sleep as foundational, not optional. Hormones, mood, and desire all recalibrate overnight.

Let pleasure be supportive, not performative. Connection, laughter, rest, and touch all count.

Look for a care team that talks to each other. When providers collaborate instead of working in silos, care is more effective.

This is about reconnecting with your body.

Your body is offering information, and it’s worth listening to.