The Hormone Balance Blueprint: A Salutogenic Approach to Optimal Health

By Kelly Knoll, Nurse Practitioner at the CHI.

A new term is making waves in the health world – Salutogenesis.

Beyond being an impressive word to drop at a dinner party, it also serves as an enlightening mindset for your health and well-being. Why do you want to be healthy? Is it to prevent future health concerns or to change your body composition? Both of these reasons can undoubtedly motivate an individual to live a healthier and more active lifestyle. However, and this is my personal opinion, I believe there is a more effective way to sustain the desire to exercise and eat cleanly.

“Salutogenesis” is an approach to health that focuses on well-being, not disease.

Exercise and clean eating can sometimes seem burdensome; but why? I believe the issue lies in our mindset towards health, more specifically, our long-term and frankly pessimistic attitude that prevents us from sticking to our goals and taking our health seriously.

Health under a salutogenesis lens is focused on the here and now. How will I feel after eating this donut? Will my energy levels plummet? It’s all too tempting to think long term because it enables us to say “just one won’t hurt”. We must focus on small decisions that affect our health at the moment. With that being said, throughout this article on sex steroid hormones, I will be writing from a salutogenesis perspective and thus the solutions I recommend will follow suit. Please note that when I say “steroids”, I am referring to testosterone and estrogen, NOT anabolic steroids.

A Basic Introduction to Sex Hormones

Before we delve into how to optimize the ratio of your sex hormones, what affects them, and how, we must first discuss where these hormones are made and how they are produced in our bodies. There are several glands in your body capable of creating both estrogen and testosterone; however, for simplicity’s sake, all you need to know is that the majority of testosterone is produced in the gonads and for women, the majority of estrogen is produced in the ovaries. It’s important to note that the gonads can also produce aromatase, a compound that can convert testosterone to estrogen and regulate hormonal balance in males.

What are normal hormonal levels and how can you tell if your body has a hormonal imbalance? There is a massive variation in “normal” hormonal levels from person to person. With that being said, I encourage young people to get their blood work done in late adolescence so that we know the base level at which their bodies operate. In men, we tend to see a gradual decline of testosterone, 1% every year after peak puberty. In women, a similar bell curve pattern is evident in regards to estrogen. We tend to see very low levels pre-puberty, a drastic spike at puberty, and thereafter a steady decline all the way to menopause. It’s important to have your doctor (or me if you are a patient) check your hormone levels frequently. Symptoms such as fatigue, low libido, and obesity are all byproducts of sub-optimal hormone levels.

What does testosterone do? 

The meatheads were always onto something about testosterone. The sex hormone testosterone’s primary function is to instill pleasure from effort. Now, biologically this begins to make perfect sense, the animal predisposed to strenuous exertion has the competitive advantage over others. Testosterone is essentially a competitive drug. Countless studies have historically proven that high testosterone is linked with low stress levels. When you begin to see testosterone as a biological advantage all these facts begin to make perfect sense. The animal that can bear the burden of stress can perform longer and harder than others (No pun intended). It is imperative to understand that competitiveness and testosterone are somewhat of a “chicken or the egg” conundrum. Not only does testosterone boost competitiveness, but interestingly enough competitive environments skyrocket testosterone. A reasonable deduction from such information would be to assume that losing competitive matches decreases testosterone while winning increases it. To an extent, this is true, however, only the neuromodulator dopamine is affected by the outcome of a competitive endeavor and not testosterone itself.

I have seen many older men hermit themselves in old age. And while isolation can act as a much needed break from others, we cannot view it as superfluous. Both men and women need to be around each other and other members of the same sex to promote competitive nature. I do believe that the cause for such isolation is a decrease in testosterone and thereafter the pattern becomes cyclical. It is imperative that in “old age” we seek out competition. Engage in competitive sports or join a sports club. Have a group of individuals that push you and vice versa.

With all this being said, excessively androgenized (High T) males can suffer from obesity, fatigue, and loss of competitive desire if their estrogen levels are too low. This piece of information is often disregarded or unaccounted for when most people think of optimal testosterone levels. The same is true for females, albeit it is the inverse. Females with too high estrogen levels and low testosterone levels can suffer from the symptoms of hormonal imbalances.

What is the role of estrogen in males and females?

Estrogen, often considered the “female” hormone, plays a significant role in both males and females. In females, estrogen is primarily responsible for the development and regulation of the female reproductive system and secondary sex characteristics. It helps regulate the menstrual cycle and is crucial for childbearing. Estrogen also has other functions: it keeps cholesterol in control, protects bone health for both women and men, and affects mood, skin, and other tissues.

In males, estrogen also plays a crucial role, albeit in a different way. Men produce estrogen, but at lower levels than women. It’s produced by converting testosterone into estrogen through a process called aromatization. While estrogen is often associated with female physiology, it’s essential to male sexual function. Estrogen in men plays a critical role in modulating libido, erectile function, and spermatogenesis, which is the production of sperm.

Estrogen’s role in promoting receptivity to mating and consensual submissiveness is an interesting one. It’s easiest to think of estrogen as the opposite of testosterone. While testosterone often drives aggression and competitiveness, estrogen tends to promote social bonding and caregiving behaviors. This doesn’t mean that estrogen makes individuals submissive, but it can promote more cooperative and less confrontational behaviors.

However, it’s important to note that the balance of estrogen and testosterone is crucial. Just as high levels of estrogen can cause problems in men, low levels of estrogen can also cause issues. For example, low estrogen in men can lead to osteoporosis. Similarly, in women, while estrogen is necessary, an excess of estrogen compared to progesterone can lead to a condition called estrogen dominance, which can cause a variety of symptoms including weight gain, fatigue, mood swings, and others.

The lesser-known cause of decreased testosterone. 

Expecting fathers have been shown to have a 50% decrease in total testosterone when expecting a child. Alas, now we know where the dad bod comes from! The scientific explanation for the phenomena is that the body experiences an increase in prolactin, thus stifling the production of testosterone. However, biologically this drop in testosterone occurs because the body prepares for loss of sleep and access to food and therefore uses estrogen to store fat. Being in the vicinity of the child and the pheromones of the newborn have been shown to increase this effect. The decreasing testosterone levels are not only prominent in the father but also the mother. This biological evolution is frivolous in our generation, and can hinder the vigor in young parents that need to work hard to provide for their children. This prolonged quiescent state can hinder a family’s ability to provide for itself in the modern age. I have been an advocate for hormonal replacement therapy for quite some time, and in light of this information, it makes perfect sense for young parents to look into HRT.

Methods to regulate and maximize efficient hormone levels

Apnea’s effects on exacerbated menopausal symptoms and Low T

Apnea is the buildup of excessive carbon dioxide in the lungs caused by irregular breathing habits during both waking and sleeping hours. The main cause for apnea is mouth breathing; In particular, mouth breathing during sleep. A common symptom of apnea is snoring. So next time your partner snores ferociously beside you, don’t just nudge them, let them know the deeper implications of their slumbering serenade. Mouth breathing and apnea have been linked with negative cosmetic implications, declining testosterone levels, and exacerbated menopausal symptoms. Excessive mouth breathing causes the chin to recede and the eyes to droop. However, apart from being a hindrance to one’s appearance, mouth breathing can indirectly destabilize your hormones.

The reduced REM sleep from mouth breathing results in declining testosterone. Luckily the solution is very straightforward and simple. In order to stabilize our hormones and experience deeper sleep, we must practice breathing through our nose. At first, it may seem impossible. However, a good starting point is to practice breathing through your nose during exercise.

Light exposure

“Seasonal depression” is a term we love to use, especially here in Canada where the winter months can leave us in a state of quiescence. But why do we feel drowsy, unmotivated, and lethargic in the winter months and energetic in the summer months? The answer is simple: the sun provides us with dopamine; however, more specifically, it is the viewing of light with our eyes and not the absorption through our skin which causes this effect. The pathway is the following -Increased VIEWING of sunlight increases dopamine levels in the brain, increased dopamine levels cause an increase in melanocytes. Increased melanocytes indirectly cause a boost in testosterone (Sexual activity, reduced stress, better sleep).

The best protocol for maximizing dopamine through sun exposure is to expose your eyes to ten minutes of sunlight early in the day. From the research we have, it is suggested to not do this with sunglasses. This practice is essential for several reasons. Firstly, you will spike your cortisol levels early in the day ensuring that it doesn’t affect your sleep at night. Secondly, you will gain sufficient dopamine for the day. It is important to note that suppression of bright light exposure at night is imperative to dopamine levels and therefore hormone maximization.


You may be yearning for additional tips and ways to optimize your sex hormones. However, I can assure you that these two provisional and proven methods of combating low testosterone work! Furthermore, the biggest factor when it comes to regulating sex hormones is SLEEP. Everything else such as vitamins, exercise, and even HRT come second to sleep, in fact all of these things are heavily dependent on it. Therefore I urge you to consider both nasal breathing and early morning light exposure to embrace a Salutogenesis attitude towards health and well-being. In the next article, we will be continuing our discussion on methods to regulate and maximize efficient hormone levels.

Source: This article was originally published on Kelly Knoll’s blog