Question: Hello, I am an almost 41 yr old female and I just read an article about cortisol levels (vampire, ghost, and zombie) that you wrote, and I’m curious to know more. I think that I’m like the vampire the most, but not exactly. I had a saliva test done recently and the results said that my levels were extremely low in the morning, then went to normal around noon but then by 4-5 they were dropping again. My doctor put me on progesterone because my estrogen to testosterone ratio was pretty severe (high estrogen/low testosterone). Although I take them at night because they make me extremely tired, I can’t but feel the struggle even more in the morning now. Will DHEA help? Or anything? Thanks, Jaime
Jamie is referring to an article we wrote about cortisol levels, adrenal fatigue, and sleeping patterns. Cortisol is a very important hormone. Without cortisol, we cannot live. But having your cortisol levels balanced plays an important part in daytime energy and sleeping patterns at night. Cortisol is released from your adrenals glands in a diurnal curve . Meaning, cortisol is highest in the morning so you wake up bright eyed and bushy tailed , ready to start your day. Over the afternoon the cortisol will dip slightly. Come evening it will drop dramatically so you are ready to go to sleep and stay asleep all night long.
In this episode, we talk about three dysfunctional cortisol curves that affect sleep and daytime energy. Having dysfunctional cortisol levels can create havoc on a person’s quality of life. We didn’t want to poke light at these dysfunctional patterns as these are serious issues. But to help with learning and teaching we created three types of dysfunctional cortisol patterns relating to adrenal fatigue.
Three types of dysfunctional cortisol release patterns that affect and contribute to adrenal fatigue. We call these types, The Vampire, Ghost A / Ghost B, and The Zombie.
Vampire: The Vampire has high cortisol in the evening and low cortisol in the morning. That makes the Vampire feel really good at night. Inevitability because Vampires feel so good at night, they have a hard time falling asleep. They will stay up late because they actually feel normal in the evening. But come morning, they have a hard time getting out of bed. These are the people that press snooze multiple times and usually takes them forever to get out of bed. Even though they reluctantly crawl out of bed, they still complain about brain fog and feeling tired until at least midmorning.
Ghost: The Ghost is the person that falls asleep easily. They always say, I have no problem falling asleep. My head hits the pillow and I am out. But I always wake up a 2-4 hours later . That is because their cortisol is low in the evening. But will raise up in the middle of the night, waking them up. You will find your Ghosts roaming the house in the middle of the night. They might end up watching TV, eating, playing on their phones or even checking their email. Some get so fed up waking up in the middle of the night that they just get up and start their day. Most Ghosts feel fairly well in the morning. But they disappear and Ghost everyone in the afternoon. Between 1230 and 330pm Ghosts say they get so tired they can barely function. They struggle to get through the rest of the day until they fall into bed and fall asleep. But like I said, they sleep for about four hours and wake up. There are two variants of the Ghost. I have named them Ghost A and Ghost B. In the article, I call them the Ghoul and the Poltergeist.
Ghost A: These people fall asleep hard but wake up about 4 hours later and cannot go back to sleep. They will be up for hours. And when they finally do become tired and fall back asleep, they have to wake up for the day soon after.
Ghost B: Like Ghost A, these people fall asleep fast and hard. But after about 2-3 hours they wake up. They then fall back to sleep, only to wake up again 45 min to an hour later. They do this all night long, waking up multiple times in the night. Needless to say, they are really tired in the afternoon because they only got a series of naps the night before.
Zombie: We really feel for the Zombie. The Zombie has low cortisol levels all day and night long. That means there is never any part of the day that they feel any energy. Zombies say they could sleep all the time, and they can. They can easily sleep 8 plus hours at night and then sleep hours in the day if allowed. Zombies are continuously mentally and physically tired 24/7.
Back to Jamie and her question. Jamie’s doctor put her on progesterone at night to balance her estrogen-dominance. I think this is a great idea as progesterone reduces cortisol at night and raises GABA. The progesterone will help Jamie falls asleep. Jamie’s goal is to reduce her cortisol at night. As she is a Vampire. She has low cortisol in the morning. Low cortisol in the morning is usually a sure indicator they are a vampire. The nighttime cortisol values are not as accurate. As the cortisol might be normal or will raise later after her last salivary testing. DHEA is great for the adrenals, but I do not think it will make Jamie’s mornings any better.
Disclaimer: Her goal is to reduce her cortisol at night and raise it in the morning. At night the progesterone is perfect to help with her sleep and reduce cortisol. But also taking supplements to reduce the cortisol, like a Cortisol Manager or Kavinace. And taking an adrenal supplement to raise her cortisol in the morning. But if her cortisol is still low with a supplement, she might need a prescription hydrocortisone short term to raise the cortisol in the morning.
The post What are the Symptoms of Low Cortisol? | PYHP 049 appeared first on .
Discover the common and unfamiliar symptoms that you might be experiencing. Get access to cases of real women with hormonal conditions.
Are you gaining weight around your midsection during perimenopause or menopause—despite eating the same and trying everything? You’re not alone, and it’s not just about willpower: In this episode, Dr. Valorie and Dr. Maki dive deep into what’s really going on with that frustrating menopause belly. From insulin resistance to estrogen and cortisol changes, they break down the complex hormonal shifts that make weight gain in midlife feel inevitable—and nearly impossible to reverse. Here’s what we cover: ✔️ Why the “unearned weight gain” often starts in perimenopause ✔️ The truth about insulin resistance and menopausal metabolism ✔️ The role of estrogen, progesterone, and cortisol in midsection fat ✔️ Why muscle mass is your best metabolic insurance ✔️ Whether hormone replacement therapy (HRT) or GLP-1 meds (like semaglutide) can help ✔️ Actionable steps to reduce belly fat and improve metabolic health Plus, we’ll share why willpower alone doesn’t cut it—and how biology always wins unless you work with it (not against it). Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode of the Progress Your Health Podcast, Dr. Valorie and Dr. Maki tackle a common yet surprisingly confusing question: When is the best time to test your blood levels if you’re using hormone replacement therapy (HRT)? Lisa, a fellow Washingtonian, submitted a thoughtful Ask the Doctor question about testing estradiol and FSH levels when using a trochee or transdermal cream. Should it be 4 to 6 hours after application? Or 10 to 12? And what do the results actually mean? We’ll break down: The ideal timing for blood draws depending on delivery method (trochee, patch, cream) How estrogen and progesterone absorb differently Why testing too soon — or too late — can skew your results How to interpret estradiol and FSH together (and why context is everything) Why the number isn’t the whole story — and how you feel matters most Plus, Dr. Valorie shares insights from her own hormone journey, including rhythmic dosing tips and lab timing mishaps. If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
Is there really an age limit for hormone replacement therapy (HRT)? What if you’re in your 70s and still feel better on hormones—but your doctor says it’s time to stop? In this episode, we answer a great question from Mary, a 76-year-old woman who’s been on HRT for over 20 years. She’s dealing with weight gain, breast tenderness, and pressure from her gynecologist to quit hormones altogether. We break it down: Why stopping HRT just because of age isn’t always the answer What to consider when switching from a trochee to a cream Why estradiol levels matter more than total estrogen The connection between insulin resistance, weight gain, and hormones How to adjust HRT in your 70s to maintain quality of life without unnecessary risk Whether you’re well into postmenopause or just starting HRT, this is a must-listen if you’re wondering how long is too long to stay on hormones. If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, we’re answering a thoughtful (and very relatable) listener question from Kari, who’s been struggling with unexpected body pain and inflammation after starting hormone therapy. She wonders if she might be hypersensitive to estrogen—something most doctors don’t talk about. Dr. Valorie Davidson and Dr. Robert Maki unpack why this happens and what to do if you suspect your body is reacting to estrogen differently than expected. In this episode, we discuss: Why some women experience increased pain, fluid retention, or inflammation on estradiol—especially starting at higher doses too quickly. The importance of starting low and increasing slowly, especially for sensitive individuals How Dr. Davidson’s personal experience with estrogen sensitivity helped shape her approach The role of the liver’s phase 1 and phase 2 detox pathways in clearing estrogen metabolites Why form, dose, and timing of hormone therapy (cream vs. patch, AM vs. PM) can affect results What to consider when adjusting your Biest ratio (80:20 vs. 90:10) or Rhythmic Dosing HRT ✉️ Here’s Kari’s full question: “I used Biest 80:20 for 3 years and suddenly stopped absorbing. I’m not sure why, but I do know I didn’t always use it the same time every day. From the moment I went on hormone therapy I’ve had body pain and thought I had fibromyalgia. When my estrogen dropped due to the absorption issue I realized the body pain completely went away. I then went on a patch because my doc said we should change the method. Immediate body pain again and even worse. Terrible. I was on 0.025 and it was tolerable, but after raising it to 0.05 it got really bad. I think I may ask to go on the compounded cream again—maybe change the site that I apply it and be more consistent. I’m very frustrated because no one talks about a subset of people that are very sensitive to estrogen. They only talk about it making joint pain go away. Do you think I should use 90:10 instead? What would you recommend that I do? I’m so sad and frustrated.” If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, Dr. Valorie Davidson and Dr. Robert Maki respond to a great listener question from April, who’s navigating hormone replacement therapy (HRT) while dealing with a history of endometriosis, polyps, and chronic cramps. April’s experience is all too familiar: spotting, cramping, hormone experimentation, and the frustrating search for symptom relief. So, can women with endometriosis safely use HRT—especially estrogen? The answer: Yes, but it has to be customized. �� In this episode, we cover: Why HRT is absolutely possible for women with endometriosis—but must be individually tailored The difference between static vs. rhythmic dosing and why rhythmic HRT may be better tolerated for some women Dr. Davidson’s personal story of having endometriosis, cysts, and polyps—and how she now uses rhythmic dosing herself without flaring The important role of progesterone in managing endometriosis and minimizing estrogen reactivity How to approach spotting, cramping, and cyst formation during HRT ● Why estrogen isn’t the enemy—but why it must be dosed thoughtfully ✉️ Here’s April’s full question: “Hi—I am a 57-year-old woman in perimenopause. My question is: is it possible for women with endometriosis or adenomyosis to do HRT? I started oral progesterone 2 years ago, got as high as 300 mg, but didn’t get much symptom resolution. Switched to a progesterone troche—50 mg morning and night. About 3 months ago, I added testosterone (0.25 mg once daily, 5 days/week) and Biest 80/20 (1 ml daily, can go up to 2 ml). Everything was good for a while, but now the cramping and spotting have returned. I’ve had heavy bleeding as long as I can remember. My main complaint is menstrual cramps throughout the month—not just during my period. I do not have fibroids, but I’ve had many cysts and polyps over the years and have had many ultrasounds and transvaginal ultrasounds because of this.” If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, Dr. Valorie Davidson and Dr. Robert Maki dive into a hot topic: Does Hormone Replacement Therapy (HRT) actually slow down aging? While the short answer may surprise you, the real conversation is about something even more valuable—your quality of life. Here’s what we cover: How HRT can support energy, strength, and resilience as we age The role of hormones in brain function, memory, and mental clarity Why estrogen and progesterone matter for muscle tone and bone density ❤️ The powerful connection between hormones and cardiovascular health. Why HRT isn’t about extending your lifespan—but enhancing how you feel through the years Obviously aging is inevitable—but suffering doesn’t have to be. This episode is all about helping you feel more like you again, even as your hormones shift. If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
