Mid-Thrive: Building Mental Resilience through Menopause, Andropause, and Genopause
by Emily Whinkin, ND, MS and Haley Horn, PMHNP-BC, CFMP
In the heart of Portland, Oregon, we’re well acquainted with the rhythm of changing seasons. Yet for many of us entering our 40’s and 50’s, the most meaningful shifts aren’t unfolding outdoors, they’re happening within our own bodies. Although hormonal shifts are a normal and natural part of midlife, they can bring about surprising and sometimes unpleasant changes to mood, sleep, energy, metabolism and overall well-being.
Often the symptoms experienced during this transition can quietly reshape how we feel, think and move through our days, and are commonly overlooked or misunderstood. When this transition brings about a dimmed sense of vitality, unexplained irritability, brain fog, or uncharacteristic anxiety or depression, it is time to seek a whole-person and integrative approach to find your new center.
Most people associate menopause, andropause (in males), or ‘genopause’ (a gender inclusive term for midlife hormone decline) with physical symptoms like hot flashes, low energy and loss of libido. Our hormones, however, also act as powerful regulators of brain chemistry and are present in people of all genders. DHEA, known as a “building block” hormone is produced primarily in the adrenal glands, with levels peaking in our mid-twenties and often decreasing by up to 80% over the lifespan. This natural steroid hormone acts as precursor to both estrogen and testosterone.
Interestingly, a 2007 study published in Psychoneuroendocronology found DHEA-S concentrations were inversely correlated with depressive symptoms in well-functioning elderly men and women. In addition, A 2103 randomized controlled trial published in Neuropsychopharmacology, administered 400 mg of DHEA (N=14) or placebo (N=15), providing 3T fMRI scans while participants performed the shifted-attention emotion appraisal task (SEAT), a test of emotional processing and regulation. The findings concluded DHEA enhances activity in regions linked to top-down regulatory control over emotion and reduces activity in regions associated with the production of negative emotion.
These results suggest this powerful adrenal precursor hormone may prove as an effective intervention in mood and anxiety disorders. Estrogen, testosterone, and progesterone are the three major sex hormones, and each play an essential role in brain function, metabolism and overall health in addition to reproduction.
The sex hormone estrogen helps modulate serotonin, the "feel-good" neurotransmitter, by upregulating enzymes that help with its synthesis and decreasing the activity of enzymes that break this neurotransmitter down. When levels drop during mid-life, it may lead to increased vulnerability to anxiety and depression.
Testosterone isn't just about physical strength; it's vital for mental clarity and motivation. The neurotransmitter associated with reward and pleasure, dopamine, helps with testosterone synthesis and in turn testosterone feeds back on the brain to increase dopamine receptor density and dopamine release.
In other words, testosterone can greatly amplify dopamine’s effect on motivation, reward and drive. Low levels may manifest in symptoms of apathy and irritability. Progesterone is anti-inflammatory, has a calming effect on the central nervous system, and aids in neuroprotection and myelination in the brain. It can convert to allopregnanolone, a neuro-steroid that can cross the blood brain barrier and act on the inhibitory calming GABA receptors, promoting a state of relaxation and improved sleep.
A 2024 randomized controlled trial published in the journal Dual Diagnosis included 13 females diagnosed with alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD). Participants were randomly assigned to receive either 200 mg of progesterone or placebo in identically appearing capsules over three days. On the fourth day, a laboratory session took place and measured craving, anxiety, affect and cognitive performance using a presentation of trauma and neutral scripts in random order with a period of relaxation in between.
The study concluded progesterone significantly reduced anxiety, fear, anger and sadness as well as stress-induced symptoms of craving. It was also concluded to be effective in ameliorating stress-induced decreases in cognitive performance. Studies such as this suggest progesterone may be useful in providing relief for a broad array of psychological symptoms.
What is "Integrative" Hormone Care?
There is no universal pattern for hormonal cycles or emotional health, and neither follows a predictable formula. An individualized, nuanced approach is used at the Amenda clinic to treat you as a whole person, and to meet you where you are. Far beyond assessing a lab value and handing over a prescription, we explore how your hormones, lifestyle, and mental health interact.
Our approach includes:
Comprehensive Testing: Looking at the full picture, including thyroid and adrenal health, which often mimic or exacerbate hormonal transitions.
Personalized Hormone Therapy: Discussing evidence-based options like Bioidentical Hormone Replacement Therapy (BHRT) to restore physiological balance.
Mind-Body Support: Utilizing evidence-based counseling techniques like Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Interpersonal Therapy (IPT), Supportive and Solutions-Focused Therapy, and mindfulness to manage the psychological toll of these transitions.
Nutritional & Lifestyle Coaching: Using individualized nutrition and specific supplements to support hormone metabolism, brain health and psych-emotional well-being.
Evidence-Based Resources
We believe in empowering our patients with data. If you’re curious about the science behind these transitions, we recommend these resources:
The Menopause Society: A leading resource for the latest research on hormone therapy and its role in midlife health.
National Institutes of Health (NIH): Comprehensive studies on the bidirectional relationship between hormonal fluctuations and mental health disorders.
Mayo Clinic on Andropause: A grounded look at how age-related testosterone decline affects emotional and physical well-being.
Reclaim Your Vitality
You deserve to feel clear-headed, centered, and confident throughout all chapters of your life.
Whether you’re navigating brain fog, quiet fatigue, or louder symptoms like night sweats and hot flashes, our Portland team is here to help you bridge the gap.
Hormonal transitions are a natural part of life, but thriving through them is possible. With the right knowledge, strategies and support, midlife can become a time of renewed mental and physical resilience and vitality.
References:
Morsink, L.F., Vogelzangs, N., Nicklas, B.J., Beekman, A.T., Satterfield, S., Rubin, S.M., Yaffe, K., Simonsick, E., Newman, A.B., Kritchevsky, S.B., Penninx, B.W., & Health ABC study (2007). Associations between sex steroid hormone levels and depressive symptoms in elderly men and women: results from the Health ABC study. Psychoneuroendocrinology, 32(8-10), 874–883. https://doi.org/10.1016/j.psyneuen.2007.06.009
Sripada, R. K., Marx, C. E., King, A. P., Rajaram, N., Garfinkel, S. N., Abelson, J. L., & Liberzon, I. (2013). DHEA enhances emotion regulation neurocircuits and modulates memory for emotional stimuli. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 38(9), 1798–1807. https://doi.org/10.1038/npp.2013.79
Ralevski, E., Newcomb, J., Pisani, E., DeNegre, D., Peltier, M., Jane, J.S., Yoon, G., & Petrakis, I. (2024). Progesterone Attenuates the Stress Response in Individuals with Alcohol Dependence and Post-Traumatic Stress Disorder - A Pilot Study. Journal of dual diagnosis, 20(1), 39–51. https://doi.org/10.1080/15504263.2023.2294989