The Dr. Josh Axe Show
Episode: What MOST Doctors Get WRONG About Fixing Your Hormones
Date: February 2, 2026
Host: Dr. Josh Axe

Episode Overview

In this episode, Dr. Josh Axe challenges the conventional medical approach to hormone health, arguing that most doctors treat hormones in isolation and focus narrowly on symptoms rather than addressing the deeper, interconnected causes—what he calls "hormone cascades." Dr. Axe breaks down the root causes of common hormone issues like hypothyroidism, insulin resistance, PCOS, low testosterone, and menopause, and shares a holistic, lifestyle-focused strategy for addressing these conditions at their sources.

Key Discussion Points & Insights

1. Understanding Hormone Cascades

• Root Issue: Most hormone problems do not stem from the gland itself, but from failures "upstream"—often in the brain or due to chronic stress and inflammation.
• Analogy: Hormones work like dominoes or a waterfall: when the first one is off, everything downstream is disrupted.
• Conventional Medicine Limitations: Standard medical practice focuses on the “broken” hormone rather than fixing the signal that triggered the imbalance.

Quote:

"They were treating the symptoms, not the root problem, which is a hormone cascade issue. And once we fix the upstream signal, the downstream hormones corrected themselves automatically."
— Dr. Josh Axe (02:13)

2. Hormone Issues by the Numbers

• Stats:
  • Hypothyroidism: 1 in 8 women; up to 80% unaware
  • PCOS: 20–25% of women; most common infertility cause
  • Testosterone: Down 30–40% in men since the 1980s
  • Insulin Resistance: 88% of American adults affected
• Insight: These conditions aren’t due solely to genetics, but to lifestyle-driven hormone cascade failures.

3. Breaking Down the Main Hormonal Cascades

a. The Thyroid Cascade

• Misdiagnosis: Most cases don’t originate in the thyroid but in the brain, gut, adrenals, or liver.
• Mechanism: Stress and inflammation reduce conversion of T4 to T3 (the active form), leading to symptoms that persist despite "normal labs."
• Solution:
  • Reduce chronic stress and cortisol overload (the main upstream issue).
  • Support liver and gut health.
  • Eat a protein/fiber/healthy fat-rich diet, with moderate, specific carbs (dark berries, pomegranate, black rice, sweet potato).
  • Focus on nutrients: iodine (cautiously if autoimmune), selenium, zinc, iron, B vitamins.
  • Warm the body: infrared sauna/pads, warm foods.
  • Adaptogens: Ashwagandha (mainly by reducing cortisol).

Quote:

"If you want to know what is the main upstream problem causing hypothyroidism today, it's not TSH. It's not T4. It's cortisol. And it's really your brain."
— Dr. Josh Axe (12:40)

Timestamps:

• How hormone cascades work (03:30–07:30)
• The thyroid cascade explained (09:28–14:15)
• Solutions & interventions (15:15–18:00)

b. The Cortisol–Insulin (Stress & Weight Gain) Cascade

• Symptoms: Wired but tired, weight gain (esp. midsection), sugar cravings, low motivation.
• Cause: Chronic stress triggers fat storage—a survival response.
• Pitfall: “Eat less, exercise more” advice often fails if stress isn't addressed.
• Solution:
  • Balance cortisol first (fight-or-flight mode needs to shut off).
  • High-protein, high-fiber, moderate-carb meals; avoid evening carbs.
  • Minimize caffeine; prioritize rest ("if you feel tired, nap or sleep more").
  • Schedule downtime and say "no" more often.
  • Herbs: Ashwagandha, rhodiola, tulsi, reishi; magnesium supplements.

Quote:

"You can be eating less, you can be exercising more. But if you are staying in the fight or flight state, you can't lose weight. Your hormones are working against you."
— Dr. Josh Axe (21:02)

Timestamps:

• Chronic stress, fat storage mechanism (19:40–23:55)
• Practical lifestyle approaches (24:12–27:38)

c. PCOS & Infertility Cascade

• Misconception: PCOS is mainly an ovary issue—actually, it's a metabolic signaling/insulin resistance issue.
• Process: High insulin stimulates androgens in ovaries, leading to hormone chaos (estrogen dominance, low progesterone, infertility).
• Solution:
  • Fix insulin signaling via high-protein, high-fiber, lower-carb diet.
  • Add herbs/spices like cinnamon (pumpkin pie spice), chromium, berberine.
  • Weight training & walking ("Even a 15-minute walk can lower insulin").
  • Manage stress; high cortisol can block improvement.

Quote:

"If you have PCOS, okay, it almost is always starting with insulin, okay? Not estrogen. It's starting with insulin."
— Dr. Josh Axe (32:05)

Timestamps:

• PCOS cascade explained (30:58–36:41)
• Diet and exercise interventions (36:46–39:03)

d. The Testosterone Cascade (Men)

• Issue: Dramatic declines in male testosterone are not simply "aging."
• Root Causes: Stress, poor sleep, metabolic issues, chemical exposures (BPAs, plastics, glyphosates).
• Mechanism: Chronic stress/sleep loss dullls hypothalamic signaling, reduces LH/FSH, increases aromatase (more estrogen, less testosterone).
• Solution:
  • Prioritize sleep (8 hrs minimum; track with Oura ring).
  • Weightlifting (especially large muscle groups).
  • Key nutrients: zinc (~30mg/day), vitamin D (~5,000 IU/day).
  • Reduce alcohol and chemical exposures.
  • Supplements: Fenugreek, Tongkat Ali, deer antler, Panax ginseng.
  • Lifestyle: margin for fun and rest.

Quote:

"Testosterone is like a performance bonus. When the system is stressed or you're not getting enough sleep...the body cuts the bonus first."
— Dr. Josh Axe (41:10)

Timestamps:

• Testosterone decline and causes (40:08–43:45)
• Solutions (44:38–47:00)

e. The Menopause Cascade

• Myth: It's just about "estrogen loss."
• Reality: Menopause is a shift to adrenal and fat tissue hormone production. Chronic stress impairs this adaptation, intensifying symptoms.
• Solution:
  • Fix cortisol, balance blood sugar.
  • "Yin building" foods: berries, pomegranate, sweet potatoes/yams.
  • Healthy fats: avocado, extra virgin olive oil ("In Chinese medicine, avocados look like a uterus, olives like ovaries").
  • Omega-3 rich foods, flax/pumpkin seeds, organic eggs, yogurt.
  • Weight training and walking to maintain muscle.
  • Herbs: black cohosh, red clover, wild yam, shatavari, dong quai.
  • HRT may help some, but lifestyle comes first ("Cherry on top, not the foundation").

Quote:

"If you truly want to have healthy hormones and live a long time, hormone replacement therapy alone is not the answer."
— Dr. Josh Axe (48:04)
"Say it with me: Berries, pomegranates, and sweet potatoes and yams!"
— Dr. Josh Axe (49:43)

Timestamps:

• Menopause cascade and misconceptions (47:15–52:50)
• Nutrition and herbs (52:51–55:11)

4. The Functional & Ancient Medicine Perspective

• Systemic View: Ancient models (e.g., Chinese medicine) approach reproductive issues systemically—not organ-based, but as flow/signal issues.
• Lifestyle: Rhythms of rest and activity, seasonal eating, and stress management were integral.
• Personalization: "Eating healthy" varies based on your issue (e.g., warming foods for hypothyroidism, not cold salads).
• Action Step: Always seek the first broken "signal," not just chase low hormones.

Quote:

"Instead of asking which hormone is low, ask which signal is broke first... Sometimes it's coming from multiple angles."
— Dr. Josh Axe (56:12)

Timestamps:

• Ancient medicine insights (55:30–59:22)
• Personalized approaches (59:23–1:01:38)

Notable Quotes & Memorable Moments

• On treating hormone issues:

  "Fixing one hormone number often doesn't fix how you feel, because the original signal never got restored."
  (05:49)

• On diet for hypothyroidism:

  "Salads and smoothies... that's not healthy in most cases for hypothyroidism. Your body's cold, so you're eating cold ice water... terrible. We got to warm the body up."
  (59:37)

• On the value of stress management:

  "If you are staying in the fight or flight state, you can't lose weight. Your hormones are working against you."
  (21:02)

• On lifestyle over medication:

  "It's not one medication or one supplement. We need a protocol, we need a lifestyle change... that's how you'll see real results."
  (01:00:41)

• On the importance of asking the right question:

  "Instead of asking which hormone is low, ask which signal is broke first. And what's the most likely reason that it broke?"
  (56:12)

Timestamps of Important Segments

• [03:30–07:30] — Hormone cascade concept explained
• [09:28–14:15] — Thyroid cascade mechanism
• [15:15–18:00] — Dietary/nutritional interventions for thyroid/adrenals
• [19:40–23:55] — Cortisol, stress, and weight issues
• [24:12–27:38] — Practical tips for balancing stress
• [30:58–36:41] — PCOS and insulin discussion
• [36:46–39:03] — Diet/exercise for PCOS
• [40:08–43:45] — Testosterone losses in men
• [44:38–47:00] — Restoring testosterone naturally
• [47:15–52:50] — Menopause cascade and solutions
• [55:30–59:22] — Ancient medicine's systemic perspective
• [59:23–1:01:38] — Personalization and next steps

Practical Takeaways

• Address upstream causes—chronic stress and insulin resistance—before chasing specific hormone supplements or medications.
• Prioritize stress management, restorative sleep, and protein/fiber- and healthy fat-rich diets.
• Tailor healthy eating to your body and hormonal state (e.g., warming foods for hypothyroidism).
• Adaptogenic herbs and minerals play valuable supporting roles, but are not meant to be the whole solution.
• “Margin”—time for rest, spiritual growth, and connection—is central for hormone balance.
• Ancient medicine’s holistic, rhythm-based approach has enduring relevance.

Final Thought (Dr. Axe):

"If you want to heal your hormones, you have to start with that first domino... lowering cortisol, improving insulin, getting to bed earlier, more time to yourself, more protein and fiber at every meal..."
(01:01:04)

This episode provides a comprehensive, actionable discussion for anyone struggling with hormone issues—encouraging listeners to move beyond symptom-focused treatments and adopt a root-cause, lifestyle-focused healing approach.