Jay Shetty & Dr. Sara Szal ON Recognizing Hormone Signals

What if the fatigue, the mood swings, or the weight gain you are struggling with were not a moral failing, but rather a biological imbalance that can be measured and addressed?

In this On Purpose episode, Jay Shetty's guest is Dr. Sara Szal, a Harvard and MIT-trained physician, researcher, educator, and the author of four New York Times best-selling books focusing on trauma, hormones, and health. Dr. Szal currently serves as a Clinical Assistant Professor at Thomas Jefferson University and is the Director of Precision Medicine at the Marcus Institute of Integrative Health. Her work focuses on personalized data and root-cause medicine to reveal the connections between mental and physical health.

Hormones and Stress

Dr. Szal told Jay Shetty that hormones are the body's chemical messengers, like text messages.¹ They instruct different parts of the body on what actions to take and are part of the five communication systems used by the body alongside peptides, proteins, nutrients, and the genome. When the body's homeostasis is disrupted, a hormonal imbalance occurs.

This imbalance can manifest in different ways, and it can trigger different conditions, such as polycystic ovary syndrome (PCOS) or endometriosis in women, low testosterone in men, or chronic stress-induced cortisol issues.²‍

The number one driver of modern hormonal imbalance is stress³, Dr. Szal told Jay Shetty. It's not a mere feeling, as one may think, but a biologically measurable reality. She explained that measurements are crucial and recommended working with a knowledgeable clinician to test your cortisol levels and other stress indicators.

You also need to understand the values of your tests, Dr. Szal stressed. She told Jay Shetty that the optimal cortisol level in the morning ranges between 10 and 15 mcg/dL, whereas in the afternoon it's between 5 and 10 mcg/dL.⁴ For DHEA (Dehydroepiandrosterone), Sr. Szal believes a good level is above 100 in women and 150 in men. She explained that too much or too little is outside of the optimal range; low cortisol can indicate an exhausted stress response level.

Metabolism and Weight

Another important factor in our hormonal balance is the metabolic system, powered by insulin. Dr. Szal described insulin as the bouncer at a club, deciding whether to let glucose into the cell. When insulin is working optimally, glucose enters the cell, is used as a fuel, and the body avoids excessive fat storage.

But when the cells become numb to insulin, insulin resistance occurs. Dr. Szal explained to Jay Shetty that this causes insulin levels to climb and glucose to accumulate in the bloodstream. It's important to prevent this from happening because high glucose causes damage to the blood vessels. According to Dr. Szal, women need to pay more attention because it can set them up for high blood pressure and cardiovascular disease, unlike what is observed in men.

She explained that insulin changes seven to fourteen years before glucose changes⁵, so the best diagnostic tool is often a two-hour glucose challenge test to observe the body's response to a carb load. When you struggle with weight loss, insulin is the main hormone you should get checked.

Hormonal Shifts by Decade

Dr. Szal told Jay Shetty that people go through constant hormonal changes throughout their lives. She broke down the changes by decades:

• 10-20: Puberty is a time of high volatility, when the control system consisting of the hypothalamus, pituitary, adrenals, and gonads is still immature.
• 20-30: The hormonal control system stabilizes; women have regular cycles, and men reach their peak testosterone. According to Dr. Szal, this is the ideal time to establish healthy habits.
• 30-40: This is the decade when you need to pay attention to any early signs of change. Women may want to check their cycle markers, and men their sperm quality.
• Ages 40+: Women experience perimenopause, which includes over a hundred symptoms, such as memory changes, mood swings, irritability, and sleeplessness. Men can experience andropause, marked by a gradual decline in testosterone.

The Pill Doesn't Fix It All

The pill is commonly prescribed for multiple reasons other than birth control, such as painful periods or acne. Yet Dr. Szal warns against using oral contraception, because it is linked to hormonal imbalances. She told Jay Shetty that the pill raises SHBG⁶ (Sex Hormone Binding Globulin), which acts like a sponge for free testosterone. While this may help with acne in some cases, for 25% of women, it can lead to decreased libido or vaginal dryness.

Another factor to consider when taking the pill is the inflammation; it can double or triple its levels. Dr. Szal explained that it can also deplete the body of essential nutrients, including magnesium, B vitamins, and potentially cause mitochondrial dysfunction. Besides potential long-term effects on fertility and gut health, it can also cause physical changes, such as clitoris shrinkage by 20%.

Contrary to the common belief that period pain is normal, Dr. Szal told Jay Shetty that it's a myth that we need to bust. The pain is often driven by prostaglandins produced in the uterus, and they can be solved through lifestyle medicine.

As an alternative to painful periods, she suggests consuming more Omega-3s (1000 to 2000 mg). It's also important to consume an anti-inflammatory diet one or two weeks before your period. If your pain is severe, you must seek a diagnosis for conditions like endometriosis or adenomyosis, which require treatment beyond merely prescribing the pill.

Rituals for Decompression and Regulation

Dr. Sara Szal told Jay Shetty that, in order to identify a hormonal imbalance, you need to implement a few changes:

1. Measure your cortisol levels.
2. Practice meditation and breathwork.
3. Use targeted supplements like Phosphatidylserine and Omega-3s.

It's important to implement daily decompression rituals. We used to have the commute home to process the day at work, but the home office makes that separation more challenging. Therefore, she told Jay Shetty that it's essential to create some habits that help us transition between work and personal life, especially when both happen under the same roof. 

Some rituals she suggests include:

• Movement and Connection: Short evening walks (15-20 minutes) help with connection, digestion, insulin, and glucose regulation.
• Mind-Body Techniques: Meditation, breath work, or even just rolling out a yoga mat for five minutes of gentle posing.
• Sensory Input: Looking far into the distance, tracing the horizon, or spending five to ten minutes in a forest helps regulate cortisol and slow the pace of the nervous system.
• Relational Check-ins: A vibe check with a partner helps with decompression and regulation.

Healing Through Connection

Dr. Szal told Jay Shetty that relationships are a common source of stress. Yet co-regulating relationships (where partners help calm each other's nervous systems) are effective at reducing cortisol. She added that people who provide some support but cause significant hassle are associated with shortened life and raised cortisol.

If you are in a relationship where physical distance is impossible, Dr. Szal and Jay Shetty offered some strategies for creating hormonal and emotional distance:

• Boundaries and Proportions: Surround yourself with three people who lift you and only one who causes stress. This way, you change the proportion of energy exposure.
• Self-Awareness: You can use a trigger as a valuable signpost for personal healing. We often become people pleasers in childhood, and it requires a great deal of responsibility to unlearn by focusing on your values and boundaries.

When it comes to divorce, Dr. Szal noted that men tend to show adverse health effects sooner than women.⁷ She told Jay Shetty that she observed the women manage the transition better by leveraging oxytocin and establishing support systems, whereas men frequently rely on their wives for community.

Avoid Hormonal Contraception

Dr. Szal told Jay Shetty that modern mainstream medicine has its limitations, too, and that it's essential for individuals to own their health data. She believes that precision medicine requires a personalized approach based on the patient's measurements and values, slowly moving away from the current standard diagnostic approach.

When it comes to women's contraception methods, Dr. Szal recommends understanding what works for you specifically but trying to avoid hormonal options. She told Jay Shetty that wearables are a potential alternative, as you can track your cycle and temperature to identify the fertility window.

She also recommends a copper IUD (Intrauterine Device), because, in her experience, its users report the highest satisfaction rates among birth control users. IUD insertion is painful, and Dr. Szal recommends finding a clinician who offers a cervical block and integrates techniques like breath work, meditation, or hypnosis to manage the procedure.

Conception After the Pill

For women transitioning off the pill and trying to conceive, Dr. Szal emphasized returning to the boring basics of foundational health. Since cortisol is the dominant hormone in the body’s hierarchy, managing the stress response is paramount. She told Jay Shetty that a stressed body will prioritize cortisol production over sex hormones, like estrogen and progesterone.

You can implement a series of lifestyle changes that can support your fertility, especially after getting off the pill, Dr. Szal explained. Some of them include:

• Getting the optimal amount of sleep every night (7 to 8.5 hours).
• Consuming five to seven colors of vegetables and fruits daily to prevent micronutrient deficiencies, which are exacerbated by previous pill use.
• Starting a prenatal vitamin three to six months before trying to conceive to replace depleted micronutrients.
• Testing hormones early, rather than waiting until six to twelve months of trying to conceive, ensures any imbalances are caught quickly.

Science Meets Spirit

Dr. Sara Szal opened up to Jay Shetty about her personal journey and how she overcame burnout in her 30s. She believes that focusing solely on the physical part of the body is not enough; we also need to take into consideration the spirit. She approaches patient care from the heart; she sees the person for who they are and tries to serve them in a way that aligns with their values. Dr. Szal explained that she focuses on meeting patients in their state of fear or dysregulation and on activating their own healing capacity rather than imposing cognitive strategies.

Jay Shetty agrees that healing needs to encompass both the body and the spirit. Dr. Szal believes that a holistic approach to hormonal health is the ultimate path toward healing and long-term homeostasis. If you're looking to heal, you need to start with measurements, commit to foundational lifestyle changes, and understand the deeper spiritual connection to your physical well-being. Dr. Sara Szal described addressing hormonal imbalances as tuning an internal orchestra: once the individual instruments (hormones) are calibrated, the entire symphony of your life can play in harmony.

More From Jay Shetty

Listen to the entire On Purpose with Jay Shetty podcast episode “Dr. Sara Szal: Stop Ignoring What Your Body’s Trying to Tell You! (THESE Are the Hormone Signals You Can’t Afford to Miss!)” now in the iTunes store or on Spotify. For more inspirational stories and messages like this, check out Jay’s website at jayshetty.me.

Disclaimer: The practices described are based on personal experiences and preliminary research. They are not medical advice, nor are results guaranteed. Individual outcomes vary, and some claims are still being studied. Always consult a qualified healthcare professional before beginning any new health, wellness, or therapeutic practice.

¹Cleveland Clinic. Endocrine System: What It Is, Function, Organs & Diseases. my.clevelandclinic.org, Health Library. https://my.clevelandclinic.org/health/body/21201-endocrine-system 

²Cleveland Clinic. Hormonal Imbalance: Causes, Symptoms & Treatment. my.clevelandclinic.org. https://my.clevelandclinic.org/health/diseases/22673-hormonal-imbalance

³Ranabir S, Reetu K. Stress and hormones. Indian J Endocrinol Metab. 2011 Jan;15(1):18-22. doi: 10.4103/2230-8210.77573. PMID: 21584161; PMCID: PMC3079864. 

⁴Cleveland Clinic. Cortisol Test: What It Is, Purpose, Types & Results. my.clevelandclinic.org. https://my.clevelandclinic.org/health/diagnostics/22417-cortisol-test

⁵Freeman AM, Acevedo LA, Pennings N. Insulin Resistance. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507839/ 

⁶Alkahlout L, Hamran S, Darwish N, Dweidri Y, Babu GR, Al Saady RM. The Association Between Estrogen-Containing Oral Contraceptive Pills and Hypothyroidism. Int J Endocrinol. 2025 Mar 18;2025:5978558. doi: 10.1155/ije/5978558. PMID: 40135042; PMCID: PMC11936525.