Hormones Are More Than Fertility

By Debbie Sweeney, BCHN, FDN-P, ONC

MamaSweeney Nutrition | Terrain Over Tumor

Say the word “hormones” and most people think reproduction. Periods, pregnancy, perimenopause, testosterone. In an oncology setting it narrows further still — to receptor status, to ER-positive or PR-positive.

That’s not wrong. It’s just far too small.

In The Metabolic Approach to Cancer, Nasha Winters and Jess Higgins Kelley name hormone balance as Terrain #8 of the Terrain Ten. But hormones aren’t really one terrain sitting beside nine others. They’re the signaling layer running through all of them.

The cast is bigger than you think

Beyond estrogen, progesterone, and testosterone:

• Insulin — a growth signal first, a blood sugar hormone second
• IGF-1 — drives proliferation, suppresses cell death
• Cortisol — stress, rhythm, and immune regulation
• Thyroid (T4, T3) — sets the metabolic pace of every cell
• Melatonin — not a sleep aid; a circadian and immune hormone
• Leptin and adiponectin — produced by fat tissue itself
• Vitamin D — a hormone, despite the name

Any of these can be off while reproductive hormones look perfectly ordinary.

Where hormones touch the other terrains

Blood sugar. Insulin is a hormone. Chronically high insulin lowers sex hormone binding globulin, which raises the free, active portion of estradiol and testosterone, and raises free IGF-1. A blood sugar problem becomes a sex hormone problem. This is why fasting insulin belongs on a hormone panel.

Inflammation. Fat tissue is an endocrine organ. Inflamed breast fat carries elevated COX-2 and prostaglandin E2, which raise aromatase — the enzyme that makes estrogen locally, in the tissue.^[1][2] The same researchers later found this pattern in women with a completely normal BMI.^[3] Which is the whole point: weight is an output of what’s happening in the terrain, not the lever. A normal number on the scale doesn’t mean a quiet hormone environment.

The microbiome. The liver packages estrogen for disposal and sends it out in bile. Certain gut bacteria unpackage it, and it gets reabsorbed. That bacterial collective is the estrobolome, and it meaningfully shapes how much estrogen stays in circulation.^[4] Fiber, transit time, and microbial diversity are estrogen interventions.

Stress and circadian rhythm. Cortisol should have a shape — high in the morning, low at night. In 104 women with metastatic breast cancer, a flattened cortisol rhythm predicted earlier mortality and tracked with lower natural killer cell activity.^[5] Melatonin runs the same axis: in 2019 the IARC classified night shift work as probably carcinogenic to humans, citing immune suppression, chronic inflammation, and cell proliferation as mechanisms.^[6] Light at night is a hormone exposure.

Genetics and detoxification. How you metabolize estrogen matters as much as how much you make. It moves through phase I hydroxylation (CYP1A1, CYP1B1) and then phase II conjugation — methylation, glucuronidation, sulfation. Individual variation here is real, and it’s nutrient-dependent.

Toxic burden. Endocrine-disrupting chemicals are a hormone problem arriving through the toxin door. BPA, phthalates, parabens, certain pesticides, PFAS. They don’t have to be potent — they just have to show up daily. This is the reason behind glass storage, filtered water, and clean personal care. Those aren’t aesthetics.

What actually moves the needle

Food:

• Vegetables forward, with cruciferous in real quantity
• Fiber every day — estrogen excretion depends on it
• Ground flaxseed for lignans
• Enough protein and fat to keep blood sugar steady
• Wild-caught, grass-fed, pastured
• No seed oils; low-and-slow cooking
• Alcohol addressed honestly — it raises circulating estrogen

Daily rhythm:

• Real darkness at night
• Consistent sleep and wake times
• Movement most days — an insulin intervention before anything else
• Regular bowel movements, so estrogen leaves instead of recycling

Notice what’s not there: a calorie target or a scale goal. Given the normal-BMI aromatase findings, that would be chasing the wrong variable.

Don’t guess — test, address, discuss with your practitioner

Fatigue, weight change, poor sleep, and low mood can all come from thyroid, cortisol, insulin, or sex hormones. Guessing usually means working hard on the wrong thing.

A useful starting picture generally includes a full thyroid panel rather than TSH alone, fasting insulin with glucose and HbA1c, SHBG, sex hormones in the right menstrual or menopausal context, a diurnal cortisol assessment, and vitamin D.

Hormone metabolite testing adds something serum levels can’t: it shows which pathways estrogen is traveling down, not just how much is present. That’s real, measurable biochemistry — and it’s a guide. It narrows where to look next, which nutrient cofactors to investigate, and what to recheck later. Read alongside your history and the rest of your labs, it turns guesswork into direction.

The takeaway

You can’t work the hormone terrain by looking only at hormones. Every real lever in Terrain #8 is also a lever somewhere else — which means the work you do for your blood sugar is hormone work. So is the work you do for your gut. So is going to bed in a dark room.

Terrain over tumor.

Debbie Sweeney, BCHN, FDN-P, ONC — MamaSweeney Nutrition

Educational content within a complementary-care model. Intended to support — never to replace, delay, or contradict — the guidance of your oncology and medical teams. Please discuss any dietary, supplement, or lifestyle change with your practitioner, especially during active treatment.

References

1. Morris PG, Hudis CA, Giri D, et al. Inflammation and increased aromatase expression occur in the breast tissue of obese women with breast cancer. Cancer Prev Res (Phila). 2011;4(7):1021–1029. doi:10.1158/1940-6207.CAPR-11-0110
2. Subbaramaiah K, Morris PG, Zhou XK, et al. Increased levels of COX-2 and prostaglandin E2 contribute to elevated aromatase expression in inflamed breast tissue of obese women. Cancer Discov. 2012;2(4):356–365. doi:10.1158/2159-8290.CD-11-0241
3. Iyengar NM, Brown KA, Zhou XK, et al. Metabolic obesity, adipose inflammation and elevated breast aromatase in women with normal body mass index. Cancer Prev Res (Phila). 2017;10(4):235–243. doi:10.1158/1940-6207.CAPR-16-0314
4. Kwa M, Plottel CS, Blaser MJ, Adams S. The intestinal microbiome and estrogen receptor–positive female breast cancer. J Natl Cancer Inst. 2016;108(8):djw029. doi:10.1093/jnci/djw029
5. Sephton SE, Sapolsky RM, Kraemer HC, Spiegel D. Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst. 2000;92(12):994–1000. doi:10.1093/jnci/92.12.994
6. IARC Monographs Vol 124 Group. Carcinogenicity of night shift work. Lancet Oncol. 2019;20(8):1058–1059. doi:10.1016/S1470-2045(19)30455-3
7. Winters N, Kelley JH. The Metabolic Approach to Cancer. Chelsea Green Publishing; 2017. Chapter 10: Hungry for Hormone Balance (Terrain #8).