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As we continue to lay the foundation for recovering from CFS and fibromyalgia, it is time to discuss the “H” in the SHINE protocol — Hormonal function.

In CFS and fibromyalgia, people are experiencing an energy crisis, which results in them essentially “blowing a fuse.” This manifests as suppression of the key control center in the brain called the hypothalamic pituitary axis, which controls virtually our entire hormonal system. Instead of causing failure of a single gland, which is what is needed for the blood tests to be “abnormal,” it instead causes widespread moderate decreases in hormone function. Being in the lowest 10 percent of the population for half a dozen different hormones can leave you crippled — and with your blood tests being totally “normal.”



Unknown to most physicians, the normal range for most blood tests has essentially nothing to do with “healthy.” It is based on a statistical norm called two standard deviations. What this means is that they test 100 people, and the 95 in the middle are defined as the normal range. In an analogy which I gave my friend Dr. Oz, and which he likes to use, we discussed how this would work for shoe sizes.

If you took 100 people and tested them, the normal range for shoe sizes would be 5 to 13. If I accidentally exchanged my size 13 shoes with somebody with a size 7, the “shoe doctor” would tell us both that there was nothing wrong with our shoes. The tests would show them both to be in the normal range– even if I was trying to put my size 13 foot into a size 7 shoe! If we continued to complain, an abusive “shoe doctor” might then start to imply that we were crazy.

This is an exact analogy to what is happening with you when you go in for hormone testing and the doctor says the tests are “normal.” If you gave them a size 6 pair of shoes to wear till your next visit (size 6 shoes are in the normal range!), they might start to gain a little more sympathy for your situation.

So let’s do a quick overview of the key hormones that need to be optimized in CFS/FMS. In upcoming articles, we will discuss each of these in-depth.

To optimize hormonal function, I recommend virtually always using bioidentical hormones. If you cannot get your physician to prescribe them, here are a few simple natural things that you can do to optimize hormonal function.

1. Thyroid. Tired, achy, weight gain, constipation and cold intolerant? If you have even two of these and FMS, then Thyroid support is a good idea. Begin with Tri-iodine (by EuroPharma) 6¼mg taken daily for three months. If your doctor won’t give prescription thyroid, I would add an over-the-counter product (usually only available from health practitioners, but sometimes available at other sites online) called BMR complex, which contains a mix of thyroid glandulars, tyrosine plus iodine (the backbone of thyroid hormone — which is simply tyrosine plus iodine), and other helpful nutrients. Give these one month to see the effect.

2. Adrenal. Do you get episodes of “feed me now or I will kill you?” Adrenal fatigue has become increasingly common, which has recently resulted in the new word, being “Hangry!” In an attempt to create a new record for insanity, food companies are now advertising candy bars to treat this, which is like going to a loan shark. You will feel better in the first half hour and then much worse after eating the sugar. Other symptoms of low adrenal include exhaustion, lightheadedness on standing, salt and sugar cravings, low blood pressure, and autonomic dysfunction called POTS and NMH.

Bioidentical adrenal hormone by prescription is sometimes dramatically helpful. In addition, key nutrients that support healthy adrenal function include adrenal glandulars, licorice, vitamin C, and vitamin B5. These can all be found in a superb product called Adrenal Stress End (Enzymatic Therapy). In addition, avoid sugar. Also increase salt and water intake. Salt restriction in people with adrenal fatigue is a very bad idea. Increase salt as much as is comfortable. I recommend using a good sea salt.

Interestingly, people will often have suboptimal adrenal hormone during the day, and too high a cortisol level at night. When this occurs, you’ll be tired all day and then your mind will be wide awake at bedtime when you try to go to sleep. Adding a mix of phosphatidylserine and Ashwagandha (I use a product called Sleep Tonight) can be very helpful in this situation to support sleep. In those whose cortisol levels are higher than is optimal (seen in about 10 percent of people with CFS/FMS) taking it in the morning can also be helpful.

You’ll see the benefits from adrenal support within two – four weeks if it is going to help.

3. Reproductive hormones. Inadequate estrogen will result in poor sleep, sweats, brain fog, and depression. Inadequate progesterone will result in anxiety and poor sleep. Inadequate testosterone in both men and women will result in weakness, loss of libido, and pain. Seventy percent of men with CFS/ FMS, and most women, are in the lowest 30th percentile for testosterone. Using bioidentical testosterone by prescription (not to be confused with the toxic chemicals bodybuilders sometimes use) has been shown to not only improve function, but also will decrease fibromyalgia pain. This was shown in a study on women with fibromyalgia done by Hilary White, PhD at Dartmouth University.

How to tell if you need reproductive hormonal support.

The tests for menopause will not become abnormal until you have been estrogen and progesterone deficient for five to twelve years. Instead, I find one single question to be most helpful. “Are your fibromyalgia symptoms worse the week around your menses?” If the sleep, brain fog, pain, and fatigue are worse around your menses, when your estrogen and progesterone are at their lowest, this suggests that deficiencies of these hormones are contributing to your symptoms and a trial of bioidentical estrogen and progesterone are warranted. If testosterone levels are in the lowest one third of the normal range, adding testosterone can be very helpful. In men under 50, I use the medication Clomid to stimulate their body’s own natural production of testosterone.

In women, eating a handful of edamame each day around her menses can also be helpful, as can black cohosh. Use a brand called Remifemin, the only form shown to be effective in research studies, to help you feel better around menopause. So as you can see, prescription and /or over-the-counter options to optimize hormonal function can be very helpful in restoring optimal health.

In my next two articles we will discuss nutritional support, followed by exercise (no, CFS and fibromyalgia are NOT an exercise deficiency, and pushing too much exercise is clearly counterproductive). We will then discuss pain relief, followed by more in-depth articles about each component of treatment. It’s time for you to get your life back!

Author’s Note: The free energy analysis program can analyze your symptoms, and even pertinent lab tests if available, guiding you and your physician on how to optimize your energy.

Jacob E Teitelbaum, MD

Jacob Teitelbaum, MD, is a board certified internist and Medical Director of the national Fibromyalgia and Fatigue Centers and Chronicity. He is author of the popular free iPhone application "Cures A-Z," and author of the best-selling books

Dr. Teitelbaum knows CFS/fibromyalgia as an insider — he contracted CFS when he was in medical school and had to drop out for a year to recover. In the ensuing 25 years, he has dedicated his career to finding effective treatments.