Hormones and Brain Health: When You Don’t Feel Like You Anymore

By Debby Maloney, MSN, APRN, FNP-BC

If you’ve ever caught yourself thinking, “Why can’t I focus like I used to?” or “I’m exhausted, anxious, and foggy—and nothing seems to help,” you’re not imagining it. And you’re not broken. Very often, this is hormonal.

Your brain is in constant conversation with your hormones. When those signals are off—even subtly—you feel it in your mood, memory, energy, sleep, and stress tolerance. Many people worry they’re “losing it,” when in reality their brain is responding to chemistry that’s out of balance.

Estrogen plays a major role, especially for women. Beyond reproduction, it supports blood flow and communication between brain cells. This is why perimenopause and menopause are often accompanied by word-finding issues, forgetfulness, anxiety, or mood shifts. Progesterone acts as a natural calming hormone. When it declines, sleep becomes lighter and anxiety tends to rise.

Testosterone matters too—for women and men. It supports motivation, confidence, and mental clarity. Low levels often show up as fatigue, low drive, or feeling emotionally flat.

The thyroid acts like fuel for the brain. When thyroid hormone is low—or not converting efficiently—thinking slows down. Many people describe this as persistent brain fog, difficulty concentrating, or feeling mentally “heavy,” even when labs are labeled as normal.

Stress hormones are another major influence. Cortisol is helpful in short bursts, but chronic stress keeps it elevated. Over time, this disrupts memory, worsens anxiety, and interferes with sleep. Too little cortisol can be just as problematic, leading to exhaustion and poor stress tolerance.

Two hormones that deserve far more attention in brain health are pregnenolone and DHEA. These neurosteroids act directly in the brain. Pregnenolone supports memory and mental clarity, while DHEA helps buffer stress and protect brain cells from inflammation. Low levels are common with chronic stress, trauma, and aging, and often show up as fatigue, low mood, and cognitive slowdown.

Blood sugar and insulin also play a critical role. The brain relies on stable glucose for energy. When blood sugar is unstable or insulin resistance is present, focus, memory, and mental stamina suffer—often long before diabetes is diagnosed.

Important Questions to Ask Your Provider

If any of this resonates with you, it may be time for a deeper conversation with your healthcare provider. Consider asking:

• “Could my symptoms be related to hormones, even if my labs are in the normal range?”

• “Which hormones should be evaluated when someone has brain fog, anxiety, or memory concerns?”

• “Should we look beyond TSH and check free T3, free T4, or thyroid antibodies?”

• “Do you evaluate stress hormones like cortisol, and how do you interpret them?”

• “Should pregnenolone or DHEA be checked, especially with chronic stress or trauma?”

• “How does blood sugar or insulin resistance affect brain health?”

• “Are there lifestyle or nutritional factors that could be worsening my symptoms?”

• “What are safe, evidence-based options for supporting hormone balance?”

• “How will we monitor response to treatment and adjust if needed?”

  
  

These questions help shift the conversation from “everything looks fine” to “let’s understand why you don’t feel well.”

The most important thing to remember is this: you don’t have to accept feeling foggy, anxious, or disconnected as your new normal. When hormones are supported thoughtfully and holistically, the brain often responds with clarity, resilience, and a sense of feeling like yourself again.

Your brain isn’t failing you—it’s communicating. And asking the right questions is often the first step toward real answers.