Tag: androgen

  • It’s Your Hormones by Geoffrey Redmond: Summary, Key Ideas & Review

    Book in one sentence: A practicing endocrinologist explains the medical mechanics behind women’s hormonal symptoms and names the specific treatments most doctors won’t offer.



    What Is It’s Your Hormones About?

    One of Geoffrey Redmond’s patients described her experience this way: “I cry every time I wash my hair because so much falls out.” Another said, “I don’t feel like I’m living in my body anymore.” A third had been told by her doctor: “I’ve got patients with cancer. Why are you worrying about your hair?”

    Redmond is an endocrinologist who spent more than twenty-five years running the Hormone Center of New York, a clinic dedicated exclusively to women’s hormonal conditions. He estimates he has seen nearly ten thousand patients. Most of them came after being dismissed elsewhere, often repeatedly. It’s Your Hormones is his attempt to translate what he learned in that clinic into something a woman can take into a doctor’s appointment and actually use.

    The book is 480 pages and not a gentle read. It reads like a medical reference because that is what it is. Redmond covers PCOS, PMS, acne, hair loss, facial hair, low libido, perimenopause, menopause, and hormone therapy, each with clinical detail that most popular hormone books skip entirely. The organizing concept is “hormonal vulnerability”: the idea that some women’s bodies react more strongly to ordinary hormonal fluctuations than average, producing real symptoms even when lab values look normal. That framing is the reason the book still matters, nearly two decades after publication.


    Why “Your Labs Are Normal” Is Often the Wrong Answer

    The printed normal range on a lab report is a statistical construct. It reflects the middle 95 percent of a tested population. It says nothing about how sensitive your particular brain, skin, or hair follicles are to the hormones in your blood.

    Redmond makes this point early and returns to it throughout the book. A woman with debilitating PMS mood symptoms may have estrogen and progesterone that land squarely in the normal range. She may also be told there is nothing to treat. What’s actually happening is that her brain chemistry responds more strongly to those fluctuations than most women’s does. The level is not the problem. Her sensitivity to the level is.

    This reframe shifts the target of treatment. Instead of waiting for a lab value to go out of range, the clinical question becomes: what reduces the impact of hormonal fluctuations on vulnerable tissues? That question opens the door to treatments that work even when the numbers look fine.

    The lab interpretation issue gets worse when testosterone is involved. Most women tested for testosterone only receive total testosterone, which is frequently “normal.” But the biologically active fraction is free testosterone, the portion not bound to sex hormone-binding globulin (SHBG). SHBG is lowered by insulin resistance, obesity, and hypothyroidism. A woman with adult acne, scalp thinning, easy weight gain, and borderline-irregular cycles may have normal total testosterone and meaningfully elevated free testosterone. Requesting free testosterone and SHBG alongside total testosterone is something Redmond recommends for any workup involving skin or hair symptoms.


    How PCOS Drives Weight Resistance

    Redmond’s chapter on polycystic ovary syndrome leads with a frank admission: the name is wrong. The ovarian cysts are the least important feature. He prefers to think of PCOS as a cluster of five partially independent features that appear in different combinations in different women.

    Those five features are:

    • Androgen effects: acne, facial hair, scalp hair loss
    • Menstrual irregularity: though notably, some women with PCOS have regular cycles, which causes missed diagnoses
    • Metabolic tendency: weight gain that centralizes around the abdomen and resists typical dieting efforts
    • Insulin resistance: metabolically the heaviest feature, carrying long-term risk for type 2 diabetes and cardiovascular disease
    • Depression: both biochemically driven and situational

    The weight piece is what matters most for people navigating food and body struggles. Insulin resistance suppresses SHBG, which raises free testosterone, which drives androgen symptoms. Everything feeds everything. A woman who is struggling to lose weight despite genuine effort, carrying extra weight in her midsection, dealing with adult acne, and feeling low may be dealing with PCOS even if her cycles are roughly regular. Redmond’s position is that the diagnostic label matters less than identifying which features are present. Women who meet two or three criteria without qualifying for the full diagnosis still carry the underlying hormonal and metabolic reality.

    The medical interventions Redmond covers for PCOS are the ones integrative and functional medicine books routinely skip: metformin for insulin resistance, spironolactone for androgen suppression, and oral contraceptives chosen specifically for low androgenicity. These are not alternatives to lifestyle change. They work alongside it. For women with significant insulin resistance, metformin can meaningfully shift the metabolic picture in a way that diet modification alone often cannot.


    Acne, Hair Loss, and Facial Hair Are One Problem

    If you are dealing with two or three of the following, adult acne (especially jawline or chin), scalp hair thinning, and unwanted facial or body hair, Redmond argues you are dealing with one problem, not three.

    All three share the same root mechanism. Testosterone is converted in the skin to its more potent form, DHT, by an enzyme called 5-alpha reductase. In women with androgen-sensitive tissue, DHT does several things at once: it stimulates oil glands (producing acne), stimulates facial follicles (producing unwanted hair), and simultaneously miniaturizes scalp follicles (producing hair loss). The same hormonal signal drives all of it.

    “By treating each of these separately, a clinician may help one while inadvertently worsening another. What is needed is a unified approach that addresses the androgen cause of all three.”

    The clinical implication is straightforward. A dermatologist who prescribes topical retinoids for acne, laser for chin hair, and minoxidil for hair loss is treating manifestations, not cause. Anti-androgen treatment addresses the common mechanism and often improves all three simultaneously.

    Spironolactone gets its own chapter. Redmond is direct about what it does: it blocks androgen receptors at the skin and hair follicle level, preventing testosterone and DHT from stimulating their targets. Typical starting doses are 50 to 100mg daily. Meaningful improvement in acne takes three to six months. Hair loss stabilization takes six to twelve months. It must not be taken during pregnancy. Many dermatologists don’t think to offer it. Redmond’s suggestion is to ask for it by name.


    Is It’s Your Hormones Worth Reading?

    Read this if you have adult acne, scalp hair loss, or facial hair that has not responded to dermatological treatments, you suspect PCOS and want a clinical explanation of what is actually happening metabolically, or you have been told repeatedly that your labs are normal while still feeling genuinely unwell. The PCOS chapter and the androgen chapters are the strongest sections, and the framing around free versus total testosterone alone is worth the price of the book for anyone who has been through inconclusive hormone testing.

    Skip it if you want a lifestyle or integrative medicine approach. Redmond is a conventional endocrinologist and writes from that frame entirely. There is no functional medicine content, no elimination diet protocol, no adaptogens. He acknowledges botanicals where he sees evidence for them, but this is a clinical book.

    One caveat: The book was published in 2006 and some treatment-specific guidance is dated. Certain delivery methods he describes as state-of-the-art have since been superseded. Treat it as a framework reference, not a current prescribing guide. The clinical reasoning is sound; some of the specifics need updating with a current provider.


    Books Like It’s Your Hormones

    BookAuthorBest For
    Hormone IntelligenceAviva Romm, MDIntegrative approach to the same conditions; functional medicine perspective
    The Hormone ShiftTasneem Bhatia, MDPerimenopause and menopause from an integrative MD
    Healthy HormonesCassandra BarnsGentler lifestyle-first entry point for hormone basics
    Women Food and HormonesSara Gottfried, MDPCOS, insulin resistance, hormonal weight patterns; overlapping territory with a functional medicine lens
    The Science of MenopauseKristi KayeCurrent, evidence-based menopause reference; updates some of Redmond’s older HT guidance