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Why Your Anxiety Might Be Hormonal: Estrogen, Progesterone, Testosterone

Monday, January 19, 2026 | By: Casey Posey, MSN, APRN-BC at Glow Health and Wellness

Why Your Anxiety Might Be Hormonal

Why Your Anxiety Might Be Hormonal: Estrogen, Progesterone, Testosterone

How shifting sex hormones can affect your nervous system, mood, sleep, and sense of calm, and what to look at next

Anxiety is not always “just stress”

Anxiety is often described as worry, tension, racing thoughts, a tight chest, a pounding heart, irritability, restlessness, or a constant sense that something is off. For some people it shows up as panic, for others it is more subtle, like feeling overstimulated, easily overwhelmed, or unable to turn the mind off at night. Many people assume anxiety must be caused by external stress, personality, or a mental health condition. Sometimes that is true. But for many women and men, anxiety is also a body signal, and hormones can be a major part of the story.

Sex hormones do far more than regulate reproduction. Estrogen, progesterone, and testosterone influence neurotransmitters, brain inflammation, blood sugar regulation, sleep quality, and how your nervous system responds to stimulation. When these hormones shift, the brain can interpret normal daily demands as “too much,” and the body can respond with fight or flight sensations even when nothing is actually dangerous. This is one reason anxiety can suddenly appear in someone who has never struggled with it before, or why long standing anxiety can intensify during certain seasons of life.

A hormone informed approach does not dismiss the emotional reality of anxiety. It expands the lens. It asks, what is happening beneath the surface that may be pushing the nervous system into overdrive, and what patterns suggest the root cause is hormonal, or at least hormonally influenced.

The nervous system connection, why hormones affect how you feel

 

Your brain is a hormone sensitive organ. Sex hormones communicate with receptors throughout the brain, including areas involved in mood regulation, threat detection, sleep, and emotional resilience. These hormones also influence key neurotransmitters like serotonin, dopamine, and GABA, which shape calm, motivation, reward, and mental clarity.

Your nervous system has two main modes, a “go” mode and a “rest and recover” mode. When the body perceives threat, it leans into the go mode, also called sympathetic activation. Heart rate rises, breathing becomes shallower, muscles tense, digestion slows, and the mind scans for problems. That is a helpful survival response in the right moment. But when hormone shifts make the nervous system more reactive, the body can stay stuck in that mode. You can feel anxious without understanding why, or feel unable to come down even when you try all the right things.

Hormones also influence sleep, and sleep influences anxiety. They influence blood sugar stability, and blood sugar swings can mimic panic. They influence inflammation, and neuroinflammation can amplify intrusive thoughts and irritability. This is why hormonal anxiety can feel like a full body experience, not simply a mental one.

Signs your anxiety may be hormone related

Hormonal anxiety tends to follow patterns. It is often tied to timing, body changes, or symptom clusters that point toward estrogen, progesterone, or testosterone shifts rather than purely situational stress.

One common clue is a change in anxiety that tracks with your cycle. You may notice heightened anxiety before your period, around ovulation, or in the days when bleeding starts. Another clue is anxiety that appears with sleep disruption, especially waking between 1 a.m. and 3 a.m. feeling wired, or waking with a pounding heart. Many people also notice anxiety alongside new PMS symptoms, heavier or irregular periods, breast tenderness, headaches, more irritability, or a shorter fuse.

Anxiety that shows up with new body composition changes can be another signal. If you are gaining weight around the middle, having stronger cravings, or feeling more sensitive to caffeine and alcohol, hormones may be affecting your nervous system and metabolism at the same time.

Anxiety during perimenopause is especially common because hormones can fluctuate dramatically. You may feel like yourself one week and like a different person the next. Mood swings, sudden panic sensations, and a sense of internal vibration can appear even in people with no prior anxiety history.

In men, low testosterone can look like anxiety, irritability, lack of motivation, low libido, poor sleep, and a reduced ability to handle stress. When testosterone drops, nervous system resilience often drops with it.

These patterns do not mean anxiety is “all in your hormones,” but they do mean hormones should be part of the evaluation.

Estrogen and anxiety, why fluctuations matter more than a single number

Estrogen has a complex relationship with mood. In many ways it supports brain function, it can improve serotonin signaling, support dopamine balance, and help the brain respond more flexibly to stress. But the key word is balance. Both low estrogen and rapidly changing estrogen can contribute to anxiety symptoms.

In perimenopause, estrogen is often unpredictable. It can spike high, then drop suddenly. Those swings can feel like emotional whiplash. A sudden drop in estrogen can increase anxious feelings, worsen sleep, and intensify irritability. For some women, this feels like a short fuse, intrusive thoughts, or a sense of being on edge for no reason.

Estrogen also affects histamine activity and inflammation for some individuals, which can influence anxiety sensations like racing heart, flushing, and feeling overstimulated. It can also influence how the body responds to caffeine, alcohol, and sugar, making anxiety more likely after triggers that previously felt fine.

Another important piece is that estrogen can affect how progesterone is experienced. When estrogen is relatively high compared to progesterone, often described as a progesterone deficiency or estrogen dominance pattern, the nervous system tends to feel less buffered. This can show up as anxiety that is worse in the luteal phase, the week or two before a period.

Estrogen patterns across life stages

Hormonal anxiety can occur at many stages, but it is especially common during windows of transition.

Puberty can bring mood swings and anxiety because hormone signaling is changing quickly. Postpartum is another major window because hormone levels drop sharply after delivery. Many women experience postpartum anxiety that feels physical, intrusive, and relentless, even when life circumstances are stable.

Perimenopause is one of the most common seasons for new or worsening anxiety. Periods may still be happening, but hormone patterns are changing underneath. You may have skipped cycles, heavier bleeding, or shorter cycles. Anxiety can rise as estrogen becomes more unpredictable and progesterone production declines.

Menopause can also be associated with anxiety, especially when sleep is disrupted. Low estrogen can affect serotonin and sleep architecture, and the nervous system can feel less resilient.

Progesterone, the calming hormone your brain often craves

Progesterone is often the missing piece in anxiety conversations. It has a strong relationship with GABA, a neurotransmitter associated with calm and relaxation. When progesterone is adequate, many people feel more grounded, more patient, and more able to fall asleep. When progesterone is low, the brain can feel less buffered, and anxiety can rise.

In the second half of the menstrual cycle, the body should produce progesterone after ovulation. But in perimenopause, ovulation becomes less consistent, and progesterone often declines first, even while estrogen may still be present or fluctuating. This is why many women develop new premenstrual anxiety, irritability, insomnia, or panic sensations in their late 30s and 40s.

Low progesterone can also show up as feeling wired at night, having racing thoughts, or waking in the middle of the night and not being able to fall back asleep. It can look like increased sensitivity to noise, conflict, or stimulation. It can also intensify PMS and make emotional responses feel disproportionate to the situation.

Progesterone is not a sedative in the simplistic sense. It is a hormone that supports nervous system balance. When it is low, your stress response can feel louder than it used to.

Progesterone and the “nighttime anxiety” pattern

Many people describe a pattern where they feel okay during the day but become anxious at night. They dread bedtime, feel more emotional after dinner, or find themselves scrolling because they cannot settle. This can be linked to progesterone, because progesterone naturally supports relaxation and sleep onset. If progesterone is low, especially in the luteal phase, the nervous system may not downshift as easily.

This pattern can be worsened by blood sugar instability, alcohol, or late day caffeine. But when it repeats monthly or intensifies as cycles become irregular, progesterone is often part of the story.

Testosterone, anxiety, and resilience, not just a male hormone

Testosterone is frequently overlooked in mood conversations, especially for women. Yet testosterone plays a role in motivation, confidence, focus, muscle maintenance, and overall resilience. When testosterone is too low, people often feel less driven, more fatigued, and less able to tolerate stress. That can show up as anxiety, especially the kind that feels like mental overwhelm, low confidence, or a sense of fragility in the face of normal demands.

In men, declining testosterone can contribute to irritability, low mood, poor sleep, and anxiety. Men may describe feeling “on edge” or not like themselves. They may also experience a drop in libido, reduced exercise recovery, and increased belly fat, which can further worsen mood through metabolic and inflammatory pathways.

In women, low testosterone may show up as reduced libido, decreased motivation, brain fog, reduced muscle tone, and a feeling of losing mental sharpness. Anxiety can appear because the person feels less resilient, less energized, and more overwhelmed.

Too much testosterone can also cause mood changes in some cases, but clinically, the more common issue is low or imbalanced testosterone relative to a person’s needs and life stage.

How hormones interact, why anxiety is rarely one hormone

Hormones do not act alone. Estrogen, progesterone, and testosterone influence each other and interact with the nervous system together. This is why anxiety often improves when the overall pattern is addressed, not when one number is chased.

For example, estrogen fluctuations can worsen anxiety, but if progesterone is also low, the brain loses its calming buffer, and symptoms intensify. If testosterone is low, resilience drops, and stress feels harder to manage. The combined effect is a nervous system that feels more reactive and less steady.

This is also why some people feel worse when they try random supplements without a clear plan. If you push one pathway while another is depleted, symptoms can shift rather than resolve. A structured approach is more effective.

Why hormonal anxiety can mimic panic

Hormonal shifts can produce physical sensations that feel like panic. Palpitations, chest tightness, shortness of breath, dizziness, nausea, sweating, and a sense of impending doom can all occur when the nervous system is activated. When these symptoms show up suddenly, the mind tries to explain them, and that explanation can become fear, which then amplifies the body response.

Estrogen fluctuations can influence vascular tone and autonomic sensitivity. Progesterone changes can affect sleep and nervous system calming. Testosterone shifts can affect stress resilience. All of these can create a body state that feels like panic even if there is no psychological trigger.

This does not mean you should ignore panic symptoms. It means the evaluation should include both safety checks and root cause exploration.

The role of sleep, blood sugar, and inflammation in hormone driven anxiety

Even when anxiety is hormonally influenced, it is rarely only about hormones. Three amplifiers commonly drive symptoms, sleep disruption, blood sugar swings, and inflammation.

Sleep disruption lowers emotional resilience quickly. When you do not sleep well, the brain becomes more threat sensitive, and the nervous system becomes more reactive. Hormone changes, especially low progesterone and fluctuating estrogen, can disrupt sleep architecture and increase nighttime waking.

Blood sugar swings can feel like anxiety. When blood sugar drops quickly, the body releases stress signals that can create shakiness, sweating, racing heart, and irritability. People often interpret that as anxiety, but it is physiology. If cravings are strong, afternoons are crashy, or you wake hungry at night, blood sugar stability should be part of the plan.

Inflammation can make the brain feel louder. Neuroinflammation can worsen intrusive thoughts, irritability, and low mood. Hormone shifts can influence inflammatory balance, and lifestyle factors like stress, alcohol, and ultra processed foods can amplify it.

When you address these amplifiers alongside hormone patterns, anxiety often becomes more manageable.

A smarter lab approach, what can be helpful to evaluate

A hormone focused evaluation should be personalized, but there are common areas that often matter when anxiety is hormonally influenced.

Sex hormone evaluation can include estrogen and progesterone patterns, and testosterone status, interpreted in context of cycle stage and symptoms. Timing matters. A random hormone lab without cycle context can be misleading.

Because hormones interact with metabolic health, it is often helpful to evaluate blood sugar and insulin regulation, especially if anxiety is paired with cravings, fatigue, or belly weight changes.

Thyroid function can also matter, even though this article focuses on estrogen, progesterone, and testosterone. Thyroid imbalance can mimic anxiety and worsen sleep and palpitations. If symptoms suggest thyroid involvement, it deserves assessment.

Nutrient status is another common factor. Low iron, low vitamin D, and low magnesium can affect mood, sleep, and nervous system stability. Nutrients do not replace hormone balance, but deficiencies can amplify symptoms.

The most important point is that labs should answer a question, not be ordered randomly. Your symptoms and patterns should guide what you test and when.

When hormone support may be appropriate

A hormone informed plan may include targeted support based on symptoms, history, and labs.

Progesterone support may be considered when symptoms suggest low progesterone, like luteal phase anxiety, insomnia, PMS mood changes, and perimenopause patterns. The form and timing matter, and it should be individualized.

Testosterone support may be considered when low testosterone is contributing to low motivation, fatigue, low libido, brain fog, reduced exercise recovery, and reduced resilience. In both women and men, appropriate evaluation and monitoring are important.

Estrogen support may be considered in certain perimenopause and menopause situations, especially when symptoms include hot flashes, sleep disruption, mood changes, and vaginal dryness.

The purpose of hormone support is not to mask symptoms. It is to restore a healthier baseline so the nervous system can function normally, sleep can improve, and emotional resilience can return.

What to avoid, common mistakes that make hormonal anxiety worse

One common mistake is assuming anxiety is purely psychological and ignoring the body. Another is trying random supplements and hormone products without understanding the underlying pattern. This can lead to temporary improvement followed by new symptoms.

Another common issue is over exercising in an attempt to “burn off stress.” For some people, intense exercise spikes stress hormones and worsens sleep and anxiety, especially when progesterone is low or sleep is already disrupted. More is not always better, the right intensity matters.

Under eating can also worsen anxiety. Skipping meals, restricting carbohydrates too aggressively, or relying on caffeine can create blood sugar instability that feels like anxiety. Balanced fueling supports nervous system stability.

Finally, ignoring sleep is a major barrier. If you are sleeping poorly, anxiety will usually persist, even with other interventions.

A patient centered way to think about anxiety and hormones

If you are experiencing anxiety, you deserve compassion and you also deserve answers. Anxiety is not a personal failure. It is often a signal that the nervous system is under strain, and hormones can be a major driver of that strain. When estrogen is fluctuating, progesterone is low, or testosterone is depleted, the brain can become more reactive and less resilient. The goal is to restore a steadier baseline, so you feel like yourself again.

For many people, the biggest relief comes from realizing their symptoms make sense. There is a reason the anxiety showed up. There is a reason it peaks at certain times. There is a reason sleep and cravings are tied to it. When you connect those dots, you can stop blaming yourself and start building a plan that addresses the real drivers.

The next step, getting a plan tailored to your symptoms

If your anxiety feels new, worse, tied to your cycle, paired with sleep disruption, mood changes, low libido, fatigue, or a sense of being on edge for no clear reason, it may be time to explore the hormonal piece. 

At Glow Health and Wellness, we're here to guide you every step of the way. Our office is in Destin, FL, and patients can be seen either in office or via telehealth. Whether you're just beginning to notice changes or seeking advanced management, contact us to reclaim your glow.

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