Category: Understanding Your Hormones

Hormones help to regulate almost all of the body’s processes, including reproductive health and fertility. Testing your hormones regularly can give you insights into your overall health and help you track changes in your menstrual cycle and fertility over time. Here we’ve broken down which hormones you should test and why.  Quick facts: What are hormones? Put simply, hormones are small chemical messengers that travel through the blood to different parts of your body. They help control many different functions from growth and development to metabolism, the menstrual cycles, fertility and mood, just to name a few. Hormones are made by special cells in the endocrine system. Some of the major endocrine glands are: Why are sex hormones important? Sex hormones are a group of hormones that help to regulate the female and male reproductive organs and fertility. They are important not only for reproductive health but for overall health too—often having multiple functions within the body.  The main hormones involved in the female reproductive system are:  Thyroid hormones can also impact your levels of reproductive hormones. Why do you need to test your hormones? Hormones are often involved in complex feedback loops with one another. This means if one hormone gets off balance, it can often disrupt the whole system and bring about multiple, often overlapping symptoms.  Our hormones are also changing constantly, as we age and in response to things like lifestyle factors, medications or external stresses. A change in your hormone levels could be the reason you’re feeling sluggish or slightly emotional, explain your irregular periods or why you’re struggling to get pregnant. Our hormone levels can give us insight into both our overall reproductive health, show our risk factors for certain conditions, explain any unwanted symptoms, or indicate the health of our ovarian reserve and fertility.  Which hormones should I test? Which hormones you need to test and monitor will depend on your individual medical history, symptoms, biometrics and fertility goals. Luckily, our Online Health Assessment is built on a proprietary algorithm that does the leg work for you, recommending you hormone panel personalised to you.  Let’s take a look at each of the main female sex hormones and what testing them could tell you.  Follicle-stimulating hormone One of the main hormones that regulate the menstrual cycle and fertility is follicle-stimulating hormone (FSH). Its main job is to stimulate your ovaries each month to mature a set of follicles (the sacs that house the immature eggs) into mature eggs.  If FSH gets out of balance, ovulation can be affected, negatively impacting fertility and causing irregular cycles.  FSH levels increase with age. High FSH is usually an indication that ovarian reserver is declining and more FSH is needed to encourage your eggs to grow. This is why monitoring FSH can help you understand the health of your ovaries.  FSH levels will slowly increase with age as your ovarian reserve declines. When your ovarian reserve is finally depleted (and menopause occurs), FSH levels become substantially elevated. This is why FSH is used as an indicator of menopause.  Persistently high FSH levels in someone younger than 40, along with irregular periods and vasomotor symptoms, could indicate premature ovarian insufficiency (POI). This is when someone experiences menopause before the age of 40. FSH levels are usually not recommended as an indicator of menopause beyond the age of 45. Oestrogen (Oestradiol) Oestrogen is an important hormone for the growth and maturation of eggs and the thickening of the uterus lining each cycle. It’s also incredibly important for overall health, regulating bone, heart, skin and hair health, as well as mood.  Oestrogen is made by the ovaries, so monitoring oestrogen levels gives a good indication of how well your ovaries, and menstrual cycle in general, are functioning. Oestrogen levels will fluctuate and eventually significantly drop when your ovarian reserve becomes depleted and menopause occurs. Low oestrogen levels are therefore linked with many symptoms of menopause, such as dry skin and hair, vaginal dryness, hot flushes, brain fog, night sweats, difficulty falling asleep and fatigue.  Luteinising hormone (LH) LH is the hormone responsible for triggering ovulation, which is the release of the mature egg from an ovary each month.  If your LH levels are too low or too high, it can interfere with ovulation. High LH levels are often seen in those with Polyendocrine Metabolic Ovary Syndrome (PMOS, formerly known as PCOS), which can cause irregular ovulation and issues with periods and fertility. Anti-Müllerian hormone (AMH) Anti-Müllerian Hormone (AMH)  is a super important hormone for fertility and overall reproductive health. AMH is made by the small sacs, called follicles, in your ovaries. These follicles house your eggs.  Since AMH is made by the follicles, your AMH levels can therefore give you an insight into your ovarian reserve, or how many eggs you have at the time of testing.  We were all born with all of the eggs we’ll ever have, and as we age, both our egg quality and quantity decline. Generally, our AMH levels will decline with age as our egg count diminishes, unless we have an underlying condition or lifestyle factor which is affecting our AMH levels (like PMOS).  High AMH levels can be an indicator of polycystic ovaries and can be used to diagnose PMOS based on recently updated clinical guidelines. On the other hand, low AMH along with high FSH and low oestrogen is usually an indicator of low ovarian reserve.  AMH is often also used to predict someone’s chances of success during fertility treatment, such as egg freezing and IVF. However, it’s important to remember that AMH can only tell you about the quantity, and not the quality, of your eggs. Testosterone Testosterone can be converted to produce the wonder hormone oestrogen and is also associated with libido, maintaining muscle mass, vaginal health, breast health and bone health.  High levels of testosterone can cause symptoms such as excess body and facial hair, acne, and irregular or absent periods. These symptoms are often seen in women with PMOS […]

Testosterone is an important androgen hormone in people of all sexes. In this article, we’ll cover exactly what it does in the body, what the symptoms and causes of high or low testosterone are and how you can ensure your levels are balanced and healthy.  Quick facts: What is testosterone? Testosterone is an important hormone for regulating sex drive (libido), bone and muscle mass and fat distribution. It’s part of a group of hormones called androgens.  There are a lot of misconceptions about testosterone being just a “male” hormone. Whilst testosterone plays an important role in the development of the male sex organs and male secondary sex characteristics, people of all sexes have testosterone.  Everyone produces and requires a certain amount of androgen hormones for reproductive development. The difference is just how much testosterone we have based on our sex-at-birth. How is testosterone made? In women and people assigned female-at-birth, testosterone is produced by the ovaries and adrenal glands. It’s then converted to hormone–oestrogen. Testosterone production is age-dependent and it gradually declines with age. Most of the testosterone in the body is inactive. It remains bound to a protein called, sex hormone-binding globulin (SHBG). The small amount of testosterone that’s unbound and therefore active, is called freely circulating testosterone (free T).  Free T can enter cells to bring about its effects. Our free T levels are affected by the levels of SHBG. Low levels of SHBG result in higher free testosterone, whereas high levels of SHBG result in lower free testosterone. What does testosterone do in the body? Some of the functions of testosterone are: What are the symptoms of high testosterone? Excess levels of testosterone in the body is called hyperandrogenism. This can bring about symptoms like:  Some studies suggest that high testosterone levels may increase the risk of developing high cholesterol, heart disease and type 2 diabetes. What causes high testosterone levels? The most common causes of high testosterone levels are underlying health conditions. It can also be caused by certain medications and lifestyle factors. Let’s look at the main ones… PMOS (formerly PCOS) Polyendocrine Metabolic Ovary Syndrome (PMOS, formerly known as PCOS) is a hormonal and metabolic condition affecting 1 in 10. The exact cause is still being researched, however, the proposed causes include an excess of androgens and insulin, genetic and environmental factors. If you suspect you might have PMOS, our at-home tests can give you a better insight into your hormones.  Congenital andreal hyperplasia Congenital adrenal hyperplasia (CAH) is an inherited condition that affects the adrenal glands. These are small glands located on top of the kidney. They produce hormones like cortisol (stress hormone), dehydroepiandrosterone (DHEA) and testosterone. People with CAH are unable to produce an enzyme necessary to regulate the production of these hormones, which can result in an overproduction of testosterone. It’s been found to be more common in some ethnic groups such as people of Hispanic, Mediterranean, Yugoslavian and Ashkenazi Jewish descent. Cushing’s syndrome is another hormonal condition impacting the adrenal glands. It results in excessive cortisol and androgen production. Medications Testosterone levels can rise due to certain medications, such as: Alcohol Excessive alcohol consumption may increase levels of testosterone in premenopausal women, however, research is conflicting.  How to lower my testosterone levels? Treatment for high testosterone depends on the cause, but generally, it is a combination of lifestyle changes and medications. Achieving a healthy weight by including a healthy balanced diet and exercise routine may help with the symptoms of a hormonal balance.  Medications used to treat high testosterone, and associated symptoms include: What are the symptoms of low testosterone? If you’re experiencing low testosterone, you may experience some of the following symptoms:  Low testosterone over a long period may also contribute to long-term health conditions such as heart disease, memory issues and loss of bone density. Often, the symptoms of low testosterone in women are undiagnosed or misdiagnosed. Some of the conditions that low testosterone may be mistaken for include stress, depression and the side effects of menopausal changes in women. What could cause low testosterone levels? The most common causes of low testosterone levels are often age, underlying conditions and problems with certain glands. Age Testosterone levels naturally decrease as we age. As it’s produced in the ovaries, the natural decrease in ovarian function with age means that some may experience low testosterone levels as they transition from the perimenopausal phase into menopause.  Underlying health conditions Premature ovarian insufficiency (POI) can increase your risk of low testosterone. Additionally, surgery, such as the removal of the ovaries, can cause lowered testosterone levels.  Problems with the hypothalamus or pituitary gland Underlying health conditions impacting the pituitary, hypothalamus, or adrenal glands can also cause lowered testosterone levels. This is because these parts of the brain are responsible for the secretion of hormones which control the proper functioning of the ovaries.  A disruption in the pituitary gland can also impact the adrenal gland. Addison’s disease or adrenal insufficiency is a hormonal condition that occurs due to underactive adrenal glands and can cause a low level of its hormones. What can I do to increase my testosterone levels? Low testosterone levels effects and treatments in women are still being researched and treatment is usually recommended only if symptoms are significantly impacting health and quality of life.  Testosterone replacement therapy is a form of hormone replacement therapy (HRT) based on the replacement of testosterone. It may be prescribed orally, as injections, gels or skin patches. DHEA is a precursor to testosterone, and it is believed that taking DHEA supplements could increase the amount of testosterone. It is always recommended to speak with a doctor before starting any medication or supplements. How to test testosterone levels? If you’re experiencing any of the symptoms mentioned above, our Advanced At-Home Hormone and Fertility Test can determine your testosterone levels. Hormone testing is the only way to know what your testosterone levels are for definite.  Our Doctors can recommend a care plan for you, based on your symptoms, hormone […]

When our reproductive hormone levels are affected, it can cause menstrual cycle disruptions that can result in fertility issues. In this article, we’ll take a look at alcohol’s effects on the main female reproductive hormones. Quick facts: How alcohol and hormones interact According to recent data, women and those assigned-female-at-birth are, on average, drinking more alcohol than ever before. Whilst many people are aware of the immediate health consequences of drinking—including the caloric impact and the dreaded hangover, there’s still very limited awareness of the effects that alcohol can have on female hormonal health.  Hormones act as chemical messengers, which control and coordinate various bodily processes. Each of our hormones relies on a complex system of interactions, often with other hormones, to maintain their levels and carry out their intended functions.  Drinking alcohol, as well as other lifestyle factors like smoking, can affect our hormones, both directly and indirectly. Which hormones are affected by alcohol? Hormones affected by alcohol include: Our hormones are sensitive. They rely on a complex set of interactions, both with one another and other bodily processes in order to stay in balance and perform their functions properly.  Alcohol consumption is known to affect our levels of oestrogen, progesterone and testosterone significantly—three very important hormones in the regulation of the menstrual cycle and overall health. It can also affect our levels of Anti-müllerian Hormone (AMH), gonadotropins like Follicle stimulating hormone (FSH) and Lutenising hormone (LH), thyroid hormones and prolactin.  Let’s take a look at each of them in turn. Oestrogen and alcohol Oestrogen is probably the hormone you know best—it plays an important role in many elements of our health, including the regulation of the menstrual cycle, maintaining bone density and skin health. Acute consumption of alcohol has been shown to increase oestrogen levels. Increased oestrogen levels over a prolonged period can be associated with breast cancer development in those assigned-female-at-birth. The United Kingdom Million Women Study revealed that every additional drink per day contributed to 11 breast cancers per 1,000 women up to age 75. Progesterone and alcohol Follicle-stimulating hormone (FSH) and luteinising hormone (LH), are involved in egg maturation and ovulation, two key elements of the menstrual cycle and female fertility. A surge in your levels of LH triggers the egg to be ovulated, however, there is some evidence that alcohol consumption may affect both the levels of LH in general and the ability of the egg to respond to LH. Excessive alcohol consumption may even affect how the cells within the fallopian tubes function. Testosterone and alcohol Testosterone is typically associated with male sexual development and fertility, but it also plays an important role in female sexual development and fertility, including regulating female libido.  There is some evidence that moderate alcohol consumption may increase testosterone levels, causing an imbalance in androgen levels. High testosterone levels can lead to symptoms like acne, excessive facial and body hair growth (hirsutism), irregular periods, mood changes and loss of libido. Anti-Mullerian Hormone (AMH) and alcohol AMH is produced by the granulosa cells within your ovarian follicles and is used as an indicator of ovarian reserve (your egg count). The relationship between alcohol consumption and AMH is slightly contentious. Some studies have found no change in AMH levels in people who consumed alcohol but more recent studies have shown those who engage in “binge drinking” had lower levels of AMH.  Binge drinking is defined by the Centres for disease control (CDC) as “a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 g/dl or above”. Basically, consuming 4 or more drinks in the space of 2 hours.  Because of AMH’s close ties to your ovarian reserve, lowered AMH levels can indicate a low ovarian reserve. Gonadotropins and alcohol There are two types of gonadotropin hormones in the body—Follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Both FSH and LH are involved in egg maturation and ovulation, two key elements of the menstrual cycle and female fertility.  A surge in LH levels at the midpoint of the menstrual cycle is what triggers ovulation—that month’s mature egg being released into the Fallopian tube.  There is some evidence that suggests alcohol consumption may increase LH levels in general and also impair the ability of our eggs to respond to LH. Excessive alcohol consumption may also affect how the cells within the Fallopian tubes function. Thyroid hormones and alcohol Your thyroid is a butterfly-shaped gland that plays an important role in the regulation of many different bodily functions such as your heart rate, body temperature and growth development.  Alcohol consumption has been shown to alter the levels of the thyroid hormones, thyroid-stimulating hormone (TSH), thyroxine (T4) and triiodothyronine (T3) with heavy use showing decreased levels of T3 and T4. Low levels of thyroid hormones are known as hypothyroidism and can cause a huge number of symptoms including fatigue, weight gain, heavy or irregular periods, fertility issues and irregular ovulation, depression and more. Prolactin and alcohol Chronic alcohol consumption is associated with increased prolactin levels. Consistently high levels of prolactin in your body is called hyperprolactinemia and is significantly associated with infertility through interference with other hormones such as oestrogen and progesterone. Alcohol and trying to conceive When trying to conceive, cutting down on your drinking is often one of the first things on your preconception to-do list. The dangerous effects of alcohol on the developing foetus can range from physical to mental and generally disrupt their development in the womb (see foetal alcohol syndrome).  It is also known that alcohol consumption affects the success of IVF treatment, with one study showing people who had at least four drinks per week were 16% less likely to have a live birth than those who had less than four drinks. Additionally, a 21% lower live birth rate was found for couples in which both drank more than four drinks per week. Other effects of alcohol on the body As well as impacting our hormones, alcohol has other broad-reaching effects on the body and the […]

We’re all sold the ideal of perfect skin by skin care companies. But sometimes the cause of our breakouts is more than skin deep. So how do we know if our skin troubles are hormone-related? Read on to find out. Quick facts: What is hormonal acne? Hormonal acne is acne or breakouts that are related to hormonal fluctuations or imbalances.  Typically hormonal acne is found on the lower face, cheeks and jawline chest, neck, shoulders and back. Hormonal acne can affect people of all ages. Whilst it’s common during puberty when lots of hormonal changes are occurring, it can also be common as an adult, especially for women and people who menstruate, due to hormonal fluctuations throughout the menstrual cycle. What causes hormonal acne? Your skin has many small glands, called sebaceous glands, that produce an oily substance called sebum. Sebum helps keep your skin supple, smooth and healthy.  These glands also have receptors for our sex hormones, particularly androgens like testosterone, and oestrogen. Both of these hormones stimulate the production of sebum. When excess sebum is produced, this buildup causes visibly oilier skin and can clog the pores, resulting in inflammation and acne breakouts. Hormonal acne and androgens When our bodies produce excess amounts of androgens, it can cause hormonal acne and other skin problems. If androgen levels are higher than normal, there is more androgen binding to the sebaceous gland receptors, promoting more sebum production.  There can be lots of reasons for elevated androgens. A common cause is Polyendocrine Metabolic Ovary Syndrome (PMOS, formerly known as PCOS). Those who experience PMOS are more likely to experience excess androgen-related symptoms like acne, excessive facial and body hair growth (hirsutism) and skin darkening.  Trans and non-binary people who begin taking testosterone as part of their transition journey may also notice acne breakouts because of raised androgen levels. Hormonal acne and oestrogen Sebum production is also influenced by the menstrual cycle, specifically by the hormone oestrogen.  Oestrogen fluctuates throughout the menstrual cycle. It’s at its lowest level during your period and gradually rises to a peak at ovulation, around the mid-point in your cycle. Although the impact of oestrogen on the sebaceous glands is not fully known, it has been shown to suppress sebum production at high levels. Therefore when your oestrogen levels are higher, generally your skin will be clearer. This is why lots of people experience hormonal acne flare-ups just before or during their periods when oestrogen levels are low.  Oestrogen is also associated with increased collagen production, skin thickness, skin hydration and wound healing—which all contribute to clear-looking, healthy skin. After menopause, your oestrogen drops. Some people find that this drop causes hormonal acne and may also leave their skin dry, itchy and saggy. For some individuals, HRT to reduce the symptoms of menopause can also cause hormonal acne. How to treat hormonal acne? If you think you suspect you’re suffering from hormonal acne, there a number of treatments you can explore.  Firstly, if you’re not already, begin tracking when you have flare-ups and your periods. You can do this with a period tracking app or just using a calendar. This will help you to understand when in your cycle you’re getting flare-ups and whether it could be due to hormonal fluctuations during your cycle.  Testing your hormones will be able to give you answers as to whether you have raised androgen levels. Our advanced hormone and fertility test can help you identify any hormonal imbalances.  There are topical treatments available that can help with flare-ups, as well as some contraceptives like the combined pill that has anti-androgenic properties. Lifestyle changes like diet, exercise, stress and alcohol reduction can also have a significant impact.  If you’re struggling with your skin, don’t suffer in silence. Reach out to us and get on a plan to find the root cause of your skin issues. References:  

Hypothalamic amenorrhea (HA) is when your menstrual cycle and ovulation are interrupted due to the influence of the hypothalamus gland, located in the brain.  In this article we run through common symptoms, the causes and treatment options available. Quick facts: What causes hypothalamic amenorrhea? The hypothalamus is a small region of the brain that plays a crucial role in lots of important bodily functions. It controls the release of certain hormone and helps to regulate body temperature, sleep patterns, hunger and the menstrual cycle.  It is a commonly occurring condition in women with eating disorders, athletes or dancers or those with a low body mass index (BMI) Hypothalamic amenorrhea is caused specifically by issues in the functioning of the hypothalamus. The function of the hypothalamus can be disrupted by lots of different things, usually lifestyle factors.  Common disruptors include: Symptoms of hypothalamic amenorrhea Common symptoms include: What causes menstrual cycle disruption When you eat too little or exercise too much, the body perceives this as stress. This can lead to severe fluctuations in a hormone called gonadotropin-releasing hormone (GnRH). This is the main hormone regulated by the hypothalamus.  GnRH influences the production of other hormones, including those involved in the regulation of the menstrual cycle.  Follicle-stimulating hormone (FSH), needed to mature an egg each cycle and luteinising hormone (LH), needed for the release of the mature egg each cycle, can become disrupted as they both rely on GnRH.  FSH and LH, in turn, regulate oestrogen and progesterone production by the ovaries. Oestrogen helps the eggs to mature and progesterone prepares the uterus lining for a fertilised egg. Typically, a rise and fall in FSH, LH, oestrogen and progesterone is what controls the menstrual cycle. If a disruption happens at the hypothalamic level, the hormonal cascade is affected, resulting in low FSH, LH and oestrogen. Essentially, this is just your body trying to protect you. It’s putting your basic energy needs ahead of your reproductive health, which is why your periods become irregular. How can hypothalamic amenorrhea be diagnosed? It is usually a “diagnosis of exclusion,” which requires healthcare providers to rule out other conditions that could be interrupting the menstrual cycle. Your doctor may consider the following blood hormone tests to base their diagnosis on:  GnRH levels are tested to analyse the function of the hypothalamus, with a low GnRH result being indicative of a dysfunctional hypothalamus. Low levels of FSH, LH and E2, may also indicate hypothalamic amenorrhea.  High levels of prolactin can also lead to irregular or absent periods. Testosterone levels are analysed to eliminate the possibility of hyperandrogenism (high androgen levels) and Polyendocrine Metabolic Ovary Syndrome (PMOS, formerly known as PCOS). Thyroid-stimulating hormone is analysed to rule out the influence of thyroid gland disorders. Human chorionic gonadotropin is purely tested to confirm or eliminate the possibility of pregnancy influencing your periods. Hypothalamic amenorrhea treatments If you’ve received a diagnosis of hypothalamic amenorrhea, your pathway to care and treatment options will usually be tailored according to the cause. Healthy lifestyle habits, diet and exercise routine modifications can help improve your symptoms, and make them more manageable. If you think you may be experiencing any of the symptoms above, reach out to us.  Hertility can help you with your initial hormone testing, along with a comprehensive Doctor-written report analysing your results. We can also support you with any onward care or treatments you may need, including tele-consultations with specialists.  Resources:

How can your thyroid be affecting your fertility? Your thyroid is a butterfly-shaped gland located at the front of your throat. It plays a crucial role in influencing metabolism, temperature, growth, and development, via the production of thyroid hormones. The main thyroid hormones are thyroid stimulating hormone (TSH) thyroxine (T4) and triiodothyronine (T3). Whilst many are aware that the imbalance of these hormones could cause changes in weight and mood, not quite so many of you know that your thyroid can also affect your fertility and menstrual cycle. If you think of your thyroid as a conductor in an orchestra, conducting many different instruments (organs) as they play their music (produce hormones), then it’s easier to understand how if one your organs is off key, it tends to mess up the whole song. If your cycles are out of sync or you’re trying to conceive, it’s probably a good idea to check your thyroid is in tune and working optimally. CHECK YOUR FERTILITY What are thyroid disorders? About 2-4% of women of reproductive age struggle with a thyroid imbalance. When your thyroid is underactive, it is known as hypothyroidism. The main symptoms of hypothyroidism are weight gain, thinning hair, severe fatigue, slowed heart rate, depression, decreased libido, and sensitivity to cold. When your thyroid is overactive, it is known as hyperthyroidism. These two issues are like yin and yang, so the main symptoms of this are pretty much the opposite of hypothyroidism. That is, rapid weight loss, increased appetite, increased sensitivity to heat, frequent bowel movements, menstrual irregularities and irritability. Also not ideal. How can thyroid dysfunctions affect your reproductive health? Thyroid disorders can mess with your metabolism, as well as disrupt your hormones in general. The hormonal issues that arise as a result can include anovulation, or the inability to ovulate, as well as luteal phase defects, hyperproalctinemia, and general sex hormone imbalance. As the thyroid plays a crucial role in growth and development, a healthy thyroid is necessary for maintaining a healthy pregnancy as well. Is there a connection with your thyroid and fertility? While thyroid issues are problematic, they are a confounding factor in your fertility, rather than a direct problem. For example, when a car blocks you in and you can’t leave, it’s not an issue with your car, but rather the other car in your way. Same goes for this –  fertility resolves once the thyroid problem resolves. One study demonstrated that 76% of women who fixed their thyroid were able to conceive between 6 weeks to 1 year afterwards. Testing your thyroid levels is the best place to start to help you understand whether you may be suffering from a thyroid disorder. In hypothyroidism, TSH would be high, while T3 and T4 would be low. With hyperthyroidism, the opposite is true, and TSH would be low, while T3 and T4 would be high. Once you have an understanding of where your thyroid stands, you can then treat this issue, which is primarily done with oral medication. Hypothyroidism is typically treated with thyroxine (T4) replacement, and Cytomel, or T3 replacement, may also be required in specific cases. Hyperthyroidism is a bit more complicated, and is treated with antithyroid medication, iodine, or surgery. Sometimes, drugs known as beta-blockers are used as well. It is important to find an endocrinologist that you trust, and possibly to even get a second opinion, if you feel like there is an issue with the treatment you’ve been prescribed. If this has got you scratching your head about your own thyroid levels or questioning your overall fertility, Hertility are here to fill in the blanks. With our at-home tests, we can give you a better insight into your health, and if this little gland isn’t in check, we’ll lead you down the path to fixing it.