If you’re new here, I’m Travis Woodley, MSN, RN, CRNP—hormone and metabolic health specialist and author of You’re Not Broken—You’re Unbalanced. In my clinic and inside the Rebuild Metabolic Health Institute, I spend a lot of time helping women in perimenopause, menopause, and post-menopause—and men facing low testosterone and andropause—connect what they feel day-to-day with what their labs are really saying.
This article is adapted from core concepts in the book and from the frameworks I use with patients and practitioners every week.
T4, T3, SHBG, and the Liver: The Part of Hormone Optimization We Skip
We talk a lot about estrogen, progesterone, and testosterone in midlife.
We talk much less about the quiet organ that often decides whether those hormones actually work: the liver.
If you’re exhausted, gaining weight around the middle, sleeping poorly, or feeling “off” while your labs keep coming back “normal,” you’re not alone—and you’re not broken. But you may be unbalanced in a way that doesn’t show up when we only glance at a standard hormone panel.
From a clinical standpoint, three liver jobs are non-negotiable if you want real hormone balance and metabolic health:
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Converting thyroid hormone T4 → T3
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Producing sex hormone–binding globulin (SHBG)
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Clearing and packaging hormones for safe elimination
If you ignore those three, you can “optimize hormones” on paper and still have a patient (or yourself) who feels nothing like optimized in real life.
This is one of the reasons I wrote You’re Not Broken—You’re Unbalanced: to give patients and practitioners a framework that connects thyroid, liver, sex hormones, gut, and metabolism instead of treating each in isolation.
Let’s walk through what the liver is really doing behind the scenes—and why it needs to be in the room for every conversation about hormones.
1. T4 → T3 Conversion: When “Normal” Thyroid Labs Aren’t Telling the Whole Story
Most thyroid panels start and stop with TSH and sometimes total T4.
But the hormone that actually drives energy, mood, and metabolic rate at the tissue level is T3, not T4. And a significant portion of that active T3 is produced in the liver when the body converts “storage” thyroid hormone (T4) into active thyroid hormone (T3).
When liver function is strained by:
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Insulin resistance or fatty liver
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Chronic inflammation
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Excess alcohol
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Certain medications
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Ultra-processed, low-protein diets
…it can quietly reduce the amount of T4 that gets converted into T3.
On paper, you may still see:
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“Normal” TSH
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“Normal” total T4
But in the real world, the person is living in a low-T3 state in the tissues, which can show up as:
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Crushing fatigue and brain fog
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Weight gain around the middle despite “doing everything right”
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Low mood, low motivation, and slower recovery
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Feeling cold, achy, or “slowed down”
This is one of the most common disconnects I see:
The lab report looks “fine,” but the person in front of you clearly doesn’t feel fine.
If you’re in perimenopause, menopause, or andropause and your hormone protocol is not working the way it “should,” the question is not just “Are we dosing estrogen, progesterone, and testosterone correctly?”
The equally important question is:
Is the liver converting enough T4 to T3 to support the rest of the system?
In You’re Not Broken—You’re Unbalanced, I walk through this disconnect step by step—why “normal” thyroid labs can still leave you clinically hypothyroid at the tissue level, and how that interacts with sex hormones, weight, and mood.
2. SHBG: The Liver’s Hand on the Hormone Volume Knob
Most people have never heard of sex hormone–binding globulin (SHBG).
But if you care about hormone balance, you need to care deeply about SHBG—because it tells you how much estrogen and testosterone are free (available to tissues) versus bound (being carried around, but not active).
And where is SHBG made?
Primarily in the liver.
When the liver is inflamed, insulin-resistant, or stressed, SHBG can move in the wrong direction. In practice, this can look like:
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In women:
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Lower SHBG → higher free androgens
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Acne, hair loss, and hair growth in places you don’t want it
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“PCOS-like” pictures, even when nobody has called it that
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In men:
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SHBG that’s too high or too low
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Total testosterone that looks “normal”
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But free testosterone that doesn’t match the way they feel
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If you ignore SHBG, you miss why two people with the same total levels can feel completely different:
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One feels sharp, lean, and energetic
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The other feels flat, foggy, and stuck
In the book, I treat SHBG as one of the core “signal amplifiers” we watch over time—not as a throwaway number at the bottom of the panel.
Because SHBG is a window into:
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Liver health
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Insulin sensitivity
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How honest your hormone replacement protocol actually is
You can’t say you’re doing full hormone optimization if you’ve never asked what the liver is doing with SHBG.
3. Hormone Clearance and Recirculation: When Hormones Don’t Actually Leave
The liver doesn’t just help activate hormones; it also helps clear them.
Estrogens and androgens are processed by the liver and packaged for elimination through bile and urine. But when detoxification pathways and the gut are overwhelmed, those hormones can be:
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Deconjugated by gut bacteria
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Reabsorbed back into circulation
This can drive symptoms like:
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Heavy, painful, or erratic cycles
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Breast tenderness and fluid retention
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Mood swings, headaches, and sleep disruption
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“Estrogen dominant” pictures—even when blood levels aren’t sky-high
This is why a purely “more or less hormone” approach can backfire.
If we increase estrogen without supporting:
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The liver’s ability to process it
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The gut’s ability to help eliminate it
…we might intensify symptoms instead of resolving them.
In our work at Revitalize Aesthetics & Wellness and through the Rebuild Metabolic Health Institute, we rarely adjust sex hormones without first asking:
What is the liver doing with thyroid hormone, SHBG, and clearance?
Only then do we decide if the problem is:
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Dose
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Delivery method
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Or the system those hormones are living in
Why I Wrote You’re Not Broken—You’re Unbalanced
Too many people—especially in midlife—are told some version of:
“Your labs are normal. This is just aging.”
And too many clinicians are given 10–15 minutes and a basic lab panel, then expected to fix complex, overlapping issues in sleep, weight, libido, mood, and cognition without a shared framework.
You’re Not Broken—You’re Unbalanced exists to fix that.
I wrote it to give patients, health and fitness coaches, and clinicians a common language for:
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Thyroid and T4 → T3 conversion
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Liver function and SHBG
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Estrogen, progesterone, and testosterone balance in women and men
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Perimenopause, menopause, and andropause/low T
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Peptide therapy and GLP-1 medications
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Gut, circadian rhythm, muscle, and mitochondrial health
Not in abstract theory, but in checklists, symptom-to-strategy maps, lab interpretation guides, and case stories you can actually use.
It’s the same framework I teach inside the Rebuild Metabolic Health Institute and apply every day with patients at Revitalize—a way to:
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Connect what someone feels with what their labs are really saying
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Decide what to address first (and what can wait)
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Build stepwise plans that are sustainable, not heroic for two weeks and gone by week three
When thyroid, liver, sex hormones, and metabolism are aligned, the story patients are living finally matches the story their labs are telling. That’s when change stops being random and starts being reproducible.
Who This Book and Framework Are For
If you’re a patient who has been told “everything looks fine” but you don’t feel fine, this book helps you understand why, and how to have a different kind of conversation with your clinician.
If you’re a health or fitness coach, it gives you a structure for recognizing when hormones, liver, and thyroid are likely part of your client’s struggle—and how to collaborate more effectively with medical providers.
If you’re a clinician, it offers a practical blueprint you can adapt inside your scope of practice, whether you’re newer to hormone/metabolic work or refining an existing approach.
The Bottom Line
You cannot truly optimize hormones while ignoring the liver.
You can’t fix perimenopause, menopause, and andropause by adjusting estrogen, progesterone, and testosterone in isolation and calling it a day.
You need to know:
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How well the liver converts T4 → T3
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What it’s doing with SHBG
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Whether it’s clearing or recirculating hormones
That’s where the gaps hide. That’s where “normal” lab reports and miserable daily life finally meet in one story.
If you’re ready for that level of clarity—whether for yourself, your family, or your patients—that’s exactly what I wrote You’re Not Broken—You’re Unbalanced to deliver.
Ready to Go Deeper?
If this resonated—whether you’re a patient, coach, or clinician—You’re Not Broken—You’re Unbalanced is the full roadmap behind what you just read.
Get the book:
• Purchase on Amazon:
https://www.amazon.com/Youre-Not-Broken-Youre-Unbalanced-rebuilding/dp/B0FQJNQ6XP/ref=tmm_pap_swatch_0
• Purchase on multiple platforms:
https://books2read.com/Youre-not-broken
Support the protocols in the book with medical-grade supplements and peptides:
• You’re Not Broken Medical-Grade Supplements & Peptides:
https://www.revitalizenutrition.net/shop-now#!/Youre-Not-Broken-Medical-Grade-Supplements/c/186608296
