Hormone Replacement Therapy (HRT) and Thyroid Treatment For Long COVID
Hormonal dysregulation is common in Long COVID, causing fatigue, brain fog, weight changes, and mood problems. Dr. Groysman offers comprehensive hormone evaluation and treatment including bioidentical hormone replacement therapy (HRT) with estrogen and testosterone pellets, plus advanced thyroid optimization addressing functional hypothyroidism often missed by standard TSH testing. Treatment targets the hormonal disruption caused by COVID-19’s impact on endocrine systems.
Hormone Optimization for Long COVID Recovery
Hormonal dysregulation is one of the most overlooked yet profoundly impactful mechanisms in Long COVID. Many patients struggle with persistent fatigue, brain fog, weight changes, mood disruption, and metabolic problems, only to be told their standard thyroid tests are “normal” or that hormone issues are just “part of aging.”
The reality is more nuanced. Long COVID can disrupt multiple hormone systems simultaneously, affecting thyroid function, sex hormones (estrogen and testosterone), adrenal function, and the complex interplay between these systems. When hormones fall out of balance, every system in your body can be affected.
At our clinic in Plano, Texas, we offer comprehensive hormone evaluation and treatment, including:
- Bioidentical Hormone Replacement Therapy (HRT) with estrogen and testosterone pellets
- Advanced Thyroid Optimization addressing functional hypothyroidism often missed by standard testing
Dr. Groysman is one of the few physicians in the Dallas-Fort Worth area providing integrated hormone treatment specifically tailored for Long COVID patients, recognizing that hormone optimization is often essential for full recovery.
Meet Hormonal Dysregulation in Long COVID
COVID-19 doesn’t just affect your lungs, it can disrupt your entire endocrine (hormone) system. Research has documented multiple mechanisms through which COVID affects hormone production and function:
- The virus can directly infect thyroid tissue, adrenal glands, and reproductive organs
- ACE2 receptors (the virus’s entry point) are present throughout endocrine tissues
- Tissue inflammation and damage can impair hormone production
Chronic Inflammation:
- Persistent inflammatory signaling disrupts the hypothalamus-pituitary axis that controls hormone production
- Inflammatory cytokines interfere with hormone conversion and cellular uptake
- Inflammation blocks the conversion of inactive thyroid hormone (T4) to active hormone (T3)
Stress Response Dysregulation:
- Prolonged illness activates chronic stress pathways
- Elevated cortisol from chronic stress suppresses thyroid function and sex hormone production
- Adrenal dysfunction (often called “adrenal fatigue”) becomes common
Autoimmune Activation:
- Post-viral autoimmunity can target endocrine glands
- Thyroid autoantibodies may develop or worsen
- Autoimmune thyroiditis (Hashimoto’s) can be triggered or exacerbated
The Hormone-Long COVID Connection
When hormones are out of balance, they create or worsen many Long COVID symptoms: Thyroid Dysfunction Contributes To:- Crushing fatigue and low energy
- Brain fog and cognitive slowing
- Weight gain or inability to lose weight
- Cold intolerance
- Depression and mood changes
- Hair loss
- Constipation and digestive slowness
Sex Hormone Imbalance (Estrogen/Testosterone) Contributes To:
- Persistent fatigue and lack of motivation
- Mood instability, anxiety, depression
- Sleep disruption
- Loss of muscle mass
- Cognitive decline
- Reduced libido
- Metabolic dysfunction
- Bone density loss
- Cardiovascular risk
The challenge is that these symptoms overlap significantly with other Long COVID mechanisms, and hormone problems are often dismissed because standard lab tests frequently appear “normal”, even when clinical hormone deficiency is clearly present.
Hormone Replacement Therapy (HRT): Bioidentical Estrogen and Testosterone
Hormone Replacement Therapy (HRT) involves supplementing your body’s natural hormones, primarily estrogen and testosterone, when levels decline due to aging, chronic illness, or other factors. At our clinic, we use bioidentical hormones delivered via pellet therapy, providing steady, physiologic hormone levels that closely mimic your body’s natural production.
Bioidentical vs. Synthetic:
- Bioidentical hormones have the exact same molecular structure as the hormones your body produces naturally
- Synthetic hormones have altered structures that can produce different effects and side-effect profiles
- Modern research strongly favors bioidentical hormones for safety and efficacy
Why Pellets?
- Small pellets (about the size of a grain of rice) are inserted under the skin in a simple office procedure
- They release hormones steadily over 3-6 months
- No daily pills, no weekly injections, no messy creams
- Stable blood levels without peaks and crashes
- No risk of transferring hormones to family members (as can happen with creams)
Why Both Men AND Women Need Estrogen and Testosterone
A common misconception is that estrogen is a “female” hormone and testosterone is a “male” hormone. In reality, both sexes require both hormones for optimal health throughout life.
Estrogen protects:
- Heart and blood vessels – reduces heart attack and stroke risk
- Brain function – lowers Alzheimer’s and dementia risk
- Bones – prevents osteoporosis and fractures
- Metabolism – improves insulin sensitivity and body composition
- Mood and cognition – stabilizes neurotransmitters, supports mental clarity
- Immune regulation – helps modulate inflammatory responses
Testosterone supports:
- Energy and motivation – combats fatigue and increases drive
- Muscle mass and strength – prevents sarcopenia (age-related muscle loss)
- Metabolic health – improves insulin sensitivity, reduces abdominal fat
- Cognitive function – supports memory, focus, and processing speed
- Bone density – prevents osteoporosis in both sexes
- Libido and sexual function – essential for normal sexual health
- Mood stability – helps prevent depression and supports well-being
For Men: Testosterone is partially converted to estrogen through aromatization. When testosterone declines with age or illness, estrogen declines too, leading to vascular aging, abdominal fat accumulation, bone loss, and increased cardiovascular risk.
For Women: The sudden drop in estrogen at menopause is why cardiovascular disease, cognitive decline, and osteoporosis sharply increase in the decade following menopause.
Benefits of HRT for Long COVID Patients
Symptom Relief:
- Significant reduction in fatigue
- Improved energy and motivation
- Better cognitive clarity and focus
- Mood stabilization
- Improved sleep quality
- Enhanced libido and sexual function
- Better body composition (increased muscle, reduced fat)
Long-Term Protection:
- Reduced cardiovascular disease risk
- Lower Alzheimer’s and dementia risk
- Maintained bone density, reduced fracture risk
- Improved metabolic health and insulin sensitivity
- Better muscle mass preservation
- Enhanced overall longevity and quality of life
For Long COVID patients, optimizing sex hormones is often a critical piece of the recovery puzzle, addressing fatigue, brain fog, mood issues, and metabolic dysfunction that other treatments may not fully resolve.
Patients have reported significant improvements in energy, cognitive clarity, and overall quality of life when hormone optimization targets their specific patterns.
Want to understand what’s driving your persistent symptoms?
Personalized protocols targeting YOUR specific hormone profile can make the difference. Call (214) 390-7557 to discuss comprehensive hormone evaluation.
Thyroid Optimization: Beyond the TSH
What the Thyroid Does
Your thyroid gland produces hormones that regulate nearly every system in your body:
- Metabolism and weight
- Energy production
- Body temperature regulation
- Brain function and mood
- Hair, skin, and nail health
- Heart rate and circulation
- Digestive function
- Hormone balance
When thyroid hormones are low—or not properly converted into active forms—your entire body slows down.
Why TSH Alone Is Not Enough
1. TSH only measures what your brain thinks your thyroid is doing—not what thyroid hormones are actually doing in your cells. You can have “normal” TSH while:- T4 (inactive hormone) is low
- T4 is not converting to T3 (active hormone)
- T3 is low despite normal T4
- Reverse T3 is blocking thyroid receptors
- Thyroid hormone isn’t entering cells properly
2. The “normal range” for TSH is too broad and includes many symptomatic patients. Studies show that many patients with TSH above 2.0-2.5 already experience symptoms and respond well to treatment, yet TSH up to 4.0-5.0 is often called “normal.” 3. Illness, stress, inflammation, and certain medications can suppress or alter TSH, making it unreliable. Clinical reality shows that in Long COVID patients, chronic inflammation and stress often distort TSH levels, masking underlying thyroid dysfunction. The mismatch between what labs suggest and how patients feel is a recognizable pattern we see repeatedly.
Treatment Options
Treatment is individualized based on your specific pattern of dysfunction:
1. T4 Monotherapy (Levothyroxine/Synthroid) – Replaces inactive thyroid hormone
2. T3 Therapy (Liothyronine) – Provides active hormone directly
3. Combination T4/T3 Therapy – Provides both inactive and active hormones
4. Natural Desiccated Thyroid (NDT) – Contains T4, T3, T2, T1, and calcitonin from animal thyroid
5. Addressing Root Causes – Optimizing iron, ferritin, selenium, zinc
We work to restore thyroid function at multiple levels, not just normalize a single lab value. Many patients experience dramatic symptom relief when treatment addresses the actual dysfunction, not just the TSH number.
Ready to explore comprehensive approaches to thyroid optimization?
Connect the diagnostic dots between your symptoms and what’s really happening at the cellular level. Call (214) 390-7557.
What Our Patients Say
“I felt alive instead of barely living.” — J.D., Long COVID patient, after treatment at our clinic. J.D. had experienced over 4 years of fatigue and brain fog before seeking care.
“This is the first time in 3 years I started feeling like a human.” — I.T., who came to our clinic after 3 years of severe symptoms including excruciating pain, brain fog, and small fiber neuropathy. After treatment, neuropathy in feet, legs, and hands resolved, with approximately 80% overall improvement.
“I can breathe and I feel alive!” — Long COVID patient from Iowa, who had spent 4+ years dealing with dysautonomia, mitochondrial dysfunction, chronic fatigue, brain fog, and memory loss before seeking comprehensive treatment.
These testimonials reflect individual patient experiences with comprehensive Long COVID treatment at our clinic. Individual results vary. Treatment protocols are personalized based on each patient’s evaluation and mechanism profile.
Frequently Asked Questions
Women naturally produce testosterone (in smaller amounts than men), and it’s essential for:
– Energy and motivation
– Muscle mass maintenance
– Bone density
– Libido and sexual function
– Mood stability and well-being
– Cognitive function
Testosterone deficiency in women causes persistent fatigue, low libido, muscle weakness, mood problems, and overall lack of vitality. Replacing testosterone to physiologic levels is safe and often dramatically improves quality of life.
Response timeline varies. Here are estimates:
– Energy improvements: Often within 2-4 weeks
– Mood and sleep: 4-8 weeks
– Cognitive clarity: 4-12 weeks
– Body composition changes: 3-6 months
– Bone density improvements: 6-12 months
– Long-term health benefits: Ongoing with continued use
Some people feel significantly better within days, while others require 2-3 months for full benefit. Pellets take about 2 weeks to reach peak levels.
Many people choose to continue HRT indefinitely because:
- Benefits continue as long as treatment continues
- Hormones remain essential for health at all ages, not just during youth
- Stopping treatment typically results in return of symptoms
- Long-term use provides ongoing protection against cardiovascular disease, osteoporosis, and cognitive decline
However, treatment duration is a personal choice made in consultation with your physician. Some people try stopping after stabilization, while others recognize that ongoing hormone support is essential for sustained well-being.
Levothyroxine (Synthroid) is T4 only—the inactive form of thyroid hormone. Your body must convert T4 into T3 (the active form) for it to work. Many Long COVID patients cannot convert T4 efficiently due to:
- Chronic inflammation blocking conversion enzymes
- Elevated stress and cortisol
- Nutrient deficiencies (iron, selenium, zinc)
- Elevated Reverse T3 blocking receptors
For these patients, Synthroid may normalize TSH and T4 levels but fail to improve symptoms. Adding T3 or switching to combination therapy often provides dramatic relief.
T4 (Levothyroxine/Synthroid): The inactive form. Must be converted to T3 to be useful. Has a longer half-life and is easier to dose consistently.
T3 (Liothyronine): The active form that actually powers your metabolism. Directly usable by cells. Has a shorter half-life and requires more careful dosing.
Most people produce both T4 and T3 naturally. Replacing only T4 assumes your body can convert it effectively—which many Long COVID patients cannot.
We look at:
- Symptoms persisting despite adequate T4 replacement
- Low Free T3 levels on testing
- High Reverse T3 (blocks T3 receptors)
- Impaired T4 to T3 conversion (normal T4, low T3)
- Clinical response to a T3
Many patients experience life-changing improvement when T3 is added or combination therapy is used, even when their TSH and T4 were “normal” on T4 alone.
It depends on the cause:
- Permanent thyroid damage (such as from Hashimoto’s destroying thyroid tissue) typically requires lifelong replacement
- Functional hypothyroidism (conversion problems, inflammation-related) may improve if underlying causes are addressed
- Long COVID-related dysfunction sometimes improves as other mechanisms resolve, but many patients continue treatment long-term
We periodically reassess to determine if ongoing treatment is necessary or if you can reduce or discontinue medication.
Natural desiccated thyroid (NDT) contains T4, T3, and other thyroid hormones from animal thyroid glands. Many patients prefer NDT because:
- It more closely mimics natural thyroid hormone production
- It provides T3 without needing a separate prescription
- Some people feel better on NDT than synthetic combinations
We consider NDT as one option among several, choosing the approach most likely to optimize your specific thyroid function pattern.
Your symptoms have real answers. Understanding these mechanisms opens doors to targeted recovery strategies. For those ready to explore comprehensive approaches that address root causes, not just symptoms, call (214) 390-7557
Disclaimer: This information is for educational purposes and does not constitute medical advice. Hormone therapy and thyroid treatment carry risks and are not appropriate for all patients. Treatment decisions should be made in consultation with a qualified physician who can evaluate your individual circumstances, test results, and health history. Not all symptoms respond to hormone optimization, and other Long COVID mechanisms may require concurrent treatment. The information provided reflects current medical understanding but knowledge evolves continuously.