For decades, the medical field operated under the assumption that what worked for men would work for women. From clinical trials to treatment guidelines, most data was gathered using male subjects, with little consideration for how sex might influence disease presentation or therapeutic response. But research over the last two decades has made one thing increasingly clear: women’s bodies are not just smaller versions of men’s; they are biologically distinct in ways that shape how illness appears and how treatments, including herbal medicine, may take effect.
All sorts of concerns can often show up differently in women than in men; there are even instances where these issues may appear so differently that they go unrecognized or are often dismissed entirely.1 The same is true for the way herbs and nutrients work in the body. Differences in hormone levels, body fat distribution, liver enzyme activity, an individual's microbiome, and immune function may all contribute to how a woman responds to both illnesses, interventions, and yes, supplements.2 When we understand how sex and gender shape the health experience, we can better honor the complexity of women’s lives and deliver care that truly fits.
Why Sex and Gender Matter in Health and Healing
Health is not a one-size-fits-all approach. Each person’s physiology is shaped by a wide range of factors, including hormones, enzyme activity, tissue distribution, and even how their bodies absorb and respond to nutrients and herbs. Among the most consistent patterns seen in research are differences related to sex-based physiology, such as hormone levels and metabolism, which can be independent of chromosomes in certain scenarios, and can influence how someone experiences imbalance, stress, and the effects of support strategies like herbs and supplements.
For example:
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People with higher estrogen levels often show different immune patterns and inflammatory responses than those with higher testosterone.3
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Liver enzyme activity, such as CYP3A4, can vary based on hormone profiles, influencing how efficiently the body processes plant compounds and other substances.4
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Variations in fat-to-muscle ratios and water content can affect how nutrients are distributed and stored in the body.5
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Cyclical hormonal rhythm, such as monthly or life-stage hormonal shifts, hormone replacement therapies, and more, can influence how the nervous system, digestion, and energy respond to external support.6
These physiological variables help explain why the same herb might feel calming to one person and overstimulating to another or why subtle early signs of imbalance might show up differently depending on someone’s internal makeup.7 Honoring these differences is essential to delivering thoughtful, personalized care. The goal isn’t to reinforce categories, but to expand our understanding of how unique bodies respond to the tools we use to support health.
When Wellness Looks Different: Recognizing the Subtle Signs
In many cases, the earliest signs that the body is out of balance are subtle and they don’t always follow the textbook examples. For anyone with estrogen dominant physiology, those early clues can be especially different from what’s traditionally expected. These differences aren’t just personal; they reflect real patterns in how bodies respond based on hormone levels, immune function, metabolism, and other physiologic factors.
Take heart-related concerns, for instance. While chest discomfort is widely recognized as a warning sign in conventional education, people with higher estrogen levels may be more likely to report fatigue, nausea, jaw tension, or shoulder tightness as their first indication of cardiovascular strain.8 These presentations are often mistaken for stress, digestive issues, or musculoskeletal tension, delaying appropriate support.
Similarly, metabolic imbalances can also show up in unexpected ways. Instead of changes in thirst or energy, some people first notice stiffness in the joints, trouble concentrating, or mood fluctuations. Hormonal shifts can mask or mimic these signs, making it harder to pinpoint the source. This complexity extends into the immune system as well. Immune reactivity can fluctuate more significantly in individuals with cyclical hormone patterns, which means inflammation may come and go in a seemingly unpredictable way sometimes felt as fatigue, digestive shifts, or skin changes. These nuances matter when assessing overall wellness and deciding which support strategies to use.9
In the realm of emotional health, estrogen-dominant cycles often are reported as physical symptoms of stress more than emotional ones. Rather than sadness or worry, they may feel muscle tension, appetite changes, or disrupted sleep signs that are easy to overlook if the focus is only on mental health “checklists.” When we understand that balance can look different in different bodies, we open the door to earlier recognition, better communication, and more personalized support.
How Herbs May Act Differently in Women
Herbal medicine has long emphasized the individuality of the person over the symptom alone. But in modern clinical research, we now have increasing evidence that sex related physiology, including hormone balance, liver metabolism, and body composition can directly influence how herbs work in the body. This doesn’t mean herbs are less effective for women; it means that herbs may need to be selected or dosed with greater care depending on the person’s internal landscape.
Metabolism and Enzyme Activity
One of the most studied areas of difference lies in the liver. The enzyme CYP3A4, which helps metabolize many herbal constituents, tends to be more active in women than in men. This means that compounds like those found in St. John’s wort, milk thistle, and ginkgo may be processed faster or differently in female-bodied individuals. As a result, the timing and effect of these herbs can vary, sometimes requiring adjustments to dosing frequency or combination strategies.
In addition, higher body fat percentages and lower total body water, common differences in female physiology, can affect how lipophilic (fat-soluble) herbs are absorbed and stored. Herbs with essential oils or fatty extracts, like turmeric or rosemary, may act differently depending on a person’s tissue distribution. It should be mentioned that these concepts are woefully understudied, like much of the nuances of medicine for women.
Hormonal Interactions and Life Stages
Some herbs contain plant-based compounds known as phytoestrogens or hormone-modulating constituents. For example:
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Shatavari is traditionally used to support hormonal balance and vitality, particularly during transitions like menopause.
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Black cohosh may offer support for temperature regulation and mood changes, especially in the context of estrogen fluctuations.
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Licorice root, though often used for energy and respiratory support, can also influence cortisol metabolism and may subtly shift hormonal balance if used long-term.
While these herbs can offer powerful support, their effects may vary depending on a person’s life stage such as menstruation, pregnancy, postpartum, or menopause. They may also interact with existing hormonal patterns or sensitivities, making it especially important to choose herbs thoughtfully.
Sensitivity and Symptom Expression
Finally, many women report greater sensitivity to herbal supplements than their male counterparts, especially in areas like mood, sleep, digestion, and temperature regulation. While this sensitivity is sometimes labeled as "overreactivity," it can actually be a sign of finely tuned nervous and endocrine systems. Rather than being a drawback, it often means that women may respond well to lower doses or gentler formulas, an approach that aligns with the general principles of herbal medicine such as using the smallest effective dose.
Why It Matters
Understanding that our bodies don’t all work the same way is a foundation for better self-care and supplement applications. Whether working with a healthcare provider, exploring natural wellness on your own, or simply trying to tune in more closely to how you feel, knowing that biology and hormonal rhythms shape your experience can be deeply empowering. Many people living with estrogen-based hormonal cycles are taught to dismiss or push through symptoms. Tiredness, discomfort, bloating, or mood changes are often brushed off as “normal” or “just part of life.” But these signs may actually be the body’s way of asking for support and understanding the patterns behind them can help you respond more effectively.
This also means that when exploring herbs, supplements, or other wellness tools, it’s helpful to:
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Start with awareness: Keep a journal or mental note of how your body feels across the month or in different life stages. Do certain herbs feel more helpful at some times than others?
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Go low and slow: Especially for people with sensitive systems or hormone fluctuations, starting with a lower dose of any new herb is often a wise strategy.
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Choose based on your body, not just the symptom: One herb might help with stress for someone who feels “wired and tired,” while a different one might be better for someone who feels flat and drained. A thoughtful match matters.
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Listen inward, not just outward: Online lists and generic advice can be helpful starting points, but your experience is the most important guide.
The more we understand how physiology and hormonal rhythms shape our experience, the more confidently we can navigate our health journeys. It’s not about labeling things as male or female necessarily, it's about honoring the real, biological diversity that exists in human bodies. When we stop expecting health to look the same for everyone, we open the door to care that is not only more inclusive but far more effective.
References
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Maserejian, N. N., Link, C. L., Lutfey, K. L., Marceau, L. D., & McKinlay, J. B. (2009). Disparities in physicians' interpretations of heart disease symptoms by patient gender: results of a video vignette factorial experiment. Journal of women's health (2002), 18(10), 1661–1667.
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Stjernberg, L., Berglund, J., & Halling, A. (2006). Age and gender effect on the use of herbal medicine products and food supplements among the elderly. Scandinavian journal of primary health care, 24(1), 50–55.
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Harding, A. T., & Heaton, N. S. (2022). The Impact of Estrogens and Their Receptors on Immunity and Inflammation during Infection. Cancers, 14(4), 909.
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Klyushova, L. S., Perepechaeva, M. L., & Grishanova, A. Y. (2022). The Role of CYP3A in Health and Disease. Biomedicines, 10(11), 2686.
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Forbes G. B. (2000). Body fat content influences the body composition response to nutrition and exercise. Annals of the New York Academy of Sciences, 904, 359–365.
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Cameron JL. Hormonal Mediation of Physiological and Behavioral Processes That Influence Fertility. In: National Research Council (US) Panel for the Workshop on the Biodemography of Fertility and Family Behavior; Wachter KW, Bulatao RA, editors. Offspring: Human Fertility Behavior in Biodemographic Perspective. Washington (DC): National Academies Press (US); 2003. 5.
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Shankar, S., Kumar, D., & Srivastava, R. K. (2013). Epigenetic modifications by dietary phytochemicals: implications for personalized nutrition. Pharmacology & therapeutics, 138(1), 1–17.
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Shankar, S., Kumar, D., & Srivastava, R. K. (2013). Epigenetic modifications by dietary phytochemicals: implications for personalized nutrition. Pharmacology & therapeutics, 138(1), 1–17.
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van Lunzen, J., & Altfeld, M. (2014). Sex differences in infectious diseases-common but neglected. The Journal of infectious diseases, 209 Suppl 3, S79–S80.