How Chronic Inflammation Affects Your Hormones and What That Means Before and After Surgery
A conversation with Dr. Inna Lozinskaya, MD, founder of Midlife Wellness Institute in Denver, Colorado.
Watch the full episode: https://www.youtube.com/watch?v=P1m8VZeF2j0
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Most conversations about preparing for surgery focus on the obvious checklist: get your bloodwork done, stop certain medications, arrange your recovery space. What rarely comes into that conversation is what your hormone system is doing before you ever reach the operating table.
For patients carrying chronic inflammation, the hormonal picture is often significantly disrupted before surgery begins. In a recent podcast conversation, I spoke with Dr. Inna Lozinskaya, a medical doctor with 26 years of hospital medicine experience who now specializes in integrative and functional medicine at the Midlife Wellness Institute in Denver. Her framework for understanding how the body responds to chronic inflammation offers clarity that I think is directly useful for anyone thinking about surgical readiness.
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## The Switch from Thriving to Survival
Dr. Lozinskaya describes what happens under chronic inflammation in terms that are easy to understand: the body switches from a thriving state to a survival state, and those two states are run by entirely different hormonal profiles.
In thriving mode, the body produces the hormones that support motivation, energy, repair, reproduction, and resilience. In survival mode, the body reorganizes around conserving resources, managing the immediate threat, and staying alive. The hormones that support thriving are dialed down or turned off because the body does not prioritize them in a survival context.
This is not a malfunction. It is the body doing exactly what it is designed to do. The challenge is that modern life, combined with chronic health burdens, can keep the body in survival mode for years. And the hormonal consequences of that prolonged state are cumulative.
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## Why the Thyroid Responds First
The thyroid is often the first endocrine organ to show the effects of chronic inflammation. Dr. Lozinskaya calls it the first line of defense, and the mechanism makes sense: the thyroid signals cells to burn fat and produce energy. A body trying to conserve resources will not optimize for energy expenditure. Thyroid output drops.
But the thyroid's vulnerability goes beyond that. Healthy thyroid function depends on a specific set of nutrients: iodine, selenium, zinc, iron, tyrosine, vitamin D, B vitamins, and magnesium. Chronic inflammation is often paired with gut dysfunction, and gut dysfunction compromises absorption. A patient can be supplementing for all of these and still be functionally deficient if absorption capacity is not there.
Increased intestinal permeability compounds this further. When the gut lining is compromised, compounds that do not belong in the bloodstream can enter it, trigger immune responses, and in some cases interact with thyroid tissue directly.
In my practice, I address this by converting as many supplements as possible to liquid or powder formulations for patients with known absorption challenges. The practical benefit is meaningful. For patients in preparation or recovery, this approach supports more consistent access to the nutrients the body needs to function.
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## Cortisol: Where Hormone Health Begins
Cortisol is the body's primary tool for managing sustained stress of any kind. Dr. Lozinskaya describes it as the foundational hormone, and the framing is accurate: if cortisol is dysregulated, the downstream hormonal environment cannot stabilize, even if the body is technically producing other hormones in normal amounts.
In early or acute inflammation, cortisol tends to run high as the body activates its stress response. In chronic, long-duration inflammatory states, cortisol can eventually deplete. Both states have consequences, and they require different approaches.
Testing matters here. A standard morning blood cortisol draw is useful for excluding diagnosable conditions like Addison's or Cushing's disease. It does not provide the functional picture needed for the range of cortisol imbalances most patients are actually experiencing. Dr. Lozinskaya uses saliva testing to evaluate how much cortisol is reaching peripheral tissues, combined with urine metabolite testing to assess total daily production. Those two together give a much more complete picture.
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## Sex Hormones in a Survival State
Testosterone, progesterone, and estrogen are all affected when the body is running in survival mode.
Testosterone, as Dr. Lozinskaya describes it, is the hormone of motivation, energy, and getting things done. Survival mode actively deprioritizes drive and initiative. Testosterone production drops to a floor that supports basic function, not to a level that supports feeling well.
Progesterone gets shut down early and reliably. Progesterone supports the calming neurotransmitter GABA, which is part of why low progesterone often correlates with anxiety and disrupted sleep. Dr. Lozinskaya notes she is now seeing near-absent progesterone in women in their 20s and early 30s, which was not a common presentation two decades ago.
The instinct to replace these hormones when they are low is understandable, but her clinical position, which I share, is that hormone replacement needs to land in a body with the conditions to use it. Adding hormones without addressing the inflammatory and stress burden driving the suppression is not a complete solution.
DHEA, the repair and restoration androgen, follows a similar pattern. It rises early in a stress response as the body tries to compensate. In prolonged states, it depletes as well. Low DHEA is a signal that the body has been managing a chronic stress burden long enough to exhaust its repair capacity.
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## The Role of Circadian Rhythm in Hormonal Health
Cortisol follows a natural daily cycle. It begins rising around 3 AM, peaks in the early morning to drive waking and productivity, then gradually declines through the afternoon and evening, dropping low enough by around 9 PM to allow melatonin to rise and sleep to begin.
When lifestyle disrupts that rhythm, as it commonly does, the hormonal consequences are real. The person who is exhausted in the morning and only finds energy late at night has a shifted cortisol curve. That mismatch creates its own inflammatory load because the body is operating against its designed biological pattern.
Blue light from screens suppresses melatonin and keeps cortisol production active. Evening alcohol disrupts the liver's overnight processing work, often waking people around 3 AM. Late eating keeps the digestive system active when it is designed to be at rest.
The starting point I give patients for sleep preparation is simple: stop eating 3 hours before bed, stop drinking 2 hours before bed, put screens away 1 hour before bed. Get the room dark and cool. Establish a consistent wake time and work backward. The cortisol rhythm will begin to shift with consistent practice, but it took time to get out of alignment and it takes time to recalibrate.
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## Sleep Apnea and Why It Is Often Missed
Sleep apnea is significantly associated with cognitive decline and dementia in the research literature. It is also significantly underdiagnosed, in part because many people associate it with snoring and with being overweight. Neither is a reliable indicator. Silent sleep apnea, without audible snoring, is a real clinical presentation.
I wear a CPAP. My airway is anatomically narrow from birth. I am not overweight and I do not snore in a way that would have flagged this without testing.
If you are waking unrefreshed, experiencing persistent brain fog, or struggling with concentration and memory, a sleep study is a reasonable step regardless of what you think your risk profile looks like.
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## The SHARP Framework and Hormone Optimization
At my practice, we use the SHARP Framework, which stands for Strategic Holistic Accelerated Recovery Program, to guide evaluation and preparation for patients considering surgery as well as those in recovery.
Hormonal health is not peripheral to surgical readiness. It is central to how the body handles the physical stress of a procedure and how efficiently it heals afterward. Before surgery, we assess inflammatory markers, metabolic status, cortisol patterns, and nutrient levels as they reflect absorption capacity. These factors influence anesthetic response, tissue healing, recovery timeline, and how the body manages the stress of the procedure itself.
What Dr. Lozinskaya describes in her four-step framework maps directly onto SHARP principles: test first to know where you are starting, address the gut as the foundation, regulate cortisol as the hormonal gateway, and optimize nutrition and lifestyle as the primary levers.
You can learn more about the SHARP Framework at drrobertwhitfield.com/sharp. The SHARP book is available in our store at drrobssolutions.com/products/sharp-by-dr-robert-whitfield for patients who want to understand the full framework in depth.
For patients currently in a pre-surgical or post-surgical preparation phase, our Pre and Post-Surgery Essentials collection at drrobssolutions.com/collections/pre-post-surgery-essentials includes products we use to support patients through this process.
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## Practical Starting Points
Dr. Lozinskaya's estimate is clear: 85% of outcomes come from nutrition and lifestyle. Supplements account for roughly 20 to 25% of the work, and only when the foundational conditions are in place for them to be absorbed and used.
The practical priorities she identified: sleep quality first, not as an afterthought. Nutrition built around real food with the nutrient diversity the endocrine system needs. Conscious reduction of unnecessary inflammatory inputs. Targeted supplement support built on a foundation with the absorption capacity to use it.
If you are preparing for surgery and want a thorough assessment of your hormonal and inflammatory status, or if you are navigating recovery and looking for a comprehensive framework, our team is available to help.
Schedule a consultation: https://discovery.drrobertwhitfield.com/form
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## About Dr. Inna Lozinskaya
Dr. Inna Lozinskaya is a medical doctor, international speaker, and expert in integrative and functional medicine with a focus on hormone optimization and longevity. She practiced hospital medicine for over 26 years and founded the Midlife Wellness Institute in Denver, Colorado. She sees patients in person and via telemedicine and offers free discovery calls for those evaluating fit.
Visit midlifewellnessinstitute.com to learn more or to download a free guide on hormone optimization.
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## Ready to Explore This Further?
Schedule a consultation: https://discovery.drrobertwhitfield.com/form
Explore Pre and Post-Surgery Essentials: https://drrobssolutions.com/collections/pre-post-surgery-essentials
Learn about the SHARP Framework: https://drrobertwhitfield.com/sharp
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The content in this post is for educational purposes only and does not constitute medical advice. All surgical and health decisions should be made in consultation with a qualified, board-certified physician who can evaluate your individual circumstances.