What's the difference between regular Lyme fatigue and PTLDS?

Lyme fatigue is an acute symptom of the active infection. PTLDS is defined by symptoms that persist six months or more after completing antibiotics in patients with a confirmed diagnosis. The driver shifts from the bacteria itself to how the immune and nervous systems were altered by it.

Does acupuncture treat the Lyme bacteria?

No, and we do not claim that. What the research supports is acupuncture's ability to modulate the inflammation and autonomic dysregulation driving PTLDS symptoms. In the key 2022 animal study, bacterial levels were identical in treated and untreated animals, but inflammatory damage was significantly reduced in the treated group.

How many sessions are typically needed?

Most patients notice initial changes within two to four sessions. Meaningful autonomic and immune shifts typically require eight to twelve weeks of consistent treatment, after which many patients transition to seasonal maintenance care.

Should I continue with my prescribing doctor while doing acupuncture?

Yes, always. Acupuncture for PTLDS is integrative support alongside conventional care, not a replacement for it. If your physician has referred you for dysautonomia evaluation, that workup is important and complementary to what we do here.

Time Restricted Eating and Hormonal Health: The Research for Men and Women

Feb 11

Written By Shaun Menashe

Hormonal health encompasses a complex network of signaling molecules, metabolic pathways, and organ systems that regulate energy, mood, body composition, and reproductive function. While discussions about wellness often focus on dietary composition or exercise routines, emerging research suggests that when we eat may be just as consequential as what we eat. Time restricted eating (TRE), a practice that confines daily food intake to a specific window while extending the overnight fast, has garnered significant scientific attention for its potential effects on insulin sensitivity, hormonal regulation, and metabolic efficiency. Importantly, the research reveals that men and women may respond differently to this dietary approach, with implications that vary based on metabolic status, body composition, and reproductive health goals.

This blog examines the current evidence surrounding TRE and its implications for hormonal architecture in both sexes, with attention to the distinction between TRE specifically and intermittent fasting (IF) more broadly.

Key Takeaways

Time restricted eating confines food consumption to a defined window, typically 8 to 12 hours, and differs from other intermittent fasting protocols such as alternate day fasting or the 5:2 method
Early time restricted feeding (eating earlier in the day) has demonstrated improvements in insulin sensitivity independent of weight loss
Research suggests TRE may modestly reduce testosterone in lean, active men while potentially benefiting women with hyperandrogenic conditions such as PCOS
The liver processes estrogen through multiple detoxification phases; meal timing may influence this metabolic clearance
Meal timing appears critical: consuming calories earlier in the day produces more favorable hormonal outcomes than late eating patterns
Individualized approaches considering metabolic status, body composition, and reproductive goals yield the best outcomes

Distinguishing TRE from Other Intermittent Fasting Protocols

Before examining the hormonal effects, clarifying terminology is essential. Intermittent fasting represents a broad category of dietary approaches that alternate between eating and fasting periods. Within this category, several distinct protocols exist:

Time restricted eating (TRE): Consuming all daily calories within a defined window, typically 6 to 10 hours, every day. Common patterns include 16:8 (16 hours fasting, 8 hours eating) or 14:10
Alternate day fasting (ADF): Alternating between unrestricted eating days and fasting or very low calorie days
5:2 diet: Eating normally five days per week while restricting calories to 500 to 600 on two nonconsecutive days
Extended fasting: Fasting periods lasting 24 to 72 hours or longer

These protocols produce overlapping but distinct physiological effects. Research findings from one protocol do not necessarily apply to another. Much of the foundational research on fasting and hormones comes from religious fasting practices (such as Ramadan), alternate day fasting studies, or extended fasting protocols. TRE specific research, while growing, remains more limited. This distinction matters when evaluating claims about fasting and hormonal health.

The Science of Time Restricted Eating

TRE emphasizes meal timing rather than caloric restriction. Unlike traditional dieting, TRE does not necessarily require reducing total food intake; rather, it compresses the eating period to align more closely with circadian metabolic rhythms.

Human metabolism follows a circadian pattern, with insulin sensitivity, glucose tolerance, and digestive enzyme activity peaking during daylight hours and declining as evening approaches. Research published in Cell Metabolism by Sutton et al. (2018) demonstrated that early time restricted feeding improved insulin sensitivity, beta cell responsiveness (the pancreatic cells that produce insulin), and blood pressure in men with prediabetes, even without weight loss. This finding proved significant because it established that TRE's metabolic benefits derive at least partly from meal timing itself rather than solely from caloric deficit.

A subsequent study by Jones et al. (2020) in the American Journal of Clinical Nutrition found that just two weeks of early TRE improved skeletal muscle insulin sensitivity and anabolic responsiveness in healthy young men, with enhanced glucose uptake and branched chain amino acid utilization in muscle tissue.

A randomized controlled trial published in Nature Communications by Xie et al. (2022) compared early TRE to mid day TRE in healthy volunteers and found that early TRE was more effective for improving insulin sensitivity, reinforcing the importance of when the eating window occurs, not just its duration.

Hormonal Regulation: The Kisspeptin Connection

Understanding hormonal health in both sexes requires examining the hypothalamic pituitary gonadal (HPG) axis. At the apex of this system sits kisspeptin, a neuropeptide recognized as essential for reproductive function. Kisspeptin neurons stimulate the release of gonadotropin releasing hormone (GnRH), which prompts the pituitary gland to secrete luteinizing hormone (LH) and follicle stimulating hormone (FSH). These hormones then signal the gonads to produce sex steroids: testosterone in men, and estrogen and progesterone in women.

Research in the Journal of Clinical Endocrinology and Metabolism by George et al. (2011) demonstrated that kisspeptin administration potently stimulated LH secretion and increased testosterone levels in healthy men. The relevance to nutrition lies in kisspeptin's sensitivity to metabolic signals. Animal studies show that fasting states can suppress kisspeptin expression in the hypothalamus, effectively dimming the reproductive axis when the body perceives inadequate energy availability.

Research by Kumar and Kaur (2013) in PLOS One found that intermittent fasting dietary restriction in young rats reduced hypothalamic kisspeptin expression alongside decreases in sex hormones. A primate study by Wahab et al. (2015)observed that 48 hour fasting significantly reduced hypothalamic Kiss1 mRNA expression in adult male rhesus macaques, accompanied by decreased plasma testosterone.

However, these studies examined prolonged fasting or severe caloric restriction rather than daily TRE. The specific thresholds at which meal timing affects kisspeptin signaling in humans practicing moderate TRE remain under investigation.

TRE and Men's Hormonal Health

Testosterone and Body Composition

The relationship between TRE and testosterone in men presents a nuanced picture. A study by Moro et al. (2016) in the Journal of Translational Medicine examined eight weeks of 16:8 time restricted feeding in resistance trained males. Testosterone and IGF 1 decreased significantly in the TRE group compared to controls. However, these hormonal changes did not impair muscular strength or compromise body composition; fat mass decreased while fat free mass remained stable.

A review by Cienfuegos et al. (2022) in Nutrients examined multiple trials and concluded that intermittent fasting may modulate androgenic markers, with testosterone reductions observed in both genders. Despite measurable declines, studies consistently reported no impairment in muscular development or athletic performance.

Importantly, a 12 month randomized controlled trial by Lin et al. (2024) in the European Journal of Clinical Nutrition found that testosterone and DHEA levels did not change significantly between TRE, caloric restriction, and control groups in male participants with obesity. The divergent findings may reflect population differences: lean, active men may experience more pronounced hormonal shifts compared to men with obesity, for whom metabolic improvements could offset direct effects on testosterone.

Estrogen Metabolism and Liver Function

Men produce estrogen primarily through the enzyme aromatase, which converts testosterone into estradiol. Approximately 85 percent of circulating estrogen in men results from peripheral conversion in tissues expressing aromatase, particularly adipose tissue.

Research by Ahmed et al. (2025) in the Journal of Clinical Endocrinology and Metabolism found that aromatase expression was elevated in subcutaneous adipose tissue from men with obesity. This elevated activity correlated with markers of insulin resistance. Increased body fat leads to greater aromatase activity, which converts more testosterone to estrogen, promoting further fat accumulation in a self perpetuating cycle.

The liver serves as the primary organ for estrogen metabolism and clearance through a multiphase process. Phase I metabolism converts estrogen into hydroxylated metabolites via cytochrome P450 enzymes. Phase II metabolism involves conjugation reactions (methylation, sulfation, glucuronidation) that render metabolites water soluble for excretion. Time restricted eating may support hepatic processing by allowing the liver to shift from digestive duties toward metabolic housekeeping during extended fasting periods.

TRE and Women's Hormonal Health

PCOS and Hyperandrogenism

Polycystic ovary syndrome (PCOS) affects up to 25 percent of women of reproductive age and is characterized by hyperandrogenism (elevated male hormones), insulin resistance, and menstrual irregularities. Emerging research suggests TRE may offer particular benefits for this population.

A foundational study by Li et al. (2021) published in the Journal of Translational Medicine examined 8 hour TRE in women with anovulatory PCOS over five weeks. Results demonstrated:

Significant decrease in total testosterone (p = 0.048)
Significant decrease in free androgen index (p = 0.001)
Significant increase in sex hormone binding globulin (SHBG) (p < 0.001)
73.3 percent of participants experienced improvement in menstrual cycle regularity
Reductions in fasting insulin, HOMA IR, and inflammatory markers (hsCRP)

A 2023 study published in Nutrients examined 30 women with PCOS undergoing six weeks of 8 hour TRE. Researchers observed significant reductions in total testosterone, free testosterone, DHEAS, and free androgen index, alongside increased SHBG. The percentage of patients meeting criteria for hyperandrogenism decreased significantly.

A systematic review published in 2025 in Clinical Nutrition ESPEN examined TRE and fertility outcomes in women with PCOS, finding a 9 percent reduction in testosterone levels, 26 percent reduction in free androgen index, and 33 to 40 percent of participants reporting normalized menstrual cycles.

The mechanism appears to involve insulin sensitization. In PCOS, hyperinsulinemia stimulates ovarian theca cells to overproduce androgens. By improving insulin sensitivity, TRE may reduce this androgen overproduction. Additionally, increased SHBG binds more free testosterone, effectively lowering active androgen levels.

Important Caveats for Women

Not all research supports TRE's superiority over standard approaches for women. A 2024 randomized controlled trial by Talebi et al. published in Diabetes, Obesity and Metabolism compared early TRE (with and without probiotics) to standard caloric restriction in 90 women with PCOS over eight weeks. While all groups experienced reductions in body weight, BMI, and improvements in hirsutism and acne scores, there were no statistically significant differences between TRE and caloric restriction for metabolic, menstrual, or gonadal variables.

Meal timing within the eating window also matters considerably. Research by Jakubowicz et al. found that women with PCOS who consumed more than 50 percent of their calories at dinner experienced increased estradiol levels, while those who ate the majority of calories at breakfast saw improvements in androgen markers without weight change. This suggests that for women with PCOS, early eating patterns may be preferable to late eating, regardless of the fasting window duration.

Considerations for Reproductive Age Women

Women's reproductive systems may be more sensitive to perceived energy deficits than men's. The hypothalamic pituitary ovarian axis can interpret fasting as a stressor, potentially affecting menstrual regularity in some women. This appears more likely with:

Extended fasting windows (greater than 16 hours)
Combining fasting with intense exercise
Inadequate caloric intake during eating windows
Already lean body composition

For women not dealing with PCOS or hyperandrogenic conditions, a more moderate approach (12 to 14 hour overnight fasts) may be prudent, with attention to maintaining adequate nutrition and monitoring menstrual cycle regularity.

Practical Considerations for Implementation

For Men

Starting conservatively: Beginning with a 12 hour eating window allows the body to adapt before progressing to more restricted windows
Prioritizing early eating: Consuming more calories earlier in the day aligns with circadian metabolic patterns
Maintaining adequate nutrition: TRE should not serve as justification for poor food quality; nutrient dense meals with sufficient protein support muscle maintenance and hormonal health
Monitoring individual responses: Persistent fatigue, decreased libido, or irritability may indicate the fasting window is too aggressive
Combining with resistance training: Strength training supports testosterone production and complements TRE's metabolic benefits

For Women

Consider reproductive goals: Women trying to conceive or with irregular cycles should approach TRE cautiously and consider shorter fasting windows
Prioritize morning calories: Research suggests eating earlier produces more favorable hormonal outcomes, particularly for those with PCOS
Monitor menstrual regularity: Any changes in cycle length or regularity warrant reassessment of the protocol
Avoid stacking stressors: Combining strict TRE with intense exercise and low carbohydrate eating may overtax the stress response system
Support liver function: Adequate protein intake provides amino acids for phase II conjugation; fiber promotes regular elimination of metabolized hormones

For Both

Distinguish protocols: Recognize that research on alternate day fasting or extended fasting may not apply to daily TRE
Consider metabolic status: Those with insulin resistance or excess body fat may experience different effects than lean, metabolically healthy individuals
Allow adaptation time: Hormonal systems require weeks to months to demonstrate meaningful changes
Work with practitioners: Complex hormonal conditions benefit from professional guidance and monitoring

Exploring Hormonal Balance at Golden Mean Acupuncture

Navigating the complexities of hormonal health benefits from individualized assessment rather than one size fits all protocols. At Golden Mean Acupuncture in Los Angeles, practitioners take a comprehensive view of wellness, examining not only specific symptoms but the underlying patterns that give rise to them. Whether concerns involve energy levels, menstrual regularity, body composition, or vitality, treatment plans integrate traditional therapeutic approaches with contemporary understanding of metabolism and endocrinology. Those interested in exploring how acupuncture and lifestyle modifications may support their hormonal architecture are invited to schedule a consultation.

Schedule your appointment today

FAQ

No. TRE compresses when you eat, but the quality of food still matters for hormonal health and metabolic function. A nutrient dense approach emphasizing adequate protein, healthy fats, and fiber supports the liver detoxification pathways and insulin sensitivity that make TRE effective. For guidance on building a hormonally supportive diet, see our article on the paleo diet, gut health, and hormones.
For most healthy individuals, a moderate 12 to 14 hour overnight fast is generally safe to explore independently. However, those with complex hormonal conditions such as PCOS, irregular menstrual cycles, thyroid disorders, or blood sugar dysregulation benefit from professional guidance to tailor the approach and monitor responses. Golden Mean Acupuncture offers nutritional guidance as part of a comprehensive treatment plan.
TRE is not recommended during pregnancy or lactation. These periods require consistent nutrient availability to support fetal development and milk production, and any form of fasting may compromise energy supply to both mother and baby. Women who are trying to conceive should also approach TRE cautiously and consider shorter fasting windows.