How hormones impact our daily lives with Dr. Trevor Cates

Women's health expert Dr. Trevor Cates on hormones, health, and why we don't have to suffer.


Article highlights

  • Hormonal imbalances like thyroid dysfunction, adrenal issues, and sex hormone disruptions are extremely common but overlooked causes of health problems in women and men.
  • Birth control pills are overprescribed as band-aid solutions for issues like acne and can worsen hormonal dysfunction instead of treating root causes.
  • Supporting metabolic health through nutrition, movement, stress management, and skin care tailored to one's needs and seasons can help restore hormonal balance.
  • Skin reflects inner health, so clean skin care without hormone-disrupting ingredients combined with internal nourishment gives the best results.
  • People must advocate for themselves, get proper testing, and find healthcare providers who address root causes, not just suppress symptoms, to achieve true hormonal health.

Dr. Lauren Kelly-Chew: Dr. Trevor Cates is a nationally-recognized naturopathic doctor, and was the first woman licensed as such in California. Her focus includes women’s health, skin, and hormones. She’s the founder of The Spa Dr. skin care line and the author of the bestselling book, Clean Skin From Within. She has a new book, Natural Beauty Reset coming out in September. She’s also host of the docuseries, “Hormones, Health & Harmony,” as well as “The Woman’s Doctor” podcast and the PBS show, “Younger Skin From Within.” Dr. Cates’ goal is to inspire and empower women to harmonize their hormones and open their eyes to their natural beauty. 

Hormones and Full-body Health

Dr. Lauren Kelly-Chew: How did you get interested in hormonal health, and what has been your personal journey to the work you’re doing now?

Dr. Trevor Cates: My health journey started with skin issues. My skin has always been like my Achilles’ heel. I also realized that my skin was a good barometer of everything else going on in my life. As a child I had a lot of skin struggles, which I got on top of thanks to natural medicine and integrative medicine. But when I was around 20, I went on birth control, and after I started taking it—I’m not sure if it was a few days or a week, and I didn’t know the correlation at first—my entire face broke out in bumps and I looked like I had chicken pox or something just completely covering my face.

I was traveling, and went to see a different doctor than I normally would have. At first, they weren’t really sure what was wrong with me. But then we started to realize it was a reaction to these birth control pills and it was actually acne. It was worse than I’d ever experienced before, so I immediately went off the pills. That’s when I started to realize, “Okay, this is interesting, this connection here.”

Then again, I guess I didn’t quite figure it out, because when I was 30, I went in to see my gynecologist at the time and said, “I think I’m putting on weight because of the hormonal birth control I’m on.”

She looked at me and said, “Well, you’re 30 now, so that means that you’re not going to be able to lose weight like you could when you were in your 20s, so it’s okay. You’re just getting older.” 

I thought, “No, there’s no way. 30 is still young.” So I went off the hormonal birth control, and that’s when I really started to make this connection. I was already a naturopathic doctor at the time, but I started to realize how often hormones play a role in our health. When we go on hormonal birth control, it’s just one of the times that we can definitely see a huge change in our health, but hormones are impacting our health on a day-to-day basis throughout our lives. As women in particular, we have some interesting complexities.

Dr. Lauren Kelly-Chew: Absolutely. Thank you for sharing that story. The birth control piece really stands out to me because I was first put on birth control when I was 19. There wasn’t really much thought that went into it. Sadly, I don’t think there has been that dramatic a change in the conversation around birth control. It’s starting to happen, and I’m so thankful for people like you who are bringing these topics into common conversation and making them something that is not only open, but filled with research and as much evidence for understanding our bodies from that perspective as there has been for other aspects of health.

Unfortunately, there hasn’t been nearly enough research on women’s health in general, but starting to have hormones and things like birth control come into the picture more is so helpful. You’ve noted that over 80% of women and 35% of men are dealing with hormonal issues, but the vast majority don’t know it. What are some of the signs that someone is dealing with an imbalance?

Dr. Trevor Cates: I really think that pretty much everyone struggles with hormonal issues at some point in their life, especially women. We have to remember that hormones rule our health in so many different ways. It’s not just sex hormones like estrogen, progesterone, and testosterone, but we have hormones, like thyroid hormone, that help us with metabolism. We have hormones, like adrenal hormones and cortisol, that help us with stress. We have hormones, like melatonin, that help us with sleep. We have hormones that help us with our appetite: leptin, and ghrelin. We have hormones that help us with our blood sugar balance: insulin. 

I really think that pretty much everyone struggles with hormonal issues at some point in their life, especially women. We have to remember that hormones rule our health in so many different ways.

We can have all kinds of issues related to hormonal imbalances. Some of the ones I most commonly see in women are fatigue, weight gain, period problems, and then for women going through menopause, hot flashes and night sweats and things like that. Infertility is another big one. These are some of the common ones I see, but really, so many of our health issues can go back to core hormones.

Levels Member Experience:

Finding a New Normal

Dr. Lauren Kelly-Chew: My guess is that before people take that step to see you, they’ve thought that being tired is just normal, or that everyone feels tired. Or, like you said, they’ve gotten to a certain age, and they’ve always been told that that means their metabolism slows and everything changes and it’s just inevitable. What is the trigger point that brings someone out of that mode of thinking and into saying, “Actually, I really do think something is going on here that’s not normal for my body”?

Dr. Trevor Cates: It’s a really, really good point. Sometimes, when people see other people their age or older thriving, they start to think, “Wait a minute, why does that person have so much energy? They’re my age or they’re older or they’re super fit and they’re not having any issues.” As women, we talk to each other. We talk to our girlfriends. We talk to our moms or sisters and we start to realize, “Oh wait, maybe what I’m experiencing isn’t totally not normal, or maybe it’s normal but not optimal.”

A lot of times, with conventional medicine, as long as you don’t have a disease, you’re viewed as fine. But we don’t want to be just fine. We want to be free of symptoms and we want to be embracing life, especially as we get older in our 40s, 50s, 60s, 70s, 80s. My mom is 82 and she’s such a great role model because she’s out riding her horse almost every day, riding through streams and over fences. She’s in her art studio. I just keep thinking, “Okay, this is what’s possible.”

Dr. Lauren Kelly-Chew: It’s such good inspiration. I would think that being in the field of hormonal health brings up a lot of questions and concerns people might feel a little bit embarrassed to talk about. You’ve been seeing patients for over 20 years. Are there common themes in what new patients confide in you that you might be able to share, just as a way of normalizing these shared experiences?

Dr. Trevor Cates: Absolutely. I am often told, “Oh, I bet I’m the worst case you’ve ever seen,” or, “I bet you’ve never experienced anything quite this bad before.” When you talk to your doctor, remember, doctors have heard just about everything, especially if they’ve been in practice a long time. Don’t be afraid to share things with your doctor.

There are certainly things we are sometimes afraid to talk about. Or we think, “I shouldn’t be a complainer.” As women, we feel we just need to suck it up because it’s just period problems, pain, PMS—it’s just part of being a woman. Believe me, that’s not the case. There are plenty of people out there who do not have period pain, who do not have PMS. You do not have to suffer through these things just because they’re common.

That’s one thing that’s really important: you don’t have to suffer. If you’re having symptoms, it’s a sign that something’s out of balance. Your body’s just yelling at you saying, “Hey, pay attention to me.” You don’t have to just put up with it. 

You do not have to suffer through these things just because they’re common. If you’re having symptoms, it’s a sign that something’s out of balance. Your body’s just yelling at you saying, “Hey, pay attention to me.”

Don’t be embarrassed by your body. Your body is wise. It’s amazing. If you’re having problems—maybe urinary incontinence problems or you’re having difficulty with your sex drive or you have concerns about what’s going on—it’s important to talk to your doctor about these things, because there are solutions. If you talk to your doctor and they give you that excuse like mine did and say, “Oh, well, that’s just normal because you’re getting older,” or, “That’s just normal because you’re a woman,” then it might be time to find a new doctor.

Dr. Lauren Kelly-Chew: One thing I love about the podcast you host is that you bring on a lot of physicians, especially female physicians, who have very open conversations about many of these topics. I was listening to one of your recent episodes, which touched on aspects of sex education and women understanding their own anatomy and bodies. As I was listening to it, I realized, even having gone through medical school and working in healthcare for my career, how it’s still surprising when you hear those conversations in a public forum. I think it is so powerful. 

I appreciate that and I appreciate what you said about not needing to suffer. People often think that what they’ve experienced for the majority of their lives is their normal. They’re actually probably shocked when they find out what their new normal is when some of that suffering is taken away.

Dr. Trevor Cates: Absolutely. So many women who have come in to see me, or whom I’ve interviewed for my “Hormones, Health & Harmony” docuseries or podcast, come out on the other side of that and realize, “Wow, I went through all these years of struggling when I really didn’t need to. I wish I had found this out earlier.” 

A lot of the doctors I’ve interviewed, including gynecologists, have been doctors who take more of a conventional approach and prescribe a lot of birth control pills for period problems or for perimenopausal symptoms—not really for birth control, but for other symptoms—without realizing the harmful effects of that.

Then later on, when they have their own health struggles, they start to realize, “Wait a minute, I don’t want this option. I don’t want all these side effects. I want to look for other solutions.” When you look at the underlying cause and things like nutritional deficiencies, gut microbiome issues, inflammation, oxidative damage, or blood sugar issues, to name a few, and you address these, then you can help a person’s health. Hormones are a part of that. Skin is a part of that. And skin is another big focus of mine, but you can help people just feel more vibrant and healthy.

I want people to realize that, if you are struggling, there are answers. Don’t stop looking. Don’t settle. It’s important. If the doctors I’d interviewed had given up, they wouldn’t be helping as many people as they are now. Just keep looking for solutions. Watch the docuseries. Listen to my podcast. There are functional medicine doctors, naturopathic physicians, and similar doctors who can really help with specialty lab testing. They can help look at hormonal imbalances and some of these other root causes, and can help address the underlying cause.

Dr. Cates’ Pillars of Change

Dr. Lauren Kelly-Chew: Speaking of solutions and getting to the root causes of these things, when people work with you, whether it’s through your books or in person, you use several key pillars: food, movement, mindset, skin care. Would you mind walking us through each of those and maybe highlighting areas that are hardest for people to change, or where there’s the most resistance, and how you navigate that?

Dr. Trevor Cates: In my new book, Natural Beauty Reset, I go through these four pillars for each season, because it’s so important for us to get back in rhythm. As women in particular, we have these rhythms in our body. We have our menstrual cycles, daily cortisol cycles, sleep cycles, circadian rhythm—all of these things. 

We also have seasons. And a lot of times, we get out of sync with that. Resetting with each season is a great opportunity to get back in sync. Doing those with food, movement, mindset, and skin care is a great way to do that, because our needs change. 

With food, a lot of times we get stuck in a rut of eating the same thing over and over again. For some people, they’re unhealthy choices. Maybe there’s a lot of processed food—maybe it’s fast food, maybe it’s sodas. Or for some people, it’s eating superfoods every day.

But they’re eating the same foods and they’re missing out on an opportunity to mix it up. When we eat foods in season, we have a chance to get more nutrient-dense foods. They’re also more flavorful and can help support our gut health even more. When we eat a variety of produce, it can help the biodiversity of our gut microbiome. That can help with our hormones, our skin, our gut health, and our brain health—so many different things. 

Movement and mindset are also important because so many of us are stressed. Stress is a normal response. Our bodies are adept and quite capable of dealing with stress, but we have to give ourselves a break. We can’t just keep stressing ourselves out because then the hormones, glands, and neurochemistry that help us respond to stress don’t work as well. 

We need to think about how we can move our bodies and incorporate mindset practices that really help with managing stress. We need to make sure we get a good night’s sleep, while also realizing that there are different times and seasons when you might not sleep as well, or when you might be more sensitive to stress. In the winter months, our cortisol levels tend to be higher and our feel-good neurotransmitters like serotonin and dopamine tend to be on the lower side. We could do things to get ourselves going and to shift out of those patterns.

We also go through changes with skin care. Part of it has to do with the sun. We’re outside more in the summer, and that might cause some damage. We need to make sure we’re protecting our skin, first of all, and then reversing any oxidative damage that may be happening in our skin. There might be times when our skin tends to be more dry. We might need more hydration with some really nice plant-based oils in our skin care, or we also might need some exfoliation. Our needs really change with the seasons. But when we get back in track, and when we give our body the right foundation, it can really align. Our bodies are so incredibly wise, and we often forget that. We’ve been told that we have to tell our bodies what to do—we have to take medications to suppress symptoms and ignore things. But really, when we’re given the right environment and the right tools, it’s amazing how our bodies can heal.

Dr. Lauren Kelly-Chew: I completely agree. If someone is struggling with hormonal issues and they want to start to make a change, is this something where it is best to make progress on all of those pillars at the same time? What is the impact of doing it on a sequential basis rather than tackling everything all at once?

Our bodies are so incredibly wise, and we often forget that. When we’re given the right environment and the right tools, it’s amazing how our bodies can heal.

Dr. Trevor Cates: Of course, it’s better than not doing anything at all. To make some movement in the right direction is good. Ideally, you want to do at least a little bit with each, and it doesn’t have to be time consuming. For example, the next time you go to the grocery store or shop online for groceries, try and just pick a couple of foods—a couple of different types of produce—that maybe you’ve never tried before, and that are in season. Maybe add those to a smoothie or salad, or sauté them. Try something new. 

Then, just getting out and going for a walk is an easy way to move. Or park your car farther away, so you have to walk a little bit more.Then take some time to take three deep, cleansing breaths. And use a natural skin care cleanser. Those are just simple things that you could do that actually can make a big difference. 

On the Importance of Clean Skin Care

Dr. Trevor Cates: When it comes to personal skin care products, we are often exposed to a group of chemicals known as endocrine-disrupting chemicals. These endocrine-disrupting chemicals, or hormone-disrupting chemicals, have been associated with a lot of different health issues from infertility, thyroid disease, obesity, breast cancer—all kinds of different hormonal issues. It’s really important for us to reduce our total exposure to these chemicals.

Choose things with organic essential oils instead of synthetic fragrances, or that are fragrance-free. Choosing a mineral sunscreen with zinc oxide instead of a chemical sunscreen with oxybenzone. Some of these things are pretty simple. Also, there are easy ways, if you want to, to do DIY skin care. That’s one of the things that I love. I included some of those recipes in my first book, Clean Skin From Within. Then, of course, the foods we eat are also going to impact our skin, so I also had to include recipes for food as well.

Dr. Lauren Kelly-Chew: I’m going to have to try some of the DIY skin care because years ago I started using the Environmental Working Group’s database, on They actually have several databases, but their oldest one I believe is the cosmetics database, Skin Deep®, where you can look up many of the products that are out there. It’ll give you a breakdown of the ingredients. I can’t speak to exactly how credible that is, but I know it’s a popular resource.

I learned that simple is really likely to be better. If you know exactly what’s going in it, you’re much more likely to come up with something that is cleaner. Yet, the vast majority of products have so much in them. Sometimes I get exhausted trying to figure out what’s what. Other than the DIY stuff, do you have shortcuts for using clean products, but not going so crazy on it that it’s paralyzing?

Dr. Trevor Cates: I appreciate that you mentioned and their Skin Deep® database. They have products that are EWG-verified. My skin care line, the Spa Dr. Skin Care, is verified by EWG. They have rigorous criteria that you have to meet, and they have to submit things to prove that your products are truly clean and free from all the toxic ingredients. Using resources like that can be really helpful. 

I have a list of ingredients to avoid in both of my books. You can start with a handful of ingredients. It’s interesting that when we get ready to put something in our mouth, we might hesitate and say, “Is this going to be good for me?” Yet when we put stuff on our skin, we don’t have that same level of criteria. Maybe just start with that: Say, “Okay, would I put this in my mouth? Probably not. Then maybe I should turn it over and look at what the ingredients are.” 

You can put things like honey and oats and yogurt on your face in DIY skin care, and you would put those in your mouth as well. Certainly, skin care products are not made to be consumed. Even my own skin care products are not made to be consumed. But if you can’t put something in your mouth, you might want to think about why, and start to learn a little bit.

There are also some simple things to think about. When we talk about seasons and things to do, a change of seasons can be a good time to evaluate what’s in your bathroom or your makeup drawer. What’s in your purse? How long have you had these products? They do have an expiration date. A lot of women buy products and keep using them for years and years. It might be time to do an overhaul. Bring a garbage bag in and start cleaning some of these out. Also clean out your makeup brushes. We want to do that on a regular basis to make sure we’re taking good care of our skin.

Dr. Lauren Kelly-Chew: It’s such great guidance. I really appreciate your sharing about the EWG, because I have used that as my primary reference for these things for many years. It’s good to have someone who’s been behind the scenes on how the verification process works confirm its rigorous process. 

It’s worth checking out, even if you don’t use cosmetics. They have a sunscreen database, one that can help you understand pesticides on your food—all sorts of other databases. It’s such a great resource. 

Mindset, Change, and Being Your Own Advocate

Dr. Lauren Kelly-Chew: If someone is at the beginning of their journey with hormonal issues and they’re starting to make these changes, how long does it typically take to start seeing results?

Dr. Trevor Cates: It really depends on what their issues are and how long they’ve had them. If someone’s had them for a really long time and they’ve been struggling—they’ve tried a lot of different things already—sometimes it can be a little bit of a longer journey. But the earlier you start to notice symptoms and you go in and you start to get help, the easier it often can be. 

It also depends on how dedicated you are to making changes, because if you see your doctor and they say, “Your thyroid is not low yet, but it’s on its way to being low,” that’s when it’s a good time to start being proactive.

If you do have some of the signs and symptoms, for example, of low thyroid—fatigue, constipation, weight gain, hair loss—these can be really debilitating symptoms for women. It’s important to get on top of that right away. Get tested; find out where your levels are; get treatment, which could be a combination of diet and supplements and maybe medication as well. 

I like to see my patients back in three weeks. If after three weeks we haven’t seen at least some progress, then we need to reevaluate. We need to look at what else might be going on. Maybe we’re going after the wrong root cause; maybe we need to go after something else first, so I might order more testing. Maybe I’ll look at gut microbiome testing or nutritional deficiencies or something like that to see what’s going on. 

Certainly, if someone’s getting worse, we may need to do more. But to really get a full recovery, it depends on the severity. I’ve seen women get better within a few weeks. I’ve seen people fully recover in six months. But for some people, it takes over a year to really get things back on track.

Dr. Lauren Kelly-Chew: I would think that because hormonal issues are so often linked to things that are visible, they can be very impactful on the way you feel about yourself—not that they should be, but I think they often are. For example, if you’re having a lot of acne, for a lot of people, that creates stress. I’ve had friends who have said that they don’t even want to enter social settings because that acne has really gotten to their sense of how they want to present themselves to the world. As you’re guiding people through this journey to hormonal health, how do you approach the psychology of it, this other side that I think is so often missed in conventional medicine?

Dr. Trevor Cates: Absolutely. One of the reasons I call my second book Natural Beauty Reset is that we are all already beautiful. We’re beautiful, but sometimes when we get things like acne, we see ourselves through a different lens, and when we look in the mirror, we don’t see our true beauty. It’s really about helping people get back to their natural beauty, or recognize their true beauty. 

Things like acne can show up, but we have to remember those are signs that something’s out of balance. We just need to address those root causes, and you’ll get back to seeing your skin the way it used to be. You might just be in this transition period. But I try to help patients realize that their natural beauty really comes from within—that it’s still there.

I’ve had so many patients with skin they were so embarrassed by. And this is where I started as a kid. I had hives and rashes and eczema and things that would show up—I was so embarrassed by my skin. When you’re in it, it’s hard to ever imagine that you’ll be out of it. But it’s important to know that there is a way to come out on the other side of it and that conventional medicines can sometimes help suppress symptoms for a period of time, but that they’re not necessarily going to really get your health back to where you want. Especially with something like acne, just going on birth control pills is probably not going to be your best option. There are other things to help address the root causes.

Of course, birth control pills are meant for birth control. They weren’t really designed for acne; they’re just now being used for it. There are so many other things we can do to get our health back on track. Acne is the most common skin issue in the United States. The thing we have to remember, though, is that acne actually doesn’t exist in certain parts of the world. If you’ve traveled internationally, you’ll notice that in some parts of the world, it’s very rare that you will see people with acne. That makes me think that a lot of this has to do with our lifestyle. If we can change our lifestyle, we can often reverse acne.

Dr. Lauren Kelly-Chew: If someone goes to their primary care physician or gynecologist and tries to share with their provider that they think there’s something going on, the provider might disagree or they might say, “Yes, there’s something going on and the fix is this medicine.”

What is your guidance for people in that situation? Ideally everyone would have access to working with you, but practically speaking, what is the next step for someone who’s just hit that wall with the conventional system?

Dr. Trevor Cates: Gone are the days when we look to our doctor for everything. Our doctors provide a lot of information, but we need to take control of our own health—realize that you are the CEO of your own health. That’s why I want to help educate consumers, especially women, to be the CEO of their health and, oftentimes, of their family’s health. Women are typically the decision makers when it comes to healthcare and health consumer products and those sorts of things. My goal is to really help women become informed decision makers so that they can make these decisions for themselves and their family.

Our doctors provide a lot of information, but we need to take control of our own health—realize that you are the CEO of your own health.

A doctor may say, “With thyroid panels, I really only run TSH.” But this person is educated and thinks they might have a thyroid problem and says, “But can you also add free T3, free T4, and thyroid antibodies? I’ve heard that’s really important and can give additional information.” A good doctor’s going to say, “Oh sure. If you’re okay, you might have to pay out of pocket for those; your insurance might not cover it. But sure, let’s add that and see what comes up.” 

Then ask your doctor, “Hey, can I get a copy of my labs?” They’ll probably tell you, “Oh yeah, you have access to them in your online portal,” and tell you where to go to get that. If people just understand a little bit, they can actually work with their doctor. The problem with conventional doctors is, these days, if they take insurance, they probably don’t have a lot of time to spend with you. If you come in ready and prepared for your appointment, it’s going to make it easier for your doctor, too.

Birth Control as a Band-Aid

Dr. Lauren Kelly-Chew: Let’s loop back to birth control. Given your clinical focus on hormone imbalance—and you’ve mentioned some context within which birth control really isn’t the best solution—what are the trade-offs, knowing that it is still very commonly prescribed, often to very young women who are on it for years? Is it possible to achieve hormonal health while you’re on the pill, or is that not really a pathway toward hormonal health?

Dr. Trevor Cates: First of all, if you’re using birth control pills for birth control, then yes—you and your doctor determined that this is the best form of birth control for you. You can sort out ways to address some of the issues that might come up, such as certain nutrient deficiencies like B12 deficiency, for example. You may start taking some supplements to support your nutrient levels. 

Birth control pills can also create gut microbiome imbalances, so make sure that you’re taking probiotics and getting plenty of fiber in your diet. It could also suppress testosterone levels and create imbalances in other hormones. Just be aware of your body; and if  you’re already on birth control pills for birth control and you’re not having symptoms, you’re probably going to be okay if you just add some additional support.

Now, it’s not my favorite form of birth control. Hormone-free versions like IUDs or barrier methods or things like that—those are my preferred birth control for most women. But I realize that there’s a certain level of convenience. And for some people, those other methods don’t work. 

If you’re given birth control pills to manage symptoms or to, “balance your hormones,” that’s really not going to be, from my perspective, the best way to address things a lot of women are put on birth control pills for, like acne, irregular periods, PCOS, or perimenopausal symptoms. There are other things you can do so that you don’t have to worry about those side effects, but you can instead look at what’s going on behind it.

In my practice, I see women who have been on birth control pills and are now wanting to come off. They were put on it for acne, or for these other things, and now they want to go off and all their symptoms come back. Then they have to deal with all of the adverse reactions or the problems that have come up from taking the birth control pill. It doesn’t address the underlying problem. 

The sooner you find a better alternative and find the root cause the better, because if you go off and you’re trying to get pregnant, it might be harder, or whatever symptoms you’re trying to address might just come right back when you’re ready to go off them. A lot of it depends on the person’s scenario.

Dr. Lauren Kelly-Chew: That makes sense and it definitely resonates with me, because I was on birth control for years. When I came off it, it was really, really challenging. It almost felt like my entire body was changing and I was almost becoming a different woman that I hadn’t gotten to know yet because of all those years of birth control. 

That experience has been mirrored in many of my friends’. It’s actually so well known how difficult it can be to come off of it that I have many friends who say, “I like the idea of coming off of it. That’s important to me in theory, but I just can’t imagine going through this phase in my life where everything feels out of whack.” 

As you’re coaching women who are on the fence about coming off birth control, how do you help women navigate that transition?

Dr. Trevor Cates: It depends on what their symptoms are. I mentioned some of the things—acne, PCOS, period problems. It really depends on what you were put on it for. You want to look at some of the hormonal imbalances that you could address naturally. You can start addressing those even before you go off the birth control pill. 

For example, if you tended toward an androgen excess, where you had acne for example, or PCOS, and you’ve got problems with that, you might start looking at what you can start doing before you even go off birth control pills. Is your fiber intake is adequate? Is your blood sugar balance is where it should be? 

There are herbs like saw palmetto that might be helpful. If you tend to be more estrogen-dominant, that is something that you might want to consider. People think, “Well, how do I know if I have low estrogen or low thyroid or low progesterone or high progesterone or whatever it is?” I have a hormone quiz that people might be interested in.

If you do the quiz and it says, “You may have low thyroid,” still go and see your doctor and see if you can get some testing to look for that. But this can help women understand where they are and start addressing that. But really, until you go off the birth control pill, you’re not going to fully be able to address it, because that’s just suppressing your testosterone. But as soon as you go off, whatever root issues were there are going to come right back because it’s not addressing them.

Being the Solution: Why Dr. Cates Created a Clean Skin Care Line

Dr. Lauren Kelly-Chew: You’re the creator of a skin care line. Some people view skin care products as icing on the cake, but they’re not really that impactful, whereas other people think that a good skin care product can make all the difference in the world when it comes to skin health. 

What inspired you to do that? How do you think about products, specifically skin care products meant to work from the outside in, and what role do these play when you’re also working from the inside out?

Dr. Trevor Cates: I’m 49 now. When I turned 40, I remember thinking, “I wonder if I should start using more skin care products.” I was really more focused on the inside-out approach. I thought, “Oh, healthy skin only comes from within.” I started to look at it for myself. 

At the same time, some of my patients were saying, “Dr. Cates, I know you told me not to have these endocrine-disrupting chemicals in my skin care products, but I can’t find one that actually works. I can’t find one with results I like.” I started to look at some of the research and learn more about the skin microbiome. More and more research has come out over the last decade about the skin microbiome and these microorganisms that live on our skin and actually protect our skin.

When our skin is in this really nice, balanced place, it can help prevent breakout blemishes and premature aging. One of the things that really impacts that is the pH of products. Our skin is naturally mildly acidic, but a lot of the skin care products out there have a high pH, especially cleansers and lotions. A high pH disrupts our natural pH. 

When I was looking for skin care products to recommend to my patients, I was looking for something truly clean and natural, rather than something with a marketing claim. The word “natural,” unfortunately, doesn’t need to have any backings. There are no FDA regulations around it. The word “hypoallergenic” actually means nothing—it’s just marketing. I wanted to create something that was truly clean and natural, and that also had a mild acidity that the research was showing was important for the skin microbiome.

I also wanted to make sure products included the right amounts of all of these active ingredients I was finding research on, instead of just having a teeny little amount with a bunch of other toxic ingredients. I wanted to make they were packed with natural actives. That’s what led me to create The Spa Dr.® skin care line. I thought it would be great, but I truly didn’t realize how much it was going to change my patients’ and customers’ lives. The results that people see on their skin are truly beautiful, because one of the biggest things we hear from people using the products is that they don’t like to wear makeup anymore. If you choose to wear makeup, of course, it’s up to you.

But a lot of women will say, “I just feel like I don’t have anything to hide anymore. I don’t have to cover blemishes or uneven skin tone.” That’s a really great thing to hear. Often, we either think that we don’t have to worry about our skin care products, as we’re taking care of it all from the inside out, or, like you said, all you have to do is use skin care products and you expect a miracle. But really, it’s a combination.

Most of the health of our skin, I believe, comes from the inside out—our food habits and our exposure to toxins and how we’re treating our bodies—but also, what we put on our skin is really important. That’s what I learned at 40, when I was doing this research, and over the last nine years of creating the products and getting results, getting feedback from our customers. When you do the two together, that’s really the magical combination.

Dr. Lauren Kelly-Chew: Definitely. I’m going to have to try your skin care line, because the philosophy you’re describing makes so much sense to me. I especially appreciate your call-out of the fact that products will often advertise great ingredients, but they’re present in a minuscule amount. It’s barely even there, and even if it is there, sometimes they’re not even active anymore—they’ve moved past the time when they’re even bioactive. You’re paying a lot for branding, essentially, or you think you’re putting something on your face, and unless you can see actual results, it’s just on the good faith of the marketing promises.

This is why databases like EWG are really helpful. At least you’re not harming yourself by what you’re doing. As to whether or not that product is actually effective, that’s much harder to find. I appreciate that you have an eye on all of these things together, and are doing it in such a way that builds credibility and trust with patients. You can’t give them something that isn’t going to actually help, because you have a shared responsibility to each other, and it’s an ongoing relationship. 

Is there anything we haven’t talked about that you want to make sure we touch on?

Dr. Trevor Cates: We’ve covered a lot today, and there’s so much, I think it can be sometimes overwhelming, but just remember that whatever steps you can make, you’ll move in the right direction. Start cleaning up your skin care products. Start asking questions of manufacturers. Talk to your doctor about getting some testing for your hormones if you think you might have some of these imbalances. And start looking at resources that are reliable. Stop just searching something on Google. You actually want to go to reputable, reliable sources that help you understand your health condition, or whatever’s going on with your health. That’s why I put together the “Hormones, Health & Harmony” docuseries, interviewing over 50 experts to really help provide solutions. 

It’s not just me who’s telling you this, but a bunch of different people. “The Woman’s Doctor” podcast and things like that are places where you can get information and resources to help you on your journey.

Dr. Lauren Kelly-Chew: Absolutely. I want to reiterate what you said at the beginning, which is that people don’t have to suffer, and that you don’t need to feel like you can’t speak up or that you can’t advocate for yourself, even if the changes you make are small to start with. 

I so appreciate your work in this area and all the advocacy you do for women and men, but especially women, on topics that haven’t gotten nearly the amount of attention they deserve.

Where can people find you, access all the resources you’ve described? What’s the best way to get in touch with you?

Dr. Trevor Cates: People can go to and check out the “Hormones, Health & Harmony” docuseries at On social media, it’s @TheSpaDr. “The Woman’s Doctor” podcast is on all the podcast locations.