Do you have an interest in understanding hormonal health for women of color? Maybe you have the understanding that hormonal health is the same for all women regardless of their racial background.
As women health practitioners, we must have a basic understanding that every racial group has specific nuances as it relates to hormonal health. We want to ensure that we provide racial-specific care to our clients with the knowledge that we have learned. Having this understanding can save much confusion on the practitioners’ end and allow for proper protocols to be made for clients. These proper protocols will help clients feel more supported and maybe also more successful in regaining specific areas of health.
We should be lifelong learners as women health practitioners and have the understanding that our learning is never exhaustive. However, it mustn’t be expected that we will learn in detail how all racial groups have peculiarities with hormonal health. Instead, we can have a basic overview of hormonal health for various races. Especially those that represent a majority of our clientele or those we wish to become a part of our clientele.
This article will provide you insight into understanding hormonal health for women of color who self-identify as Black/African-American. In addition, let’s keep in mind that those who self-identify as Black/African-American comprise multiple cultures, languages, and ethnicities. 
Hormonal Health for Black & African-American Women
Black/African-Americans make up about 12% of the US population.  This race is the 2nd largest minority in the US.  Therefore, you may have clientele from this group, so it is important to understand hormonal health experiences for this race, especially if you have the desire to make this group your focus when looking for clients.
Many deep-rooted issues affect the hormonal health of women of color. When reviewing the hormonal health of this race, research has shown the levels of estrogen and cortisol are higher when compared to other races. Some of these concerns are caused by the gaslighting in our healthcare system, genetic disposition, and racism.
Having an understanding of these hormonal dispositions can help when ordering functional lab tests/ blood work, creating protocols, and providing specific insight into this race.
Specific Hormonal Concerns for Women of Color
African- American women have a higher disposition to estrogen when compared to Caucasian women.  The higher levels of estrogen in Black women can lead to earlier onset of puberty, increased occurrences of breast cancer, and higher bone mineral density.  Estradiol (E2) is one of the main hormones that seem to be elevated and is related to increased ovarian aromatase activity.
When we consider these higher estrogen levels as practitioners, we should also think of the increased signs and symptoms of irregular hormonal activity that this race may exhibit. These levels may cause increased PMS symptoms, as higher levels of estrogen may affect progesterone levels. An increase in bleeding, premenstrual spotting, dysmenorrhea, PCOS, and other estrogen-dominant symptoms may also be seen.
When searching for reproductive treatment in our healthcare system this predisposition to estrogen is not always considered. Thus, the options for treatment depending on the concern may rely heavily on prescribing estrogen as a solution. For example, young African-American women may speak with their provider about birth control options and are encouraged to use an estrogen-based contraceptive instead of another option.
Another example includes Black women in their early menopausal years being prescribed estrogen to alleviate menopausal symptoms. In both circumstances, the hormonal predisposition of this race may have not been taken into consideration when making these recommendations. In both examples, when additional estrogen is being prescribed, African-American women may be at increased risk for blood clots, fibroids, and breast cancer because of the estrogen-based recommendation. 
One of the main stress hormones is cortisol, and some studies reveal that African-American women have higher levels of cortisol when compared to other races.  These increased levels of cortisol are caused by stress which arises from various factors. For African-American women, some of these factors include stress caused by racial issues within our society, stress caused by lifestyle choices, and fear.  While all women may face stress of some sort, research has shown that African-American women have a higher stress exposure directly related to racial issues.
Epigenetics research has also shown that stress caused by racial issues in our society with a trauma response can be passed down through generations of DNA. This has created a predisposition to increased cortisol levels amongst Black women.  Increased levels of cortisol in the body can result in hormone disruption that perpetuates the cycle of stress, as cortisol is a preferred hormone pathway. As women’s health practitioners, we may even see that our African-American clients exhibit higher occurrences of cortisol dominance because of this disposition.
Due to the inequalities and biases that exist in our healthcare system, African-American women are more likely to be misdiagnosed and experience chronic conditions.  So as women’s health practitioners, we should also take this predisposition to estrogen and cortisol when reviewing their history, developing protocols, and recommending certain supplements. Taking this approach will help us to differentiate from the traditional medical system and become a part of the solution.
What We Can Do as Healthcare Practitioners
There is still much research to be done on hormonal health for women of color, especially as it relates to the reproductive years. Much available research focuses on menopause and does not provide great insight into the reproductive years.
A few choices that we can make as healthcare practitioners to increase our knowledge in understanding hormonal health for women of color, is to read available articles such as this one and studies that cover this topic. We can also gradually look at increasing our clientele in this population to gain additional practice and insights into their hormonal health dispositions. In addition, we can also collaborate with other practitioners who have more experience with this race and learn from them. This approach to gaining an understanding of hormonal health in the African-American race can be used when desiring to gain specific insight into any race.
Looking for additional resources to learn more?
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About the Author
Felicia Enoch, RN, FAE, IC-FHS
Felicia Enoch is a Registered Nurse, with over eight years of experience in the women’s health field. Her focus is the reproductive years and supporting women transitioning through the various phases of womanhood to motherhood. The passion she has for the field has led her on a journey to become a Certified Lactation Consultant, Fertility Awareness Educator, and IAFHH Certified Functional Hormone Specialist. She desires all women would have the support, knowledge, and resources to make informed decisions about their health. This has led her to establish Pure Nurturing, a company that focuses on restoring and supporting various aspects of women’s health.
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- Chinn, J. J., Martin, I. K., & Redmond, N. (2021, February 21). Health Equity Among Black Women in the United States. PubMed Central. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020496/
- Jones, N. (2022, June 10). 2020 census illuminates racial and ethnic composition of the country. Census.gov. Retrieved from https://www.census.gov/library/stories/2021/08/improved-race-ethnicity-measures-reveal-united-states-population-much-more-multiracial.html
- Marsh, E. E., Shaw, N. D., Klinman, K. M., Morgan, T. O., Yialamas, M. A., Sluss, P. M., & Hall, J. E. (2011, October 1). Estrogen Levels Are Higher across the Menstrual Cycle in African-American Women Compared with Caucasian Women. The Journal of Clinical Endocrinology & Metabolism. Retrieved from https://academic.oup.com/jcem/article/96/10/3199/2834917
- Rosenberg, L., Palmer, J. R., & Wise, L. A. (2006). A Prospective Study of Female Hormone Use and Breast Cancer Among Black Women. JAMA International Medicine. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/410100
- Perry Rainey, A. (2021, July 30). Why are black women more likely to have fibroids? mater mea. Retrieved from https://matermea.com/black-women-and-fibroids/
- Samuels, M. (2019, February 27). Several factors linked to endocrine-disrupting chemical levels in black women. SPH Several Factors Linked to Endocrine Disrupting Chemical Levels in Black Women Comments. Retrieved from https://www.bu.edu/sph/news/articles/2019/several-factors-linked-to-endocrine-disrupting-chemical-levels-in-black-women/
- Williams, N. E. (2021, May 11). Black women and cortisol: How chronic stress affects your fitness. Healthline. Retrieved from https://www.healthline.com/health/fitness/black-women-cortisol-and-fitness-Recognizing-an-ever-present-obstacle