Struggling with hormonal weight gain around your middle? It’s a common problem with PCOS and menopause but it’s not caused by estrogen.
In women, estrogen is beneficial for weight loss. The abdominal weight gain of PCOS and menopause is more likely to be caused by insulin and testosterone.
Let’s take a closer look.
Insulin resistance and weight gain
Insulin resistance is the condition of having chronically elevated levels of insulin. It’s also called hyperinsulinemia, metabolic syndrome, or pre-diabetes.
There’s growing evidence that high insulin causes abdominal obesity and that it does so by increasing appetite, preventing fat-burning, and promoting the growth of fat cells.
Do you have insulin resistance? Are you sure?
A test for blood glucose is not a test for insulin resistance. To assess insulin, you have to test insulin either as fasting insulin or a glucose tolerance test with insulin (also called an insulin assay or Kraft test, named after Dr Kraft, a clinical pathologist).
You then look at your insulin reading, not your glucose reading. A healthy fasting insulin should be less than 60 pmol/L (8 mIU/L). One hour after the sugar challenge, insulin should be less than 410 pmol/L (60 mIU/L).
High insulin can cause abdominal weight gain. So can high testosterone.
The link between testosterone and insulin resistance
In women, higher levels of testosterone increase the risk of insulin resistance and abdominal obesity. In men, it’s the opposite; higher levels of testosterone reduce the risk of insulin resistance and abdominal obesity.
The link between testosterone and insulin resistance is most clear with the hormonal condition PCOS, which is the classic condition of “testosterone dominance,” or too much testosterone or other male hormones (androgens) compared to estrogen and progesterone.
With PCOS, there’s a bi-directional relationship between high testosterone and insulin resistance.
In one direction, insulin resistance or high insulin increases testosterone by stimulating ovarian cells to make more testosterone. That’s the more conventionally understood aspect of PCOS.
In the other direction, testosterone worsens insulin resistance, and there’s growing evidence that in at least some cases of PCOS, high testosterone comes first and then causes or worsens insulin resistance.
It becomes a vicious cycle of more testosterone leading to more insulin resistance leading to more testosterone. All made worse by the relative lack of estrogen and progesterone — two hormones that help to reduce both insulin and testosterone.
Estrogen and progesterone to the rescue
Estrogen improves insulin sensitivity and reduces the risk of insulin resistance. That’s why losing estrogen with menopause increases the risk of insulin resistance and abdominal weight gain. Estrogen also helps to lower testosterone by increasing sex hormone binding globulin (SHBG) — a protein that binds and inactivates testosterone.
Progesterone also improves insulin sensitivity to some extent but its main benefit is that it lowers testosterone. For more information about progesterone’s natural anti-androgen effect, read The 7 Best Natural Anti-Androgen Supplements.
👉 Tip: There’s no progesterone in hormonal birth control. Contraceptive drugs are progestins, some of which are “androgenic” or testosterone-like and so can cause abdominal weight gain.
Two situations of testosterone dominance: PCOS and menopause
PCOS and menopause are similar in the following ways:
- Relatively low level of estrogen.
- No progesterone.
- Relatively high level of free or active testosterone due to a low level of SHBG.
- Insulin resistance.
PCOS and menopause are different in that with PCOS, it’s possible to ovulate and make estrogen and progesterone. With menopause, ovulation is no longer possible.
👉 Tip: Testosterone does not increase with menopause. The higher level of “free testosterone” is due to a lower level of SHBG. (Less SHBG binding to the same amount of total testosterone.)
How to treat the hormonal weight gain of PCOS and menopause
If you’re in a situation of abdominal weight gain and testosterone dominance, your strategy is two-fold: 1) reverse insulin resistance and 2) lower androgens.
The first part is relatively straight-forward with a combination of diet, exercise, and magnesium. Read my updated blog post: Reverse Insulin Resistance in 4 Easy Steps.
The second part (reducing androgens) can be a little harder to do.
First, you can look at using a natural anti-androgen supplement such as those discussed in The 7 Best Natural Anti-Androgen Supplements. There’s not yet a lot of research but conventional anti-androgen treatment has been shown to improve insulin resistance in women with excessive testosterone.
You can also look at increasing estrogen and progesterone for their natural anti-androgen properties and their beneficial effects on insulin and weight.
If you have PCOS, the way to make estrogen and progesterone is to ovulate. Try to identify the underlying driver of PCOS, and correct that. (Read The 4 Types of PCOS.)
If you are in menopause, you can no longer make estrogen and progesterone, but you could look at taking body-identical hormone therapy. Read 4 Things to Know About Menopausal Hormone Therapy.
Ask me in the comments!