How Testosterone Causes Weight Gain in Women

Testosterone causes weight gain in women.

In women, too much testosterone can cause insulin resistance and abdominal weight gain.

That’s why androgen excess contributes to the weight gain associated with polycystic ovary syndrome (PCOS), menopause, and some types of birth control.


The link between testosterone and insulin resistance is most clear with the hormonal condition PCOS, in which high androgens made (mostly) by the ovaries cause insulin resistance and impair ovulation. Impaired ovulation, in turn, causes low progesterone and, therefore, robs the system of progesterone’s beneficial anti-androgen effect. This causes more high androgens and insulin resistance, creating a vicious cycle I describe in my peer-reviewed paper.

Natural progesterone can help to lower androgens, improve insulin sensitivity, and break the cycle of PCOS. That’s why Professor Jerilynn Prior’s protocol of cyclic progesterone therapy for PCOS is currently undergoing a clinical trial.

👉 Tip: There’s no progesterone in hormonal birth control. Contraceptive drugs are progestins, many of which are androgenic or testosterone-like (see below).

Perimenopause and menopause

With the menopause transition, first progesterone and then estrogen drop away while androgens slightly increase before resuming their gradual decline with age (as happens in both men and women). The menopausal situation of relatively high testosterone paired with relatively low estrogen and progesterone causes a profound shift in fat distribution from gynoid (hourglass) to android (thicker waist and heavier upper body).

Menopausal hormone therapy (estrogen and progesterone) can have a beneficial anti-androgen effect and improve insulin sensitivity. For example, estrogen therapy directly improves insulin sensitivity and lowers testosterone by increasing sex hormone-binding globulin (SHBG), the protein that binds and inactivates testosterone. Progesterone indirectly improves insulin sensitivity by stimulating metabolic rate and lowering testosterone.

Taking testosterone or androgenic progestins can worsen insulin resistance and cause weight gain.

Birth control

Androgenic (testosterone-like) progestins can cause insulin resistance and weight gain. They include levonorgestrel, norethindrone, and etonogestrel, found in many pills, Nuvaring, Mirena IUD, and the Nexplanon implant.

Anti-androgenic progestins can promote weight loss while being taken but rebound weight gain when they’re stopped. Anti-androgenic progestins include drospirenone, norgestimate, dienogest, and cyproterone.

There’s a bi-directional relationship between high testosterone and insulin resistance.

Androgens, insulin resistance, and weight gain.

In one direction, insulin resistance or high insulin can stimulate ovarian cells to make more testosterone. That happens with PCOS and menopause.

In the other direction, testosterone can cause or worsen insulin resistance. That happens with PCOS, menopause, and androgenic progestins.

All of it can lead to weight gain, acne, facial hair, irregular periods, and a long-term risk of diabetes.

The solution has two parts: 1) reverse insulin resistance and 2) lower androgens, which, in turn, can improve insulin resistance.

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