Struggling with hormonal weight gain around your middle? It’s a common problem with PCOS, menopause, and birth control, but it’s not caused by estrogen. In women, estrogen is beneficial for weight loss.
Instead, abdominal weight gain is caused by insulin, testosterone, and progestins with a “high androgen index.”
Here’s what you need to know.
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 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). 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, with higher levels of testosterone reducing the risk of insulin resistance.)
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.
Other situations of testosterone dominance include menopause and the use of progestins with a “high androgen index” such as levonorgestrel, norethindrone, etonogestrel, and medroxyprogesterone. Androgenic progestins are used in many pills, Nuvaring, Mirena IUD, Nexplanon implant, and Depo-Provera shot. In fact, the depo shot has been observed to cause “unstoppable weight gain.” Progesterone, on the other hand, is good for weight loss (see below).
There’s a bi-directional relationship between high testosterone and insulin resistance.
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 or worsens insulin resistance. That happens with PCOS, menopause, and androgenic hormonal birth control. Conversely, non-androgenic progestins such as drospirenone and cyproterone are more likely to help with weight loss and insulin resistance but can be hard to come off without experiencing rebound weight gain.
It can then become a vicious cycle of more testosterone leading to more insulin resistance leading to more testosterone unless there is enough estrogen and progesterone to exert a natural anti-androgen effect.
Estrogen and progesterone are good for weight loss
Estrogen helps to reduce abdominal weight by improving insulin sensitivity and increasing sex hormone-binding globulin (SHBG), a protein that binds and inactivates testosterone.
Progesterone helps to reduce abdominal weight by improving insulin sensitivity (but only in the presence of estrogen), and by stimulating metabolic rate and lowering testosterone. See Professor Jerilynn Prior’s protocol of “cyclic progesterone therapy” for PCOS.
👉 Tip: There’s no progesterone in hormonal birth control. Contraceptive drugs are progestins, many of which are “androgenic” or testosterone-like.
How to treat the hormonal weight gain of PCOS, menopause, and hormonal birth control
The strategy is two-fold: 1) reverse insulin resistance and 2) lower androgens, which been shown to improve insulin resistance in women.
To reverse insulin resistance, follow the recommendations in my updated blog post Reverse insulin resistance in 4 easy steps.
To lower androgens, promote ovulation so you can make estrogen and progesterone and consider using a natural anti-androgen supplement. See The 7 best natural anti-androgen supplements.
👉🏽 Tip: If you are in menopause, you can no longer make estrogen and progesterone, so look at taking body-identical hormone therapy. Read Body-identical hormone therapy for perimenopause and menopause.
Ask me in the comments!