Too much testosterone can cause insulin resistance and abdominal weight gain in women.
That’s why androgen excess is a factor in 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. Which in turn, causes more high androgens and more insulin resistance, creating a vicious cycle that I discuss in my new peer-reviewed paper.
Natural progesterone can help to lower androgens, improve insulin sensitivity, and break the cycle of PCOS. See Professor Jerilynn Prior’s protocol of cyclic progesterone therapy for PCOS, 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).
With menopause, progesterone and estrogen drop away while androgens remain constant and even slightly increase. The result is what I call the “testosterone dominance” of menopause and resulting weight gain and change from an hourglass body shape to a squarer shape with a thickened waist and heavier upper body.
Using both estrogen and progesterone as hormone therapy can have a beneficial anti-androgen effect in menopause. Estrogen has been found to improve insulin sensitivity and lower testosterone by increasing sex hormone-binding globulin (SHBG), the protein that binds and inactivates testosterone. Progesterone promotes weight loss by stimulating metabolic rate and lowering testosterone.
Taking testosterone, on the other hand, can cause weight gain.
Progestins with a “high androgen index” are testosterone-like and so can cause insulin resistance and weight gain. They include levonorgestrel, norethindrone, etonogestrel, and medroxyprogesterone, found 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.”
Progestins with a “low androgen index” can promote weight loss and but then cause rebound weight gain when they’re stopped. They include drospirenone, norgestimate, dienogest, and cyproterone.
The link between high testosterone and insulin resistance
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 can cause or worsen insulin resistance. That happens with PCOS, menopause, and androgenic progestins.
The solution is therefore 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, try to correct your type of PCOS to establish regular ovulation to make estrogen and progesterone. You can also consider using cyclic progesterone therapy or other natural anti-androgen supplements. If you are already in menopause (and can therefore no longer ovulate), consider taking bioidentical estrogen and progesterone.