How Testosterone Can Cause Weight Gain in Women

Testosterone causes weight gain in women.

The hormonal weight gain of PCOS, menopause, and some types of birth control is caused by a combination of insulin resistance and androgen excess.

Here’s what you need to know.

Insulin resistance causes abdominal 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 weight gain by increasing appetite, preventing fat-burning, and promoting fat storage.

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, a higher level of testosterone increases the risk of insulin resistance and abdominal obesity. (In men, it has the opposite effect.)

The link between testosterone and insulin resistance is most clear with the hormonal condition PCOS, in which high androgens cause insulin resistance and delay ovulation. Delayed ovulation 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.

Other situations of relatively high androgens include menopause and progestins (birth control) with a “high androgen index” such as 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.”

Progesterone, on the other hand, promotes weight loss (see below).

So, there’s a bi-directional relationship between high testosterone and insulin resistance.

The link between androgen excess 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.

👉🏽 Tip: Non-androgenic progestins such as drospirenone and cyproterone promote weight loss and but can cause rebound weight gain when you try to stop them.

Estrogen and progesterone are good for weight loss

Both estrogen and progesterone have a beneficial anti-androgen effect to break the vicious cycle of testosterone and insulin resistance. For example, estrogen directly improves insulin sensitivity and lowers 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. See Professor Jerilynn Prior’s protocol of cyclic progesterone therapy for PCOS. It also improves insulin sensitivity (but only in the presence of estrogen).

👉 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.

👉🏽 Tip: If you are in menopause, you can no longer ovulate to make estrogen and progesterone and may need to consider body-identical estrogen and progesterone

Ask me in the comments!

64 thoughts on “How Testosterone Can Cause Weight Gain in Women”

  1. Hi 51 y/o perimenopause, heavy but regular periods, doctor has recommended dheas as my testosterone is low, all other markers on day 3 of my cycle were within range. Is it bad to go into to menopause with low testosterone? Thanks

    Reply
  2. Hi Lara, I have PCOS and recently was diagnosed with Sjogren’s Syndrome (an autoimmune disease) as well. I was wondering what you thought of autoimmune protocol diets (paleo but also no nightshades, eggs, seeds, etc)? A lot of people claim to have reversed symptoms of autoimmune diseases with these diets but it also seems very extreme. (I was already gluten and dairy free.)

    Reply
  3. Thanks so much for your work. The most comprehensive that applies to myself and daughter. Could high androgen be caused by non classical congenital adrenal hyperplasia? I want the DNA test for it, the hormone tests will do me no good as I have no ovaries and am in menopause, taking premarin and no progesterone. Unopposed estrogen has sent me back to depression and anxiety, but no flashes.

    Reply
  4. Hi Lara,
    I heard recently about some pills called Saheli that are non hormonal contraceptive. The active substance is ormeloxifene, wich is an estrogen receptor. What do you think about this kind of pills?
    Thank you.

    Reply
  5. Hi Lara! I am currently detoxing off visanne after taking it for 3 years after my endo surgery. It created too many side effects for me. But now, my hormones are absolutely OUT of control and nothing feels good or consistent. Is there anything you can suggest?

    Reply
  6. Hi Lara, have bern reading your book religiously. But now seems like a puzzle for me to fight middle weight gain. I m in perimenopause, 42, still having my periods. Doing cyclic progesterine with utrogestan cd 14 till cd 28 and estrogel cd1 till cd 25. Nevertheless, weight gain is not improving. Even with sport (I was even more starving…). My abdominal fat is my main concern. Any help?

    Reply
  7. Hello Lara,

    Your book was a huge help for me so thank you so much! It made me feel not alone and my gynecologist has made me feel crazy for refusing hormonal birth control.

    I have had extremely painful periods since I was young. The cramps last for about 4-6 hours every once in a while all day but they can be so excruciating I am hugging the toilet and live on midol, definitely get in the way of work. My PMS can actually affect my life and mental health between depression, anxiety, I become a different person. My bloating is ridiculous and takes over my whole body. I have never been obese by any means but have had the tendency to gain weight very easily since I was a child, I have definitely been overweight. I am very active and eat very well, to the point where in the past I am so anal about my diet it has lead to eating disorders which for the most part I have resolved, but even with working out ( I am a yoga instructor and practice/ meditate almost daily) and eating well I always stay pretty soft and don’t gain the muscle tone I feel as though i should.

    I went to an acupuncture/dietician who told me I was intolerant to wheat/sugar/dairy shortly before reading your book and that helped a ton but just recently my weight has been climbing back up with no changes to diet. Like I said I am very active, walk, yoga, horseback ride. I stopped running because my body became so inflamed. I have added your fasting as well just recently so hopefully that helps and I now take a magnesium/zinc/D3/calc vitamin after dinner.

    Thankfully as a teenager I got off the pill quickly, I noticed the dramatic effects it had on my mental health. I used to have intense brain fog as well especially around the time of PMS but that has been pretty resolved with diet. I am a pescatarian but eat fish pretty regularly and make sure to get my protein.

    I just recently had an ovarian cyst rupture and it put me in the hospital because it was so painful I thought I had appendicitis. My cycle used to be around 35 days now it is 38 days, I know I used to ovulate regularly, pretty sure I still do but unsure.

    I wake up energized and sleep well but I start to get fatigued throughout the day.
    Sorry for the novel but I am so frustrated.

    Reply
  8. Hi!

    What happens if one has little or no testosterone??

    I’m 45, healthy never took the pill, and have 0 testosterone. All other hormones are normal. I do get horrible minstrel migraines . Have good diet take mag.

    Reply
  9. Hi Lara,
    I don’t seem to fit in any of these categories. I have a lean build with healthy BMI, don’t have PCOS, but have high fasting insulin and c-peptide. I got it tested due to worsening symptoms of what I now know is reactive hypoglycemia over many years. All my sex hormone levels are normal, including testosterone and DHEAS, I ovulate regularly, etc. But I have slightly low morning cortisol, and low ferritin despite plenty of iron within a healthy balanced diet, and I recently think I might have excess/coarser facial fair on my chin and upper lip. I also have unexplained infertility, have done every test under the sun including laparoscopy to check tubes. All healthy. What could be causing my high insulin? Could this finally be a clue to explain my infertility? I already take adrenal and liver herb mixed through my naturopath. It would be so good to know any thoughts you might have.
    Claire

    Reply
  10. I was wondering if insulin resistance and an increase in belly fat can be triggered by a viral infection like Shingles?

    Reply
  11. Dear Lara!
    What next steps would you recommend if all androgens are low to normal and I’m not over or under-exercising, low stress levels, I don’t have any chromosomal abnormalities or POF. I’ve been tracking my cycles – they’re anovulatory and very irregular – thus it isn’t surprising my estrogen and progesterone (and testosterone) and FSH and LH are super low. I also don’t have any other abnormal labs like high prolactin etc. TSH was elevated but now hovers around 2 after taking iodine (i had a significant deficiency). It seems like a don’t fit in the HA or PCOS category…
    Kind regards!
    Emilise

    Reply
  12. Is there any evidence between progesterone use and repeating vaginal yeast? As a 32 y o woman with pcos, i take natural progesterone during my luteal phase until i get my period and parallel with that use, i usually have yeast a few times a year…

    Reply
  13. I am 51, periods are now several months apart. I have always struggled with mid section weight, only ever losing it from upper and lower body. I have no menopausal symptoms other than dryness, insomnia and the sporadic periods. Should I be considering estrogen as about five years ago I was diagnosed with fibroids?

    Reply
    • certainly, it’s worth looking at a vaginal estrogen for the dryness.
      In terms of the mid-section weight, the first priority is to try to obtain a test for insulin.

      Reply
      • Hi Lara, also have midsection weight. how do I get doctor to agree to an insulin test – or other tests for that matter which may help with my management of endometriosis.
        I’ve recently ‘lost’ my 3rd mirena & symptoms are back.

        Reply
  14. Lara, thank you for taking the time to reply. It’s been so confusing and so many doctors have said so many different things. I am a Certified Birth Doula and I recommend your book to all of my clients, my sisters, my sister-in-law’s, and my friends.

    Reply
  15. Hi Lara! Thanks for your response. I’m 47, have Hoshimotos, stopped having periods 5 months ago which my dr said is due to perimenopause/menopause, and just these last two days had a bit of spotting. I have blood work from three months ago. (I’m from Alberta too, but I live in Utah so the numbers are American, if that matters) Progesterone LC/MS 0.5, Testosterone total MS 34, Testosterone free 2.8, Estradiol 145. My bloodwork shows only my glucose, which is normal, but I just requested to have my insulin checked. My My thyroid panel was low so my Armor thyroid has been bumped up, I’ve been taking the B6, Taurine, Magnesium, and an oral trochee of bio identiical hormones with 200mg Progesterone and 0.6 Testosterone which has reduced the horrible hot flashes to almost nothing. (today I’m picking up a new one with a slightly less testosterone dose), I’m also taking a small amount of iodine, and a supplement with Vitex/White peony/Raspberry leaf/Yarrow/Dong quai/Blessed thistle/Licorice. Before my periods stopped I was also taking a lot of Turmeric. I feel forgetful but my brain races, my body feels lethargic and tired and it’s hard to move, and I’ve gained a lot of weight especially around my middle. Going by my abdominal measurement and how I respond to sugar I’m sure I have insulin resistance. I CANNOT stop eating it. I NEED it. And all my body does is gain weight. I feel stuck. I feel like I can’t and won’t change. It’s a very helpless, depressing feeling. Thank you for your help.

    Reply
    • As I discuss in this blog post, I fear that testosterone worsens insulin resistance so I am highly doubtful of the wisdom of including testosterone in menopausal formulas — especially for anyone who already has insulin resistance.

      Your #1 step is probably to reverse insulin resistance and that means finding a way to break the sugar addiction. Read Reverse insulin resistance in 4 easy steps and Chapter 7 of Period Repair Manual.

      Reply
  16. I’m 47 years old and stopped having periods five ago. My doctor says my estrogen is high, testosterone normal, no progesterone, even though I’m using oral progesterone. I’ve got lots of weight gain around my middle. What can I do with that combination of circumstances?

    Reply
    • your estrogen is high? are you sure? Is your lack of periods due to PCOS or menopause? And the most important question: do you have insulin resistance?

      Reply
  17. Hi Lara. I m really struggling to decide whether to take the HRT route or not. I ve always been a naturalist and lived off grid in nature and the idea of HRT really is against my principals in life but on the other hand l don t want to risk my life expectancy and be there for my only daughter. I entered early menopause at 32 refused Hrt back then and had spontenous pregnancy and gave a birth at 34. Breastfed for 3 years and when l weaned the nightmare started. Heart beats, insomnia, depression, brain fog… Eventually took the bodyidentical route. I am 37 now and been told to use it for the next 10 years. I want to know if l can manage to ease the symptoms with herbal medicine and life style, would l still risk my hearth health and bone health in the long run? Shortly do l really need the Hrt ? I was also thinking that my not having it l could perhaps cut down my risk of breast cancer although it is said that in my situation there is no risk however on the other hand there is really no data on the long term effects of bodyidentical hormones on women with premature menopause. Thank you,

    Reply
    • Most of the evidence suggests that women with premature menopause benefit from hormone replacement — preferably in the form of estradiol patch plus micronized (natural) progesterone capsule — which is the safest type of hormone therapy.

      Reply
  18. Incredibly interesting and informative article! For me now this question is very relevant since I am almost 40 years old and I have already begun to feel the symptoms of perimenopause. Many of them began to appear from the age of 35-36. These are such as insomnia, stress, changes in mood and sometimes sweating. But only closer to 39 years old, I realized that my lifestyle has not changed, and excess weight began to appear. I immediately connect this with hormonal imbalance and perimenopause, and when I read your article I understood in detail the whole connection between hormones and women’s health, weight gain, etc. Many thanks to the author for a really good and clear article!

    Reply
  19. I would be interested to know this also! I have high androstenedione and DHEAS – I have managed to lower DHEAS slightly through your blog post and book recommendations but my androstenedione remains high at 10 (ref range is 3 – 9.5). Would love to know your thoughts here Lara?

    Reply
  20. Hi Laura,
    Thank you for sharing your wealth of knowledge on women’s health. I have your book but wondering if there is any evidence you’ve seen in your research or clinical experience that women experience neuralgia sensations after menopause? Due to drastic shift in hormones.
    Thank you,
    Jane

    Reply
  21. Thank you for your great article. I am 44 years old and for the past year I started developing acne again. I had bad acne as a teenager but it cleared up and my skin has been good. I was diagnosed with PCOS in my twenties. My periods are around a 5/6 week cycle but I managed to have 3 children. I am not overweight but I do watch what I eat and exercise regularly. I do suffer from hirutism. My skin as I explained earlier has been good but lately I feel like a teenager again with red spots, infected acne. I went to a herbalist who prescribed Vitex, it did work for a bit but acne flared up again. I noticed that my skin is worse during ovulation and much better during my period which is opposite to what normal people experience. I have been searching and searching for alternative methods so I am so thrilled to have discovered your website. 10 days ago, I started taking wild yam and sage herb but acne seems to be worse. Can you please help..

    Many thanks

    Reply
    • As I describe in Period Repair Manual, zinc is one of the simplest and most effective treatments for acne. It works in part by reducing androgens. Please also consider whether you have insulin resistance, which is possible even if you are normal weight.

      Reply
  22. Hi Lara,

    My daughter is 16 with possibly high testosterone (not tested but she has acne, body hirsutism, no periods etc). You’ve mentioned in past comments not to use Vitex before the body has a chance to communicate to get periods started but you said that some time ago.

    We use Thorne Zinc often, can I use the other options on the 7 Best Natural Anti-Androgens safely. She has all the signs of puberty.

    I can’t stop her from eating deserts and junk (she doesn’t consume direct milk products as she doesn’t like a1 or a2 milk).

    Reply
    • I hate to say it, but she’ll probably have symptoms for as long as she keeps eating sugar. There’s no herb or supplement that can counteract the insulin and testosterone promoting effects of sugar.

      If I was going to choose one supplement for a teen in that situation, it would probably be magnesium to help insulin and try to relieve sugar cravings.

      You could also try to talk her into a protein breakfast (eggs or meat in the morning), which can help to prevent sugar cravings later in the day.

      Reply
  23. I too would really appreciate help with this! 6 days of sharp one-sided pain (alternating each month) and bloating in the lead up to ovulation. I refuse to go on the pill which is the only advice I have been given. Thank you for all your help on this topic.

    Reply
  24. Odd I cannot reply on the site so will try this.

    For me a must is Spironolactone and unfortunately natural progesterone made my hair fall out and gave me horrible acne. These hormones are just a nightmare. Thanks for your information, I appreciate your site 🙂
    ********************************************************************************************************************************
    thanks for commenting.
    I’ve never heard of natural progesterone causing hair loss. Just a quick question about the timing of the hair loss because there is always a 2-4 month delay after the initiating event. Had anything else happened with your health 4 months previously? ie coming off birth control? or heavy bleeding causing iron deficiency?
    *********************************************************************************************************************************
    From what I was told progesterone can take the path to create androgens but it’s rare, I just happened to be that person. Nothing happened 2-4 months prior but I will say that I started taking the 20-40 mg (can’t recall now) that was recommended then increased the dose substantially after getting a different opinion so do you think it was the amount I took?
    I know how beneficial progesterone is but now I’m just scared to try it again. It also affected my emotions making me extremely moody.

    Reply
  25. Hi Lara! Thanks for another excellent article. I have PCOS and my only high androgen is androstenedione. I have tried and am currently doing all of the androgen lowering techniques in your book and blogs, however my androstenedione just doesn’t seem to respond. Is there a different way you would go about lowering it?

    Reply
  26. You do know that the liver converts excess Estrogen into Testosterone right? lol so this isnt entirely accurate. bu I get what you’re trying to say 🙂

    Reply
    • Thanks for commenting.
      It’s actually the other way around. Most cells in the body can convert testosterone to estrogen with the enzyme aromatase.
      But, high or excess testosterone is still a thing.

      Reply
  27. For me a must is a Spironolactone and unfortunately natural progesterone made my hair fall out and gave me horrible acne. These hormones are just a nightmare. Thanks for your information, I appreciate your site 🙂

    Reply
    • thanks for commenting.
      I’ve never heard of natural progesterone causing hair loss. Just a quick question about the timing of the hair loss because there is always a 2-4 month delay after the initiating event. Had anything else happened with your health 4 months previously? ie coming off birth control? or heavy bleeding causing iron deficiency?

      Reply
  28. Testosterone was tested by blood. When I use it I actually have a libido. Without it I’d really rather do laundry or dishes. I have not been tested for IR and do not know how to convince my dr to order the test. I don’t know if insurance will cover it, that is usually the biggest hang up with the dr.

    Reply
  29. My testosterone is low and I’m estrogen dominant. I’m on Prometrium and compounded testosterone cream. I’ve gained back the 5 pounds I lost earlier in the year. I have not had labs done recently. Any other signs of insulin resistance to convince my dr to test for that? I’m pretty sure I have blood sugar issues, maybe reactive hypoglycemia. I’m also hypothyroid but have not lost weight despite free T3 being optimal. I’m still cycling regularly and have signs of ovulation but not sure how to know if I’m actually ovulating.

    Reply
    • Have you been tested for insulin resistance?
      Also, how was your testosterone tested? I don’t love the idea of women taking testosterone.

      Reply
  30. Yes, I’ve read Period repair manual. Which actually helped me to ask my doctor about testing certain hormones. But they are all fine, apparently. Only testosterone is at the upper limit of the referance range, others including LH/FSH, prolactin, SHBG etc. are completely normal. Ugh, I wish I would find a way to get that insulin tested.

    Reply
  31. Hi Dr. Briden,

    I am 29 years old and this summer was diagnosed with premature ovarian insufficiency. This diagnosis was given by my obgyn after missing periods for four months at the time, spotting, receiving an ultrasound that showed slightly large ovaries and multiple cysts (some up to 3cm) on each ovary, and a hormone panel that showed FSH at 82, testosterone at 38 ng/dl, AMH at .534, LH at 44.3, estradiol at 28, and TSH at 1.15. I never took birth control. I am seeing an RE soon and am really worried. I have been receiving acupuncture and herbs, but recently discovered my acupuncturist who initially gave me hope that I could correct this, though at a natural fertility clinic, is completely inexperienced and and now I’m losing hope. What are the main things you suggest I do? I do not want to be in menopause at such a young age and am willing to do anything. I have a hard time finding any resources or even message boards with people with a similar experience, unless it’s an article about how terrible it is. Last fall, my fsh was 13, so it increased a lot under a year. I lost 35 lbs last year and eat a pretty healthy and am vegetarian, but not restrictive.

    Do you have any advice? I feel very lost.

    Thanks,
    Catherine

    Reply
  32. I am three years post partial hysterectomy and dealing with all this. Cystic acne and hair loss are my top two symptoms, also chin hair and lower belly fat. I exercise daily and not over weight. Derm put me on spironolactone. I do a low carb diet 50-100 carbs daily and fasting insulin is in the 90s. Not sure to go from here. Help please😔

    Reply
    • were you told PCOS? because you probably want to look at the treatments that I discuss for insulin-resistant PCOS both in Chapter 7 of period repair manual and in the blog post The 4 types of PCOS. If you’re younger than 45 (and still have your ovaries) you should be able to ovulate and make progesterone. Although, spironolactone does suppress ovulation, depending on the dose.

      Reply
  33. Thank you for another useful post Dr. Lara.
    Would it be possible to do a post on causes and treatments for ovulation bloating and pain?
    Not sure if there are any ladies out there struggling with the same issue, but recently I’ve been experiencing heavy bloating and severe pain during ovulation. It would be wonderful to read more about it and how to address it 🙂
    Thank you Dr. Lara!

    Reply
    • Oh I would love this too. I have terrible bloating and pain the entire second half of my cycle. My doctor says the only thing I can do to fix it is go on hormonal birth control, but I feel like that’s a terrible idea.

      Reply
  34. Have you encountered patients who where relatively slim with low triglycerides and still had insulin resistance? No doctor is willing to test me for insulin resistance because of that. But I do have some acne on the forehead, irregular cycles and I gain fat predominantly around the middle.

    Reply
    • low triglycerides does suggest that it’s probably not insulin resistance.
      Are you in a country where you can self-order an insulin test?

      Reply
      • Unfortunately no, I can’t self-order an insulin test in my country.
        Interestingly, my sister has perfect 29-day-cycles and the only difference in our lifestyle is that I have often eaten too many sweets as a teenager, which she’s never done. She also doesn’t have any acne. That’s the reason why I was confident it has to be insulin resistance, but then on the other hand, there’s the low triglycerides. So confusing.
        So, would you say low triglycerides rule this condition out or is there still a chance it could be insulin resistance?

        Reply
  35. What about weight gain that is less in the middle/tummy and far more significantly in the thighs and calves…can that still indicate androgen dominance?

    Reply

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