How Your Sex Hormones Can Support (or Hinder) Your Weight Loss Journey

By Dr. Melissa (Mel) Irvine, DNP – Clinical Sexologist – Specializes in Sexual Medicine and Beauty

Are you aware of the role your sex hormones play in regulating glucose and promoting weight loss? While thyroid hormone plays a role in regulating the metabolism and how the body burns calories, sex hormones play a role in distribution of fat stores and water retention.

Have you ever put in all the effort to lose weight—modifying your diet, adding in exercise—only to have the numbers on the scale stay the same? It can be aggravating to feel as though all your efforts are going to waste, but it may not be because you’re not doing enough; it could be because your hormones are unbalanced, causing your body to hold onto glucose.

With high blood sugar leaving your body in a perpetual state of fat-storing instead of fat-burning, it’s no wonder why weight loss becomes exceptionally challenging.

Let’s further explore the role some crucial hormones have in blood sugar management and weight loss and what the key is to finally seeing those numbers on the scale go down.

Estrogen: A Glucose Reducer
Estrogen, the female hormone known for regulating the menstrual cycle and promoting the development of female characteristics, also plays a crucial role in directing glucose to the right areas of your body. Namely, estrogen encourages muscle cells to take in glucose.

Estrogen accomplishes this by stimulating the cells lining your blood vessels to deliver insulin to muscles, with insulin then encouraging the muscle to take in glucose and use it. The result? Thanks to estrogen, your blood sugar level lowers.

Researchers have long known the protection offered by estrogen against Type 2 diabetes, a disease where insulin becomes less effective in the body organs responsible for controlling blood sugar, resulting in high blood sugar. They’ve seen that women undergoing menopause have a significantly higher risk of Type 2 diabetes, meaning Type 2 diabetes risk increases when estrogen levels decrease. Additionally, it’s been shown that this risk of diabetes becomes less drastic when menopausal women are given hormone replacement therapy to restore their estrogen levels.

While women have more estrogen circulating through their bodies, men still require this hormone, and its declining numbers can also increase their risk of insulin resistance.

In short, it’s clear that estrogen is crucial for regulating glucose levels in the body.

However, these benefits of estrogen can reverse if the amounts are too high. Some research has found that high concentrations of estradiol, a form of estrogen, can cause insulin resistance, which can cause blood sugar levels to rise.

Progesterone: An Insulin Inhibitor
While estrogen is crucial for helping your body deliver insulin where needed and increase glucose uptake—lowering blood sugar levels—progesterone does the opposite.

Progesterone, a hormone that supports menstruation and, if a woman is pregnant, supports the pregnancy, can also affect insulin signaling in a type of fat cell, 3T3-L1 adipocytes. This can lead to higher blood sugar levels because progesterone keeps these cells from up taking glucose, which then allows the glucose to continue circulating in the blood.

Progesterone increases significantly during pregnancy, and given its influence over insulin, this increase in progesterone may be what contributes to gestational diabetes in pregnant women.

Everything is about balance in the body and progesterone is the counterbalance to the negative side effects of estrogen. When estrogen is in excess it may also lead to insulin resistance and in turn weight gain. Progesterone is also a natural diuretic and keeps both estrogen and testosterone in check when maintained within the right levels.

Testosterone: The Baby Bear of Hormones
Do you know how, in the fairy tale, Baby Bear has everything that is “just right?” This is how testosterone levels need to be, with studies showing that both high and low testosterone are associated with insulin resistance. This data shows the importance of finding the ideal target range for each person and keeping hormones within these personalized bounds to ensure the other parts of the body work as needed.

Additionally, testosterone regulation and its influence can vary based on gender. Studies have shown that increased testosterone levels in males (if they are low) can cause a more favorable metabolism of glucose, lowering glucose levels and improving insulin sensitivity. However, increased testosterone was not shown to influence glucose metabolism in women.

Hormone replacement therapy has traditionally taken a very cookie cutter approach, and everyone is treated as if they are the same. This evidence showcases the importance of a customized approach to hormonal management, as not everybody will respond in the same way or need the same alterations.

Blood Sugar And Weight Loss: How Are They Connected?
We’ve spent a lot of time discussing how various hormones affect our body’s ability to manage blood sugar levels, but how does blood sugar influence our weight loss journey? It’s simple: your blood sugar levels can either make it easier or harder to lose weight, and it’s all because of how your body signals within itself.

If your insulin levels are high, your body never receives a signal to run through glycogen (a form of glucose and a primary energy source) and then burn fat stores for energy. Instead, your body will remain in fat-storing instead of fat-burning mode. As you can expect, this makes weight loss challenging—not impossible, but much harder than it could otherwise be.

Insulin is what unlocks the insulin receptors on your cells. They’re like a gate; once it’s open, your cells can let in glucose and convert it into energy. If the gate remains shut, though, which can occur if your blood sugar is too high, the cells don’t open, and glucose stays in the bloodstream, making your blood sugar rise even more. This phenomenon is referred to as insulin resistance.

When insulin resistance occurs, your body produces more insulin to try and unlock the cells, but it only makes matters worse. So, the key to making fat-burning possible is to ensure your body has stable sugar levels and that insulin never goes into overdrive; otherwise, those gates will stay shut.

Hormone Optimization: A Necessary Element of Weight Loss
Society places diet and exercise as the two key components of losing weight, but there’s a hidden factor that many people don’t consider despite it making all the difference for your weight loss journey: your hormonal balance.

The most current and hottest weight loss trend are peptide injections of Semaglutide (Ozempic®/Wegovy®/Rybelsus®) and Tirzepatide (Mounjaro®/Zepbound™). While these therapies are effective and individuals will lose weight, once the weight loss goals are met and the medication is discontinued the weight lost will return if the hormones are not optimized.

Blood sugar levels that are too high, or insulin that is not receptive enough, can cause your body to stay in fat-storing mode, and the culprit of these high blood sugar levels and insulin sensitivity may be your hormones.

So, even if you revamp your diet or add in an exercise routine, if your hormones are imbalanced and affecting your blood sugar, your body will fight to hold on to its fat stores. This means that the numbers on the scale might not change or will change very slowly, no matter how many healthy habits you adopt.

Ultimately, the key to weight loss is ensuring your hormones are properly balanced. This not only means that your hormone levels, individually, should be within your body’s ideal range—which can be different from the standard recommendations—but your hormones need to be balanced with each other. For instance, blood sugar levels are best managed when your estrogen is higher than your progesterone, so you need to check the levels of each hormone, how they compare to each other, and which ratio produces the best results.

This is a challenging balance to find, which is why working with a hormone specialist is so crucial—they can find the balance that helps you regain control of your hormones and encourages your body to finally release its hold on glucose and fat.

Can Weight Loss Medications Replace the Need for Hormone Optimization?
Even if you take medication for weight loss, you still need hormonal balance if you want to maintain your weight loss.

To better understand why, we need to look at how blood sugar levels become fat.

Your body requires energy from food to complete all its processes, but if you eat more than your body needs, glucose will be left floating around in your bloodstream. When your body has excess glucose, it stores it as fat, leading to weight gain.

Weight loss medication often suppresses your appetite, which lowers blood glucose levels and encourages your body to instead break down fat for energy. However, once you come off the medication, your blood sugar can once again rise if your hormones are imbalanced, causing the excess glucose to once again become fat.

When your hormones are optimized, though, your body will use glucose more efficiently, which can keep your blood sugar levels normal. This puts you in the right place to maintain your weight loss even when you stop taking medication.

If you’re looking to lose weight, diet and exercise are crucial components of any healthy lifestyle, but to truly see success, you need to take a closer look at your hormones and ensure that they’re setting your body up for success.

References
Sacharidou, A., Chambliss, K., Peng, J., Barrera, J., Keiji Tanigaki, Luby-Phelps, K., İpek Özdemir, Khan, S., Sirsi, S. R., Sung Hoon Kim, Katzenellenbogen, B. S., Katzenellenbogen, J. A., Kanchwala, M., Sathe, A. A., Lemoff, A., Xing, C., Hoyt, K., Mineo, C., & Shaul, P. W. (2023). Endothelial ERα promotes glucose tolerance by enhancing endothelial insulin transport to skeletal muscle. Nature Communications, 14(1). https://doi.org/10.1038/s41467-023-40562-w

Suba Z. (2012). Interplay between insulin resistance and estrogen deficiency as co- activators in carcinogenesis. Pathology oncology research : POR, 18(2), 123–133. https://doi.org/10.1007/s12253-011-9466-8

Nagira, K., Sasaoka, T., Wada, T., Fukui, K., Ikubo, M., Hori, S., Tsuneki, H., Saito, S., & Kobayashi, M. (2006). Altered subcellular distribution of estrogen receptor alpha is implicated in estradiol-induced dual regulation of insulin signaling in 3T3-L1 adipocytes. Endocrinology, 147(2), 1020–1028. https://doi.org/10.1210/en.2005-0825

Quintanilla Rodriguez BS, Mahdy H. Gestational Diabetes. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545196/

Leutner, M., Matzhold, C., Bellach, L., Wohlschläger-Krenn, E., Winker, R., Nistler, S., Endler, G., Thurner, S., Klimek, P., & Kautzky-Willer, A. (2022). Increase in testosterone levels is related to a lower risk of conversion of prediabetes to manifest diabetes in prediabetic males. Wiener klinische Wochenschrift, 134(1-2), 1–6. https://doi.org/10.1007/s00508-021-01903-1

Xing, Z., Kirby, R. S., & Alman, A. C. (2022). Association of age at menopause with type 2 diabetes mellitus in postmenopausal women in the United States: National Health and Nutrition Examination Survey 2011-2018. Przeglad menopauzalny = Menopause review, 21(4), 229–235. https://doi.org/10.5114/pm.2022.123514

Mauvais-Jarvis, F., Manson, J. E., Stevenson, J. C., & Fonseca, V. A. (2017). Menopausal Hormone Therapy and Type 2 Diabetes Prevention: Evidence, Mechanisms, and Clinical Implications. Endocrine reviews, 38(3), 173–188. https://doi.org/10.1210/er.2016-1146