How BHRT Supports Weight Loss and Metabolic Health

A common misconception is that hormones only control things like our emotions and mood, when in fact, they do much more than that. Hormones actually play an integral role in our body’s metabolism, directly contributing the things like appetite, metabolism, and weight. Thus, hormones are a key factor to consider when on your weight loss journey.

While bioidentical hormone replacement therapy (BHRT) commonly tackles symptoms associated with conditions like menopause, it may also have some other beneficial effects. This article will explore how hormones and BHRT could support your weight loss journey and promote metabolic health.

The role of hormones in weight and metabolism

We know by now that hormones act as chemical messengers, sending signals throughout the body and communicating what to do and when. One of the many processes hormones contributes to as a result is metabolic health, which is intimately linked to weight loss.

Key hormones such as leptin, insulin, sex hormones, and growth hormones are all implicated in our appetites, metabolism, and fat distribution. That is why obese individuals tend to have abnormal hormone levels that disrupt metabolism, leading to excess body fat (1). In fact, hormone imbalances can cause issues such as:

• Elevated visceral fat. Visceral fat is a type of fat that you can’t necessarily see. It is the fat deep within your body that surrounds and protects your internal organs. However, too much visceral fat is linked to health complications such as diabetes, cardiovascular disease, and more.
• Decreased resting metabolic rate. Your resting metabolic rate refers to how many calories your body burns at rest when conducting normal bodily functions such as breathing and circulation. When this is reduced, your body does not burn as many calories at rest, which can contribute to weight gain.
• Insulin resistance. Hormones can also affect your body’s ability to respond to insulin, which can lead to elevated blood sugar levels over time. High blood sugar is linked to obesity.
• Abnormal appetite signaling. Hormones have a direct influence on our appetite. Thus, when your hormones are out of whack, you may experience increased appetite which in turn can lead to weight gain.

Therefore, it is important that we keep hormones in check to ensure that we maintain healthy eating habits and manage weight. But, what hormones do we need to look out for?

What hormones contribute to metabolism

Several hormones are implicated in our metabolism, so it’s essential to keep an eye on these throughout your weight loss journey. Let’s dive into what hormones are important to weight and why.

Estrogen and progesterone

Changes to female sex hormones, estrogen and progesterone, can greatly influence weight and metabolism. A great example of this are the changes that many women experience throughout menopause. Many individuals report rapid weight gain during menopause, and this can typically be attributed to fluctuations in estrogen and progesterone.

During menopause, levels of estrogen and progesterone decrease. This causes reduced muscle mass, which leads to less calories being burned and your metabolism slowing down. Because less calories are being burned, fat builds up more rapidly than you may be used to (2).

Testosterone

Testosterone is a male sex hormone that is also implicated in metabolism and weight loss. In fact, as many as 40 percent of obese men have low testosterone. Thus, testosterone is an important hormone to monitor in those that are looking to maintain a healthier weight.

Research shows that calorie restriction and associated weight loss can increase testosterone levels. Additionally, treatment with testosterone can actually minimize fat. This was demonstrated in a study of 100 obese men between the ages of 20 to 70 years old. For 10 weeks, participants were put on a very low-calorie diet along with exercise. In addition, roughly half the men took testosterone injections while the other half took placebo.

Findings indicated that weight loss was relatively similar across both groups (around 24 pounds). However, individuals taking testosterone lost almost exclusively fat, while the placebo group lost both fat and lean muscle (3).

DHEA

DHEA is yet another hormone that can contribute to weight, and this is because of its close relation to testosterone. The body can actually convert DHEA into testosterone, so testosterone levels are closely linked to DHEA. As such, you DHEA can also influence metabolism.

This is exemplified by another study that evaluated 56 elderly individuals with age-related decreases in their DHEA levels. Investigators randomly assigned individuals to receive either DHEA or placebo for six months. Findings indicated that DHEA therapy resulted in significant reductions in visceral fat versus placebo therapy. Additionally, an increase in insulin sensitivity index was also observed in the DHEA-treated group (4).

Thyroid hormones

Oftentimes a sneaky contributor to weight are your thyroid hormones. The thyroid gland produces, stores, and releases thyroid hormone. Thyroid hormone is important for many bodily processes, including metabolism. As such, low thyroid hormone levels can lead to decreased metabolism and subsequent weigh gain.

Low thyroid hormone levels is known as hypothyroidism. With hypothyroidism, circulating levels of thyroid hormones, such as triiodothyronine (T3) and thyroxin (T4) are low. As many as five percent of individuals in the US have hypothyroidism. People at higher risk of an underactive thyroid include individuals over the age of 60 and women (5).

Cortisol

The adrenal glands are responsible for producing a hormone known as cortisol, which is commonly referred to as the “stress” hormone. As a stress hormone, it contributes to things like blood sugar, energy metabolism, and inflammation. When cortisol is released as the result of stress, bit can lead to metabolic changes. For example, it can lead to increased fat storage in the abdomen and slowed metabolism. It can also activate insulin release which can elevate blood sugar levels and cause food cravings. Together, these two phenomenons can lead to excess visceral fat (6).

How BHRT can help with hormones

Knowing the impacts of hormones on our metabolism, it only makes sense that hormone therapy could help with weight management. That is why many individuals turn to BHRT therapy to augment their weight loss journey. Here are a few ways that BHRT can help.

1. Improved insulin sensitivity

Many menopausal women are at increased risk of insulin resistance because menopause can lead to reductions to estrogen levels. A common side effect of insulin resistance is weight gain or difficulty losing weight. Thus, improving insulin sensitivity through hormonal therapy could be beneficial.

For example, a meta-analysis of 17 randomized, controlled trials indicated that hormone therapy could be beneficial in improving insulin sensitivity. Findings showed that hormone therapy decreased insulin resistance in postmenopausal women, particularly in individuals receiving estrogen only therapy (7).

2. Increased lean muscle mass

As previously mentioned, while testosterone and DHEA may not directly impact weight, they can certainly have an effect on body composition. Supplementation with testosterone and/or DHEA has the potential to increase lean mass, decrease body fat, increase insulin sensitivity, and decrease visceral fat.

3. Reduced fat accumulation

Postmenopausal women are at increased risk of accumulating visceral fat because of decreases in estrogen. Thus, some hypothesize that estrogen replacement therapy could impact visceral adipose tissue. In animal models of aged female mice, estrogen supplementation helped to prevent visceral fat accumulation (8).  Other studies in humans examined how menopausal hormone therapy impacted fat accumulation. Results indicated that women were less likely to accumulate abdominal fat tissue when taking hormone therapy (9).

Important caveats

It is important to note that while there is some evidence that hormonal therapy can lead to downstream effects on weight and metabolism, more research is still needed. Many of the studies have small sample sizes or were conducted only in animals. Thus, caution should be taken and hormonal therapy should only be received under medical supervision. The benefits of BHRT will depend on the correct hormone, dose, and delivery method in the context of your individual patient profile.

Additionally, lifestyle can also have a profound effect on your hormones. Thus, hormonal therapy should not be a replacement for lifestyle. Instead, you should focus on these key pillars in addition to hormonal therapy when it comes to regulating your metabolism:

• Sufficient protein intake and resistance training to develop lean mass
• Blood sugar control
• Sleep optimization
• Management of stress and cortisol levels
• A regular and effective exercise routine

Aside from just weight, you’ll want to also track key metrics like body composition, insulin levels, lipid profile, energy levels, and cognition to track your progress.

Conclusion

Although many people turn to hormone therapy like BHRT to treat menopause symptoms like hot flashes and mood changes, hormone therapy can actually have many other beneficial effects. In restoring hormone balance, BHRT may be able to impact hormones like estrogen, progesterone, testosterone, DHEA, and more that are implicated in weight. Thus, individuals may experience improved metabolism and better weight management when using hormone therapy.

References

1. https://www.betterhealth.vic.gov.au/health/healthyliving/obesity-and-hormones#obesity-and-sex-hormones
2. https://www.uchicagomedicine.org/forefront/womens-health-articles/menopause-weight-gain-hormone-therapy
3. https://www.endocrine.org/news-and-advocacy/news-room/2016/in-some-men-taking-testosterone-while-dieting-may-help-lose-fat-not-muscle
4. https://jamanetwork.com/journals/jama/fullarticle/199765
5. https://www.nm.org/healthbeat/healthy-tips/im-gaining-weight-is-it-my-thyroid
6. https://www.torrancememorial.org/healthy-living/blog/cortisol-and-your-waistline-the-unseen-battle/
7. https://menopause.org/press-releases/new-meta-analysis-shows-that-hormone-therapy-can-significantly-reduce-insulin-resistance
8. https://www.sciencedirect.com/science/article/abs/pii/S0531556522001048
9. https://www.endocrine.org/news-and-advocacy/news-room/2018/treating-menopause-symptoms-reduces-abdominal-fat-tissue

Author

David J. Bauder, PA-C David Bauder, PA-C, is a certified physician assistant and the assistant medical director at Weight Loss and Vitality in Manassas and Alexandria, Virginia, Washington, DC; and Gaithersburg, MD. He enjoys helping patients optimize their physical and mental health to improve their overall well-being. He earned his physician assistant degree from the University of Texas Health Science Center at San Antonio. Afterward, he gained admission into the reputable graduate program for physician assistant studies at the University of Nebraska Health Science Center in Omaha. David has over 26 years of experience working as a physician assistant. He’s practiced in podiatry, family medicine, emergency medicine, general surgery, urgent care, and functional medicine.