TESTOSTERONE & BODY FAT - men and women are different

The problem

A man of 52 and a woman of 52 walk into the same hormone conversation and get handed the same advice.

Fix the testosterone, fix the fat.

That advice is wrong for at least one of them, and possibly both.

In men, body fat crushes testosterone, so adding more is rarely the answer.

In women, body fat can be CAUSED by excess androgens, so for those ladies adding more is NOT the answer

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What this episode covers

From a review in Frontiers in Medicine, October 28, 2026, by Komai and colleagues, a subject Joanne has taught in her Mastering Midlife program for five years.

In men, fat drags testosterone down.

• Excess body fat suppresses testosterone.
• Sex hormone binding globulin (SHBG) rises with age and binds testosterone, leaving less of it active.
• Aromatase, an enzyme stored in fat, converts testosterone into oestrogen.
• So a heavier man prescribed testosterone can end up converting much of it into oestrogen. A futile cycle.

Body fat loss itself is the first testosterone intervention for men.

• Training, protein, sleep, and a calorie deficit you can actually live with come first.
• Resistance training in itself raises testosterone.
• Only once body fat is down, and numbers are still low and symptoms are present, is there a role for testosterone replacement therapy.

In women, the arrow often points the other way.

• Obesity in women is more often linked to androgen excess, not androgen deficiency.
• Insulin resistance pushes the ovaries to produce more androgen and lowers SHBG, leaving more androgen free and active.
• Fat tissue converts androgens through an enzyme called AKR1C3.
• This pattern is clearest in PCOS, now called PMOS under the 2026 global consensus, polyendocrine metabolic ovarian syndrome.

PCOS does not go away at midlife.

• If you dealt with it in your twenties and thirties, it is still there in midlife.
• Do not jump on the testosterone bandwagon without checking insulin load, insulin resistance, and androgens first.

A quick rule Joanne uses for both sexes.

• If your waist is more than half your height, you are likely insulin resistant, or heading that way.
• That rule alone tells you a lot about what is happening with testosterone, before any lab result.

Joanne's own experience

• She has taken testosterone for years.
• For years, on a very low dose, she felt it did nothing at all.
• Her insulin was already in good shape and her waist was less than half her height, so foundation was not the issue. The dose was simply too low.
• When she raised it, modestly, and her level reached 90 and above, she felt a difference in energy.
• Older women, she says, tolerate and indeed need higher testosterone than younger women would. At 35, a level of 90 would have meant acne, hair loss, and road rage. At 59, it is doing great things for her.
• Foundation first, always. If midsection fat and insulin load are high, testosterone is not the first answer.

What this does not prove

• This is a review of existing studies, not a new trial.
• It does not mean every overweight man is hypogonadal.
• It does not prove testosterone replacement is right for every man with low readings.
• For women without PMOS, the optimal testosterone range is still poorly understood over the long term.

This is general information, not personal medical advice. Talk to your own doctor about what it means for you, with your own history and bloodwork in front of them.

New series: Midlife Memoirs

Joanne is starting a new series of short conversations, 30 to 45 minutes, about people's real experiences going through midlife. Informative, vulnerable, and funny. First guest: Amanda Fletcher, a cancer survivor, on hormones and the advice she received after breast cancer. One or two a month. If you would like to be included, message Joanne.

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