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Alan Terlinsky, MD, FACP
Body Fat Increase After Menopause The Impact Of Testosterone
Nu-Living Weight Management
. http://www.nu-living.com

Body Fat Increase After Menopause The Impact Of Testosterone

The menopausal transition for many women is a time of weight gain, food cravings and tight fitting clothes. Women are perplexed over whether these changes reflect hormonal factors, stress, lifestyle or aging.

Laboratory research (in animals) has established that removing the ovaries is associated with substantial accumulation of deep organ fat (visceral fat), increased food intake, and reduced physical activity and energy expenditure.

In human studies of menopause and perimenopause (the time right before menopause), an inconsistent clinical effect of estrogen (or estradiol) deficiency is observed, sometimes associated with weight gain, increased body fat and fat redistribution, energy expenditure and physical activity. Increased testosterone during perimenopause may be more important than the impact of estrogen deficiency.

Cardiovascular risk increases in women after menopause as metabolic syndrome, diabetes, and coronary artery disease, conditions associated with increased visceral fat, become more prevalent.

Studies seem to suggest that low estrogen is responsible for the increased visceral fat accumulation. Women who have had a hysterectomy are even more susceptible to rapid body fat gain, plus redistribution from the thighs, hips and buttocks to the abdomen where it becomes metabolically active visceral fat associated with insulin resistance, abnormal cholesterol, hypertension and increased cardiovascular risk.

Several studies have suggested and demonstrated that women who begin hormone replacement around perimenopause have less body fat and weight gain. But, in addition to estrogen, there are other hormonal changes occurring during the menopausal transition.

The Study of Women's Health Across the Nation (SWAN) assessed visceral fat measurements in women at different stages of the menopausal transition. The study evaluated the impact of multiple hormonal factors on visceral fat accumulation and found that testosterone levels may be even more important than estrogen levels.

Testosterone levels were associated with visceral fat independent of age, race, percent total body fat, and other cardiovascular risk factors. Increasing testosterone was a stronger predictor of visceral fat than diminished estrogen. After adjusting for age, race, percent total body fat, presence or absence of insulin resistance and estrogen levels, testosterone seemed to play the most critical role in body fat gain and fat distribution.

In summary, several factors influence weight gain during a woman's menopausal transition as ovarian hormonal production of estrogen, testosterone and progesterone are all in decline. However, an increase in testosterone effect occurs as lowered estrogen levels reduce the testosterone binding protein, SHBG, thereby increasing “relative” testosterone levels, which produce the body fat gain and redistribution.

SWAN demonstrated an inconsistent effect of estrogen levels on body fat.

Women receiving hormone replacement who seem leaner, may be achieving this by increasing estrogen and SHBG and controlling the relative impact of testosterone.

Women experiencing the menopausal transition should anticipate decreased energy, perhaps caused by hormonal changes, and make a conscious effort to increase physical activity and lower caloric intake.

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