Myths of Testosterone Replacement, Part 3: Will Testosterone Make You Fat?

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This week, we continue our discussion about different myths of testosterone replacement. Specifically, we address the accusation that testosterone replacement therapy makes patients gain unwanted weight.

Brett Newcomb and I have been doing a series of podcasts on the myths that prevent people from replacing their testosterone with bioidentical pellets. The myth we are confronting this week is that replacing your lost testosterone will make you gain weight. The reality is that testosterone replacement will help you lose fat and gain muscle. The end result is that you may not immediately lose weight, but you will decrease your clothing size. It takes a while for you to actually lose weight on testosterone because losing fat and gaining muscle is a slow process.  In the end (after 12 months) a person taking testosterone pellets should have enough muscle to increase their resting metabolism, which helps them lose weight even when they are asleep!

Remember that muscle weighs more than fat tissue, and as you age and lose testosterone you tend to lose muscle mass and to develop fat cells where once you had muscle, particularly around your “six pack” area. As our stomach gets larger and muscle mass diminishes, we tend to put on fat, even if the scale does not increase, our waist size does. Women in particular notice that at 40, when testosterone is depleted, their midriff and their love handles begin to bulge.

One of the reasons that this happens is that without testosterone, we become insulin resistant. Insulin resistance is one of the mechanisms of fat-gain as we age. Insulin is meant to carry glucose into our cells, but with insulin resistance their power to penetrate our cells decreases and our insulin-glucose combo bounces off of our cells and not only decreases our energy but stores the glucose as fat.

The second mechanism of weight gain without testosterone is that our muscles deteriorate. With less muscle mass to burn our calories, our metabolic rate decreases. Muscle mass burns calories and fat is inert (does nothing metabolically,) so the treatment requires testosterone replacement—most effectively through pellets—and weight training. At a certain point, your muscle mass burns calories even when you sleep. Without testosterone, a viscous cycle ensues that causes chronic and continual weight gain. Your testosterone drops and insulin resistance increases, causing an increase in stored fat that slows the metabolism and makes insulin resistance worse.

When testosterone is replaced, the outcome is a leaner body with a higher metabolism. This makes it easier to limit food to reduce more fat, and we ultimately have dense bodies that are smaller than they were to begin with. The scale may not show it, so the change should be monitored through the measurements of the waist and hips instead.

In this podcast, we also discuss the role of the thyroid in metabolism. It burns calories more efficiently and increases the fat loss through exercise. We talk about the mechanics of insulin regulation within the body which is so vital to every cell. Part of our discussion focuses on the unhealthy food training we receive in our culture today, and the normalcy of sitting around and not exercising. The group mentality allows us to be lazy and stay the same, believing it is ok. I hear “I eat very well” daily and that usually means they eat per the old food pyramid that has proven to be the gateway to diabetes.  Also, many of us follow the rules of our parents who valued the theory of their children being members of the “clean your plate club.” This is inappropriate as we age, which harms our health and body habitus. We will discuss some behavior methods for limiting food intake.