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In this quick hits I sit down with Dr. Gillett, to exam the complex world of women's hormones today. We'll be focusing on androgens like testosterone, DHEA, and dihydrotestosterone, and their profound impact on female health. Dr. Gillett provides insights on the role of binding globulins, hormone replacement therapy, and the interplay between insulin and androgens. We also discuss the challenges of menopausal weight gain, the benefits of GLP-1 medications for weight loss, and practical strategies anyone can use for maintaining lean body mass.

 

In this Quick Hits episode, I sit down with Dr. Gillett to examine the complex world of women’s hormones, with a special focus on androgens and how they affect female health in perimenopause and menopause.

We talk about hormones like testosterone, DHEA, and dihydrotestosterone, also known as DHT, and why these hormones matter for women’s energy, mood, libido, muscle, metabolism, body composition, and overall well-being.

Dr. Gillett also breaks down the role of sex hormone-binding globulin, or SHBG, and why it is such an important marker when evaluating hormone balance. We discuss how SHBG affects free testosterone, how oral contraceptives and synthetic hormones may influence SHBG levels, and why high SHBG can sometimes leave women feeling unwell if hormone levels are not adequate.

 

This conversation also goes into the relationship between insulin, androgens, thyroid binding globulin, cortisol binding globulin, hormone replacement therapy, and menopause weight gain.

And because weight gain in menopause is never just about calories, we also discuss GLP-1 medications, body composition, sleep, lifestyle, and practical strategies women can use to preserve lean muscle mass while losing weight.

This episode is a must-listen if you want to better understand how testosterone, DHEA, DHT, SHBG, HRT, insulin, GLP-1s, and menopause weight gain all connect.

In This Episode, We Discuss:

• How androgens such as testosterone, DHEA, and DHT affect women’s health and well-being

• Why sex hormone-binding globulin, or SHBG, is critical for hormone balance and stability

• How thyroid binding globulin and cortisol binding globulin affect hormone dynamics

• How hormone replacement therapy may influence androgens in women

• How to manage testosterone replacement therapy while minimizing virilization symptoms

• Why facial hair, acne, hair loss, and voice changes can happen with excessive androgen exposure

• The role of DHT blockers in managing androgen-related symptoms

• How SHBG may support overall hormone stability when levels are balanced

• Why high SHBG can create symptoms if free hormone levels are too low

• How oral contraceptives and synthetic hormones can affect SHBG and hormone availability

• Why SHBG matters for women using HRT or hormonal contraceptives

• The challenges of menopause weight gain and changing body composition

• How insulin and androgens interact in women’s metabolic health

• Why lifestyle habits still matter when using GLP-1 medications for weight loss

• How to preserve lean body mass during weight loss

• Different forms of testosterone therapy, including subcutaneous and intramuscular injections

• How estrogen and progesterone may influence testosterone through feedback mechanisms

• How poor sleep quality and hormonal changes contribute to menopause weight gain

• The complex effects of HRT on body composition, fat gain, and lean mass

• Why artificially high SHBG from medication can create hormone challenges

Why Androgens Matter for Women

Androgens are often thought of as “male hormones,” but women need them too.

Testosterone, DHEA, and DHT all play important roles in female health. They can influence libido, mood, motivation, muscle, strength, energy, metabolism, cognition, and sexual function.

In perimenopause and menopause, androgen levels and androgen availability can change. Some women feel flat, tired, unmotivated, weak, or disconnected from their sex drive. Others may have signs of androgen excess, such as acne, facial hair, hair thinning, or oily skin.

This is why hormone balance is not about chasing one number. It is about understanding the full hormone picture, including total hormones, free hormones, binding globulins, symptoms, metabolism, and individual sensitivity.

What Is SHBG and Why Does It Matter?

SHBG stands for sex hormone-binding globulin.

It is a protein that binds to sex hormones like testosterone and estrogen. When hormones are bound to SHBG, they are less available for the body to use.

This matters because a woman can have a “normal” total testosterone level but still have low free testosterone if SHBG is high.

High SHBG can sometimes contribute to symptoms such as low libido, low energy, poor motivation, reduced muscle, and feeling hormonally flat, especially if available hormone levels are too low.

On the other hand, very low SHBG may be associated with higher free androgens, insulin resistance, acne, hair growth, or other androgen-related symptoms in some women.

The goal is not simply high or low SHBG. The goal is balance.

Testosterone Therapy for Women: Benefits and Risks

Testosterone therapy can be helpful for some women, especially when low testosterone is contributing to low libido, fatigue, loss of muscle, poor motivation, low mood, or reduced sexual function.

But testosterone therapy needs to be done carefully.

Too much testosterone, or too much conversion to DHT, may contribute to unwanted side effects such as acne, oily skin, facial hair, hair thinning, irritability, or voice changes.

This is why dose, delivery method, labs, symptoms, and follow-up matter. Women should not be treated like small men. We need female-specific hormone care that respects both the benefits and the risks.

DHEA, DHT and DHT Blockers

DHEA is an adrenal androgen that can convert downstream into testosterone and estrogen. For some women, DHEA may support energy, mood, libido, and hormone balance. For others, it may worsen androgenic symptoms if they convert strongly toward testosterone or DHT.

DHT is a more potent androgen made from testosterone. In women who are sensitive to DHT, it may contribute to acne, facial hair, and androgen-related hair thinning.

DHT blockers may be considered when androgen-related symptoms are present. These can include natural options and prescription medications, depending on the person’s symptoms, labs, health history, and goals.

Menopause Weight Gain, Insulin and Androgens

Menopause weight gain is not just about willpower.

Hormonal shifts can affect insulin sensitivity, muscle mass, sleep, cravings, fat distribution, inflammation, and how the body responds to diet and exercise.

Insulin and androgens are also connected. When insulin is elevated, it can influence androgen activity and body composition. This is one reason metabolic health is such a critical part of hormone balance.

If a woman is gaining weight in menopause, it is important to look beyond calories and consider insulin, thyroid function, sleep, stress, muscle mass, sex hormones, and inflammation.

GLP-1 Medications and Lean Body Mass

GLP-1 medications can be powerful tools for some women struggling with weight loss, appetite, blood sugar, and metabolic health.

But medication alone is not the whole plan.

Women using GLP-1s need to be intentional about protein intake, strength training, nutrients, hydration, and preserving lean body mass. Losing weight without protecting muscle can create long-term problems for metabolism, strength, insulin sensitivity, and healthy aging.

The goal is not just a smaller body.

The goal is a healthier, stronger, more metabolically resilient body.

This Episode Is For You If:

• You are curious about testosterone therapy for women

• You want to understand DHEA, DHT, and androgen balance

• You have low libido, low motivation, fatigue, or reduced muscle in menopause

• You have androgen-related symptoms like acne, facial hair, or hair thinning

• You have been told your testosterone is “normal,” but you still feel off

• You want to understand SHBG and free testosterone

• You have used oral contraceptives or synthetic hormones and wonder how they affected your hormones

• You are struggling with menopause weight gain or body composition changes

• You are using or considering GLP-1 medications

• You want to preserve lean muscle while losing weight

FAQ Section

Are testosterone and DHEA important for women?

Yes. Women need androgens such as testosterone and DHEA for libido, energy, motivation, mood, muscle, metabolism, cognition, and overall vitality. The key is having the right balance and avoiding excessive androgen exposure.

What is DHT?

DHT, or dihydrotestosterone, is a more potent androgen made from testosterone. In some women, DHT may contribute to acne, facial hair, oily skin, and androgen-related hair thinning.

What is SHBG?

SHBG stands for sex hormone-binding globulin. It binds to hormones like testosterone and estrogen and affects how much hormone is available for the body to use.

Why does high SHBG matter?

High SHBG can bind up testosterone and estrogen, leaving less free hormone available. Some women with high SHBG may experience low libido, low energy, poor motivation, reduced muscle, or feeling hormonally flat, even if total hormone levels look normal.

Can oral contraceptives increase SHBG?

Yes. Oral contraceptives and some synthetic hormones can increase SHBG in some women. This may reduce free testosterone availability and contribute to symptoms such as low libido or reduced sexual function in certain women.

Can testosterone therapy cause facial hair or voice changes?

Testosterone therapy can cause androgenic side effects if the dose is too high or if a woman is sensitive to androgens. Possible side effects include acne, facial hair, hair thinning, oily skin, irritability, and in more concerning cases, voice changes.

What are DHT blockers?

DHT blockers are natural or prescription options that may help reduce DHT activity or conversion. They may be used in women with androgen-related symptoms such as hair thinning, acne, or unwanted facial hair, depending on the person’s labs and health history.

How does insulin affect androgens?

Insulin can influence androgen activity and hormone balance. Insulin resistance may contribute to higher androgen activity in some women and can also affect weight gain, cravings, inflammation, and body composition.

Why do women gain weight in menopause?

Women may gain weight in menopause because of changes in estrogen, progesterone, testosterone, insulin sensitivity, sleep, stress, thyroid function, muscle mass, and inflammation. Menopause weight gain is usually not just about calories.

Can GLP-1 medications help with menopause weight gain?

GLP-1 medications may help some women with appetite regulation, blood sugar, cravings, and weight loss. However, they should be paired with protein, strength training, sleep support, and a plan to preserve lean muscle mass.

How can women preserve muscle while losing weight?

Women can preserve muscle by eating enough protein, strength training consistently, getting enough essential nutrients, sleeping well, managing stress, and avoiding overly aggressive weight loss. This is especially important when using GLP-1 medications.