Hormone Replacement Therapy and Weight Loss
Hormone Replacement Therapy (HRT) is a common treatment for both women and men that has raised significant controversy over the last 20 years. There are many reasons why someone may pursue or be recommended to be treated with HRT. The most common for women are the symptoms associated with menopause which include hot flashes and night sweats. Men are more frequently treated for feelings of fatigue, poor sleep, erectile dysfunction and low energy. There are many ways to treat someone with hormones including FDA approved formulations requiring prescription, compounded medications that require a prescription but are not FDA regulated and a bioidentical dosing of either mode of formulation. There are also numerous non-FDA, non-prescription nutraceuticals claiming to provide the same result without oversight, physician involvement or evidence to support their claims. A nice review of bioidentical hormones can be found here for a more in depth look at the landscape of HRT.
As specialists and experts in the field of weight loss we have investigated the use of HRT specifically for purpose of losing excess weight. I was unable to find a single study looking specifically at the target of weight loss for HRT. So, while HRT and optimizing hormones may result in subtle weight treatment goals are not for weight loss specifically. It does not appear that HRT, Bioidentical Hormones or any other hormone therapy should be used for weight loss exclusively. I recently published a blog on hCG (Human Chorionic Gonadotropin) which is a common hormone therapy for weight loss. It can be found here. The blog explains that the evidence clearly demonstrates no benefit of the hormone treatment and there is associated risk. The approach is also paired with a severe calorie restriction diet which leads to challenging weight maintenance as I discuss in both the hCG blog and this one. However, I did uncover some compelling evidence to explore hormone treatment after body composition is optimized that is worth discussing here.
This 2012 randomized controlled trial was designed to evaluate three approaches to weight loss. Calorie restriction and a low-fat diet alone, calorie restriction and a low-fat diet combined with an exercise regimen and exercise alone compared with controls. This study did not evaluate hormones in the original trial but the follow up did. This trial is worth looking at because it is another example of the limited benefit of calorie restriction as a weight loss tool and more so the profound ineffectiveness of exercise for weight loss. The exercise alone arm failed to demonstrate significant weight loss compared to controls. The diet alone group failed to achieve the meager goal of a 10% reduction in weight and over 10% of the weight they did lose was in lean muscle mass. Lean muscle mass preservation is critical for successful weight maintenance. The combined diet and exercise group did achieve the 10% weight loss goal with less loss of lean muscle compared to diet alone. This supports the commonly believed idea of “eat less and move more” being the recipe for success. However, let’s look at the long-term results in the follow up study to see why this dogma should changed.
The 2019 follow up study looked at the same participants 18 months after the start of the previous study. This was in addition to the 12-month duration of the first study for a total of 30 months after the start of their program. The purpose of this study was to evaluate the hormone levels of the participants after weight loss with the hypothesis that their estrogen levels would be reduced and that this should protect them from obesity related cancers such as breast cancer. The data can also be examined to review the success of their weight loss in maintenance and their circulating hormone levels compared to non-obese standards.
Unfortunately, with the data presented you cannot tell exactly what the maintenance success rate was, but you can get an idea. Over 230 participants lost close to an average of 10% of their body weight. In the follow up only 30 were still classified in the >10% weight loss category. If we assume a normal distribution at least 118 should have been in this category at the end of the first trial. That would mean that only 25% of participants were able to maintain their >10% weight loss. Without the raw data and 100% follow up I cannot be certain that this is true, but these numbers would be consistent with other studies and our anecdotal experience at PHD. There was also noted bias in those that did participate in the follow up study. These participants had a lower BMI and more muscle mass to start. This means that a 10% weight loss may have put them closer to or in line with a body composition that would support maintenance.
Regarding circulating hormones, they failed to demonstrate statistically significant reduction in circulating androgen hormones at 30 months from baseline. Interestingly, they did find reductions at 12 months with a linear correlation to percent weight reduction. Meaning that the more a participant lost the more their hormone levels changed. The failure to continue to demonstrate the improvement at 30 months may be due to the failure to maintain weight loss or demonstrate rebound levels due to homeostasis mechanisms within the body.
So, what does this all mean and how does it relate to PHD clients or those that have let go of weight and successfully maintained their weight loss? These studies demonstrate that hormone levels do change as a result of weight loss. The effects of weight loss on the body are profound and every system and cell can feel the improvement. Hormonal regulation is complex, sensitive and subtle changes will affect how you feel. If you have optimized your body composition, nutrition, sleep hygiene and stress reduction strategies but still feel something is off testing your hormone levels may be appropriate. Treatment with some kind of hormone replacement will likely be temporary as your body adjusts to its new set point. The improvement in mood and energy may help in weight maintenance for those with symptomatic hormone abnormalities.
Symptoms of hormone imbalance include but are not limited to low energy, poor sleep, moodiness, fatigue, lack of motivation and low libido for both men and women. Women specifically may experience abnormal menstrual cycles and post-menopausal women may experience hot flashes and night sweats. If you are experiencing these symptoms and have optimized your body composition, nutrition, sleep and stress habits I would encourage you to discuss options and risks with your physician health team. If you would like to look outside of your team we have partnered with Renew Life Rx. They are a telemedicine-based organization that will evaluate lab work and set you up with recommendations from their specialized physicians for treatment. Renew Life Rx offers a discount to PHD clients so please use the link below to get 50% off of your initial lab work and consultation. As always discuss any changes in medications to your primary physician team before starting any new program!
Renew Life Rx
50% off code: PHD50
Supporting your Performance, Health, Diet, PHD
Douglas E Lucas, DO
Chief Science Officer
PHD Weight Loss and Nutrition