GLP-1 and Hormone Therapy for Weight Loss

A common question I get is, you know, I want to lose weight and should I do hormone replacement therapy or these GLP1 agonists such as semaglutide or tirzepatide, also known as Wegovy, Ozempic, Zepbound in Manjiorno. That's a great question. And it's really probably not a one or the other. If you have hormone derangement, you can lose weight on these drugs, on the GLP1 agonist, but you're really fighting potentially the wrong battle. And if you go on hormone replacement therapy and you have metabolic dysfunction, obesity, syndrome X or, or metabolic syndrome, you're going to probably you're going to get some benefit clinically, might get some benefit with weight, but still maybe missing a key component. And I'll tell you that they are synergistic. So let's just go over this briefly. What hormone dysregulation can cause weight gain and how can hormones improve it? One would be thyroid, something that we don't clinically treat here, but hypothyroidism is associated with, you know, weight gain typically, and other symptoms as well. And this is something that's very easy to check. There's blood work for it, it's very easy to treat. There's medications that work, and there's certain controversies about what medications are the best, so I won't get into that. But if you're hypothyroid and you're overweight, you definitely should be treating your thyroid disease. How about testostero and estrogen, the sex hormones? So in menopause, which would be the classic example, or andropause, which is more or less a male menopause, this is where hormones, particularly testosterone, but also estrogen, decline. So women have about 20 times more testosterone than estrogen and men have about 10 times more testosterone than women. And the primary hormone that declines in menopause is testosterone, even though we think of it as estrogen. Estrogen is on both men and women, almost similar levels. Testosterone is much less in women than men, but way more testosterone than estrogen in women. And when women go into menopause, both estrogen and testosterone are favorable on weight loss or weight maintenance. So, for example, different studies over the years have looked at different forms of estrogen versus nothing in menopause and found that topical or subcutaneous estrogen is beneficial for weight maintenance or weight loss, over taking nothing in menopause, and superior to oral hormone replacement therapy for women. Testosterone as a standalone is effective for women for weight maintenance. The Largest study that I'm aware of for weight loss, specifically in perimenopausal women, was using testosterone as a single dose, 100 milligrams, which may not be the ideal dose. That's probably pretty close. So as a pellet in women that were in perimenopause around 50 years old, that were overweight, and there's another group that were placebos, in other words, getting nothing. At the end of six months, the women on testosterone had lost a little bit of weight and the women on nothing had gained a little bit of weight, which we typically see in menopause is weight gain. Unfortunately for men, we see the same thing. When your testosterone is low, you will put on fat, there's no doubt about that. You'll lose muscle mass, lose lean body mass and put on fat. And longitudinal studies and long term studies show that testosterone doesn't make the weight fall off, but it favors weight loss over the long haul. So the longer a man who is low testosterone is on testosterone replacement, the better his lean body mass gets and the lower his fat becomes. So there's no doubt that if you have hormone dysregulation, which is easy to test for in women, it's really obvious because they go through menopausal symptoms. Men is more subtle. Hormone replacement therapy will favor weight loss. And semaglutide or tirzepatide, the GLP1 agonists, independently help with weight loss. We like to look at this as a holistic standpoint. If you're overweight or obese and you want to lose weight, we should be addressing both your hormone status and your metabolic status in addition to your lifestyle. Now, exercise does help maintain weight. It's not great for losing weight, but does help maintain weight. So that's part of it. And obviously dietary intervention, there's all kinds of dietary options for people, but eating more calories than your body needs does favor weight gain. So dietary interventions, we recommend a Mediterranean diet, which seems to be the most. The Mediterranean diet is the most consistent diet for weight loss. Might not be the best, but it's most consistent. Exercise is very consistent for maintaining weight. Hormone replacement, hormone replacement therapy, particularly sex hormones and thyroid hormones, are effective for helping with weight maintenance if those hormones are not optimized or not are dysfunctional. And semaglutide is helpful for people who are over overweight or obese, pretty much regardless of hormone status, but it should not be done at the exclusion of managing the other words to say that in a different way, if somebody is eating terrible they're not exercising and they go on semaglutide. Yeah, they're going to lose some weight. Most likely our treatment failures, it's very rare, they're not going to lose a whole lot. And the ones that make some effort, people make some effort to change their diet, made more towards a Mediterranean diet, adding olive oil and cutting down on processed food and ultra processed food, those people will have the best outcome. And if they manage their hormones as well, their outcomes will be even better. So I think it's a little short sighted to just address these GLP1 agonists, semaglutide, tirzepatide, as standalones for weight. When we don't assess other lifestyle issues and other causative agents such as again thyroid or sexual hormone health, these are again very easy to test. Your family doctors probably checked it before. Doctors don't always check testosterone. It's not as, but it's very easy and inexpensive to test for. Probably costs less than $50 for the blood work and replacement is very simple. I've written a couple books on this subject. There's one for women called if your testosterone is strong enough for a man made for women and one for men called if your testosterone is low, you're going to get fat. So those are catchy titles signifying that testosterone is a hormone that doctors might take for granted, not routinely check when they're prescribing these GLP1 agonist drugs. Just like we might not really assess the person's lifestyle when we're prescribing GLP1 agonist drugs. And if we look at the studies themselves for these different drugs, there was a big variation in the amount of weight lost by individuals over a period of time. And there were some people lost very little weight, 5% of their weight, let's say, and people lost 30% of their body weight over a given period of time. And the people who lost the most weight, very likely, although the studies did not track this, had the biggest intentional efforts. In fact, when we see the long term studies where they took people off of their GLP1 agonists, the people that lost the most weight during the run in with the drugs were most likely to keep the weight off. And the people that lost the least amount of weight pretty much gained it all back. This led to the conclusion, well, if you stop these drugs, you gain all the weight back. Well, not really. If you made some efforts, you really don't have to take this stuff forever. And we've proven internally that this might be something that you take periodically, even microdosing to keep the weight off. You don't need to take the high dose of the GLP1 agonists long term to keep the weight off. And we should be assessing the status of our sex hormones and our thyroid hormones.