Does hormone replacement therapy (HRT) cause weight gain, or is something else going on?
I get this question all the time, and the truth isn’t a simple yes or no.
At Viking Medical Group, I’ve helped tons of patients like you through hormone therapy. In this article, I’ll explain how HRT works, how hormone levels affect your metabolism, and what you can do to manage your weight while still getting the full benefits of HRT.
Feeling off and not sure if HRT would help? Book an appointment with Viking Medical Group. We’ll assess your concerns and recommend the best treatment plan to help you feel like yourself again.
What Is HRT, and What Is It Used For?
Hormone replacement therapy, although I prefer to call it hormone rebalancing therapy, helps us achieve the best results for our body, restoring balance and proper function.
We use HRT not only to alleviate symptoms of aging, but more importantly to correct the unbalancing of hormones that happens as we get older. By restoring that balance, we can reduce symptoms and help you feel better.
With HRT, we increase hormones that naturally decrease with age, such as:
- Testosterone
- Estrogen
- DHEA
While we focus on these, there are a lot of other hormones we can target depending on your individual needs.
How Does Menopause Affect Weight Gain?
When women go through menopause, their basal metabolic rate tends to drop. This is one of the main reasons why women tend to gain weight during this time, especially in the form of a “menopause belly.”
The same phenomenon occurs in men as well, what we often call the “spare tire.” The decreased metabolic rate causes the body to burn food at a slower rate, so it stores excess energy as fat. This makes it harder to lose weight, even with exercise.
A lack of testosterone usually causes an increase in weight. As we age, testosterone naturally declines, which affects our ability to:
- Burn fat
- Build muscle
- Convert food into energy
So, testosterone deficiency can be a symptom of menopause. We actually make estrogen from testosterone, so if you have a lack of testosterone, you’re going to have a lack of estrogen as well.
This will cause low estrogen symptoms, but it will also lead to low testosterone symptoms. You can exercise, but you won’t be putting on any weight or building any muscle, because you don’t have the testosterone signaling your body to do that.
So, Does HRT Actually Cause Weight Gain?
That’s a great question, and the answer depends on how we define weight gain.
Muscle vs. Fat
There are two key components of weight that we get concerned about: muscle and fat.
As I mentioned, low testosterone slows down your basal metabolic rate, which increases fat storage. Fat also stores estrogens, toxins, and other substances that can contribute to higher blood pressure and other health issues.
As we replace and rebalance your hormones and get your testosterone back to a normal level, you’ll start to see a change in body composition:
- An increase in muscle mass
- A decrease in fat mass
But since muscle is heavier than fat, you may see a short-term increase in weight until your basal metabolic rate, which goes up with hormone therapy, helps to burn off that extra fat.
Studies show that testosterone therapy, when done correctly, does not directly cause weight gain.
What About Bloating?
Bloating may occur when estrogen levels get too high, especially in comparison to testosterone levels. Just like women who bloat around their menstrual cycle, bloating is usually caused by a hormonal imbalance, not actual weight gain.
It can feel like weight gain, but it’s not the same. The good news? Once we get your hormone levels balanced correctly, the bloating usually resolves on its own.
How HRT Can Indirectly Affect Your Weight
HRT can affect weight in indirect ways:
Water Retention
As I mentioned, bloating or water gain is not really weight gain. It’s usually just an excess of water, which is easily fixed with changes in diet and hormonal balance.
Fat Redistribution
Think about it: if you’ve been deficient in your hormones for a long period of time, which is usually the case before people figure out it’s their hormones, you’ve probably lost muscle mass and experienced a change in body composition. That’s where we see the menopause belly in women and the spare tire in men.
As we rebalance your hormones, that fat should burn off, because the body uses more resources to maintain muscle. You’ll start to put on muscle when we start HRT and get the balance right. That muscle will help to burn off the fat, which changes your body composition.
Weight Management Strategies on HRT
HRT can support weight loss, but it’s not a replacement for healthy habits. Here’s what I recommend:
- Eat a balanced diet
- Exercise regularly
- Manage stress levels
- Get a good night’s sleep
Stress, in particular, is a huge factor. It raises cortisol levels (another hormone we monitor), which can increase bloating and fat storage. Managing stress and getting good sleep can make a major difference in how your body responds to HRT.
Should You Combine HRT with Weight Loss Medications?
That’s another great question. And the usual answer is: maybe.
I usually recommend starting with HRT alone. Once your hormones are balanced, your body may respond well enough that you feel motivated, energized, and ready to exercise without needing any additional medications.
However, if after balancing your hormones you’re still struggling to lose weight despite an active lifestyle, we may consider using weight loss medications.
Are There Risks in Combining the Two?
Not any more than there are with taking them individually.
They don’t interact with each other very much in terms of how they move through our body and what systems they’re affecting.
In general, weight loss medications work on one hormone system, and hormone replacement therapy is more directed toward testosterone, estrogens, and DHEA. So they’re working on different systems in the body.
Weight Gain on HRT: When to Talk to Your Doctor
If you’re concerned about weight gain while on HRT, don’t hesitate to reach out to your provider.
If you experience sudden weight gain, bloating, or discomfort after starting HRT, your provider may:
- Adjust your hormone levels or ratios
- Review your diet and exercise habits
- Monitor for other causes of bloating or discomfort
We’ll listen to your concerns and adjust your treatment accordingly for the best results.
Feel Like You Again with HRT from Viking Medical Group
If you’re considering HRT and want to learn more about how it might affect your weight, book an appointment at Viking Medical Group. We’ll assess your concerns and create a custom treatment plan to restore balance to your body and mind.