Sex Hormones and Health

Over 50% of men with Type 2 diabetes have lower than normal testosterone[1] (T) levels. Men with Type 1 also tend to have low T levels[2]. Now research shows that women with diabetes often have low levels of estrogen[3] (E), and that raising E protects against kidney and heart disease in this population.

This sex hormone/diabetes connection may be very deep. In our current column on sex and diabetes[4], my partner and I reported on how raising T levels can help with insulin resistance[5] (IR), lower cholesterol[6], and improve glucose control.


Then I found some research from Georgetown[7] researchers Shannon Sullivan, MD, and Christine Maric, PhD. They report that, among people without diabetes, men have much more kidney disease than women. But in people with diabetes, women and men have a more similar rate of kidney disease.

Estrogens and Diabetes
Women with diabetes tend to have too little estrogen and/or too much testosterone (a “low E:T ratio”). Sullivan and Maric say this lack of estrogen is associated with increased kidney disease and worse outcomes.

Sullivan and Maric report on data showing that postmenopausal women with Type 2 improved their glucose control with hormone replacement. Supplementing low-E women with the hormone 17-β-estradiol reduced the incidence of diabetes and protected against diabetic kidney disease. This is similar to reports on testosterone for men[8].

Sullivan and Maric say that, “Diabetic women reach menopause earlier than non-diabetics, suggesting lower baseline E levels.” They also point out that in the rat version of Type 2,[9] females have lower estrogen levels compared to females without diabetes.

The value of hormone replacement therapy (HRT) for women has been questioned recently. But HRT still seems to prevent heart disease[10] in women with diabetes.

A large study at Kaiser (with over 22,400 women) showed a 16% reduction in heart attack risk[11] for those taking hormones who had not had a recent heart attack — a 25% reduction if taking both progesterone and estrogen and a 12% reduction in women taking only estrogen.

What This Means for Us
So what is going on here? How can sex hormones affect diabetes, and vice versa? The answers may take us into the deep social and spiritual causes of diabetes and other metabolic illness.

In conducting research for my piece on T, I came across an article called “Maintaining Healthy Levels of Testosterone,”[12] by Richard Cohen, MD. Cohen works mostly with bodybuilders who like high levels of T, because T helps build muscle mass.

Why listen to a bodybuilder about diabetes? Because the same things he says about building muscle also apply to reducing IR. (Strength training in itself reduces IR[13].) And quite probably, the same things he says about T levels also apply to E levels.

Cohen’s message is that too much stress, along with the wrong kinds of food and physical activity, lower people’s level of T. And we know that lower hormone levels are strongly associated with diabetes and other metabolic diseases[14].

That means that the harder your life is (the higher your stress), the more likely you are to have low T or E, to have diabetes, and to have it progress faster. But possibly, raising hormone levels is part of a strategy that will give us happier lives and more control of diabetes.

Raising Hormone Levels
I figured Cohen would be going on about supplements and prescriptions, but he focused on diet, exercise, stress, and rest. Cohen says that, chronic stress[15] “is not only the greatest cause of premature aging and cardiovascular disease but it severely inhibits testosterone function, making it almost impossible to build muscle and strength.”

Why would stress lower T levels? Think about it. Stress is our bodies’ natural response to threat[16]. If the body feels threatened, it focuses on survival, not reproduction. So it doesn’t want testosterone. And if you’re a stressed woman, why bother with estrogen? You don’t want to be sexual. You don’t want babies when you’re scared or exhausted.

Fatigue is a physical stress. That is why overtraining and overworking are bad for bodybuilders and people with diabetes. Most of our readers probably don’t overtrain, but many of us do overwork. Cohen says that, “Frequent extended training doesn’t allow for repair and recovery of testosterone.” Shorter, more intense exercise[17] is better — some studies show that very short bursts[18] (ten minutes or less) are enough.

This doesn’t just apply to bodybuilders. Cohen says that among construction workers, those who “lift moderate loads all day are frequently listless and tired and not as strong and muscular as their co-workers who perform less frequent but more intense activity.”

Diet and Hormones
Hunger is a major source of stress. Bodies need quality food to feel safe, not just empty carbs. Dr. Cohen points out that a diet moderate in fat and protein is vital to T levels. “If your diet is very low in fat and high in complex carbohydrates and fiber, your testosterone levels may remain very low.”

The types of fats and proteins Cohen endorses are Mediterranean-style[19]: fish, nuts, and olive oil, for example.

I’m going to write more about these issues, and I would like to hear from you. When I think of those construction workers “lifting moderate loads all day,” it seems a perfect metaphor for many lives. Just working, working, not having time to rest or to feel the joy of vigorous activity. Feeling stressed because you have to do this job you don’t like. Just being worn down, with your sex hormone levels dropping, because who has time and energy for reproduction? And your cells becoming insulin resistant, because they’re stressed and not doing much with the glucose anyway.

I’m afraid that most people’s lives are too much like that. That’s one way our social environment causes diabetes. It’s not our fault. But what can we do about it? I have some ideas, but what do you think?

  1. lower than normal testosterone:
  2. have low T levels:
  3. low levels of estrogen:
  4. column on sex and diabetes:
  5. insulin resistance:
  6. cholesterol:
  7. research from Georgetown:
  8. testosterone for men:
  9. rat version of Type 2,:
  10. heart disease:
  11. reduction in heart attack risk:
  12. “Maintaining Healthy Levels of Testosterone,”:
  13. reduces IR:
  14. metabolic diseases:
  15. chronic stress:
  16. response to threat:
  17. more intense exercise:
  18. very short bursts:
  19. Mediterranean-style:

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David Spero: David Spero has been a nurse for 40 years and has lived with multiple sclerosis for 30 years. He is the author of four books: The Art of Getting Well: Maximizing Health When You Have a Chronic Illness (Hunter House 2002), Diabetes: Sugar-coated Crisis — Who Gets It, Who Profits, and How to Stop It (New Society 2006, Diabetes Heroes (Jim Healthy 2014), and The Inn by the Healing Path: Stories on the road to wellness (Smashwords 2015.) He writes for Diabetes Self-Management and Pain-Free Living (formerly Arthritis Self-Management) magazines. His website is His blog is

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