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How Menopause Turns Women Into SWANs

Okay, I just couldn’t resist this headline – I hope my female readers will forgive this tongue-in-cheek title after they read the rest of the story.

The acronym “SWAN” simply refers to the Study of Women’s health Across the Nation (SWAN) Fat Patterning Study, results of which are now published in a paper by Imke Janssen and colleagues from the Rush University Medical Centre in Chicago, in this month’s issue of OBESITY.

This study examined the relationship between the male hormone testosterone and the accumulation of visceral fat (VF) in 359 women (47.2% black), aged 42-60 years randomly selected from the community. VF was measured using computer tomography.

Bioavailable testosterone levels were strongly associated with the amount of VF independent of age, race, percent total body fat, and other cardiovascular risk factors.

This study suggests that the previously described tendency for women to develop visceral adiposity as they go through menopause is probably related to an increase in biologically active testosterone levels that happens during the menopausal transition.

As readers of these postings are probably well aware, male-pattern abdominal or belly fat deposition is a strong risk factor for the development of diabetes, hypertension, and other cardiometabolic risk factors. In contrast, female-pattern or lower-body obesity appears to be less dangerous and has even been associated with reduced risk of metabolic disease.

This study links the increased bioavailability of the male hormone testosterone to the change in fat patterning observed during menopause.

Interestingly, these higher levels of bioavailable (or bioactive) testosterone after menopause are not due to an increase in testosterone production but rather due to a decrease in sex-hormone binding-globulin (SHGB), possibly resulting from the menopausal decline in estrogen levels (a powerful stimulator of SHBG).

(SHBG, as the name implies, normally binds testosterone, thereby rendering it biologically inactive – the less SHBG there is to bind testosterone, the more free testosterone there is around to do its thing)

Of course, as a cross-sectional study, it is not possible to completely rule out the fact that other factors may lead to the accumulation of visceral fat, which in turn may lead to hormonal changes like higher insulin levels, which can also reduce SHBG levels.

However, given the fact that fat precursor cells are known to have androgen (testosterone) receptors, the testosterone hypothesis certainly merits consideration.

Whatever the precise mechanism, it certainly appears that menopause increases the risk of visceral fat accumulation and thus brings women closer to the cardiometabolic risk profile normally seen in men.

Edmonton, Alberta


  1. Dr Sharma,
    Could you help me understand this please?
    In the March of 1999 a special menopause supplement issue of the “American Journal of Obstetrics and Gynecology” recommends the addition of androgen (testosterone) to estrogen for all women undergoing surgical menopause. It also suggests the use of androgen therapy may be beneficial to women who experience loss of libido and other symptoms of testosterone deficiency during natural menopause.
    It further explains that testosterone provides several benefits to women:
    • improves relief of vasomotor symptoms of menopause
    • increases energy levels
    • enhances of feelings of well-being
    • improves sexual desire
    • increases the frequency of coitus
    • enhances orgasm
    Now ten years later, testosterone hypothesis is discussed and you say “However, given the fact that fat precursor cells are known to have androgen (testosterone) receptors, the testosterone hypothesis certainly merits consideration”
    That said, how can we measure risk /benefit of use of testosterone therapy in post menopausal women specially those with hypoactive sexual desire disorder (HSDD)? Do we use it or do we not?

    BTW. Thanks for the wonderful post, beautiful title and the picture.

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  2. Aema: I guess testosterone may do all of these good things and still increase visceral fat.

    Things are probably a lot more complex than the article makes them out to be. In men, lack of testosterone leads to increased visceral fat – sometimes treated with androgens – so go figure 🙂


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  3. Hi Dr. Sharma;

    Ok lunch bag let down I was really looking for a pearl on my 46th birthday. I will have to settle for being 100 lbs less since the last time you saw me. It has been almost 2 years since my banding, best thing I ever did.

    All the best,


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