0:00 – 34:00
Insulin resistance is the silent variable in hormone practice. Elevated insulin affects aromatization, inflammation, visceral adiposity, and symptom expression in both men and women. If you optimize hormones without addressing insulin, you are building on sand. Testosterone and estrogen pathways do not operate in isolation from metabolic health. I see patients labeled as hormone failures who are actually insulin-dominant. Workup should include fasting insulin where available, glucose markers, waist trend, blood pressure, and lifestyle history. GLP-1 therapies now belong in the conversation for appropriate patients. Hormones and metabolism are one conversation. Teach it that way.