Understanding Insulin Resistance: What It Means for Your Hormones

Insulin resistance is something I talk about with my patients almost every day. It plays a role in so many hormonal conditions, yet many women have never heard of it or don’t fully understand what it means. I thought it was time to break it down.

If you have ever been told your blood sugar is “borderline” or “on the higher end of normal,” or if you have been struggling with stubborn weight gain, fatigue, or sugar cravings that just won’t quit, insulin resistance may be part of the picture.

What is Insulin?

Let’s start with the basics. Insulin is a hormone produced by your pancreas. Its primary job is to help your cells absorb glucose (sugar) from your bloodstream so that it can be used for energy. Think of insulin as a key that unlocks the door to your cells, allowing glucose to enter.

Every time you eat, especially carbohydrates, your blood sugar rises and your pancreas releases insulin to bring it back down. In a healthy system, this process works smoothly and efficiently.

So What is Insulin Resistance?

Insulin resistance happens when your cells stop responding to insulin as effectively as they should. Imagine that the locks on your cell doors have become a bit rusty. The key (insulin) still fits, but it takes a lot more effort to turn it. Your pancreas compensates by producing more and more insulin to get the job done.

The result? You end up with higher levels of insulin circulating in your blood, even though your blood sugar may still appear normal on a standard lab test. This is why insulin resistance can go undetected for years. Your fasting glucose might look fine while your insulin levels are working overtime behind the scenes.

Why Should Women Care About Insulin Resistance?

Here is where it gets really interesting, and why this topic comes up so often in my practice. Insulin doesn’t just regulate blood sugar. It has a significant influence on your other hormones as well.

The Androgen Connection

Elevated insulin levels can signal your ovaries to produce more androgens, like testosterone.¹ For women, this can contribute to symptoms like unwanted hair growth, acne, and hair thinning. This is one of the key mechanisms behind conditions like Polycystic Ovary Syndrome (PCOS), where insulin resistance is present in a large percentage of patients.²

Impact on Ovulation and Your Cycle

When insulin levels are chronically elevated, it can disrupt the delicate balance of LH and FSH, the hormones responsible for triggering ovulation. This disruption can lead to irregular or absent cycles, which is something I see frequently in my practice.

Weight and the Hormonal Feedback Loop

Insulin is also a storage hormone. When levels are high, your body is more likely to store fat, particularly around the midsection.³ This excess weight can in turn worsen insulin resistance, creating a frustrating cycle that can feel impossible to break through with diet and exercise alone.

Inflammation

Insulin resistance is also associated with increased levels of inflammation in the body.⁴ Chronic low-grade inflammation can worsen hormonal imbalances and contribute to fatigue, brain fog, and mood changes. These are symptoms that many of my patients describe during their first visit.

Common Signs of Insulin Resistance

While insulin resistance can be subtle, there are some common patterns that I look for:

• Difficulty losing weight, especially around the midsection
• Sugar and carbohydrate cravings
• Fatigue, especially after meals
• Brain fog or difficulty concentrating
• Skin tags
• Darkened skin patches (acanthosis nigricans), often on the neck or underarms
• Irregular menstrual cycles
• Feeling “hangry” or shaky between meals

It is important to note that not everyone with insulin resistance will experience all of these. Some women may only notice one or two of these patterns.

What Contributes to Insulin Resistance?

Insulin resistance is multifactorial, meaning there is usually more than one thing going on. Some of the common contributing factors include:

• Genetics: If insulin resistance or Type 2 diabetes runs in your family, you may be more predisposed.⁵
• Diet: A diet high in refined carbohydrates and processed sugars can drive insulin levels up over time.
• Sedentary lifestyle: Regular movement helps your cells stay sensitive to insulin. Without it, resistance can develop more easily.
• Stress: Chronic stress elevates cortisol, which in turn can raise blood sugar and contribute to insulin resistance.⁶
• Sleep: Poor sleep quality and insufficient sleep have been shown to decrease insulin sensitivity, even in otherwise healthy individuals.⁷
• Hormonal changes: Conditions that affect your hormones, like PCOS or the transition into perimenopause, can both contribute to and be worsened by insulin resistance.

How is Insulin Resistance Identified?

This is something I feel strongly about. A standard fasting glucose test alone is often not enough to catch insulin resistance in its early stages. By the time fasting glucose is elevated, insulin resistance may have been present for years.

More comprehensive testing can include:

• Fasting insulin levels, to see how hard your pancreas is working
• Hemoglobin A1c (HbA1c), a measure of your average blood sugar over the past 2-3 months
• Glucose and insulin together, because looking at these values in context with each other can provide a much clearer picture

This is one of the reasons I use optimal reference ranges in my practice rather than relying solely on conventional ranges. A value that falls within the “normal” range doesn’t always mean it’s optimal for you.

The Bigger Picture

What I find most important about insulin resistance is that it rarely exists in isolation. It is connected to your hormones, your energy, your weight, your cycle, your mood, and your long-term health. When I work with patients, addressing insulin sensitivity is often a foundational piece of the puzzle. It is not the only piece, but it is one that can make a significant difference in how everything else responds.

Understanding how your blood sugar and insulin interact with the rest of your body is a powerful first step. Knowledge is empowering, and I believe that the more you understand about how your body works, the better equipped you are to advocate for your own health.

If any of this resonated with you, I encourage you to have a conversation with a healthcare provider who is experienced in hormonal health and who will take the time to look at the full picture.

References:

• Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012;33(6):981-1030. doi:10.1210/er.2011-1034
• DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. Fertil Steril. 2005;83(5):1454-1460. doi:10.1016/j.fertnstert.2004.11.070
• Kahn BB, Flier JS. Obesity and insulin resistance. J Clin Invest. 2000;106(4):473-481. doi:10.1172/JCI10842
• Shoelson SE, Lee J, Goldfine AB. Inflammation and insulin resistance. J Clin Invest. 2006;116(7):1793-1801. doi:10.1172/JCI29069
• Warram JH, Martin BC, Krolewski AS, Soeldner JS, Kahn CR. Slow glucose removal rate and hyperinsulinemia precede the development of type II diabetes in the offspring of diabetic parents. Ann Intern Med. 1990;113(12):909-915. doi:10.7326/0003-4819-113-12-909
• Adam TC, Hasson RE, Ventura EE, et al. Cortisol is negatively associated with insulin sensitivity in overweight Latino youth. J Clin Endocrinol Metab. 2010;95(10):4729-4735. doi:10.1210/jc.2010-0322
• Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354(9188):1435-1439. doi:10.1016/S0140-6736(99)01376-8