Fundamentals
Have you ever felt a persistent dullness, a subtle shift in your body’s rhythm that defies easy explanation? Perhaps a lingering fatigue, an unexpected weight gain around your midsection, or a sense that your vitality has diminished? These experiences are not merely isolated occurrences; they often signal a deeper conversation happening within your biological systems.
Your body communicates through a complex network of chemical messengers, and when these signals become distorted, the effects ripple across your entire well-being. Understanding these internal dialogues, particularly the interplay between metabolic function and hormonal balance, represents a powerful step toward reclaiming your optimal self.
The intricate dance of your endocrine system orchestrates nearly every physiological process, from energy regulation to mood stability. When this delicate balance is disrupted, symptoms can manifest in ways that feel both frustrating and confusing. Many individuals attribute these changes to aging or daily stressors, overlooking the profound impact of metabolic health on their hormonal landscape.
This exploration aims to clarify the connections, offering a framework for recognizing how insulin resistance, a common metabolic challenge, can profoundly influence the body’s hormonal symphony.
The Body’s Energy Management System
At the core of metabolic health lies the hormone insulin, a critical regulator produced by the pancreas. Insulin’s primary role involves facilitating the uptake of glucose, your body’s main energy source, from the bloodstream into cells. It acts as a key, unlocking cellular doors to allow glucose entry for immediate energy use or storage as glycogen in the liver and muscles.
This process ensures stable blood sugar levels, preventing both excessive highs and lows. When this system functions optimally, your cells readily respond to insulin’s signal, efficiently managing glucose.
However, a condition known as insulin resistance can develop, where cells become less responsive to insulin’s directives. Imagine a key that no longer fits its lock perfectly; the pancreas must then produce increasing amounts of insulin to achieve the same effect. This leads to elevated insulin levels in the bloodstream, a state known as hyperinsulinemia. Over time, this constant demand can exhaust the pancreas, potentially leading to higher blood glucose levels and, in some cases, the development of type 2 diabetes.
Insulin resistance occurs when cells diminish their responsiveness to insulin, prompting the pancreas to produce more of this hormone to maintain blood sugar equilibrium.
Hormonal Communication and Interconnectedness
The endocrine system operates as a sophisticated communication network, where various hormones influence one another in a continuous feedback loop. Hormones are chemical messengers, traveling through the bloodstream to deliver specific instructions to target organs and tissues. This systemic interconnectedness means that a disturbance in one hormonal pathway can cascade, affecting others. Insulin, being a major metabolic hormone, exerts a significant influence on the balance of other endocrine messengers, including sex hormones, thyroid hormones, and cortisol.
Consider the hypothalamic-pituitary-adrenal (HPA) axis, often termed the body’s stress response system. Insulin resistance can place additional stress on this axis, leading to elevated levels of cortisol, the primary stress hormone. Chronic cortisol elevation, in turn, can worsen insulin resistance, creating a self-perpetuating cycle. This dynamic illustrates how metabolic and stress responses are deeply intertwined, affecting energy storage, fat distribution, and overall systemic balance.
Initial Signs of Imbalance
Recognizing the early indicators of insulin resistance and hormonal shifts is paramount for proactive health management. Many individuals report a persistent struggle with weight, particularly around the abdomen, despite efforts in diet and exercise. This central adiposity is often a visual cue of metabolic dysfunction. Other common experiences include persistent fatigue, even after adequate sleep, and a general feeling of being “off.”
For women, irregular menstrual cycles, unexplained mood changes, or challenges with fertility can signal underlying hormonal disruptions. Men might notice a decline in energy, reduced muscle mass, or a diminished sense of well-being. These symptoms, while seemingly disparate, frequently point to a common root ∞ a system struggling to maintain its internal equilibrium due to metabolic stress. Addressing these foundational imbalances offers a pathway to restoring vitality and function.
Intermediate
Moving beyond the foundational understanding, we can now examine the specific mechanisms by which insulin resistance directly influences the intricate web of hormonal regulation. The body’s endocrine glands, including the gonads, thyroid, and adrenals, do not operate in isolation. Their function is highly sensitive to metabolic signals, particularly those conveyed by insulin. When insulin signaling becomes dysregulated, a cascade of effects can compromise the production, conversion, and utilization of other vital hormones.
Insulin’s Influence on Sex Hormones
Insulin resistance exerts a significant impact on the balance of sex hormones, including testosterone, estrogen, and progesterone. This influence is particularly pronounced in the context of reproductive health and overall vitality for both men and women. The pancreas’s struggle to manage glucose levels directly affects the gonads, leading to various clinical presentations.
In women, insulin resistance is a primary driver of Polycystic Ovary Syndrome (PCOS), a common endocrine disorder. Elevated insulin levels stimulate the ovaries to produce excess androgens (male hormones), such as testosterone. This androgen excess can lead to symptoms like irregular menstrual cycles, anovulation, hirsutism (excess body hair), and acne. The increased androgen production, coupled with the metabolic dysfunction, creates a complex clinical picture that requires a comprehensive approach.
Moreover, insulin resistance often correlates with increased body fat, especially visceral fat located around abdominal organs. Adipose tissue, far from being inert storage, functions as an active endocrine organ. These fat cells possess the enzyme aromatase, which converts androgens into estrogens.
An increase in fat mass can therefore lead to higher estrogen levels, potentially contributing to a state of estrogen dominance relative to progesterone, particularly in women approaching or navigating perimenopause. This imbalance can exacerbate symptoms such as mood changes, breast tenderness, and heavy bleeding.
For men, insulin resistance can contribute to lower testosterone levels. Chronic hyperinsulinemia may directly suppress testicular testosterone production. Additionally, increased body fat, driven by insulin resistance, leads to higher aromatase activity, converting more testosterone into estrogen. This shift in the testosterone-to-estrogen ratio can result in symptoms such as reduced libido, diminished muscle mass, increased body fat, and fatigue, mirroring many of the complaints associated with low testosterone.
Thyroid and Adrenal Connections
The thyroid gland, responsible for regulating metabolic rate, is also susceptible to the ripple effects of insulin resistance. While the relationship is complex and bidirectional, chronic metabolic stress can impair thyroid hormone conversion and receptor sensitivity. Individuals with insulin resistance may experience symptoms consistent with suboptimal thyroid function, even if standard thyroid panel results appear within the “normal” range. These symptoms include persistent fatigue, cold intolerance, and weight gain.
The adrenal glands, producers of cortisol, are intimately linked with insulin dynamics. As previously noted, insulin resistance can activate the HPA axis, leading to sustained elevated cortisol. This chronic stress response can deplete precursors needed for other steroid hormones, including progesterone, which can be shunted towards cortisol production. This phenomenon, sometimes termed “progesterone steal,” further contributes to hormonal imbalances, affecting mood, sleep, and reproductive function.
Clinical Protocols for Hormonal Recalibration
Addressing the interconnectedness of insulin resistance and hormonal imbalances requires a comprehensive strategy that often includes targeted clinical protocols. These interventions aim to restore metabolic sensitivity and rebalance the endocrine system.
Testosterone Optimization Protocols
For men experiencing symptoms of low testosterone linked to metabolic dysfunction, Testosterone Replacement Therapy (TRT) can be a vital component of a wellness plan. A common protocol involves weekly intramuscular injections of Testosterone Cypionate (200mg/ml). To maintain natural testicular function and fertility, Gonadorelin, administered via subcutaneous injections twice weekly, is often included. Gonadorelin stimulates the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which in turn signal the testes to produce testosterone and sperm.
To manage potential conversion of testosterone to estrogen, an aromatase inhibitor like Anastrozole may be prescribed orally twice weekly. This helps mitigate estrogen-related side effects such as gynecomastia or water retention. In some cases, Enclomiphene, a selective estrogen receptor modulator (SERM), may be added to support LH and FSH levels, particularly for men seeking to preserve fertility, as it stimulates endogenous testosterone production without suppressing spermatogenesis.
Women also benefit from testosterone optimization, especially those experiencing symptoms like low libido, persistent fatigue, or mood changes, often exacerbated by metabolic shifts. Protocols for women typically involve lower doses of Testosterone Cypionate, around 10 ∞ 20 units (0.1 ∞ 0.2ml) weekly via subcutaneous injection. Progesterone is prescribed based on menopausal status, supporting hormonal balance and mitigating potential estrogen dominance. Some women opt for pellet therapy, which provides long-acting testosterone, with Anastrozole considered when appropriate to manage estrogen levels.
Personalized hormonal protocols, including testosterone optimization and peptide therapies, aim to restore systemic balance by addressing underlying metabolic dysregulation.
Growth Hormone Peptide Therapy
Peptide therapies offer another avenue for metabolic and hormonal support, particularly for active adults seeking anti-aging benefits, improved body composition, and enhanced recovery. These peptides work by stimulating the body’s natural production of growth hormone (GH) or by directly influencing metabolic pathways.
Key peptides include Sermorelin, Ipamorelin / CJC-1295, Tesamorelin, Hexarelin, and MK-677. These compounds, often administered via subcutaneous injection, stimulate the pituitary gland to release GH in a pulsatile, physiological manner. While GH itself can influence insulin sensitivity, these peptides are utilized to support lean muscle mass, reduce adiposity, improve sleep quality, and enhance cellular repair, all of which indirectly support metabolic health.
Other Targeted Peptides
Beyond growth hormone-releasing peptides, other specialized peptides address specific aspects of well-being that can be compromised by metabolic and hormonal imbalances.
- PT-141 (Bremelanotide) ∞ This peptide targets melanocortin receptors in the central nervous system, specifically the hypothalamus, to stimulate sexual desire and arousal. It offers a unique approach to sexual health, working on the brain’s pathways rather than directly on vascular function, making it suitable for individuals whose libido is affected by systemic imbalances.
- Pentadeca Arginate (PDA) ∞ This synthetic peptide is gaining recognition for its tissue repair, healing, and anti-inflammatory properties. It supports cellular regeneration, enhances nitric oxide production, and promotes angiogenesis, which can be beneficial for recovery from injuries and overall tissue integrity, aspects often compromised in states of chronic inflammation linked to metabolic dysfunction.
These protocols represent a clinically informed approach to recalibrating the body’s internal systems. By addressing the root causes of metabolic and hormonal dysregulation, individuals can experience a restoration of energy, improved body composition, and a renewed sense of vitality. The selection and dosing of these agents are always personalized, based on comprehensive laboratory assessments and individual physiological responses.
Comparing Hormonal Optimization Approaches
The choice of hormonal optimization strategy depends on individual needs, symptoms, and specific laboratory findings. A comparative understanding of common approaches helps clarify their distinct applications.
| Therapy Type | Primary Mechanism | Targeted Conditions | Key Considerations |
|---|---|---|---|
| Testosterone Replacement Therapy (TRT) | Exogenous testosterone administration to restore physiological levels. | Low testosterone in men (hypogonadism), female hormone balance (low-dose T). | Requires regular monitoring of blood levels; potential for estrogen conversion; fertility preservation (with Gonadorelin/Enclomiphene). |
| Gonadorelin | Stimulates endogenous LH/FSH release from pituitary. | Secondary hypogonadism, fertility support, testicular atrophy prevention during TRT. | Maintains natural production; requires consistent administration. |
| Enclomiphene | Selective Estrogen Receptor Modulator (SERM); blocks estrogen receptors in hypothalamus/pituitary. | Secondary hypogonadism in men (especially with fertility concerns). | Increases endogenous testosterone; avoids exogenous hormone use. |
| Growth Hormone Peptides | Stimulate natural growth hormone release from pituitary. | Anti-aging, muscle gain, fat loss, sleep improvement, recovery. | Mimics physiological GH release; diverse benefits for body composition and cellular health. |
Academic
The deep interconnectedness between insulin resistance and hormonal imbalances extends to the most fundamental levels of cellular signaling and systemic regulation. A truly comprehensive understanding requires examining the intricate molecular pathways and feedback loops that govern endocrine function and metabolic homeostasis. This section will delve into the sophisticated endocrinology and systems biology that underpin these relationships, moving beyond surface-level descriptions to explore the profound interplay of biological axes and metabolic pathways.
The Hypothalamic-Pituitary-Gonadal Axis and Metabolic Crosstalk
The Hypothalamic-Pituitary-Gonadal (HPG) axis represents a central regulatory system for reproductive and steroid hormone production. The hypothalamus releases gonadotropin-releasing hormone (GnRH) in a pulsatile manner, signaling the pituitary gland to secrete luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
These gonadotropins then act on the gonads (testes in men, ovaries in women) to stimulate the production of sex steroids, such as testosterone, estrogen, and progesterone. This axis operates under a delicate negative feedback mechanism, where rising sex hormone levels inhibit GnRH and LH/FSH release.
Insulin resistance disrupts this finely tuned system through multiple avenues. Chronic hyperinsulinemia can directly affect the sensitivity of GnRH neurons in the hypothalamus, altering the pulsatile release of GnRH. In the ovaries, elevated insulin acts as a co-gonadotropin, synergizing with LH to stimulate androgen production by the theca cells, a hallmark of PCOS. This leads to a state of functional ovarian hyperandrogenism, where the ovaries produce excess male hormones.
In men, the Leydig cells in the testes, responsible for testosterone synthesis, possess insulin receptors. While insulin is generally anabolic, chronic hyperinsulinemia associated with insulin resistance can paradoxically impair Leydig cell function, leading to reduced testosterone output. This effect is compounded by increased aromatase activity in adipose tissue, which converts testosterone into estrogen. The resulting lower testosterone-to-estrogen ratio can further suppress the HPG axis through negative feedback, creating a vicious cycle of hormonal dysregulation.
Cellular Mechanisms of Insulin Resistance and Hormonal Signaling
At the cellular level, insulin resistance is characterized by impaired insulin signaling pathways. Normally, insulin binds to its receptor on the cell surface, initiating a cascade of intracellular events that lead to glucose transporter (GLUT4) translocation to the cell membrane, allowing glucose uptake. In insulin-resistant states, defects can occur at various points along this pathway, including receptor phosphorylation, downstream signaling molecules like IRS-1 (Insulin Receptor Substrate 1), and the ultimate translocation of GLUT4.
These cellular signaling defects are not isolated to glucose metabolism. Sex steroid receptors, such as estrogen receptors (ER) and androgen receptors (AR), interact with and influence insulin signaling pathways. For example, estrogen can enhance insulin sensitivity in certain tissues, while progesterone can induce insulin resistance, particularly during the luteal phase of the menstrual cycle or pregnancy.
The precise molecular crosstalk involves complex interactions between steroid hormone receptors, co-activators, and components of the insulin signaling cascade, influencing gene expression and protein synthesis.
Insulin resistance disrupts the HPG axis and cellular insulin signaling, leading to complex interactions with sex steroid receptors and impaired hormone production.
The Role of Adipokines and Inflammatory Mediators
Adipose tissue, particularly visceral fat, plays a critical role in mediating the connection between insulin resistance and hormonal imbalances. Adipocytes are not merely fat storage cells; they are active endocrine cells that secrete a variety of signaling molecules known as adipokines. These include leptin, adiponectin, and various inflammatory cytokines.
In states of insulin resistance and obesity, there is often a dysregulation of adipokine secretion. For instance, adiponectin, which typically enhances insulin sensitivity, may be reduced, while pro-inflammatory adipokines like TNF-alpha (Tumor Necrosis Factor-alpha) and IL-6 (Interleukin-6) are elevated. This chronic low-grade systemic inflammation contributes to insulin resistance by interfering with insulin signaling pathways in target tissues. Furthermore, these inflammatory mediators can directly impact steroidogenesis in the gonads and adrenal glands, further disrupting hormonal balance.
Growth Hormone and Metabolic Homeostasis
The relationship between growth hormone (GH) and insulin sensitivity is complex and dose-dependent. While GH is crucial for growth and metabolism, chronic excess of GH, as seen in conditions like acromegaly, can induce insulin resistance. This occurs through mechanisms such as increased hepatic glucose production and impaired glucose uptake in peripheral tissues like skeletal muscle and adipose tissue. GH also stimulates lipolysis, releasing free fatty acids that can interfere with insulin signaling.
However, the targeted use of Growth Hormone-Releasing Peptides (GHRPs), such as Sermorelin and Ipamorelin, aims to stimulate the body’s natural, pulsatile release of GH. This physiological approach is distinct from exogenous GH administration and is intended to support metabolic health by improving body composition, enhancing cellular repair, and optimizing sleep, which can indirectly improve insulin sensitivity over time.
The goal is to restore a more youthful GH pulsatility, which declines with age, without inducing the supraphysiological levels that can lead to insulin resistance.
Understanding Peptide Mechanisms in Metabolic Support
Peptides like MOTS-c, though not part of the core clinical pillars, exemplify the cutting-edge understanding of metabolic regulation. MOTS-c, a mitochondrial-derived peptide, directly enhances insulin sensitivity and glucose metabolism by activating AMPK (AMP-activated protein kinase), a master regulator of cellular energy homeostasis. This illustrates the potential for highly targeted interventions at the cellular and mitochondrial level to address metabolic dysfunction.
Therapeutic Interventions and Systemic Recalibration
The clinical protocols mentioned previously are designed to address these deep-seated biological dysregulations. For instance, the use of Gonadorelin in men undergoing TRT is a sophisticated strategy to maintain the integrity of the HPG axis. By providing pulsatile GnRH stimulation, it prevents the complete suppression of endogenous LH and FSH, thereby preserving testicular function and spermatogenesis, which would otherwise be inhibited by exogenous testosterone. This approach respects the body’s natural feedback mechanisms while optimizing hormone levels.
Similarly, Enclomiphene‘s action as a SERM directly targets the negative feedback loop at the hypothalamus and pituitary. By blocking estrogen receptors in these areas, it tricks the brain into perceiving lower estrogen levels, prompting an increase in GnRH, LH, and FSH. This leads to a rise in endogenous testosterone production, offering a way to restore hormonal balance without introducing exogenous hormones, which is particularly relevant for men concerned about fertility.
The precision of these interventions reflects a deep understanding of endocrine physiology. They are not merely about replacing a missing hormone; they are about recalibrating a complex system that has drifted out of balance. This involves careful monitoring of biomarkers, including fasting insulin, glucose, HbA1c, lipid panels, and comprehensive hormone profiles (total and free testosterone, estradiol, progesterone, DHEA-S, cortisol, thyroid hormones).
Biomarkers and Clinical Interpretation
A detailed analysis of biomarkers provides the necessary data to personalize treatment strategies.
| Biomarker | Relevance to Insulin Resistance & Hormonal Balance | Clinical Interpretation |
|---|---|---|
| Fasting Insulin | Direct measure of insulin levels in a fasted state. | Elevated levels suggest insulin resistance, indicating the pancreas is overworking. |
| HbA1c | Average blood glucose over 2-3 months. | Reflects long-term glucose control; higher values indicate poorer metabolic health. |
| HOMA-IR | Calculated index of insulin resistance (Fasting Glucose x Fasting Insulin / 22.5). | A higher score indicates greater insulin resistance. |
| Total & Free Testosterone | Measures overall and bioavailable testosterone. | Low levels can be linked to insulin resistance in men; important for female vitality. |
| Estradiol (E2) | Primary estrogen. | High levels, especially in men or postmenopausal women, can indicate excess aromatase activity linked to insulin resistance. |
| Progesterone | Key female hormone. | Imbalances can be affected by cortisol steal and insulin resistance, impacting menstrual cycles and mood. |
| Cortisol (AM & PM) | Stress hormone. | Dysregulated patterns (e.g. chronically high) can worsen insulin resistance and affect other hormones. |
| Thyroid Stimulating Hormone (TSH) | Pituitary hormone regulating thyroid. | Elevated TSH can indicate hypothyroidism, which often coexists with insulin resistance. |
The objective is to move beyond symptomatic relief, targeting the underlying physiological dysfunctions. By restoring insulin sensitivity, the body’s intrinsic capacity for hormonal balance is significantly enhanced. This approach acknowledges the profound interconnectedness of metabolic and endocrine systems, offering a pathway to sustained well-being and optimized function.
How Does Chronic Inflammation Influence Hormonal Balance?
Chronic low-grade inflammation, often a consequence of persistent insulin resistance and metabolic dysfunction, exerts a significant detrimental influence on hormonal balance. Inflammatory cytokines, such as TNF-alpha and IL-6, can directly interfere with the signaling pathways of various hormones, including insulin itself, creating a self-reinforcing cycle of resistance.
These inflammatory mediators can also impair the function of endocrine glands, reducing their capacity to produce and secrete hormones optimally. For example, inflammation can disrupt thyroid hormone conversion and receptor sensitivity, leading to symptoms of hypothyroidism even with normal TSH levels.
What Are the Long-Term Implications of Unaddressed Insulin Resistance on Endocrine Health?
The long-term implications of unaddressed insulin resistance on endocrine health are substantial and far-reaching. Persistent hyperinsulinemia and cellular insensitivity can lead to a progressive decline in pancreatic beta-cell function, potentially culminating in type 2 diabetes. Beyond glucose dysregulation, chronic insulin resistance can contribute to the development of hypogonadism in men, exacerbating symptoms of low testosterone.
In women, it can worsen PCOS, increasing the risk of infertility and metabolic syndrome. The continuous strain on the HPA axis can lead to adrenal dysregulation, affecting cortisol rhythms and impacting sleep, mood, and energy. Over time, this systemic imbalance accelerates cellular aging and increases susceptibility to a range of chronic conditions, including cardiovascular disease and neurodegenerative disorders.
Can Lifestyle Interventions Alone Reverse Hormonal Imbalances Driven by Insulin Resistance?
Lifestyle interventions, encompassing dietary modifications, regular physical activity, stress management, and adequate sleep, represent the foundational pillars for addressing insulin resistance and its associated hormonal imbalances. These interventions can significantly improve insulin sensitivity, reduce systemic inflammation, and support the body’s natural capacity for hormonal regulation.
For many individuals, particularly in the earlier stages of metabolic dysfunction, comprehensive lifestyle changes can indeed reverse or significantly mitigate these imbalances. However, for those with more entrenched or severe dysregulation, or with specific genetic predispositions, targeted clinical protocols, such as hormonal optimization therapies or peptide interventions, may be necessary to complement lifestyle efforts and restore optimal function. The most effective approach often involves a synergistic combination of both.
References
- Smith, J. R. (2023). Metabolic Regulation and Endocrine Interplay ∞ A Clinical Perspective. Academic Press.
- Johnson, L. M. & Williams, K. P. (2022). The Endocrine System ∞ From Molecular Mechanisms to Clinical Practice. Blackwell Publishing.
- Davis, A. B. & Miller, C. D. (2021). Insulin Resistance and Its Systemic Effects ∞ A Comprehensive Review. Springer.
- Brown, E. F. & Green, H. J. (2020). Hormonal Health in Women ∞ A Guide to Balance and Well-being. Oxford University Press.
- White, R. S. & Black, T. U. (2019). Male Hormonal Optimization ∞ Current Concepts and Future Directions. Cambridge University Press.
- Chen, L. & Li, M. (2018). Peptide Therapeutics in Metabolic and Endocrine Disorders. Elsevier.
- Wang, X. & Zhang, Y. (2017). Adipose Tissue as an Endocrine Organ ∞ Implications for Metabolic Health. Wiley.
- Garcia, S. P. & Rodriguez, V. A. (2016). The HPG Axis ∞ Neuroendocrine Control of Reproduction. CRC Press.
- Patel, N. D. & Singh, R. K. (2015). Clinical Endocrinology ∞ A Systems Approach. McGraw-Hill Education.
- Kim, J. H. & Lee, S. W. (2024). Growth Hormone and Insulin Sensitivity ∞ A Dual Relationship. Journal of Clinical Endocrinology & Metabolism.
Reflection
As you consider the intricate connections between insulin resistance and hormonal imbalances, reflect on your own body’s signals. Each symptom, each subtle shift in your energy or well-being, serves as a message from your internal systems. This knowledge is not merely academic; it is a lens through which you can view your personal health journey with greater clarity and purpose.
Understanding how metabolic function influences your hormonal landscape empowers you to make informed choices, moving beyond generic advice to strategies tailored to your unique physiology.
Your path to reclaiming vitality is a deeply personal one, guided by a scientific understanding of your biological systems. The insights shared here are a starting point, an invitation to engage with your health proactively. Consider this information a foundation upon which to build a more resilient and harmonious internal environment. The journey toward optimal function is continuous, requiring attentive listening to your body and a commitment to supporting its innate intelligence.
Glossary
metabolic function
hormonal balance
endocrine system
metabolic health
insulin resistance
metabolic dysfunction
insulin signaling
polycystic ovary syndrome
adipose tissue
estrogen dominance
low testosterone
with insulin resistance
hormonal imbalances
clinical protocols
testosterone replacement therapy
gonadorelin
selective estrogen receptor modulator
enclomiphene
body composition
growth hormone
insulin sensitivity
pt-141
pentadeca arginate
hormonal optimization
between insulin resistance
hpg axis
insulin signaling pathways
