Research
Muscle Mass and Hormonal Balance in PCOS
Learn how building muscle helps manage PCOS symptoms by improving insulin sensitivity, balancing hormones, and supporting overall health.
June 11, 2025
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Learn how building muscle helps manage PCOS symptoms by improving insulin sensitivity, balancing hormones, and supporting overall health.
Building muscle can help manage PCOS symptoms by improving insulin sensitivity, balancing hormones, and reducing androgen levels. Women with PCOS often face challenges like irregular periods, weight gain, and excess hair growth due to hormonal imbalances. Strength training and proper nutrition are key to addressing these issues.
By combining muscle-building strategies with a healthy lifestyle, women with PCOS can better manage symptoms and improve overall well-being.
PCOS throws several hormonal systems out of sync. At its core, it’s a condition of hormonal imbalance where the ovaries produce excessive amounts of certain hormones.
One of the key players here is androgens, often referred to as male hormones. Women with PCOS tend to have elevated levels of androgens like testosterone. This overproduction, driven by both the ovaries and adrenal glands, is called hyperandrogenism and impacts about 60–80% of women with PCOS.
Insulin is another hormone deeply tied to PCOS. When the body becomes less responsive to insulin - a condition known as insulin resistance - the pancreas compensates by producing more. This overproduction disrupts other hormonal processes, with insulin resistance affecting an estimated 60–70% of women with PCOS.
High insulin levels also lower Sex Hormone–Binding Globulin (SHBG), a protein responsible for binding to testosterone and keeping it inactive. With reduced SHBG, more free testosterone circulates in the bloodstream, intensifying androgen-related symptoms.
The balance between Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) is also disrupted in PCOS. Elevated insulin levels can increase LH production, prompting the ovaries to produce more estrogen and testosterone. Without regular ovulation, progesterone levels drop while estrogen fluctuates, leading to irregular menstrual cycles and fertility challenges.
These hormonal shifts are at the heart of the diverse symptoms women experience with PCOS.
The hormonal chaos in PCOS triggers a wide range of reproductive and metabolic symptoms. For instance, high androgen levels interfere with ovulation, leading to irregular periods and fertility struggles. Insulin resistance and elevated LH further disrupt follicle development, compounding these issues.
Excess hair growth, a condition called hirsutism, is one of the hallmark symptoms, affecting up to 70% of women with PCOS. Elevated androgens stimulate hair follicles and oil glands, turning fine, light hair into coarse, dark hair on areas like the face, chest, and back. Acne is another common issue, with a meta-analysis showing that 42% of adult women with PCOS experience acne compared to just 17% of women without it.
Weight gain and difficulty shedding pounds are also closely tied to insulin resistance. High insulin levels encourage fat storage, particularly around the abdomen, while also increasing hunger and cravings for carbs. This contributes to obesity in 40–80% of individuals with PCOS.
The interaction between insulin and androgens creates a vicious cycle. Elevated insulin boosts ovarian testosterone production and increases LH, which, in turn, raises both estrogen and testosterone levels. This cycle further entrenches insulin resistance.
Recognizing these hormonal dynamics highlights why treatments that focus on improving insulin sensitivity and reducing androgen levels are so important. Strategies like building muscle mass can play a key role in breaking this cycle and managing PCOS symptoms effectively.
Muscle tissue plays a key role in managing hormones for women with PCOS, particularly by improving how the body processes insulin and moderating androgen levels. Studies reveal that women with PCOS phenotypes A and B tend to have a higher median appendicular lean mass index (ALMI) compared to controls (7.01 vs. 6.69). This increase in lean muscle mass highlights the body's natural response to hormonal imbalances often seen in PCOS.
Muscle tissue is the main site where glucose is processed in the body. The more muscle mass you have, the better your body can use insulin. Resistance training, in particular, boosts muscle insulin sensitivity, making glucose uptake more efficient and reducing the overall demand for insulin. It also increases the resting metabolic rate, which can help with weight management - an ongoing challenge for many women with PCOS. On top of that, building muscle through strength exercises can lower health risks tied to chronic insulin resistance. But the benefits don’t stop there - muscle growth also helps regulate androgens, which is another critical factor in managing PCOS symptoms.
Beyond its impact on insulin, muscle mass also helps balance androgen levels, a common concern in PCOS. Elevated androgens can have anabolic effects, which might increase lean muscle mass. However, regular strength training has been shown to regulate these hormone levels over time. Research supports this, showing that strength training can lower androgen levels in women with PCOS. As the Aster Women's Health Team explains:
"strength training lowers male hormones...when it comes to PCOS"
Additionally, improved insulin sensitivity is linked to a lower free androgen index (FAI). In other words, as muscle cells become better at utilizing insulin, androgen levels tend to drop. Strength training also promotes the growth of new muscle cells, which not only supports blood sugar regulation but also helps normalize hormone production.
Recent research highlights how muscle mass plays a key role in regulating hormones in women with PCOS. This connection sheds light on why building muscle can be an effective way to manage the condition’s symptoms.
A 2023 study by Fighera et al. explored the relationship between muscle mass and hormone levels in women with various PCOS phenotypes. The study revealed that women with phenotypes A and B had a higher appendicular lean mass index (ALMI) compared to healthy controls (7.01 vs. 6.69 kg/m²). Additionally, fasting insulin, free androgen index (FAI), fat mass, and total femur bone mineral density were found to be positively associated with ALMI in women with PCOS. Even after accounting for body mass index, ALMI showed a positive correlation with creatinine levels in women with phenotypes A and B (rho = 0.319, p = 0.023), but this was not observed in women with phenotype C or in healthy controls.
"In conclusion, the results of the present study suggest that women with PCOS phenotypes A and B have increased lean mass, which is associated with fasting insulin, androgens, fat mass, and total femur BMD."
– Fighera et al.
Exercise has emerged as a promising intervention for hormone regulation. Studies show that it can increase SHBG concentrations, improve free androgen levels, and reduce hyperinsulinemia. These changes enhance ovarian function and promote more regular menstrual cycles. Next, we’ll look at how muscle and fat mass each contribute to managing cardiometabolic risks in PCOS.
Expanding on the hormonal effects of muscle mass, a 2024 study by Cai et al. investigated how body composition impacts cardiometabolic risk in women with PCOS. The research found that both skeletal muscle mass and fat mass influence cardiometabolic risk, though the effects vary based on body composition. Among obese women (BMI ≥ 28 kg/m²), skeletal muscle mass was linked to a 2.27 times higher likelihood of cardiometabolic risk (95% CI 1.15–4.47). On the other hand, in women with a lower BMI (<28 kg/m²), trunk fat mass posed a greater risk, with odds ratios of 2.12 for PCOS (95% CI 1.06–4.24) and 2.04 for controls (95% CI 1.04–4.02).
The study also highlighted differences between PCOS subtypes. In metabolic PCOS (average BMI 30.9 ± 4.8 kg/m²), skeletal muscle mass was associated with increased cardiometabolic risk (OR 2.63, 95% CI 1.13–6.16). Conversely, in reproductive PCOS (average BMI 22.8 ± 4.2 kg/m²), trunk fat mass was linked to higher cardiometabolic risk (OR 2.37, 95% CI 1.33–4.21).
"Our results highlight the importance of both fat mass and skeletal muscle mass in the management of PCOS to reduce their cardiometabolic risk."
– Cai et al.
Additional research shows that reducing body fat while increasing lean muscle mass can significantly lower testosterone and glucose levels after just four months of resistance training. These body composition changes are also tied to improved hormone levels and more regular menstrual cycles.
These findings emphasize the intricate relationship between muscle mass, fat distribution, and hormonal balance in PCOS. They also highlight the importance of individualized treatment approaches that account for a person’s specific body composition and PCOS phenotype. This reinforces the value of muscle-building strategies as part of managing hormonal health in PCOS.
Research shows that building muscle can play a key role in improving hormone levels, which is especially important for managing PCOS. However, building muscle with PCOS requires a thoughtful approach that takes into account the hormonal challenges associated with the condition. Studies highlight that strength training can be particularly effective in helping reduce testosterone levels in women with PCOS. Here’s how you can approach muscle building while addressing these challenges.
When it comes to weight training, focusing on endurance-based resistance exercises is generally more beneficial than high-intensity lifting. High-intensity strength workouts may actually increase testosterone levels, which is something to be mindful of if you have PCOS. Instead, opt for lighter weights, resistance bands, or bodyweight exercises performed with a higher number of repetitions.
A good starting point is to dedicate 30–45 minutes to moderate-intensity resistance exercises three to five times a week. Gradually increase the number of repetitions over time to build strength without pushing intensity too high. Incorporate basic compound movements like push-ups and tricep dips, which not only build muscle and improve upper body strength but also enhance insulin function and boost calorie burn post-workout. These exercises are also great for supporting healthy muscle and bone development.
Women with PCOS who adopt regular strength training often report benefits like lower blood pressure, more balanced hormones, and improved menstrual regularity.
Nutrition is a cornerstone of muscle growth, particularly when managing the insulin resistance and hormonal imbalances associated with PCOS. Focus on lean protein sources such as chicken, fish, tofu, and legumes to support muscle development without causing insulin spikes.
Pair these proteins with complex carbohydrates like brown rice, quinoa, sweet potatoes, whole grains, and vegetables. These carbs provide sustained energy and help stabilize blood sugar levels. Don’t forget to include healthy fats - nuts, seeds, avocados, and olive oil - as they are essential for hormone production and muscle repair.
Meal timing can also make a difference. Eating balanced meals and snacks regularly helps fuel workouts and aids recovery. Avoid processed foods and refined sugars to prevent blood sugar spikes, and choose low-glycemic fruits like berries, apples, and pears alongside nutrient-rich greens like spinach, kale, and collard greens.
To maximize the benefits of strength training and a healthy diet, consider adding aerobic activities into your routine. A mix of resistance training and cardiovascular exercises can significantly improve hormonal regulation. Activities like walking or swimming complement strength training by enhancing overall insulin sensitivity and promoting better hormonal balance.
Building muscle also means creating more muscle cells, which are key players in glucose consumption. This naturally helps maintain stable blood sugar levels. Focus on exercises targeting major muscle groups and gradually increase the intensity over time. Together with a balanced diet, this approach supports both muscle growth and overall health.
Strength training plays a key role in managing PCOS symptoms by helping to stabilize blood sugar, reduce insulin resistance, and increase your resting metabolic rate. These changes can make it easier to manage weight, which is often a challenge for individuals with PCOS. This metabolic boost lays the groundwork for the hormonal benefits that come with regular strength training.
One of the standout advantages of strength training is its ability to lower excess androgen levels. In fact, a 20-week study revealed that combining a balanced diet with aerobic exercise and progressive resistance training led to significant improvements in fasting insulin levels, reduced testosterone, and an increase in sex hormone–binding globulin (SHBG).
"Movement is more than just a fitness goal. It's a holistic approach to restoring balance, health, and emotional well-being." – Dr. Madhu Goel
Strength training also helps combat inflammation and oxidative stress, both of which can disrupt hormone balance. For the best results, aim to work major muscle groups like your legs, back, and core two to three times per week. Start with low-impact exercises to reduce the risk of injury, and gradually increase the intensity as you build strength. Incorporating daily or every-other-day activity can further support insulin function.
A well-structured muscle-building program doesn’t just address insulin resistance and high androgen levels - it helps create a healthier hormonal balance overall. Beyond physical changes, building muscle empowers you to take control of your hormones and feel better in the long run. This approach forms a crucial part of managing PCOS symptoms effectively.
Building muscle plays a key role in improving insulin sensitivity for women dealing with PCOS. More muscle mass means your body becomes better at processing glucose, as muscle cells respond more effectively to insulin. This can significantly reduce insulin resistance - a common challenge with PCOS - and support healthier blood sugar levels.
On top of that, strength training and preserving muscle mass can increase your resting metabolic rate. This not only helps regulate hormones but also lowers the risk of long-term health problems like type 2 diabetes and heart disease. For women managing PCOS, focusing on muscle-building is a powerful way to support both metabolic and hormonal balance.
Strength training offers a great way for women with PCOS to tackle hormonal imbalances. It can help improve insulin sensitivity and lower androgen levels, both of which are crucial for managing symptoms. Here are some exercises that can make a difference:
Adding these exercises to your weekly routine can make a noticeable impact on hormone regulation and PCOS management. However, it’s always a good idea to consult with a healthcare professional before starting any new fitness program to ensure it suits your specific needs.
Managing PCOS symptoms often starts with thoughtful dietary adjustments, particularly focusing on insulin resistance, a common issue for many dealing with this condition. Eating more high-fiber foods while cutting back on refined carbs and sugars can help with weight management and support better hormone balance. That said, diet alone typically isn’t enough to make a significant impact.
Adding regular exercise to the mix is just as crucial. Physical activity plays a key role in building muscle mass, lowering insulin resistance, and amplifying the positive effects of dietary changes. When combined, a well-rounded diet and a consistent fitness routine can work together to manage PCOS symptoms more effectively and boost overall health.
