THE INFLUENCE OF SEX HORMONES ON DIABETES: COMPARATIVE ANALYSIS OF WOMEN AND MEN

Karolina Maria Dubiel; Monika Białowąs; Weronika Białowąs; Michał Maćkowski; Sandra Balon; Kacper Piotr Urban; Adam Śmietana; Piotr Szwed; Natalia Julia Sojka; Jakub Jan Magnowski

doi:10.31435/ijitss.1(49).2026.4890

Authors

Karolina Maria Dubiel Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0008-2445-3043
Monika Białowąs Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0001-9662-7347
Weronika Białowąs Wroclaw Medical University, Wrocław, Poland https://orcid.org/0009-0005-1785-0321
Michał Maćkowski Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0000-4219-2125
Sandra Balon Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0007-7106-1133
Kacper Piotr Urban Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0001-7979-5904
Adam Śmietana Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0005-1834-3815
Piotr Szwed Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0007-3204-5042
Natalia Julia Sojka Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0002-4779-1295
Jakub Jan Magnowski Medical University of Gdansk, Gdańsk, Poland https://orcid.org/0009-0009-7862-233X

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.4890

Keywords:

Sex Hormones, Diabetes, Sex Differences, Women and Men, Glucose Metabolism, Insulin Resistance

Abstract

Diabetes is a complex metabolic disorder whose development and complications are influenced not only by genetic, environmental and lifestyle factors, but also by sex hormones. Women and men differ in regulation of glucose metabolism and insulin sensitivity, which leads to specific patterns in diabetes risk and clinical presentation. Among women, estrogen plays a protective metabolic role before menopause, while hormonal fluctuations during the menstrual cycle, pregnancy and menopause significantly affect glycemic control and may increase the risk of diabetes type 2.

In men, testosterone deficiency is strongly associated with insulin resistance, obesity and an increased risk of developing type 2 diabetes, while diabetes itself may contribute to reduced testosterone levels and reproductive dysfunction. These hormonal differences also contribute to variations in diabetes complications, cardiovascular risk and treatment responses between sexes. This article presents a review of current literature on the relation between sex hormones and diabetes, highlighting biological mechanisms, clinical implications and the importance of considering sex-specific factors in prevention, diagnosis and management strategies. Understanding these distinctions may support more personalized and effective approaches to diabetes care.

Materials and methods: The review was based on an analysis articles published in the PubMed and Google Scholar databases between 2015 and 2025, using the following keywords: sex hormones, diabetes, sex differences, women and men, glucose metabolism, insulin resistance, diabetes risk.

Results: The analysis revealed significant sex-specific differences in the association between sex hormones and glucose metabolism. Women demonstrated a stronger protective influence of estrogens, reflected in better glycemic control and lower insulin resistance before menopause, whereas postmenopausal women showed a marked aggravation in metabolic parameters. In men, higher androgen levels are associated with improved insulin sensitivity, while androgen deficiency correlates with increased diabetes risk. Across both sexes, hormonal imbalance was strongly linked with impaired glucose tolerance, higher prevalence of type 2 diabetes and altered insulin secretion.

Conclusions: This study highlights the crucial role of sex hormones in modulating glucose metabolism and showing the risk and progression of diabetes in women and men. Estrogens exert a protective effect in women, particulary before menopause, while their decline is associated with worsening metabolic control. In men, androgen levels appear beneficial for insulin sensitivity, whereas androgen deficiency increases metabolic disturbances. Overall, the findings emphasize that hormonal status should be considered an important determinant in diabetes risk assessment, prevention strategies and therapeutic approaches. Incorporating sex-specific hormonal factors into clinical practice may improve early identification, management and outcomes in diabetes.

References

Raeisi-Dehkordi, H., Amiri, M., Rathmann, W., Zeller, T., Adamski, J., & others. (2017). Associations of steroid sex hormones and sex hormone-binding globulin with the risk of type 2 diabetes in women: A population-based cohort study and meta-analysis. Diabetes, 66(3), 577–586.

O’Reilly, M. W., Glisic, M., Kumarendran, B., Subramanian, A., Manolopoulos, K. N., & others. (2019). Serum testosterone, sex hormone-binding globulin and sex-specific risk of incident type 2 diabetes in a retrospective primary care cohort. Clinical Endocrinology, 90(1), 145–154.

Lin, J., Wu, W., Weng, Y., Zhong, Y., & others. (2024). Correlation between serum sex hormone-binding globulin levels and nutrition indicators and malnutrition exposure risk in men and postmenopausal women with type 2 diabetes. BMC Endocrine Disorders, 24, 117.

Simons, P., Valkenburg, O., van de Waarenburg, M. P. H., van Greevenbroek, M. M. J., Kooi, M. E., Jansen, J. F. A., … & Stehouwer, C. D. A. (2022). Serum sex hormone-binding globulin is a mediator of the association between intrahepatic lipid content and type 2 diabetes: The Maastricht Study. Diabetologia.

Look AHEAD Sex Hormone Study. (2024). Weight loss differentially impacts sex hormones in women and men with type 2 diabetes. The Journal of Clinical Endocrinology & Metabolism.

Mauvais-Jarvis, F. (2015). Sex differences in metabolic homeostasis, diabetes, and obesity. Biology of Sex Differences, 6, 14.

Rodriguez, J., Smith, L. A., & Chen, X. (2023). Estrogen and insulin signaling in metabolic regulation. Clinical Science.

Schiffer, L., Kempegowda, P., & Arlt, W. (2020). The sexually dimorphic role of androgens in human metabolic disease. European Journal of Endocrinology, 177(3).

Zhao, Y., & Xu, S. (2022). Effects of androgens on glucose metabolism. Metabolic Reviews.

Estrogen and metabolism: Navigating hormonal transitions from reproductive to metabolic health. (n.d.). Journal of Mid-Life Health.

Role of estrogen and its receptors in adipose tissue glucose and insulin metabolism. (n.d.). PubMed Central.

Mauvais-Jarvis, F. (2015). Sex differences in metabolic homeostasis, diabetes, and obesity. Biology of Sex Differences, 6, 14.

Mauvais-Jarvis, F. (2017). Menopausal hormone therapy and type 2 diabetes prevention: Mechanisms and clinical implications. PMC.

Shi, Y., et al. (2025). Association between circulating sex hormone levels and type 2 diabetes outcomes. World Journal of Diabetes, 16(11).

Zhu, D., Chung, H.-F., Dobson, A. J., Pandeya, N., Giles, G. G., Bruinsma, F., & Mishra, G. D. (2024). Menopausal transition and risk of type 2 diabetes: A population-based cohort study. Diabetologia, 67(2), 312–321.

Wang, Y., Li, Y., Liu, J., Zhang, M., & Chen, X. (2024). Association of age at menopause with type 2 diabetes mellitus: A systematic review and meta-analysis. Nutrition & Metabolism, 21(1), 58.

Sheridan, P., et al. (2024). Sex-based differences in insulin resistance. PubMed Review.

Mauvais-Jarvis, F., & others. (2024). Additional evidence on metabolic actions of sex steroids. JCI.

Kautzky-Willer, A., Leutner, M., & Harreiter, J. (2023). Sex differences in type 2 diabetes. Diabetologia, 66(6), 986–1002.

Mauvais-Jarvis, F. (2018). Gender differences in glucose homeostasis and diabetes. Physiological Reviews, 98(1), 1–50.

Navarro, G., Allard, C., Xu, W., & Mauvais-Jarvis, F. (2021). The role of androgens in metabolism, obesity, and diabetes in men and women. Nature Reviews Endocrinology, 17(9), 529–546.

Ohkuma, T., Komorita, Y., Peters, S. A. E., & Woodward, M. (2018). Diabetes as a risk factor for cardiovascular disease in women compared with men: A systematic review and meta-analysis. BMJ, 362, k3703.

Kautzky-Willer, A., Harreiter, J., & Pacini, G. (2016). Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocrine Reviews, 37(3), 278–316.

Mauvais-Jarvis, F. (2018). Gender differences in glucose homeostasis and diabetes. Physiological Reviews, 98(1), 1–46.

Grossmann, M., & Matsumoto, A. M. (2017). A perspective on middle-aged and older men with functional hypogonadism: Focus on holistic management. The Journal of Clinical Endocrinology & Metabolism, 102(3), 1067–1075.

Raeisi-Dehkordi, H., Amiri, M., Rathmann, W., Zeller, T., Adamski, J., Bano, A., van der Schouw, Y. T., Thorand, B., Muka, T., & Nano, J. (2024). Sex hormone-binding globulin may explain sex differences for glucose homeostasis and incidence of type 2 diabetes: The KORA study. European Journal of Epidemiology, 39(8), 915–924.