The excesses of fat being generated by insulin and cortisol also more readily secrete enzymes (such as aromatase) that stimulate the excessive conversion of testosterone to estrogen in men (the number one cause of so-called testosterone deficiency in men) and the conversion of estrogen to toxic DHT testosterone in women, making weight loss extremely difficult in both men and women and mimicking in women many symptoms commonly associated with low thyroid function.
This can make one appear testosterone or estrogen deficient in blood or saliva tests. Lower testosterone levels also make men more prone to dopamine neurotransmitter deficiencies, as depressed testosterone activity also depresses dopamine receptor activity. Excessively lower estrogen levels in women suppress serotonin receptor activity and increases the proneness to depression and other issues. Good times.
The answer here is almost never hormone replacement, even with bioidentical hormones, which only temporarily alleviate the symptoms and can eventually greatly exacerbate the problem. You may feel temporarily better with supplemental estrogren, or even feel like Superman, at least for a while, on supplemental testosterone, but in the end, you are only making the problem worse. The underlying answer is in controlling this whole cascade of events by basically doing what is necessary to manage your levels of leptin, insulin, and adrenals (which usually means starting with addressing your blood sugar issues). The excessive conversion of hormones is an extremely viscious cycle and is at the heart of syndrome X, or metabolic syndrome.
Metabolic syndrome and its other related negative hormonal influences cannot ever be effectively micromanaged in the long term by hormone replacement. Bioidentical hormones have their rightful place in medicine, but their overuse often causes many more problems than they ultimately solve. The practices of functional medicine should have its foundation in respect for the complexity of the human organism and the intricate, interrelated web of endocrine function. One must peel back the layers of the onion to find the source of the problem and not simply persist in treating the symptoms.