What did @drsteveng actually say?
The creator, identified as a chiropractor based on the hashtags, argues that before anyone considers hormone replacement therapy, they should look upstream at blood sugar regulation. His core claim: "the most common cause of low testosterone in men and low estrogen in women is poor regulation of blood sugar and the hormones that control blood sugar." He frames this as something fixable without medication, and suggests HRT is often a premature jump.
That's the argument. It's not a fringe idea, but the way it's packaged matters. He says this is "the number one cause" of hormone problems for both sexes. That's a specific, testable claim, and it deserves a harder look than the video gives it.
Does the science back this up?
Partly. The insulin-testosterone connection in men is real and reasonably well-documented. Insulin resistance does suppress the hypothalamic-pituitary-gonadal (HPG) axis, which can reduce LH signaling and depress testosterone production. A 2020 study by Grossmann and Matsumoto in the Journal of Clinical Endocrinology and Metabolism confirmed that metabolic dysfunction, including hyperinsulinemia and obesity, is associated with functional hypogonadism in men.
For women, the estrogen picture is more complicated. Insulin resistance can actually raise estrogen in premenopausal women via increased aromatization in adipose tissue, while suppressing progesterone and disrupting ovulation. This is central to conditions like PCOS. But calling insulin dysregulation the "most common" cause of low estrogen broadly, across all women, overstates what the evidence supports. Postmenopausal estrogen decline is driven by ovarian senescence, not blood sugar, and that accounts for a massive share of "low estrogen" cases clinically.
What did they get wrong (or right)?
Credit where it's due: the advice to investigate root causes before starting hormone replacement therapy is clinically reasonable. Functional hypogonadism secondary to obesity and insulin resistance can often improve with lifestyle intervention. A 2016 randomized trial by Villareal et al. in the New England Journal of Medicine showed that diet and exercise improved hormonal profiles in obese older adults without any hormonal medications.
But the "number one cause" framing is where this tips from useful to misleading. The most common causes of low testosterone in men include age-related decline, obesity, sleep apnea, opioid use, and pituitary disorders. Blood sugar dysregulation overlaps with several of these but doesn't cleanly sit at the top of a ranked list. And for women, the sweeping claim about low estrogen ignores that menopause is the single most prevalent driver of low estrogen, full stop. That's not a blood sugar problem. Telling perimenopausal or postmenopausal women to "fix their blood sugar hormones" before considering HRT could delay appropriate care.
There's also a scope-of-practice question worth naming. A chiropractor advising patients to manage blood sugar dysregulation "without medication" before addressing confirmed hormonal deficiencies is operating in territory that warrants a referral to an endocrinologist or primary care physician, not a social media video.
What should you actually know?
If you have confirmed low testosterone or low estrogen on a blood test, the clinical workup should absolutely include metabolic markers: fasting glucose, insulin, HbA1c, and lipids. Insulin resistance is a legitimate contributor to hormonal dysfunction in both sexes, and addressing it first is often reasonable clinical practice.
But "reasonable starting point" is different from "the number one cause." If you've already made meaningful lifestyle changes and your hormones remain clinically low, that's a conversation to have with an endocrinologist or a physician who specializes in hormone management, not something to indefinitely defer because a video told you blood sugar is the real problem.
The causes of hormonal dysfunction are not a single-item list. Sleep quality, chronic stress, thyroid function, medications, and age all matter. A proper workup accounts for all of them. Anyone who tells you there's one dominant root cause for a whole category of complex endocrine disorders is simplifying in a way that can cost you time and health.
- Get a full panel before making any decisions: testosterone, LH, FSH, estradiol, SHBG, fasting insulin, and thyroid function.
- Lifestyle intervention is a legitimate first step for functional hypogonadism linked to metabolic dysfunction.
- Menopause-related low estrogen is not primarily a blood sugar problem and should not be managed as if it is.
- Scope of practice matters. A chiropractor is not the right specialist to manage confirmed endocrine disorders.