PCOS, Insulin Resistance & The Physiology I Didn’t Understand Yet

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There’s a specific kind of exhaustion that comes from doing everything “right” and watching nothing change.

When you realize that the problem isn’t laziness. You don’t actually have a problem with inconsistency. It’s not even living in denial per se. The exhaustion comes from overeffort. Even if you haven’t been physically doing the things you want to because you’re frozen in fear, it’s because of the mental reps you’ve done and the mental beatings you’ve given yourself because you don’t have the strength to get out of your own head.

Years and years of measured meals. Hours and hours of logged workouts. Macros tracked down to the gram. Fasted cardio before sunrise and refusing to eat until lunch time. Relentless lifting sessions are scheduled like appointments at 5 am. Counting all of the steps. Trying my best to count and prioritize protein. Giving up my favorite thing ever (sugar) all for the sake of “health” and wellness.

From the outside, I looked disciplined. From the inside, I was completely unraveling. Because despite the spreadsheets and meal plans and structured routines, my body wasn’t responding the way everyone said it should.

And when weight doesn’t budge the way the internet promises it will, the blame has to land somewhere. I would always internalize it and tell myself that I wasn’t doing enough. Even though I’d tried every single thing I could.

The Moment I Realized Something Was Off

For years, I believed my struggle was a personal flaw.

If I wasn’t losing weight, I must not be trying hard enough. There must be something that I was missing. If someone else could do it naturally, why couldn’t I? If the plan worked for them, what was wrong with me?

But living with PCOS is like running uphill on terrain other people don’t see. PCOS isn’t just irregular cycles or ovarian cysts. What I’ve recently learned is that it’s often a metabolic condition. And the missing piece in my story - the piece no one explained clearly enough - was insulin resistance.

The relief I felt when I realized that the problem was not from my own behavior or personal failure was overwhelming.

What I Found When I Dug Deeper Into Insulin Resistance

For a long time, I didn’t understand what insulin resistance actually meant. It sounded clinical… distant… like something happening in a lab instead of inside my own body.

But here’s the simplest way I can explain it.

Imagine your cells are little houses. Glucose — which is energy from the food you eat — is trying to get inside those houses so it can be used. Insulin is the key. It gently unlocks the door and lets that energy in so your body can burn it, use it, and live on it.

In a healthy system, the key fits easily. The door opens. Energy goes where it’s supposed to go. But with insulin resistance, the locks start to get rusty.

The key still shows up. Insulin is still trying to do its job. But the door doesn’t open as smoothly anymore because the hinges are rusty. So your body responds the only way it knows how — it makes more keys. More insulin. And then more. And then more.

And here’s the part no one explained to me for years… Insulin doesn’t just unlock doors. It also sends a message. And that message is: “Store this. Save this. Hold onto this.”

When insulin levels stay elevated, your body is being told to store energy - especially as fat - and to protect it. Even if you’re eating well. Even if you’re moving your body. Even if you’re trying so hard.

So if you’ve ever felt like you were doing everything “right” and nothing was happening… it might not have been about effort at all. It might have been about signaling. Your body wasn’t stubborn. It wasn’t broken. It wasn’t trying to betray you. It was responding to chemistry.

And when we understand that, something shifts. The shame softens. The war quiets. We stop yelling at ourselves for not being disciplined enough… and start asking better questions about what our bodies actually need.

Sometimes the work isn’t about forcing the door open harder. It’s about restoring the lock so the key fits again.

Add elevated androgens and chronic low-grade inflammation - both common in PCOS - and the hormonal environment shifts even further. You can eat in a calorie deficit. You can lift weights. You can “do everything right.” But if insulin remains elevated and cortisol is chronically high, the body protects itself by holding on.

That doesn’t mean you’re lazy. It means your physiology requires a different approach. The most painful part? No one explains this when they hand you a macro plan. It’s sad that we have to go through years and years of struggle until we get desperate enough to do our own research.

When Discipline Turns Into Burnout

If you know me at all then you know that I doubled down. If it wasn’t working, I just needed more discipline. More cardio. More steps. Lower calories. More tracking. Less rest.

In the research I read, I kept seeing the same pattern: chronic stress and under-fueling can raise cortisol levels. And in some people, elevated cortisol may make blood sugar regulation harder. When I looked at my own patterns of restriction and overtraining, that connection made a lot of sense.

I was trying to solve a hormonal issue with sheer willpower. And I was completely burning out in the process. Macro tracking stopped feeling empowering and started feeling suffocating. Every meal became math. Every deviation felt like failure. My body felt inflamed. My mind felt exhausted.

Now, I know that I wasn’t weak. I was metabolically stressed. Just making that distinction changed everything for me.

The Research (Two Years, Not Two Weeks)

I did not arrive at medication lightly. If you’ve been on the same sides of the internet as me, then you know that taking a GLP-1 can be very shameful and invites the worst types of critics (usually people with perfectly functioning systems) commenting on your posts.

For two years, I researched. I read medical journals and used AI to try to understand what I was reading. I followed endocrinologists. I listened to podcasts. I read Reddit threads from women who felt like me. I asked hard questions about long-term safety, hair loss, muscle loss, metabolic adaptation, and even the cancer data often cited in early animal studies. All issues and concerns that I had watched my own friends go through as they struggled their way through GLP-1 use.

I especially wanted to understand one thing: Would this support my body, or override it?

Here’s what I learned.

How GLP-1 Medications Actually Work

When I first started learning about GLP-1 medications, I thought they were some kind of artificial appetite suppressant. That’s what the internet made it sound like. But that’s not actually what they are.

GLP-1 receptor agonists mimic a hormone your body already makes after you eat. Your body naturally releases GLP-1 to help regulate digestion and blood sugar. The medication isn’t introducing something foreign… It’s amplifying a signal that was already designed to exist.

And that signal does a few really important things. It slows digestion down a little. It helps your body respond to insulin more efficiently. It steadies blood sugar instead of letting it spike and crash. It reduces glucagon, which is a hormone that tells your liver to release more glucose into the bloodstream. And maybe most noticeably… it quiets appetite signaling. Not by force. Not by willpower. By recalibrating communication.

For someone with insulin resistance, that shift isn’t cosmetic. It’s foundational.

If insulin resistance is like rusty locks and too many keys floating around… GLP-1 helps calm the chaos. Slower digestion means glucose enters the bloodstream more gradually, instead of flooding it all at once. Improved insulin sensitivity means your body can actually use the energy you eat instead of immediately storing it. Blood sugar stabilizes. The rollercoaster softens.

And when blood sugar stabilizes… the cravings soften too.

For me personally, especially without a gallbladder, that slower digestion felt like relief. Before, meals could feel frantic. Like my body was rushing and dumping everything at once. I’d feel shaky, uncomfortable, and inflamed. Slowing that down didn’t just help with weight. It helped me feel steady after eating instead of chaotic.

This wasn’t about taking the “easy way out.” It was about addressing root physiology instead of blaming myself for not trying hard enough. You can’t out-discipline a signaling issue. But you can support it. And for me, that support finally felt like peace in my body.

The Muscle Preservation Question

One of my biggest fears was muscle loss. What I learned through my own research is that rapid weight loss without adequate protein and resistance training can lead to lean mass loss. That’s not a GLP-1 problem; that’s a calorie deficit problem.

The more research I did, the more I leared that adequate protein intake and strength training dramatically reduce muscle loss during fat loss, whether medication is involved or not.

That’s why in this season, protein and lifting aren’t optional for me. They are protection for every system in my body. The medication regulates appetite and insulin. My job is to protect muscle, metabolism, and long-term health. I finally feel like I’m not doing this alone. I have the support that I need to actually succeed.

The Cortisol Layer No One Talks About

Another super important missing piece of the puzzle that we are not taught about is a woman’s metabolism. As you have probably heard, chronic stress elevates cortisol. Elevated cortisol adds to the shit storm of insulin resistance. Insulin resistance makes fat loss harder.

It’s an ugly loop. For an entire decade, my body wasn’t just managing and struggling with macros. It was trying to juggle stress management on top of all the other things.

When appetite regulation stabilized and food noise quieted, my nervous system softened. And when my nervous system softened, my body responded differently.

This wasn’t just about calories in, calories out. It was about full system regulation.

What This Really Means

Choosing to work with a GLP-1 was not abandoning my self-discipline. It was supporting it. I still lift. I still prioritize protein. I still hydrate intentionally.

But now my effort aligns with my physiology instead of fighting it. The most liberating realization of all? I was never broken. Even when I felt like everything was working against me. My hormones were dysregulated. And treating dysregulation is not a weakness. Like any other health care plan, it’s actually completely necessary.

Continue The Weight Loss Truce Series

If you’re carrying quiet shame about needing support, I wrote about that next.

I invite you to read: The Shame Around GLP-1 No One Wants to Admit

And if you’re ready for the practical side - how I’m protecting muscle, managing protein, and stabilizing metabolism - that’s coming next: How I’m Protecting My Metabolism on GLP-1

This series isn’t about taking shortcuts. It’s about understanding your body deeply enough to stop fighting it. And that new perspective changes everything. 🤍

If you want the foundation of this entire series (and the emotional “why” behind it), start here: GLP-1 Weight Loss Without War: When My Body Finally Felt Safe .

References

• Dunaif A. Insulin resistance and the polycystic ovary syndrome. Endocr Rev. 1997.
• Diamanti-Kandarakis E, Dunaif A. Insulin resistance and PCOS revisited. Endocr Rev. 2012.
• Drucker DJ. Mechanisms of Action of GLP-1. Cell Metab. 2018.
• Nauck MA, Meier JJ. Incretin hormones. Diabetes Obes Metab. 2019.
• Weinheimer EM et al. Effect of weight loss on lean body mass. Am J Clin Nutr. 2010.
• Longland TM et al. Higher protein intake preserves lean body mass. Am J Clin Nutr. 2016.
• Rosmond R. Stress and metabolic syndrome. Psychoneuroendocrinology. 2005.
• Joseph JJ, Golden SH. Cortisol and metabolic disease. Curr Diabetes Rep. 2017.