Subcutaneous vs Visceral Fat: Understanding Age-Related Fat Changes & Health Risks

March 21, 2026 Ananya Mittal - World Editor

As women age, shifts in hormone levels and metabolism often lead to changes in body composition, including how and where fat is stored. Recent research and a growing body of evidence suggest that testosterone, often considered a male hormone, plays a surprisingly important role in regulating fat distribution for women, particularly as they move through menopause and beyond. Understanding this connection could offer new avenues for addressing age-related health risks linked to fat accumulation.

The Shifting Landscape of Fat Storage with Age

Throughout life, our bodies maintain a certain amount of fat, essential for hormone production, nutrient storage, and protection of vital organs. However, the location of that fat is crucial. Most fat is subcutaneous – stored directly under the skin. While noticeable, subcutaneous fat isn’t generally considered detrimental to health. The more concerning type is visceral fat, which accumulates around the abdominal organs. This deep, internal fat is strongly linked to increased risk of type 2 diabetes, cardiovascular disease, and other metabolic problems. Research published in Frontiers in Cardiovascular Medicine highlights the significant impact of visceral adipose tissue on cardiovascular risk, even in individuals with overall healthy body weight.

With age, particularly during and after menopause, women experience a decline in estrogen levels. This hormonal shift often leads to an increase in visceral fat and a decrease in subcutaneous fat. The body tends to store fat more readily in the abdominal area, contributing to a higher risk profile for several chronic diseases. However, the interplay between estrogen, testosterone, and fat distribution is complex and not fully understood.

Testosterone’s Unexpected Role in Women’s Health

While testosterone is primarily associated with men, women likewise produce testosterone, albeit in smaller amounts, in their ovaries and adrenal glands. It plays a vital role in maintaining muscle mass, bone density, and libido. Emerging evidence suggests that testosterone also influences fat metabolism and distribution. A position statement in The Lancet Diabetes & Endocrinology identifies visceral adiposity as a key risk factor for cardiometabolic disease, and while the statement doesn’t focus specifically on testosterone, it underscores the importance of addressing visceral fat accumulation.

Studies indicate that adequate testosterone levels in women are associated with a more favorable fat distribution pattern – meaning more subcutaneous fat and less visceral fat. Testosterone appears to promote the storage of fat in subcutaneous tissues, rather than allowing it to accumulate around the organs. This effect is thought to be mediated by testosterone’s influence on enzymes involved in fat metabolism and its ability to promote muscle mass, which in turn increases metabolic rate and fat utilization.

What the Evidence Shows: VAI and Cardiovascular Risk

The visceral adiposity index (VAI) is a calculation used to estimate the amount of visceral fat. A recent meta-analysis published in Nutrition, Metabolism and Cardiovascular Diseases, analyzing data from over 824,000 participants, found a strong association between higher VAI scores and increased risk of cardiovascular disease (CVD), stroke, and cardiovascular death. Specifically, the study showed a 55% increase in risk of cardiovascular death for every 0.5-unit increase in VAI. While this study doesn’t directly examine testosterone levels, it reinforces the critical link between visceral fat and adverse health outcomes, suggesting that interventions aimed at reducing visceral fat accumulation are crucial.

It’s important to note that correlation does not equal causation. The meta-analysis demonstrates an association between VAI and cardiovascular events, but it doesn’t prove that high VAI directly causes these events. Other factors, such as genetics, lifestyle, and overall health status, also play a significant role.

Implications for Women’s Health and What This Doesn’t Prove

These findings suggest that maintaining healthy testosterone levels may be beneficial for women as they age, potentially helping to mitigate the increase in visceral fat and reduce the risk of associated health problems. However, it’s crucial to emphasize that testosterone therapy for women is a complex issue and should only be considered under the guidance of a qualified healthcare professional. Self-treating with testosterone can have serious side effects, including acne, hair loss, and changes in menstrual cycles.

Currently, there is no widespread recommendation for routine testosterone testing or supplementation in women. Research is ongoing to determine the optimal testosterone levels for women and the potential benefits and risks of testosterone therapy. The existing evidence is not strong enough to support universal testosterone supplementation.

What Comes Next: Research and Clinical Practice

Further research is needed to fully elucidate the relationship between testosterone, fat distribution, and cardiovascular health in women. Future studies should focus on:

  • Investigating the effects of testosterone therapy on visceral fat accumulation and cardiovascular risk factors in postmenopausal women.
  • Identifying the optimal testosterone levels for women at different stages of life.
  • Exploring the potential benefits of lifestyle interventions, such as exercise and diet, in conjunction with testosterone therapy.

As our understanding of the role of testosterone in women’s health evolves, clinical guidelines may be updated to reflect the latest evidence. In the meantime, women should focus on maintaining a healthy lifestyle, including a balanced diet, regular exercise, and stress management, to support overall health and well-being. Regular check-ups with a healthcare provider are also essential for monitoring health status and addressing any concerns.