Weight Reduction via Lifestyle Intervention Improves Androgen Levels and Glucose Metabolism in Women of Reproductive Age with Hyperandrogenism: A Real-World Observational Study

Background/Objectives: Weight loss achieved through lifestyle interventions has been demonstrated to improve the clinical prognosis of female hyperandrogenism. However, the interplay between such interventions, androgens, and glucose–lipid metabolism remains heterogeneous. This study evaluated the effects of lifestyle-induced weight loss on glucose and lipid metabolism and androgen levels in Chinese women of reproductive age with hyperandrogenism and examined the association between the degree of weight loss and changes in androgen levels, glucose and lipid metabolism, exercise capacity, and dietary patterns. Methods: This observational study, based on real-world clinical settings, collected medical records of women of reproductive age with hyperandrogenism who underwent weight-loss interventions between July 2023 and September 2025. Correlation analysis employed Spearman’s rank correlation coefficient, whilst pre- and post-weight-loss comparisons utilised paired t-tests or Wilcoxon signed-rank tests. Results: After a follow-up of 6 to 7 months, a total of 66 participants achieved a mean weight loss of 5.67 ± 4.27 kg. Statistically significant reductions were observed in testosterone (0.40 ± 0.10 vs. 0.30 ± 0.10 ng/mL, p < 0.001), androstenedione (p < 0.001), and the free androgen index (p < 0.001). Glucose metabolism showed statistically significant improvement, with decreases in HOMA-IR (p = 0.040), fasting glucose (p = 0.001), and fasting/2 h postprandial insulin (p < 0.001). However, lipid profiles showed no statistically significant changes. Multiple linear regression revealed that change in testosterone was independently and inversely associated with change in apolipoprotein A1 (β = −0.496, p = 0.008), while change in dehydroepiandrosterone sulfate was inversely associated with change in fasting insulin (β = −0.357, p = 0.032). A non-linear, inverted U-shaped relationship was found between weight loss magnitude and change in sex hormone-binding globulin, with moderate weight loss (5–10%) yielding the greatest increase (p = 0.044). Marked weight loss (≥10%) was associated with the lowest follow-up fasting insulin levels (p = 0.039). Conclusions: Weight loss achieved through lifestyle interventions is associated with improvements in androgen levels and glucose metabolism, though its impact on lipid metabolism remains limited. The degree of improvement in insulin sensitivity correlates more strongly with the magnitude of weight reduction.