You’ve started hormone therapy to improve energy, focus, and overall wellness—but recently, you’ve noticed something isn’t quite right. Your rings feel snug, your face looks puffier in the mirror, and your ankles seem swollen by the end of the day. You may feel bloated or uncomfortable in your skin. Naturally, you're wondering: Is my hormone therapy making me retain water?

This is a common and valid concern. Hormone therapy, including Sermorelin, offers powerful benefits, but like any treatment that affects your endocrine system, it can sometimes lead to shifts in fluid balance. At Genesis Lifestyle Medicine, we help patients across the country monitor their hormone health with advanced testing and tailored care. Below, we explore why water retention may occur with hormone therapy—and what your lab results can reveal.

How can hormone therapy lead to water retention?

Not everyone experiences water retention with hormone therapy, but for those who do, the cause is typically linked to how hormones influence the body’s sodium and fluid regulation systems. This can result in mild swelling, puffiness, or bloating. Two hormones that may play a role in this process are estrogen and cortisol.

Shifts in estrogen balance

While Sermorelin does not directly impact estrogen the way testosterone does, increasing growth hormone (GH) levels can indirectly influence other hormones, including estradiol, especially in men. Elevated estradiol may promote sodium reabsorption in the kidneys, which leads to water retention. This can show up as swelling in the face, hands, or feet—even if your overall hormone levels seem stable.

Cortisol fluctuations

Cortisol, the body’s primary stress hormone, also plays a significant role in fluid balance. Hormone therapy, particularly treatments that influence the hypothalamic-pituitary axis, can sometimes alter cortisol levels. Elevated cortisol can trigger your body to retain more sodium and fluid, contributing to that heavy, bloated feeling. It may also disrupt sleep and energy levels, making symptoms more noticeable.

How to identify the cause of fluid retention

Understanding whether your symptoms are tied to Sermorelin or other underlying issues starts with proper lab work. Here's how Genesis Lifestyle Medicine helps patients get answers:

Use accurate estradiol testing methods

If estradiol is a concern, it’s important to use high-sensitivity testing, such as liquid chromatography-mass spectrometry (LC/MS-MS). Standard immunoassay methods may not pick up clinically relevant levels, especially in men. LC/MS-MS offers a clearer picture of your estrogen profile and how it may be affecting your water retention.

Track cortisol with precise timing

Cortisol varies throughout the day, so timing matters. A morning blood draw (around 8 a.m.) gives the best snapshot of peak cortisol levels. In some cases, a 24-hour cortisol test provides more complete insight. While some use saliva-based methods, we recommend blood testing for the most reliable results.

Consider a full estrogen panel

Sometimes, estradiol alone doesn’t tell the full story. A broader estrogen panel can detect other forms of estrogen that may influence fluid retention or hormonal imbalances. If estradiol is in range but symptoms persist, this deeper dive can help rule out hidden contributors.

Check electrolytes and osmolality

Hormone-induced fluid retention often affects your electrolyte balance. Testing sodium, potassium, and blood osmolality helps assess how concentrated your blood is and how much water you're retaining. These values can guide dosing adjustments or additional therapies to restore balance.

Tailor your hormone therapy for better results

Hormone therapy like Sermorelin can support energy, recovery, and overall vitality—but it works best when customized to your body's needs. If you’re dealing with bloating, puffiness, or swelling, the key is understanding the hormonal and metabolic factors behind it.

Schedule a consultation at Genesis Lifestyle Medicine, we offer personalized hormone optimization backed by precision diagnostics. Our approach includes estradiol, cortisol, and electrolyte testing to help uncover the root causes of symptoms like water retention. With expert insight and ongoing monitoring, you can stay on track with your wellness goals—and feel great while doing it.