A while back, a corporate VC said something to me that I haven’t stopped thinking about. “We haven’t really invested in a women’s health company,” he said. “But we’ve invested in a metabolic health company, and most of the users are women.”
That observation keeps coming back to me. Looking at our most recent investment roundup, the metabolic health cluster stands out: Nourish raised $100 million for its AI-native metabolic health platform with GLP-1 integration. Signos raised $20 million for CGM-based weight management. Ilant Health raised $15 million for value-based obesity care. That’s $135 million into metabolic health in a single month. And if I were to tally the total investment flowing into this category over the past year - across GLP-1 platforms, CGM-based tools, nutrition infrastructure, employer obesity programs, and so on - I’d likely arrive at a very substantial number. None of these companies would likely describe themselves as women’s health. But the data suggests they probably should.
Follow the Users
Approximately 70% of people taking a GLP-1 medication for weight loss are women, based on a study of 581,000 patients. In the U.S., roughly 19 million women are currently on semaglutide or tirzepatide. Women respond differently to these drugs too - they lose more weight on average, but experience 2.5x higher rates of nausea and vomiting, and are more likely to discontinue. When 70% of your users are women, and women have systematically different responses to your product, you are building for women whether you acknowledge it or not.
How Metabolic Health Shows Up Differently in Women
Women’s metabolic health isn’t a fixed state. It shifts across the lifecycle, driven by hormonal transitions that fundamentally alter how the body processes energy, stores fat, and responds to insulin.
PMOS (recently renamed from PCOS) for example affects 1 in 8 women and is now understood as fundamentally a metabolic condition - insulin resistance is central to its pathology. GLP-1 prescribing among women with PMOS has surged 7-fold since 2021. Gestational diabetes affects roughly 8% of pregnancies, dramatically raising the risk of developing Type 2 diabetes within 5 years - yet most women receive no structured metabolic follow-up after delivery. Menopause triggers measurable changes in insulin sensitivity, body composition, and cardiovascular risk profile. And throughout all of this, women face higher rates of obesity and more severe clinical stigma when seeking treatment for it.
These aren’t edge cases. They describe the metabolic reality for a substantial share of the female population at any given time. And yet the products being built for metabolic health - the CGM dashboards, the GLP-1 protocols, the nutrition plans, the employer benefit packages - are often almost entirely gender-neutral.
Where the Innovation Is
What’s interesting is how many different angles are being pursued simultaneously.
GLP-1 support infrastructure
The GLP-1 boom has created an enormous downstream need. Medication alone doesn’t produce durable outcomes - patients need nutrition counseling, behavioral support, and metabolic monitoring to maintain results. An entire ecosystem of platforms is emerging to provide this: Insurance-covered dietitian networks, AI-assisted clinical documentation, real-time metabolic coaching, bone health startups. Major insurers are beginning to require dietitian engagement as a condition of GLP-1 approval. Given that 70% of GLP-1 users are women, this infrastructure is functionally women’s metabolic health infrastructure - even if nobody is calling it that.
Continuous metabolic monitoring
CGM has moved beyond diabetes management into preventive metabolic health. A growing number of platforms now use CGM data to personalize weight management - showing users in real time how specific foods, meals, and behaviors affect their glucose response. For women whose metabolic profile shifts with their cycle, pregnancy, or menopausal status, continuous monitoring could be particularly valuable. The opportunity to overlay hormonal data onto metabolic data is significant.
Employer and payer models
Value-based obesity care for health plans and employers is gaining traction - aligning incentives around outcomes rather than prescriptions. This matters because the economic burden of metabolic conditions falls disproportionately on women (who also pay 18% more than men in out-of-pocket healthcare costs, even excluding pregnancy). Employer-based models that cover metabolic care as a standard benefit rather than an out-of-pocket expense could meaningfully change who gets access.
Lifecycle-aware metabolic care
Women’s health companies are already building metabolic-relevant care for specific life stages - hormonal health platforms addressing insulin resistance, menopause companies tackling cardiometabolic risk, maternal health startups focused on gestational diabetes. What doesn’t exist yet at scale is the connective tissue between them. The stage-specific building blocks are there. The integration across the lifecycle isn’t yet.
The Framing Problem
There’s an argument that this is fine - that embedding women’s health into mainstream metabolic care means bigger rounds, bigger trials, more infrastructure, and less of the “niche” label. Nourish’s $100 million is a scale of capital that few explicitly women’s health companies have accessed.
But if metabolic health companies don’t build for the specific ways these conditions manifest in women - the hormonal drivers, the lifecycle transitions, the sex-specific drug responses - then women end up as the majority of users of products that weren’t designed for them. We’ve seen this pattern before in cardiovascular research, in drug dosing, in clinical trials.
The metabolic health space has an opportunity to avoid repeating it. Whether it will is an open question.
