Key Points In general, females favor lipid energy metabolism during moderate-intensity exercise, while men favor carbohydrate energy metabolism. Factors such as age, dietary intake, genetics, and methodological decisions can confound study findings, including properly identifying and reporting the menstrual cycle phase when researching female subjects. The increases in and ratios between estrogen and progesterone throughout the menstrual cycle could be critical factors that impact the role female sex hormones have in energy metabolism at rest and during exercise. Underlying mechanisms impacting observed sex differences in energy metabolism include female sex hormones, adrenergic activation patterns, muscle fiber distribution, fat mass distribution, resting substrate content, and methodological confounders and challenges. Pregnancy presents no significant difference in substrate utilization during exercise; blood glucose levels seem the most variable. However, the limited amount of research on this population opens up future opportunities to understand metabolic processes and changes that occur during pregnancy. Body composition changes that occur as a female progresses through menopause lead to greater susceptibility to metabolic disorders, as these changes particularly impact lipid energy metabolism.
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