I don't have the full explanation in front of me right now, but from what I've heard (and would probably do more research first) Pioglitazone helps new fat cells be created and with weight redistribution (especially belly, thighs, hips, face). It either helps take fat from subq to the other kind of fat or the other way around, whichever is the more "fem" one (sorry typing this out quickly and from memory). So people take it for a few months and gain and lose weight in that time to help redistribution go faster. Less belly/more hips/etc. more feminine fat placement.