What to do about androgens if you have PCOS
If you have PCOS you know the frustration of trying to handle those androgen symptoms. Androgens contribute to the most frustrating symptoms in PCOS such as acne, hirsutism, anovulation, irregular periods, and hair loss. Not only do these present debilitating symptoms on a daily basis but they can also worsen the phenotype of PCOS and long-term health risks.
What are androgens?
Androgens are essentially male sex hormones such as testosterone and androstenedione. Though women should produce androgens in normal amounts, when they are overproduced we can see unwanted male symptoms like those mentioned above. In PCOS we see an exaggerated secretion of androgens that are triggered from the ovaries or the adrenal glands. In order to make our symptoms go away and minimize long-term risks from this hyperandrogenic state, we need to look at where they are coming from.
So where is this hyperandrogenic state coming from?
High insulin
Hyperinsulinemia accounts for about 70% of PCOS cases. High insulin levels can trigger high androgen production in the theca cells of the ovaries such as testosterone and androstenedione (1). Many women have issues with the hormone insulin and more those weight issues than lean PCOS types. However, all body types can have problems with insulin functioning, making it crucial to do proper testing. High insulin also decreases SHBG, which is a protein that binds onto androgens in the bloodstream. Low levels are commonly seen in PCOS women which results in more androgens floating around in the bloodstream. So essentially we are producing more androgens from the ovaries resulting in symptoms but this also inhibits ovulation which is crucial for reproduction but also a healthy body.
Adrenal stress
The production of androgens is split about half in half between the ovaries and the adrenals. PCOS women may also see high levels of androgens originating from the adrenals and this may account for up to 50% of PCOS cases (2). DHEA-S on bloodwork is usually a good indicator that your androgens are stemming from the adrenals as DHEA-S is an androgen that is only produced in the adrenal glands. Evaluating current or even past stressors is important when addressing adrenal derived androgens as DHEA-S will be produced in higher amounts in response to significant and chronic stress. This is where diet and lifestyle changes can make a huge impact.
Exposure in utero
There is evidence that supports the claim that exposure during pregnancy to androgens may predispose the child to develop PCOS in later adulthood (3).
Animal studies showed that exposure to testosterone in utero reproduced the PCOS phenotype in the adult animal. And there seems to be evidence of a similar link in humans, though it would be unethical to reproduce these same studies in humans (4).
A study in humans, however, showed that the female foetuses of PCOS mothers were exposed to greater amounts of androgens than non-PCOS mothers, suggesting that the overexposure of androgens starts during pregnancy and may contribute to the pathophysiology of PCOS later on (5).
Note: Even if you have normal levels of androgens on a blood test, this does not necessarily mean you don’t have PCOS or elevated androgens as serum testing can be inaccurate. Symptoms are an important indication of androgen problems therefore if you show signs of acne, hair loss, or hirsutism this could be indicative of PCOS. Testing such as the DUTCH test can help determine your status as well as testing for underlying imbalances such as inflammation, adrenal stress, and insulin resistance.
Inflammation
In PCOS, markers of oxidative stress and inflammation are highly correlated with circulating androgens. This is because inflammation can increase insulin resistance, metabolic syndrome, and obesity - all of which can drive up androgens. Chronic low-grade inflammation is a driving factor in the PCOS pathogenesis, and this usually stems from the gut.
Natural remedies to reduce androgens
While there are anti-androgenic drugs that are commonly prescribed in PCOS, there are also natural anti-androgen therapies that may be just as effective without the side effects.
Reishi
A mushroom that has been shown to inhibit type 1 and type 2 alpha-reductase (higher amounts of these enzymes are more common in PCOS and associated with androgenic symptoms such as hair loss) and may have a role as an androgen receptor blocker. Reishi is also an adaptogenic mushroom meaning it helps to modulate cortisol levels (shown to be high among PCOS women) and help you to chill out, which frankly I think we could all use more of!
Don’t like the taste of mushrooms? Four Sigmatic brings you mushrooms in coffee and hot chocolate, the best of both worlds! I also love Purica and Botanica which have chocolate mushroom powders perfect for the holiday and winter season. Just add hot water or warm up some nut milk and blend up!
Spearmint
1 cup of Spearmint tea twice per day has been shown to be anti-androgenic and reduce the level of free testosterone circulating in the blood (6).
Green tea
Green tea contains an important compound called epigallocatechin also known as EGCG, which is a polyphenol with potent antioxidant actions. EGCG can inhibit the conversion of testosterone to DHT via the 5 alpha-reductase enzyme (7). EGCG is also highly anti-inflammatory, helping to reduce oxidative stress in the body, which can help improve adrenal stress, inflammation, and insulin resistance, all key drivers of PCOS symptoms. A cup of green tea can be a good replacement to coffee as it doesn’t stimulate the nervous system as much due to the calming amino acid it contains, L-theanine.
Zinc
Zinc is an essential mineral that is commonly low due to low dietary intake. It actually acts as an anti-androgen by acting as a natural androgen blocker and as another 5-alpha-reductase inhibitor, reducing the conversion into DHT (8). A study among PCOS women showed that zinc reduced hirsutism and acne in only 8 weeks making it a potential treatment option for PCOS women (9). Zinc can be taken in supplement form (take with food) or directly from food sources such as whole grains, pumpkin seeds, oysters, seafood, and animal products.
What’s your root cause?
As mentioned we always want to follow a root-cause approach, especially for the maintenance of PCOS over the long-term. Though anti-androgenic treatments can be beneficial and effective in managing symptoms, we need to address where the androgens are coming from in order to actually heal. This is why it is essential that you do proper testing to figure out where your root imbalances lie. Check out my free guide here on PCOS testing to request from your doctor.
Many times it can be obvious and easy to assess but sometimes it can take further digging and working with your practitioner. If you are requiring more personalized support navigating PCOS using natural alternatives and a holistic approach without the diets or medications, please reach out at info@laurence-annez.com or book a consultation call here.
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Disclaimer: Information on this site is intended only for informational purposes and is not a substitute for medical advice. Always consult with a healthcare provider before implementing changes. Read additional disclaimer info here.