Androgens … and the mischief they can cause

To find out more about what androgens are and what they do, please check out last week’s post.

PCOS … polycystic ovarian syndrome … is a condition where the sex hormones become unbalanced for some yet unknown reason, and start making more androgens which in turn often causes infertility. Excess androgens are in fact the top reason for infertility in women. Eighty-two percent of women with excess androgens have PCOS. And we wonder why so many women, especially younger women, are having trouble conceiving.

What happens when a woman’s testosterone level is too low? This is where hot flashes and a substantial decline in sex drive, confidence and joy comes in. This happens suddenly when women have their ovaries surgically removed. Since testosterone levels in women peak in their mid-twenties, by the time they hit their 40s, testosterone levels have decreased but with functioning ovaries, the change is not quite as drastic. When ovaries are removed surgically, the backup source of testosterone is suddenly gone, often resulting in the above symptoms.

Testosterone and estrogen have some overlapping roles. Testosterone can be converted to estrogen; fat cells contain an enzyme called aromatase that converts testosterone to estradiol. The more fat you have the more likely it is that you’ll create an excess of both androgens and estrogens. We know that excess estrogen may make it extremely difficult to lose weight, which then reinforces the cycle of more fat, estrogen and weight. Too much testosterone is associated with mood problems such as depression and anxiety, weight gain and sexual issues.

Women with too much testosterone have deeper voices, more pubic and facial hair and more muscular builds than women with normal amounts of this hormone. Extreme cases may cause balding, a full beard or growth of the clitoris. High testosterone levels may result in criminal violence, aggressive dominance and riskier behavior.

As if menopause wasn’t challenging enough for most women, those with high testosterone levels usually experience more depressive symptoms during this time of transition.

The extended androgen family has its challenges as well. Excess DHEA has been linked to depression during menopause and acne in women with PCOS, while insufficient levels are associated with vaginal atrophy and dryness. Too much androstenedione can cause minor symptoms such as acne and hair loss. Excess dihydrotestosterone is the main cause of male-pattern hair loss in both men and women.

Most women with high androgens also deal with insulin resistance. Androgens and insulin have their own tango. Insulin resistance is when you need higher and higher levels of insulin to drive glucose into cells as fuel.   Over time, insulin becomes less effective at lowering blood glucose and eventually results in high insulin and high glucose. High insulin causes ovaries to make excessive amounts of androgens and insulin also gets the liver to make less sex-hormone-binding globulin, the key protein that binds testosterone and keeps it from causing trouble. This combination results in more free testosterone around the bloodstream like a bull in a china shop. High glucose inches you towards prediabetes and diabetes. I’ll be talking more about insulin resistance and metabolic syndrome next week. Suffice it to say there is a close relation between high androgens and insulin resistance.

So what are some of the causes for excess androgens? Genetics is one. Forty percent of women with PCOS have a sister with the same condition and thirty-five percent have a mother with it but you can inherit the risk from either mother or father. Chronic stress seems to be connected to everything. It can throw your adrenal glands into overdrive, increasing the release of cortisol and androgens resulting in the symptoms described above. Even mild anxiety raises your DHEA, which can cause pimples and rogue hairs.   Excess body fat impacts androgen levels as I mentioned earlier.

PCOS and metabolic syndrome are both very extensive topics. I’ll follow up with posts about these topics over the next couple of weeks.

In the meantime, have a fabulous week!

Sandy

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