PCOS and Androgen Excess

Five to 20% of women fall on the PCOS spectrum, making it the most common endocrine disorder in women during the reproductive years. PCOS (polycystic ovarian syndrome) can look unique to each woman, but the most common presentation involves elevated androgens.

We typically think of androgens, like testosterone, as male hormones, but they are critical for women as well. However, when androgens are high and out of balance, they contribute to hormonal, metabolic, reproductive, and psychological issues, affecting all facets of life.

Today’s article will explore the relationship between PCOS and elevated androgens in women so you’ll understand what may be signs of this hormonal imbalance. For those with PCOS and androgen excess, you’ll learn some holistic strategies to support the restoration of healthy androgen levels. Keep reading to discover more about:

• The role of androgen hormones in women
• PCOS and hyperandrogenism (high androgens)
• Elevated testosterone symptoms
• The testosterone and insulin connection
• Integrative, holistic strategies for PCOS healing and lowering androgens

Androgens in Women

Androgens aren’t just for men. In fact, women have more testosterone than estrogen and progesterone at all stages of life. Testosterone is essential for:

• Reproduction
• Heart health
• Libido
• Muscle mass
• Bone strength
• Motivation

The primary androgen hormones in women are:

• DHEA (dehydroepiandrosterone) – the precursor to testosterone and estrogen
• DHEA-S (dehydroepiandrosterone-sulfate) – made in the adrenal glands
• Androstenedione (A4) – a pro-androgen hormone
• Testosterone – necessary for the functions listed above
• DHT (dihydrotestosterone) – made from testosterone; it’s the most potent androgen

All the androgens are critical for women’s health when in balance, but too much (or too little) can lead to symptoms and health issues.

Hyperandrogenism and PCOS

Hyperandrogenism (elevated androgens) can occur with or without PCOS, but PCOS is the most common cause of elevated androgens in women. High androgens are a clinical characteristic of PCOS and also a risk factor for PCOS development.

According to the Rotterdam diagnostic criteria, women with PCOS have two of the three characteristics, including absent or irregular ovulation, hyperandrogenism or symptoms of high androgens, and polycystic ovaries.

Hyperandrogenism is very common, affecting 60 to 80% of women with PCOS. Typically, the ovaries produce elevated androgens in PCOS, but in 20-30% of cases, adrenal hyperandrogenism plays a role (this PCOS presentation is called adrenal PCOS). 4 Types of PCOS Instagram Post.

Lab work showing high androgens suggests hyperandrogenism. However, it’s important to note that blood tests can look normal when clinical symptoms are present. In other cases, lab work can suggest hyperandrogenism, but a woman doesn’t have the symptoms of elevated testosterone. These inconsistencies let us know there is more to the androgen story, and we can’t test everything. Importantly, androgen symptoms (without elevated labs) are included in the Rotterdam criteria.

Besides PCOS, other causes of elevated androgens could be:

• Chronic stress
• Adrenal hyperplasia, a genetic condition that causes an overproduction of adrenal hormones (including DHEA-S)
• Cushing’s disease, an autoimmune disease that causes elevated cortisol (stress hormone) production (which can lead to more testosterone)
• Pituitary, ovarian, or adrenal tumors

In patients with elevated androgens, it’s critical to determine the underlying cause. Most commonly, the cause is PCOS, but we want to rule out all other possibilities.

High Testosterone Symptoms in PCOS

Elevated testosterone and other androgens may lead to unwanted symptoms, including:

• Irregular periods or missing periods
• Anovulatory cycles (menstrual cycles where you don’t ovulate)
• Oily skin and acne
• Hair loss on the head (male pattern baldness)
• Hair growth in unwanted places like the chin and chest (hirsutism)
• Weight gain, especially around the midsection
• Mood swings, irritability, anger
• Fertility challenges
• Fatigue
• High blood sugar and insulin resistance

The Testosterone and Insulin Connection

Many women with PCOS also have insulin resistance, characterized by elevated insulin and blood sugar, leading to metabolic dysfunction. Learn more about insulin resistance and cardiometabolic health here.

Insulin resistance and high testosterone (and other androgens) go hand in hand.

Insulin resistance drives PCOS and makes it worse over time. Insulin increases luteinizing hormone (LH), a brain (pituitary) hormone that signals the ovaries to produce estrogen. A surge in LH occurs just before ovulation. When LH is elevated due to high insulin, testosterone levels increase.

In other words, insulin resistance impairs ovulation, and the ovaries begin making more testosterone instead of estrogen.

In addition, insulin lowers sex hormone binding globulin (SHBG), a protein that binds to hormones (estrogen and testosterone) in the blood. When SHBG is low, fewer hormones can bind to it, allowing higher levels of free testosterone in the blood.

The insulin-testosterone isn’t just a one-way street. High testosterone levels also drive insulin resistance. This bi-directional relationship is one reason why women with PCOS experience a greater risk of:

• Fertility issues
• Pregnancy complications like gestational diabetes
• Metabolic syndrome, hypertension (high blood pressure), dyslipidemia (lipid imbalance)
• A higher risk of diabetes, heart disease, and certain cancers

Treating PCOS can be very challenging because of the interactions between insulin and testosterone. Often, treatment plans need to address both hormonal simultaneously.

Integrative PCOS Solutions to Lower Androgen Levels

For those with PCOS and high androgen symptoms, it can feel overwhelming to find long-term solutions. With conventional treatments, you’ll see metformin for insulin resistance, oral contraceptives to lower natural hormone production, or spironolactone for acne. While medication can be helpful in some instances, you aren’t limited to just these strategies.

Integrative and functional medicine offers holistic strategies to address the root causes of PCOS symptoms and help bring the whole body back into balance. Diet and lifestyle habits can be incredibly supportive and not only reduce PCOS symptoms but also improve fertility and reduce disease risk.

Always work with your healthcare provider for personalized medical advice. Here are some strategies to discuss:

• Nutrition – Nutrition is a foundational PCOS approach and can help reverse insulin resistance and lower inflammation. Balancing blood sugar with diet strategies supports hormonal balance throughout the body, including adrenal and sex hormones.

Blood sugar balance comes from eating balanced meals composed of whole foods. Include protein, healthy fats, and fiber-rich carbohydrates with meals. Significantly reduce or eliminate ultra-processed “junk” foods containing refined sugar and flour. 

Additionally, meal timing matters. Eat most of your food earlier in the day when insulin works better, and allow your digestive system to rest in the evening and overnight.

• Stress management – Women with PCOS experience stress like everyone and also have the added layer of stress around their health and fertility. High stress can contribute to insulin resistance and elevated androgen levels, so finding ways to reduce stress and practice self-care is critical in the healing process.

• Exercise – Regular physical activity helps with weight management, cardiovascular health, mood, and more. Exercise may be particularly beneficial for women with PCOS. While cardio helps improve insulin resistance, strength training and yoga may help lower androgen levels.

• Use targeted supplements – We have more options than ever before regarding scientifically supported nutrients and herbs to help lower androgens. Combined with lifestyle changes, these supplements can help break the cycle of insulin resistance leading to elevated testosterone leading to insulin resistance.

Always discuss new supplements with your doctor or pharmacist if you take medication for PCOS to avoid interactions.

Inositol

One of the most helpful supplements may be inositol (myo-inositol). In a review of 26 randomized controlled trials of inositol in women with PCOS, researchers found the supplement helps lower:

• BMI (body mass index)
• Free and total testosterone
• Androstenedione
• Blood glucose (blood sugar)
• Insulin

It also helps increase SHBG.

Vitex

Vitex (Chaste tree) is an herbal remedy that supports the communication between the brain and ovaries, promoting healthy ovulation and fertility. From that perspective, it’s a good match in many PCOS cases.

Further, a compilation of PCOS studies shows vitex supports hormone balance and lowers testosterone. It also reduces hirsutism symptoms.

Stinging Nettle

Stinging nettle root (not the leaf) is supportive for PCOS. It inhibits the 5-alpha-reductase enzyme, which converts testosterone to the ultra-potent DHT. In women with hyperandrogenism, daily nettle root helps lower androgen levels (including DHEA, testosterone, and DHT) as well as androgen-related symptoms such as acne, oily skin, and menstrual irregularities.

Other supplements with the potential to help decrease androgen levels include:

• Ashwagandha, rhodiola, and other adaptogens
• Berberine
• Peony
• Licorice
• Magnesium
• Saw palmeto

PCOS is common in women, and elevated androgens are common in women with PCOS. PCOS is a complex condition with many interplays between hormonal systems, including the bidirectional relationship between testosterone and insulin. While women with PCOS face many challenges, there has never been a time with more research and healing tools than today.

At TārāMD, we offer a personalized, integrative approach to PCOS care. No two women with PCOS have the same treatment plan; we tailor every strategy to your unique symptoms, hormonal levels, and needs. With conventional therapies and holistic strategies to draw from, you don’t need to look any further. Reach out today!

References

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3. Xu, Y., & Qiao, J. (2022). Association of Insulin Resistance and Elevated Androgen Levels with Polycystic Ovarian Syndrome (PCOS): A Review of Literature.Journal of healthcare engineering, 2022, 9240569.
4. Shele, G., Genkil, J., & Speelman, D. (2020). A Systematic Review of the Effects of Exercise on Hormones in Women with Polycystic Ovary Syndrome.Journal of functional morphology and kinesiology, 5(2), 35.
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