Dear Dr G,
I am really confused and hope to get some help from you regarding my hormonal complaint.
My husband and I just got married and are hoping to have a Tiger Baby this year.
Despite increased sexual desire I have problems with irregular periods and this clearly makes planning a baby impossible
Obviously, this makes planning a baby impossible.
I understand that I have been overweight since my teenage years; this is also associated with excessive facial hair and acne.
I often think it’s part of my growing pains, yet I’m almost thirty now, and the troubles of “puberty” don’t seem to be easing.
My husband and I went to the fertility specialist for help. We were told that I was most likely having issues with excess testosterone and possibly suffering from a condition called polycystic ovary syndrome (PCOS).
I understand that this month’s theme is sexual health and testosterone and as such I hope to bring Dr. G up to speed on this puzzling issue of testosterone in women.
First, why do women even have testosterone? Isn’t it a male hormone? Also, does high testosterone cause me to have horrible acne, unwanted hair on my face while losing hair on my head? Is testosterone also causing me disturbed menstrual cycles?
I hear that testosterone is responsible for increased sexual desire in women, does this happen to me? Can you also explain what exactly is PCOS, am I really becoming a man?
Testosterone is the main sex hormone in men and it plays a key role in the development of sexual and reproductive health.
Although we generally perceive that men are driven by testosterone and women by estrogen, the fact is that both men and women produce both hormones, and the dominance of one hormone over the others will determine the dominant sex characteristics. In women, testosterone is produced in the ovaries, adrenal glands and fatty tissue. This is about 5% of the amount of testosterone in men.
Testosterone plays a crucial role in women for bone and muscle strength. The right sex hormone balance also determines libido, menstrual health, and fertility. Most women do not develop secondary male characteristics because most testosterone is metabolized and converted to estrogen.
However, when a woman produces an excessive amount of testosterone due to PCOS and congenital adrenal hyperplasia, masculinization of a woman with male secondary characteristics occurs.
As for the correlation between circulating testosterone and sexual desire in women, it is more complicated, and often subject to debate. On the one hand, testosterone at physiological levels in postmenopausal women or age-related androgen decline is known to enhance sexual desires.
However, on the other hand, excessive testosterone levels in women with PCOS do not have a significant impact on improving libido. Sexual dysfunction is thought to affect up to 50% of women with PCOS. Most studies have demonstrated the negative body image impact of obesity and hirsutism, leading to low levels of sexual arousal, lubrication, and orgasm.
Polycystic ovary syndrome, or PCOS, is a common hormonal disorder in women, which was documented in Italian medical literature as early as 1721. The disorder is characterized by multiple cystic formations in the ovaries due to an unknown trigger.
About three quarters of people with PCOS have high levels of male hormones (hyperandrogenism) leading to a disruption of their menstrual cycle. The prevalence ranges from 2% to 26% of the adult female population, with prevalence varying by country.
The World Health Organization (WHO) estimates that 116 million women worldwide suffer from PCOS with the manifestation of symptoms in women of reproductive age between 18 and 44 years old.
The exact cause of PCOS is largely unknown, but the etiology is usually associated with the combination of genetic and environmental factors. Obesity and lack of exercise are well recognized to be associated with PCOS, especially in people with such a family history.
The manifestation of the disorder can range from mild symptoms of irregular periods to excessive body and facial hair, acne, male pattern baldness, mood disorders, diabetes, and obstructive sleep apnea.
In severe cases, high testosterone in PCOS sufferers can even lead to heart disease and endometrial cancer.
PCOS is generally considered a chronic, incurable disease. Lifestyle changes, such as weight loss and regular exercise, are known to minimize general symptoms. As hormonal derangement can affect women in various forms and in different degrees of severity, targeted measures to address the specific symptoms experienced by patients, along with a healthy and disciplined life are essential for a successful outcome.
Oral contraceptive pills and diabetes medications such as metformin are used to improve the regularity of periods. Hirsutism problems can be treated with cosmetic laser hair removal technology.
Besides hair removal treatment, many patients would also accept medications such as anti-androgens used to reduce acne, facial hair growth and progression of male pattern baldness.
That said, not all women with PCOS experience infertility issues. Weight loss and dietary adjustment, particularly carbohydrate reduction, are known to be associated with the resumption of natural ovulation. For women who do not respond to these lifestyle changes, medications such as clomiphene and assisted reproductive technologies can often overcome PCOS-induced infertility.
The complex configuration of the female hormonal system is the right balance between estrogen and testosterone. This is crucial for the bodily order of sexual functions, reproductive health, and secondary female characteristics. Although the onset and progression of PCOS is largely unknown, an unhealthy lifestyle and obesity are well known to be the trigger that tips the scales. Clearly, excess androgen intake is associated with adverse effects on irregular periods, skin conditions, and general health chaos in women. American historian,
Henry Adams once said, “Chaos was the law of nature; order was a man’s dream”. When women with the chaotic hormonal issues of PCOS put Dr. G in the hot seat, her point is that “maintaining a healthy lifestyle can restore the law of nature.”