THE CONNECTION BETWEEN PCOS, LOW LIBIDO, UNCONTROLLED BLOOD SUGAR, AND HIGH TESTOSTERONE
"Androgen excess is the most common endocrine disorder in women of reproductive age. Androgens are produced primarily from the adrenal glands and the ovaries. However, peripheral tissues such as fat and skin also play roles in converting weak androgens to more potent ones. Androgen excess can affect different tissues and organs, causing variable clinical features such as acne, hirsutism, virilization [masculinization] and reproductive dysfunction." From the opening paragraph of Dr. Mohamed Yahya Abdel-Rahman's online article called Adrogen Excess. Androgens are hormones which, while being made by and used by females in amounts far less than that of men, are largely thought of as "male" hormones. Dr. Abdel-Rahman is a Reproductive Endocrinologist at Sohag University in Egypt.
Generally speaking, when men have chronic health problems they end up with low libidos, which is actually one of the first signs of ill health in males (HERE). They are usually told that this is the result of "Low T" (not enough testosterone), although Low T is almost always caused by something else. Women likewise end up with low libidos as the result of long-standing generalized health problems. You have heard me say repeatedly that UNCONTROLLED BLOOD SUGAR --- even in the absence of full-blown DIABETES ---- is at the root of almost every health problem you can name (HERE is a recent post on this topic). One of the most visible examples of this phenomenon is something called PCOS (Poly-cystic Ovarian Syndrome). We know that PCOS is heavily linked to BLOOD SUGAR and INSULIN RESISTANCE. So much so in fact, that it is frequently treated with Diabetes drugs such as metformin / glucophage. With PCOS, women's bodies fail to respond normally to insulin (they require more) and they make much more testosterone than they need. And as you might have imagined from this post's title, it affects the libido.
Although I did not spend a lot of time trying to sort out the peer-reviewed literature on this topic, a simple search of the PCOS Message Boards will reveal this simple fact to you. Some women with PCOS actually have an increased sex drive. On some level, this makes sense (HERE is one such example). On the other hand, I would say that the majority of the PCOS Message Boards tell a different story ---- a story of dramatically decreased (or even non-existent) libido. HERE is a frankly shocking example of how pervasive this situation is. It seems that PCOS is not only the number one cause of INFERTILITY in America (it is inarguably America's #1 female endocrine problem), but also a huge contributing factor to SEXUAL DYSFUNCTION as well. While the medical community is busy trying to solve this problem with a host of drugs and procedures (including IVF), I would like to show you what you can do to start the process of getting your life, your fertility, and your libido back. Why is this such a big deal? Read the email I got from R.F. of the Seattle area just the other day.
Dear Dr. Schierling,
I am at my wits end. I am a 38 year old married female in very poor physical condition. I admit that I am severely addicted to sugar, sweets, and fast food. Although I was an athlete in college and took great care of myself, over the course of the past 15 years (two healthy teenagers), I have gained over 100 pounds (I am 5'7"). I have been to lots of doctors, and although they all tell me that among other things I have PCOS, nothing they prescribe seems to work for me. I am now on antidepressants along with several other medications. I have absolutely no libido and my husband is becoming more distant by the day. What advice can you give me? I am willing to do anything. Just please do not just tell me to eat less and exercise more like my doctor does. That approach does not work. I cannot go on living like this. Thank you for your website and the amazing amount of information you provide.
Sincerely, XXXXX XXXXX
Here is one of the things you have to remember about all of this. When women end up with high levels of testosterone caused by Insulin Resistance, they also end up making excess Estrogen as well. This is why they not only end up with PCOS, but are thrown into ESTROGEN DOMINANCE at the same time. Because the female hormones get fouled up, one of the common solutions is to get a prescription for certain hormones (bio-identical hormones are particularly hot right now) to "balance" things out. With women, it is often some sort of HRT, with men, it is taking testosterone for the supposed "Low T". Let me show you why in and of itself, this is extremely short-sighted.
Don't get me wrong, someone who really knows what they are doing with these hormones can make some dramatic changes in symptoms --- at least for awhile. The problem is that virtually all of the hormones in your body are on a negative feedback loop ---- the same sort of loop your air conditioner and heater are on. A thermostat has an adjustable set point, and shuts off your heater or air conditioner once that temperature is achieved. When the temperature changes, the thermostat fires your unit up again. Hormones are on similar thermostat-like feedback loops. When the body has enough of a hormone, it will shut down endogenous (its own) production. This is why bodybuilders who take testosterone end up with shriveled testicles.
THE TESTOSTERONE DICHOTOMY
Your body's tissues / cells communicate with each other via a number of chemicals. These chemicals have interesting names like cytokines, chemokines, interleukins, or any number of others. We like to refer to these chemicals collectively as "Inflammation". Not too long ago I was at a nutritional seminar where the speaker made an interesting statement. When referring to solving chronic disease states, he said, "Inflammation is everything". In other words, find out what is driving INFLAMMATION, and you'll likely be a long way to solving your problem. Sugar is extremely inflammatory, as is JUNK FOOD. For many people, GLUTEN is massively inflammatory. The list is extensive, and can include everything from heavy metals to parasites. In fact, it can be nearly endless.
What does this have to do with PCOS? Listen to what Hethir Rodriguez of the Natural Fertility Info website has to say on this subject. "It has also been found that women with PCOS have low-grade inflammation, which may be a cause for insulin resistance. White blood cells produce substances to fight infection, this is known as inflammatory response. In some predisposed people eating certain foods, or exposure to certain environmental factors may trigger an inflammatory response. When inflammatory response is triggered, white blood cells produce substances that may contribute to insulin resistance and atherosclerosis." If you want to see a list of the "substances" she is talking about, HERE is a post on the subject.
But back to the question at hand. Why do you find some women with PCOS who are obese and some who are not (because 70% of our society is overweight or obese, most of those with PCOS are naturally going to fall into this category)? And why do you find some women whose sex drive is off the charts, while others (the majority) have sex drive that are in the dumps? There are any number of reasons, but I will attempt to shine some light on a few that I am aware of. I am sure that I am just scratching the surface.
- LENGTH OF TIME WITH THE PROBLEM: When researching this post, it seemed that generally speaking, the vast majority of the women touting increased sex drive with PCOS had not been living with the problem for very long. It also seemed like they were not, for the most part, women struggling with the most hardcore PCOS Symptoms. In other words, I am not sure if I recall seeing a post from a woman with all of the PCOS SYMPTOMS saying that she had a raging libido. Those in this boat were generally younger and less severe as far as their symptoms were concerned. In fact, many had no other symptoms than high testosterone on their blood work, and the inability to get pregnant (they may or may not have been overweight).
- SHBG: SHBG stands for Sex Hormone Binding Globlulin. Women manufacture testosterone in several places (25% from the adrenals, 25% from the ovaries, and about half comes from the conversion of androstenedione in the fatty tissues). However, when it comes to testosterone, the number that really matters is how much free testosterone is circulating in the blood stream --- most labs will say this is about 30-75 ng/dl, which is only about 1% of one's total testosterone. According to Dr. Mohamed Yahya Abdel-Rahman, some of the things that cause SHBG to "unbind" from testosterone and leave women with increased levels of free testosterone circulating in their bodies includes HYPOTHYROIDISM (sometime take a moment and compare the symptoms of Hashimoto's to PCOS), EXCESS INSULIN / OBESITY (these two go together like peas in a pod), Glucocorticosteroids such as CORTISOL and CORTISONE, as well as excess androgens themselves. An interesting side note is that Estrogen is antagonistic to Testosterone (it decreases it), which is why the birth control pill is a commonly used medical treatment for PCOS. Just be aware that 'The Pill' has an incredible number of potential side effects itself --- particularly with long term use.
- ESTROGEN DOMINANCE: I believe that there are any number of reasons that women can have higher testosterone levels in their system. PCOS is only one of many. Some women simply have more T than others. Read the internet message boards on the subject or look at the peer-reviewed literature, and you'll find that women who engage in heavy, complex, multi-joint weight lifting also seem to have both high testosterone levels and higher sex drives (HERE). Remember that although there are dozens (maybe hundreds) of reasons that women have androgenic hormones (testosterone or precursors such as DHEA) in their systems, conversion to Estrogen is one of the biggies. Over-conversion is just one more thing that can lead to Estrogen Dominance, which is an epidemic among American women. As far as I am aware, you simply do not find women with Estrogen Dominance who have heightened (or even normal) sex drives. To read more about ESTROGEN DOMINANCE, just follow the link.
- GENETICS: I would never hope to tell you that genetics play no part in PCOS. However, it is critical that you understand that EPIGENETICS trumps genetics in case after case after case. "It's my genes" has become the excuse du jour. Once you understand that in many cases you have the ability to turn genes on or off via diet and lifestyle, it can be very empowering.
- POLLUTION / TOXIC LIVING: We are exposed to a wide array of pollutants on a daily basis. The majority of these are considered to be "Endocrine Disruptors". Most of these are considered XENOESTROGENS. If you are not familiar with this term, you need to do so immediately. Along this same line of thinking, having a toxic (or absent) microbiota (POOR GUT HEALTH) is being linked, along with blood sugar, to most health problems as well. This is loosely called "DYSBIOSIS", and is one of the major consequences of our nation's UNBRIDLED ANTIBIOTIC USE.
- STRENGTH TRAINING: STRENGTH TRAINING can increase androgen levels somewhat. However, because it is extremely effective at lowering insulin levels, you will never see it associated as a causal or contributing factor as far as developing PCOS is concerned.