The past few weeks on the blog, I have been writing about Polycystic Ovarian Syndrome, a condition that causes weight gain, infertility, facial hair growth, acne and irregular menstrual cycles.
If you want to learn more about this condition and its risk factors, you can read the full article here. I also recently wrote about the PCOS diet, lifestyle and supplement protocol that can help you reverse this condition and boost your fertility. You can read that article here.
PCOS is generally characterized by elevated testosterone, irregular or absent cycles and cystic ovaries. But there are many women out there who have regular cycles and no ovarian cysts but are struggling with symptoms of high testosterone.
If you know your testosterone is elevated but you don’t have a PCOS diagnosis, you can still benefit from following the PCOS protocol. But what if your testosterone is “normal” and you are still struggling with the typical symptoms of testosterone dominance? These include;
This is an interesting thing. It is possible to have normal or even lower testosterone but also have a testosterone dominance.
Today I want to talk about testosterone metabolism. If your testosterone appears normal on a saliva or blood test but you still have these typical symptoms of too much testosterone than your metabolism may be to blame.
Let’s start at the top. Pregnenolone is your master hormone. It is the building block for all your other steroid sex hormones including progesterone, cortisol, estrogen, DHEA and testosterone.
Pregnenolone is derived primarily from cholesterol. Yep, remember cholesterol? The big bad cholesterol that clogs your arteries and gives you heart disease?
What the government and general public are finally starting to learn is that cholesterol is crucial, not only for hormone production but also for the health of your brain.
Without cholesterol you cannot make sex hormones. And without sex hormones you are in trouble. 75% of your body’s cholesterol is produced in your liver but 25% comes from your diet. Therefore, getting enough cholesterol in your diet is crucial to your hormones. Cholesterol comes from animal products.
Pregnenolone can be converted into progesterone which can then be broken down to produce cortisol, your body’s main stress hormone. Pregnenolone is also a precursor for Dehyroepiandrosterone (DHEA). DHEA can then be broken down into either testosterone or estrone. Estrone can then be converted to estradiol (your body’s most potent estrogen) which can be converted to estriol.
But hormone metabolism doesn’t stop there. Both testosterone and estrogen are broken down further into metabolites. Today we will focus on the main metabolites of testosterone and what this means for you and your hormone health.
After testosterone is formed, it can be broken down via two different pathways; the alpha pathway and the beta pathway. The beta pathway, also called the Etiocholanolone metabolite, is a less androgenic pathway. This means that when you metabolize your testosterone down this pathway, it reduces the effects of testosterone.
In this case, you could have high blood or saliva testosterone but if you push primarily down the beta pathway than you may not exhibit any symptoms of high testosterone.
The alpha pathway, also know as the dehyrotestosterone (DHT) pathway, is a significantly more androgenic pathway. This means that if you tend to metabolize more of your testosterone down the DHT pathway then actions of testosterone become increasingly stronger in your system.
This is because DHT metabolites bind about 3 times more strongly to androgen receptors than Etiocholanolone metabolites. 5 alpha reductase is the enzyme that pushes the conversion of testosterone into DHT. Everyone will push some testosterone down the DHT pathway but some people push significantly more of their testosterone in this direction meaning that their testosterone becomes extra potent.
What this means for you is that you may have “normal” or even lower testosterone that becomes increasingly potent as it is being metabolized. This is why your testosterone may look normal but your symptoms tell you otherwise.
There is usually an insulin issue at play. Insulin, the hormone needed to regulate blood sugar and fat storage, enhances the actions of the DHT pathway. The more insulin you have, the more 5-alpha reductase you have (the enzyme that pushes DHT production). Women with acne, PCOS and obesity have significantly more 5-alpha reductase than women without these issues.
Progesterone, on the other hand, reduces 5 alpha reductase activity, at least in vitro, according to this study. Often times when I see elevated DHT metabolites in a client, I also see depleted progesterone levels.
Being aware of the DHT pathway is especially important for those struggling with infertility (elevated testosterone is a huge cause of infertility in the Western world), acne and obesity.
If this article resonates with you and some of your recent experience, I recommend getting your testosterone metabolism evaluated. You can do this by getting a urine hormone panel. The best hormone panel that I currently run is the Precision Analytical Dried Urine Test for Comprehensive Hormones (DUTCH). This test will not only evaluate your testosterone metabolism but also the metabolism of your other steroid hormones including; progesterone, estrogen and cortisol.
If you are interested in getting a full hormone evaluation to get to the bottom of your ongoing infertility, painful acne breakouts, explainable scalp hair loss or your complete inability to lose weight, please schedule a FREE 30 minute consultation with me. You can do that here and choose the service labeled, “FREE Discovery Session.”
Blood Sugar Management. I feel like a broken record here but having healthy blood sugar levels throughout the day is not only important for your testosterone metabolism but is crucial for your health in every other way.
The Paleo Diet is a fantastic way to manage blood sugar. You should also consider buying a glucometer and actively checking your blood sugar throughout the day.
Before meals, your glucometer should ready 80-90 mg/dl. If it is lower than this, you waited to long to eat that meal or didn’t eat enough at your previous meal. Add more whole foods or include an extra snack.
The post-prandial measurement is a fantastic way to assess your carbohydrate sensitivity. If you are carb sensitive, the more carbs you eat, the more you increase your insulin and make it more likely have a testosterone metabolism issue. 2 hours after a meal, your blood sugar should be under 120 mg/dl (but ideally under 100 mg/dl). If you are above this, you ate way too many carbohydrates or sugar at that previous meal and you need to reduce accordingly.
EPA & DHA. These are fatty acids that come from Omega 3 and 6 fatty acids. These come from cold water fatty fish and shellfish. I recommend supplementing with a high quality fish oil supplement derived from mackerel, sardines and/or anchovies. EPA and DHA have a positive effect on insulin and also reduce inflammation which can push up blood sugar levels.
Saw Palmetto. This herb can have potent effects on the DHT pathway. It effectively shifts metabolism from the alpha to beta pathway. Be wary that higher doses of saw palmetto can reduce DHT too much and throw of your testosterone levels. If you are using saw palmetto, you should be monitoring your levels regularly.
Exercise. Exercise is known to increase sensitivity to insulin. When your cells are insulin sensitive, you need less insulin. Less insulin has a positive effect on DHT.
Nettle. Stinging nettle tea increases Sex Hormone Binding Globulin in your blood. This can bind to excess testosterone and decrease the levels of testosterone that need to be metabolized, and thus reducing the effects of DHT.
Zinc. According to this study which was performed on human skin in vitro, zinc can have a reducing effect on 5-alpha reductase when used in combination with Vitamin B6. This is promising but there has been some conflicting research. Clinically, I see Zinc boost testosterone production and improve metabolism.
Looking at single hormone markers can be helpful but never gives you the full picture of what is happening. Just because your testosterone is “normal,” does not mean you are in the clear from the potent side effects of too much testosterone. If you are suffering from the symptoms elevated above but your doctor says your levels are “normal,” consider your metabolism. Click here to schedule a free meeting with me to see if comprehensive hormone testing is a fit for you.
Are you struggling with testosterone dominance or any of the symptoms mentioned above? Please feel free to comment with your experience below.
This week on the blog we are talking about PCOS or Polycystic Ovarian Syndrome. Last week I discussed this condition in detail and how it is the leading cause of infertility in women in the Western world. If you want to get all the details about PCOS, you can read the article here.
According to statistics, PCOS effects up to 20% of women in childbearing years. Unfortunately, it is not completely clear what causes this condition and this is still up for heavy debate in the scientific community.
The medical industry has put its focus on treating the symptoms of this condition through medication, like the birth control pills and metformin, rather than addressing the root cause. This has led to the misconception that PCOS is an unpreventable and incurable disease. This simply is not true. If you have PCOS, do not feel hopeless and please do not give up all your dreams of having children. PCOS is not only treatable, it is preventable, and it may even be curable in many women.
To be diagnosed with PCOS, you must meet two of these three criteria;
• Irregular or absent periods
• Elevated androgenic hormones (DHEA, testosterone)
• Cystic ovaries
Having PCOS is not fun. Often times women have a hard time losing weight, acne breakouts, facial hair growth, oily skin and hair, infertility and issues with anger and irritability.
We still don’t know what the definitive cause of PCOS is but it tends to come hand in hand with insulin resistance.
Insulin (the blood sugar hormone) is released into our bodies in response to sugar in the bloodstream. Its purpose is to grab this sugar from the blood and get it into the cells so that it can be burned for energy or stored as fat. Now, when we’re eating healthy complex carbohydrates, these break down gradually keeping our insulin and sugar levels balanced with only slight increases after meals. But when we eat unhealthy refined, or simple sugars (think cake and cookies, white bread, white rice) these break down much more quickly causing a dramatic spike in our insulin levels.
That huge spike that occurs when we eat refined sugars causes sugar to get pulled from the blood too quickly. The result is a dramatic drop blood sugar levels which then causes intense sugar cravings to normalize blood sugar again. This is known as the blood sugar roller coaster and for many people they ride it all day long.
It goes a little bit like this: High sugar/carbohydrate breakfast. Flood of insulin to reduce blood sugar. Blood sugar goes to low. You experience dizziness, fatigue, “hangryness,” and intense sugar cravings. You reach for more sugar/carbohydrates (ie. pastry, donut, bread, etc.) Blood sugar spikes again and you start the cycle all over again.
Eventually, if you continue with this vicious cycle, your body will develop insulin resistance. Extreme fluctuations of blood sugar is not normal. Previous to one hundred years ago, people did not have unlimited access to sugar and refined carbohydrates. This is not a normal situation. As insulin continues to knock on the doors of the cells and force sugar through the door, the cells stop hearing insulin. They become resistant. If the cells won’t let sugar into the blood, insulin then is forced to bring the sugar to the liver where it can be converted to fat.
1. Most women who have insulin resistance also have high testosterone and DHEA. For some reason insulin resistance seems to drive the androgen pathway, leading to elevated androgen levels.
2. Excess insulin causes the liver to make less sex-hormone-binding globulin (SHBG), the main protein that binds testosterone and keeps it from exerting its potent effects. This leads to extra free testosterone in the blood.
3. Insulin resistance increases the enzyme, aromatase. Aromatase causes the conversion of testosterone into estrogen. This can create estrogen dominance and lead to a whole host of nasty symptoms. Learn more about estrogen dominance here.
4. Insulin is a fat storage hormone which means you gain weight, typically around the abdomen.
5. Fat is found to act like an endocrine organ in itself. Excess fat can release excess testosterone, estrogen and cortisol. Too much of any of these hormones can block the pituitary from making enough Follicle Stimulating Hormone. This means FSH is not longer in balance with Lutenizing Hormone (LH). Too little FSH means that follicles in your ovaries cannot mature as usual. The dominant egg is never formed and instead the many immature follicles end up becoming cysts in your ovaries.
So now that you have a pretty good idea what’s going on, you are probably wondering, “How the heck do I fix this?!” It is completely possible to fix this issue but it does mean taking a careful look at your diet and lifestyle. Good things don’t come easy but with a little bit of love and attention you can bring your body and your hormones back into balance. Here is where to start:
1. Eat a low sugar diet – when it comes to PCOS, the most important thing to get under control is your diet. The quickest way to fix insulin resistance is to start pulling sugar and refined carbohydrates out of the diet. This can be hard at first since it is the norm to eat a diet high in these things. Ditch the refined sugar but also be wary of high sugar health foods like dried fruit, tropical fruits, honey, maple syrup and agave.
Make sure to have a high protein breakfast with lots of healthy fat. Try to keep sugar and carbohydrates as low as possible. Great choices for breakfast are eggs, free range meat, avocado and non-starchy vegetables (ie. greens, onions, broccoli, cauliflower, etc.).
If you are insulin resistant, you may be extra sensitive to sugar. You really need to remove it from your diet as much as possible. If you continue to struggle with sugar cravings despite reducing it in your diet, you can try this supplement or eat low sugar fruit like berries and apples. Coconut butter is also a delicious treat to help curb your cravings.
2. Eat Fibre – A high fibre diet may help pull excess testosterone out of the body. Cholesterol based hormones like estrogen and testosterone are secreted with the bile produced by the liver. Fibre can bind to hormone containing bile in the gut and be excreted in the stool. It isn’t known how much fibre can actually bind to fibre but there is likely some amount of binding which may reduce re-absorption of cholesterol-based hormones back into the blood. Too little fibre in the diet may lead to excess androgens circulating the blood and exerting their powerful effects.
Try to eat 35-50 grams of fibre a day in the form of fresh fruits and vegetables. The highest fibre foods include berries, apples, sweet potatoes, carrots, turnips, asparagus, squash, zucchini and broccoli.
3. Omega-3’s – According to this study, Omega 3’s may help reduce serum testosterone levels in the blood without a significant effect on Sex Hormone Binding Globule and insulin levels. The best way to do this is to include wild salmon in your diet or take a high quality fish oil supplement.
When it comes to supplementing with fish oil, quality matters the most. Many brands are not processed well and the result in rancid oil hiding in a capsule. Want to know if your fish oil supplement is any good? Open one of your capsules and smell it. If it’s gone bad, you will know. I generally recommend sticking to fish oil supplements made with mackerel, sardines and anchovies. My current favorite is Thorne Research Fish Oil and Orthomolecular Orthomega.
4. Vitamin D – A 2011 study concluded that most women with PCOS are deficient in Vitamin D. In another study, 67-85% of women struggling with infertility were also vitamin D deficient. Vitamin D, which is actually a hormone, is crucial for your immune system, bone development and muscle function. Low levels of vitamin D have been associated with insulin resistance, obesity and inflammation, all drivers of PCOS. Make sure you get enough unfiltered natural sunlight every day if possible. The amount of time you should spend in the sun depends on your skin tone. Fair skinned persons may only need 15-20 minutes of unfiltered sun exposure daily, whereas dark skinned individuals may need as much as an hour or more.
If you have PCOS, it is a good idea to supplement with vitamin D. Make sure you purchase a Vitamin D3/K2 combo, without K2 you won’t absorb much vitamin D. The Vitamin D counsel recommends that you take a minimum of 1000 IU per 25 lbs of body weight. I personally take 10,000 IU’s a day because I was found to be significantly deficient in my last blood test.
5. Chromium – chromium is a mineral that promotes proper insulin utilization and helps with blood-glucose management. This is one of my favorite supplements for blood sugar control. Chromium can be found in a wide range of foods – Broccoli, sweet potatoes, grass-fed beef, raw onions, and eggs are all good sources. You can also supplement with 200mcg of chromium picolinate a day.
6. Exercise – This is important. Exercise improves insulin sensitivity. Make sure to get a little bit of exercise every single day. Be mindful of your activity levels. You want to be active but you also do not want to go overboard. Too much exercise can lead to excess cortisol levels. High cortisol leads to high blood sugar levels. Exercise should make you feel energized, not exhausted. If you feel exhausted after exercise, take it down a notch.
7. Acupuncture – I am a huge proponent of acupuncture for reproductive health. I know many women who have regulated their cycles and gotten pregnant after introducing acupuncture into their lives. Acupuncture is a powerful thing. Give it a try before taking any prescription drugs or surgery.
If you were to look at what the medical industry has to say about PCOS, you would think it was an unavoidable incurable genetically contracted disease. I do not believe this is anywhere near the truth.
Remember that families share a lot more than just genes. They share meals, habits, lifestyle and environment. They may also share their love of Chinese takeout, Netflix and inactivity. To say that genetics is the main cause of PCOS is to say that you have no role in your condition. This ignores all of the things you can start doing right now to get to the root cause of PCOS and reverse it.
When a woman hears that she has been diagnosed with an incurable disease that was handed down to her, her options for treatment immediately become limited. In a condition like PCOS, where a woman’s lifestyle and food choices are such a huge component, I urge all women to at least consider all their options before resorting to drugs or invasive medical procedures.
What helped you overcome PCOS? Please tell me about your experience below.
Do you want to hear me talk about this article in a video? Check it out below.
What is PCOS? PCOS stands for Polycystic Ovarian Syndrome and to be diagnosed you must have at least two of the following criteria;
• Irregular or absent menstrual periods
• Elevated testosterone or other androgens
• Cystic ovaries
Up to 15% of women suffer from this condition. It is considered the leading cause of infertility in women in the Western world.
This condition is not very fun and I truly feel for every woman who is struggling with it. According to conventional medicine there is no cure for PCOS. Generally a physician will prescribe birth control pills to regulate sex hormone production. Birth control pills can also reduce free testosterone which can alleviate symptoms from increased androgen production.
If the woman is attempting to become pregnant, she may be referred to a fertility specialist.
Some women may undergo surgery to remove ovarian cysts. While this process may reduce testosterone levels and regulate ovulation, it may leave damaging scar tissue and many times the effects of the surgery only last a few months.
Unfortunately, none of these options addresses the root cause of the condition and the progression of the disease will continue if no interventions are made.
While testosterone and other male hormones are a huge driver of PCOS, estrogen and progesterone are important as well. They need to be in proper balance with testosterone in order to effectively regulate the menstrual cycle.
Common symptoms associated with PCOS include;
• Irregular or Absent periods
• Scalp hair loss
• Facial hair growth
• Inability to lose weight
• Oily skin and/or hair
• Irritability and/or anger
In order to understand how this condition affects a woman’s cycle, it is important to understand how a normal, healthy cycle progresses throughout the month.
The first day of the menstrual cycle is the bleeding phase. During a woman’s period, estrogen and progesterone are at their lowest levels. During this time, the lining of the uterus is shed for the first 3-7 days of the first half of the menstrual cycle. The first half of the menstrual cycle, from Day 1-14, is called the Follicular Phase.
After bleeding stops, estrogen begins to rise. Estrogen, which is a growth hormone, begins to build and thicken the uterine lining. During this phase the Pituitary gland secretes the Follicle Stimulating Hormone (FSH) which causes the growth of between 3 and 30 follicles, each of which contains an egg.
Eventually FSH starts to decline and only one of the follicles continues to grow. The other follicles decay and breakdown.
When the Pituitary detects this shift, it secretes Lutenizing Hormone (LH), which causes the follicle to rupture and release the egg inside. This occurs at day 14 and is called Ovulation. During ovulation, testosterone surges and estrogen begins to drop.
If that egg is not fertilized after 24 hours then the egg turns into the corpus luteum and begins to break down. As it breaks down, it secretes progesterone, making it the dominant hormone of the second half of the menstrual cycle. This phase is called the luteal phase. As progesterone levels begin to fall, this triggers the shedding of the lining and the cycle starts over again.
The cycle generally lasts 28 days but can be up to 35 days in some women.
It’s not completely clear how this occurs but there are a few ways depending on the woman in question.
1. Women with PCOS typically have low levels of Sex Hormone Binding Globulin (SHBG). SHBG is responsible for binding to hormones and making them inactive. This could result in increased levels of testosterone. Low levels of SHBG decrease the rate of conversion from testosterone to estrogen. Low levels of estrogen may result in poor signalling to the Pituitary gland leading to irregular cycles.
2. High levels of testosterone can also block the effects of progesterone and estrogen, disrupting the cycle.
3. If there is a Pituitary problem present, FSH and LH may not be secreted as they normally should. Typically, the ratio of FSH to LH is 1:2 but in women with PCOS it is 2:1.
The mechanism driving PCOS likely varies for each woman. What we do know is that insulin resistance plays a large role in PCOS. Whether the PCOS causes the insulin resistance or insulin resistance drives PCOS is unclear.
Insulin resistance plays a huge role in androgen metabolism, causing a women to prefer androgen production over estrogen production. Anytime I see elevated DHEA or testosterone in a woman on a hormone panel, I always focus on blood sugar control.
70% of women diagnosed with PCOS are also insulin resistant according to this study. PCOS needs to be taken seriously as it predisposes women for coronary artery disease later in life.
Insulin is a hormone made in the beta cells of the pancreas. Although it has many jobs, it is known for its ability to manage blood sugar levels. When you eat a meal, sugar levels rise in your blood. Insulin is then secreted to usher sugar into the cells where it can be used for energy.
Without insulin, you would die. Insulin is the only way for sugar in your blood to get into the cells where it can be used. Insulin becomes an issue when you continually eat foods that push the blood sugar too high. Refined sugar and processed carbohydrates require little breakdown and go straight into the blood, elevating blood sugar levels higher than what the body likes. The body overcompensates by pushing out extra insulin which can then drop blood sugar levels too low, causing you to crash and crave more sugar and carbs, starting the cycle over again.
If a person continues to consume sugar and carbs, the cells are constantly being bombarded by insulin knocking on the door trying to push sugar in. At some point, the cells stop listening to insulin knocking and become resistant. This means sugar levels rise in the blood and the cells don’t receive it for energy.
So that sugar levels don’t get dangerously high, sugar is then sent to the liver to be converted in triglycerides. That can lead to increased weight gain, especially around the abdomen.
A sign that you might have insulin resistance is getting sleepy after a meal. The conversion of sugar into triglycerides uses a lot of resources and the result is your energy levels crashing.
Any treatment plan for PCOS needs to involve careful attention to blood sugar levels and unwinding insulin resistance. How do you do this?
I plan to discuss solutions for PCOS in next week’s blog post. See you then!