Androgens in Women

Overview

  • Androgens may be called "male hormones”, but they have and important role in women’s health.

  • Androgens have more than 200 actions in women.

  • The principal androgens are testosterone and androstenedione. Other androgens include: dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEA-S).

  • Androgens are converted into  estrogens.

  • Androgens are produced in the ovaries, adrenal glands and fat cells.

  • Androgens are vital to normal reproductive function, emotional well-being, cognitive function, lean muscle function and growth, and bone strength.

  • Androgens are believed to regulate the function of many organs, including the reproductive tract, bone, kidneys, liver and muscle. In adult women, androgens are necessary for estrogen synthesis and have been shown to play a key role in the prevention of bone loss, as well as sexual desire and satisfaction.

  • Androgens play many roles in the human body. Some androgen hormone effects include the stimulation of body and pubic hair growth, sexual desire (libido), muscle growth, and fat cell action and location. In both men and women, androgens are the precursor to estrogens.

    In women, androgen hormones are created in the adrenal glands, the ovaries, and in fat cel

  • Androgens are:

    ·       Testosterone

    ·       Androstenedione (A4)

    ·       Dehydroepiandrosterone (DHEA)

    ·       DHEA sulfate (DHEA-S)

    ·       Androstenediol (A5)

    ·       Androsterone

    ·       Dihydrotestosterone (DHT)

  • Excess amounts of androgens can pose a problem, resulting in such "virilizing effects" as acne, hirsutism (excess hair growth in "inappropriate" places, like the chin or upper lip) and thinning of hair on the head (balding).

  • About 10 percent of women with high levels of a form of testosterone called "free" testosterone have polycystic ovary syndrome (PCOS), characterized by irregular or absent menstrual periods, infertility, blood sugar disorders (prediabetes and type 2 diabetes), and, in some cases, symptoms like acne and excess hair growth.

Causes of Elevated Androgens in Women

In addition to PCOS, other causes of high androgen levels (called hyperandrogenism) include congenital adrenal hyperplasia (a genetic disorder affecting the adrenal glands that afflicts about one in 10,000 to one in 18,000 Americans, about half of whom are women) and other adrenal abnormalities, and ovarian or adrenal tumors.

Low Androgen Levels

  • Low androgen levels can be a problem as well, producing effects such as low libido (interest in or desire for sex), fatigue, decreased sense of well-being and increased susceptibility to bone loss, osteoporosis and fractures.

  • Low androgen levels may affect women at any age, but most commonly occur during the transition to menopause, or perimenopause.

  • Androgen levels begin dropping in a woman's 20s, and by the time she reaches menopause, have declined 50 percent or more from their peak as androgen production declines in the adrenal glands, and the mid-cycle ovarian androgen boost lessens.

  • Combination estrogen/testosterone medications are available for women in both oral and injected formulations. Small studies find they are effective in boosting libido, energy and well-being in women with androgen deficiencies, as well as providing added protection against bone loss.

  • Testosterone is also undergoing studies for treating premenstrual syndrome (PMS) and autoimmune diseases. Women with PMS may have below-normal levels of testosterone throughout the menstrual cycle, suggesting that a testosterone supplement may help, but such treatments have not been proven effective.

  • Results from blood tests are often misleading and may not be conclusive because there is no agreement on just what constitutes "normal" androgen levels in women.

  • Levels fluctuate depending on a woman's age, the timing of her menstrual cycle and her menopausal status. Further, many standard laboratory tests, optimized for measuring testosterone in men, may not be sensitive enough to accurately measure women's levels. As a result, it is easier to diagnose androgen levels that are too high, rather than levels that are too low.

Elevated Androgens

  • Hyperandrogenism can produce bothersome cosmetic symptoms like unwanted hair on your upper lip and chin.

  • Hyperandrogenic conditions are also associated with serious health problems like insulin resistance (a precursor to diabetes), diabetes and heart disease.

  • Hyperandrogenic syndromes often go undiagnosed, even though symptoms may be treated.

  • The signs and symptoms of hyperandrogenism are:

    • ·       Hirsutism (excess facial or body hair)

    • ·       Persistent acne and/or oily skin

    • ·       Alopecia (thinning hair on the head)

    • ·       Insulin resistance

    • ·       Acanthosis nigricans (rough, darkly pigmented areas of skin)

    • ·       High blood pressure

    • ·       Low HDL cholesterol ("good cholesterol") and high LDL cholesterol ("bad cholesterol")

    • ·       Obesity around the mid-abdomen

    • ·       Irregular or absent periods or frequent skipped cycles

    • ·       Enlargement of the clitoris

    • ·       Deep or hoarse voice

  • If symptoms include irregular or absent periods, you may have polycystic ovary syndrome (PCOS)––the most common condition associated with hyperandrogenism.

  • Hyperandrogenic symptoms may also be caused by a genetic disease called congenital adrenal hyperplasia (CAH).

  • Milder cases may look a lot like PCOS, with symptoms possibly including facial hair, irregular periods and high blood pressure. Women with mild CAH may also be shorter than their parents.

  • Laboratory tests usually serve to confirm the presence of hyperandrogenemia. A blood test for total and free testosterone may be ordered, as well as a lipid profile (to measure cholesterol levels), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin and a fasting glucose test. Several endocrine function tests may also be ordered to determine the site(s) of abnormal androgen secretion, such as DHEA or its sulfate form, DHEAS. Thyroid tests are usually included in the evaluation. Inflammation is also a component of PCOS, so a physician may choose to measure some inflammatory markers as well.

  • The majority of women with hyperandrogenism have PCOS. That said, there are other possible causes of hyperandrogenism that must be ruled out before a diagnosis of PCOS can be made

  • There are two “kinds” of hyperandrogenism: clinical and biochemical.

  • It is possible to have clinical signs of hyperandrogenism and for all blood work to come back normal, and it’s possible to have labs indicate excess androgens but there be little to no clinical signs.

  • Clinical signs include:

    Abnormal hair growth on the face, chest, or back: Hair growth usually associated with men, like facial hair or chest hair, can be a clinical sign of hyperandrogenism. The medical term for this is hirsutism. Between 75 and 80 percent of women with male-like hair growth have PCOS, but not all women with PCOS experience this symptom.7 Many women remove this excess hair growth.

    Acne: Acne during adolescence is common in teenage boys and girls.8 Even in adulthood, mild acne is not considered to be abnormal. However, moderate to severe acne, especially when accompanied by other troublesome symptoms, can be an indicator of excess androgens.

    Male pattern-balding: Both men and women may experience hair loss as they age. However, when women experience “male pattern balding,” especially at a younger age than might be expected, this can be a possible sign of clinical hyperandrogenism.9

    Male-pattern balding is when hair loss occurs either by the hairline, resulting in a receding hairline, or when balding occurs on the crown of the head. This is different than female pattern balding, where hair thins out on the top of the head, but the hairline itself remains unchanged.

    Virilization: This is when a woman develops traits associated with men, like a deepening voice or more male-like muscle growth.10 While this is a possible clinical sign of hyperandrogenism, it is not usually seen with PCOS. Other possible causes of hyperandrogenism should be considered.

  • Biochemical Hyperandrogenism

    Biochemical hyperandrogenism is when blood work indicates that androgen levels are higher than normal. Testing androgen levels when making a diagnosis of PCOS is important. Even if there are clinical signs of hyperandrogenism already evident, blood work can help rule out other possible causes of hyperandrogenism.

  • Can You Still Have PCOS But Have Normal Androgen Levels?

    Maybe your doctor has diagnosed you with PCOS, but you see that your labs indicate normal levels for androgens. Does this mean you don’t have PCOS? This is a somewhat complicated question because not everyone agrees on how to diagnosis PCOS.

    Most experts say that increased androgen levels are not necessary to be diagnosed with PCOS. However, the Androgen Excess (AE) and PCOS Society argues that irregular cycles and polycystic ovaries, without also excess androgens, is not enough to qualify as a diagnosis of PCOS.

    However, here are some things to keep in mind. One, the most commonly used diagnostic criteria used for PCOS—the Rotterdam criteria—indicates that either biochemical or clinical signs of hyperandrogenism qualify

    No two women with polycystic ovary syndrome (PCOS) have the exact same symptoms. This makes PCOS diagnosis challenging, as does the fact that many other conditions can present similarly. Because of this, an ultimate diagnosis of PCOS heavily relies on ruling out other possible causes. To be formally diagnosed with PCOS, you must meet two of the following diagnostic criteria:

    1.     Irregular or absent periods

    2.     Biological or physical signs of hyperandrogenism (high androgen level) without another medical cause

    3.     A string of small follicles (cysts) on an ultrasound examination

    These guidelines, referred to as the Rotterdam Criteria, are the ones most commonly used by endocrinologists in the United States and abroad

  • Other Diseases and Conditions With Elevated Androgens in Women

    PCOS is partially a diagnosis of elimination.15 Before your doctor can say you have PCOS, she needs to confirm your symptoms can’t be explained by another hormonal disorder. Specifically, when it comes to androgens, there are two possible other causes of hyperandrogenism that your doctor will want to check for: congenital adrenal hyperplasia and Cushing’s disease.

    Congenital adrenal hyperplasia (CAH) is an inherited disease that results in abnormal functioning of the adrenal glands.16 Men and women with CAH are missing a vital enzyme that impairs to production and regulation of certain hormones. One of the possible hormones affected are androgens.

    Most people born with CAH are diagnosed when they are young, but there is a milder variation of the disease and doesn’t produce obvious symptoms until later in life. This is sometimes known as late-onset CAH or non-classic CAH. The symptoms of non-classic CAH can be very similar to PCOS. Before your doctor can diagnose you with PCOS, non-classic CAH should be ruled out first.

    Cushing’s disease is another syndrome that can lead to symptoms similar to PCOS.17 Cushing’s disease occurs when the body is exposed to high levels of cortisol over an extended period of time. This can happen due to long-term oral steroid use, or it can also occur if the body itself creates the excess cortisol.

    When the body itself causes Cushing’s syndrome, it may be caused by a non-cancerous tumor on the pituitary gland or adrenal gland. This growth may produce abnormally high levels of an androgen hormone, adrenocorticotropic hormone (ACTH).18 The excess androgens can be mistaken for PCOS. This is why Cushing’s disease must be ruled out first.

  • Other Health Issues Caused by Elevated Androgens

    Increased androgen levels can cause irregular cycles, other symptoms such as facial hair growth and infertility in women. But they are also responsible for some of the other risk factors that often accompany PCOS.

    Fat distribution: Androgens seem to play a role in where fat is stored in the body.  Elevated androgens may lead women to carry more fat in their abdominal region.

    Insulin resistance:  It has been found that women with higher levels of androgens tend to also be at a higher risk of insulin resistance.

    Cardiovascular problems: Having either abnormally high or low levels of androgens is associated with an increased risk of cardiovascular problems in women.

  • Hormone therapy (HT), which consists of either estrogen and progestin (sometimes referred to as hormone replacement therapy, or HRT) or estrogen-only therapy (ET), and birth control pills containing estrogen, are other treatment options. Oral estrogens boost levels of sex hormone binding globulin (SHBG), a protein made in the liver that binds testosterone and estrogen. This reduces levels of free testosterone, which may be triggering symptoms. Glucocorticoids (cortisone), which are often prescribed for asthma or inflammation, can also suppress production of androgens.

Androgen Deficiency

  • Androgen levels in women peak during their 20s. Then a decline in daily production begins that continues throughout a woman's life. The only time a sudden drop-off in androgen levels occurs is in women who have their ovaries removed (about half of all androgens are produced in a woman's adrenal glands and half in her ovaries). By the time a woman reaches menopause, blood androgen levels are about half of what they were at their peak.

  • Low androgen levels in women during their reproductive years, as well as following menopause, result in three noticeable symptoms: low libido, fatigue and a reduced sense of well-being.

  •  Low androgen levels also have been linked to bone loss and osteoporosis (a disease that causes thin, fragile bones), possibly explaining the phenomenon of excessive bone loss in some women who go through ovarian failure or surgical removal of the ovaries.

  • Low sex drive and vaginal dryness are two common symptoms experienced by some women during the transition to menopause, making sex uncomfortable or painful.

  • To diagnosis androgen deficiency, your health care professional will consider symptoms such as low libido and fatigue. Other conditions that can cause similar symptoms will also need to be ruled out levels, while in others, it can increase greatly and give rise to lowered sex drive (undesirable) or reduced free testosterone and a resulting decrease in side effects such as acne and hirsutism (desirable).

  • Blood testing for testosterone in hypoandrogenic women is problematic. Health care professionals have not reached a consensus about what constitutes low levels in women, and levels at the lower end of the female range are difficult to measure with many commercially available laboratory tests.

  • The causes of androgen deficiency are varied. The most common cause of low androgen is aging.

  • If your symptoms bother you, you may want to talk to your health care professional about androgen replacement.

  • Androgen deficiency may be a particular problem if:

    • Your ovaries have been removed

    • You have undergone early menopause (generally defined as menopause occurring prior to age 40)

    • You have Turner's syndrome, a genetic growth disorder that occurs in about one in 2,000 girls that arises when one, or part of one, of the two X chromosomes is missing (two X's code for a female, an XY for a male). This is a condition in which the ovaries fail to develop.

    • You are postmenopausal

    • You have undergone chemotherapy or radiation treatment for cancer

  • Other conditions associated with low testosterone include hypothalamic amenorrhea (absence of menstrual periods resulting from excessive dieting and exercising) and hyperprolactinemia (characterized by high levels of prolactin, the hormone that drives milk production when a woman breastfeeds). Additionally, a variety of pituitary gland tumors are also associated with low production of testosterone, as well as other hormones.

  • Sometimes there is no obvious cause of androgen deficiency. Otherwise healthy women of reproductive age can suffer from low androgens, which can be confirmed with blood tests and after other potential causes of low libido and fatigue are eliminated.

  • To exclude other potential causes of low libido and fatigue, your health care professional may ask you about past psychological or relationship problems and check for other potential causes of fatigue, such as depression, hypothyroidism and iron deficiency.Treating Excess Androgens Associated

Treatment of Hyperandrogenism

  • Typically focuses on treating problematic symptoms. This will vary from person to person since PCOS and hyperandrogenism don’t always present the same way.

  • Birth control: For women who aren’t trying to get pregnant, hormonal birth control pills may be used to reduce androgens and also treat symptoms.

  • Not everyone does well on birth control, however, and some prefer to avoid taking hormonal medications. This is also not a solution for women trying to get pregnant.

  • Anti-androgen drugs: Another possibility is anti-androgen medication.26 These are drugs that reduce the effects of excess androgens circulating in your body. They may be used alone or in combination with birth control pills.

  • Anti-androgen drugs include spironolactone, CPA, and flutamide

  •  Spironolactone may be used to treat irregular hair growth (hirsutism).

  • CPA may be used along with birth control pills to treat unwanted hair growth and acne.

  •  Flutamide, a drug usually used to treat prostate cancer, may be used in PCOS to treat hirsutism.

  • Insulin reducing drugs: Metformin may also be used to treat PCOS-related androgen symptoms, including unwanted hair growth and acne.28 Metformin can also be taken when you’re trying to conceive and is sometimes used as part of a fertility treatment protocol.

  • Hair removal: Directly removing unwanted hair growth is also an option.29 Some possibilities include waxing, threading, laser hair removal, and electrolysis. 

  • Acne treatments: There are a number of over-the-counter acne treatments, but for those with PCOS-related acne, these are unlikely to make a significant difference

  • Anti-androgens are an assorted group of drugs and compounds that reduce the levels or activity of androgen hormones within the human body.

  • Disease states in which this is relevant include polycystic ovarian syndrome, hirsutism, acne, and hair loss.

  • There is an increasing recognition of the benefits of plant-derived anti-androgens, for example, spearmint tea in the management of PCOS, for which some evidence about efficacy is beginning to emerge.

Anti-Androgens

An androgen antagonist (anti-androgen) can broadly be defined as any compound that has the biological effect of blocking or suppressing the action of male sex hormones such as testosterone within the human body.

  • This may occur at any point in the hypothalamic-pituitary-gonadal-end-organ axis and could be through a direct effect on gonadotropin production at the level of the pituitary or by competing for binding sites at the receptor level on the normally androgen sensitive tissues in the body.

  • Cyproterone Acetate

    Cyproterone acetate is a synthetically derived steroid that acts as a potent anti-androgen. It also possesses progestational properties and can be used to assist conception in subfertile individuals.

  • Spironolactone

    Spironolactone, a synthetic 17-spironolactone corticosteroid, is commonly used as a competitive aldosterone antagonist and acts as a potassium sparing diuretic. It used to treat low-renin hypertension, hypokalemia, and Conn’s syndrome. It has recognized anti-androgen effects.

  • Flutamide/Nilutamide/Bicalutamide

    Flutamide/nilutamide/bicalutamide are all non-steroidal, pure anti-androgens. Bicalutamide is the newest agent and has the fewest side effects.

  • Ketoconazole

    Ketoconazole is a derivative of imidazole that is used as a broad spectrum antifungal agent. Recognized effects are severe liver damage, but there is also an adrenolytic function. Ketoconazole reduces androgen production in the testes and the adrenal glands. It is a relatively weak anti-androgen, but is used with good effect in patients with Cushing’s syndrome.

  • Finasteride/Dutasteride

    Finasteride/dutasteride are inhibitors of 5-alpha reductase, an enzyme that prevents the conversion of testosterone into the active form dihydrotestosterone (DHT). They are specific anti-androgens in that they only counteract the effects of testosterone and not other androgens.

Naturally Occurring Anti-Androgens

  • Red reishi, which has been shown to reduce levels 5-alpha reductase, the enzyme that facilitates conversion of testosterone to dihydrotestosterone (DHT).

  • Licorice, which has phytoestrogen effects and reduces testosterone levels.

  • Chinese peony, which promotes the aromatization of testosterone into estrogen;

  • Green tea, which contains epigallocatechins and also inhibits 5-alpha reductase, thereby reducing the conversion of normal testosterone into the more potent DHT.

  • Black cohosh, which has been shown to kill both androgenresponsive and non-responsive human prostate cancer cells.

  • Chaste tree, which has a reduces prolactin from the anterior pituitary.

  • Saw palmetto extract, which is used as an anti-androgen although it shown no difference in comparison to placebo in clinical trials.

Details: Plant-Derived Anti-Androgen Therapies

Believed that there are fewer adverse effects of such alternative therapies.

  • Reishi (Ganoderma lucidum)

    Red reishi, commonly known as LingZhi in Chinese, is a mushroom thought to have many health benefits. In a research study exploring the anti-androgenic effects of 20 species of mushrooms, reishi mushrooms had the strongest action in inhibiting testosterone (3). That study found that reishi mushrooms significantly reduced levels of 5-alpha reductase, preventing conversion of testosterone into the more potent DHT. High levels of DHT are a risk factor for conditions such as benign prostatatic hypertrophy (BPH), acne, and baldness.

  • Licorice (Glycyrrhiza glabra)

    Licorice is a flavorful substance that has been used in food and medicinal remedies for thousands of years. It is also known as “sweet root,” licorice root contains a compound that is about 50 times sweeter than sugar. It has been used in both Eastern and Western medicine to treat a variety of illnesses ranging from the common cold to liver disease. Licorice affects the endocrine system because it contains isoflavones (phytoestrogens), which are chemicals found in plants that may mimic the effects of estrogen and relieve menopausal symptoms and menstrual disorders. Licorice may also reduce testosterone levels, which can contribute to hirsutism in women.

    A small clinical trial published in 2004 by Armanini and colleagues found that licorice root significantly decreases testosterone levels in healthy female volunteers. Women taking daily licorice root experienced a drop in total testosterone levels after 1 month and testosterone levels returned to normal after discontinuation. It is unclear as to whether licorice root affects free testosterone levels. The endocrine effect is thought to be due to phytoestrogens and other chemicals found in licorice root, including the steroid glycyrrhizin and glycyrrhetic acid, which also have a weak anti-androgen effect.

  • White Peony (Paeonia lactiflora)

    Chinese peony is a widely grown ornamental plant with several hundred selected cultivars. Many of the cultivars have double flowers with the stamens modified into additional petals. White peony has been important in traditional Chinese medicine and has been shown to affect human androgen levels in vitro. In a 1991 study in the American Journal of Chinese Medicine Takeuchi et al described the effects of paeoniflorin, a compound found in white peony that inhibited the production of testosterone and promoted the activity of aromatase, which converts testosterone into estrogen .To date, there have been no studies that translate or explore the clinical effects.

  • Green Tea (Camellia sinensis)

    In addition to supporting the cardiovascular system and somewhat reducing the risk of cancer and type 2 diabetes, green tea may also have an important anti-androgen effect because it contains epigallocatechins, which inhibit the 5-alpha-reductase conversion of normal testosterone into DHT. As previously noted, this anti-androgen mechanism may help to reduce the risk of acne, and hair loss. As yet, no randomized controlled trials of green tea for these androgen dependent conditions have been conducted.

  • Spearmint (Mentha spicata [Labiatae])

    Spearmint, usually taken in the form of tea, has been thought for many years to have testosterone reducing properties. It is commonly used in Middle Eastern regions as an herbal remedy for hirsutism in females. Its anti-androgenic properties reduce the level of free testosterone in the blood, while leaving total testosterone and DHEAS unaffected. One study has shown that drinking spearmint tea twice daily for 30 days (vs. chamomile tea, which was used as a control) significantly reduced plasma levels of gonadotropins and androgens in patients with hirsutism associated with polycystic ovarian syndrome. There was a significant change in patients’ self-reported dermatology-related quality of life indices. It is possible that sustained daily use of spearmint tea could result in further abatement of hirsutism.

  • Black Cohosh (Actaea racemosa)

    Black cohosh (Actaea racemosa) is a plant of the buttercup family. Extracts from these plants are thought to possess analgesic, sedative, and anti-inflammatory properties. Black cohosh preparations (tinctures or tablets of dried materials) are used to treat symptoms associated with menopause, such as hot flashes.

  • Chaste Tree (Vitex agnus-castus)

    Chaste tree (or chasteberry) is a native of the Mediterranean region and is traditionally used to correct hormone imbalances. In ancient times, it was believed to be an anaphrodisiac, hence the name chaste tree. Clinical studies have demonstrated effectiveness of medications produced from extract of the plant in the management of premenstrual syndrome (PMS) and cyclical mastalgia. The mechanism of action is presumed to be via dopaminergic effects resulting in changes of prolactin secretion from the anterior pituitary. At low doses, it blocks the activation of D2 receptors in the brain by competitive binding, causing a slight increase in prolactin release. In higher concentrations, the binding activity is sufficient to reduce the release of prolactin.

  • Saw Palmetto (Serenoa repens)

    Saw palmetto is a small palm tree native to eastern regions of the United States. Its extract is believed to be a highly effective anti-androgen as it contains phytoesterols. This has been the subject of a great deal of research with regards to the treatment of androgenic alopecia and PCOS.

Summary of Effects of Plant Derived Anti-Androgens

Red Reishi (Ganoderma lucidum)     

  • Reduction in 5-alpha-reducatase enzyme activity, reduction in DHT levels

Licorice (Glycyrrhiza glabra)

  • Reduction in total testosterone levels (effect on free testosterone levels not clear)

White Peony (Paeonia lactiflora) Paeoniflorin

  • Inhibits the production of testosterone and promotes the activity of aromatase - the enzyme that converts testosterone into estrogen

Green Tea (Camellia Sinensis)  

  • Contains chemicals epigallocatechins, which inhibit the enzyme 5-alpha-reductase, and thereby reduce the conversion of normal testosterone into the more potent DHT

Spearmint (Mentha spicata[Labiatae])

  • Decreases free testosterone, increases LH, FSH and estradiol. Reduction in patient reported measures of hirsutism

Black Cohosh (Actaea racemosa)     

  • Black cohosh extract has been shown to inhibit the proliferation of human breast cancer cells and kill both androgen-responsive and unresponsive human prostate cancer cells by induction of apoptosis and activation of caspases.

Chaste Tree (Vitex agnus-castus)     

  • Clinical studies have demonstrated effectiveness of medications produced from extract of the plant in the management of premenstrual syndrome (PMS) and cyclical breast pain (mastalgia) as well reduction of mild hyperprolactinemia.

Saw Palmetto (Serenoa repens)

Summary

  • There is now a small amount of data showing that androgen, prolactin, and gonadotropin levels can be biochemically modulated by the active compounds contained within these natural sources.

  • Further work is clearly needed before the use of such compounds becomes part of routine practice.

  • There is currently a paucity of high quality data derived from rigorously conducted trials. However, there are a few clinical and pre-clinical studies, although small in number, that have demonstrated that some natural anti-androgens address the underlying pathophysiology and can have effects on endocrine mediated disorders.

  • What is now required are several larger, well-controlled, randomized studies aimed at proving their efficacy. While this group of treatments may be slow to find favor and may not be used first line, it does at least appear to be more acceptable to patients because of its perceived more natural origins.

Foods to Lower Androgens

Nuts

  • Nuts of any type are great for PCOS. Research has indicated that the monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) found in nuts have been shown to improve androgens as well as insulin and cholesterol levels in women with PCOS.

Fish

  • There is some evidence regarding the effect of omega-3 intake on androgen levels in women with PCOS. In a study published in Iran Journal of Reproductive Medicine, overweight women with PCOS were randomized to receive omega-3 (3grams per day) or a placebo for 8 weeks. Testosterone concentration was significantly lower in the omega-3 group compared with placebo, after supplementation. After the trial, the percentage of regular menstruation in the omega-3 group was more than the placebo group (47.2% vs. 22.9%).

  • Fish, in particular, cold water fish, are rich sources of omega-3 fatty acids. Examples of these types of fish include salmon, tuna, and trout.

Tea

  • Studies have shown drinking tea (hot or iced) may help improve PCOS symptoms. Spearmint tea, for example, has been shown to have anti-androgen effects in PCOS and can reduce hirsutism

  • Marjoram herb is reputed for its ability to restore hormonal balance and to regulate the menstrual cycle. A study published in the Journal of Human Nutrition and Diet investigated the effects of marjoram tea on the hormonal profile of women with PCOS. Women who were assigned to receive marjoram tea twice a day for one month were found to improve insulin sensitivity and reduce the levels of adrenal androgens compared to a placebo tea.

Red Reishi Mushrooms

Flaxseed

  • Flaxseed has been shown to reduce androgen levels in men with prostate cancer. In a case study involving a 31-year old woman with PCOS, flaxseed supplementation (30 g/day) reduced total and free testosterone. The patient also reported a decrease in hirsutism at the completion of the study period. Further research of flaxseed supplementation on hormonal levels in women with PCOS are warranted.