In part one of this series we looked at the cause of polycystic ovarian syndrome (PCOS) and the many complications it causes. Weight gain, acne, excess hair growth on the face and body, high cholesterol and high blood sugar due to insulin resistance are among the problems associated with PCOS. One particular area of concern for PCOS sufferers is infertility due to lack of ovulation. PCOS is the cause of anovulatory infertility in 3 out of 4 cases. Before the acceptance of medical therapy for infertility due to PCOS a surgical approach referred to as a wedge resection of the ovary was performed which allowed patients with PCOS to ovulate and conceive normally. Low success rates with this procedure, complications of surgery and improved medical therapies have all resulted in the end of this type of treatment in most situations. At present, treatment of infertility associated with PCOS generally consists of using a drug to combat insulin resistance known as metformin often in combination with the fertility drug clomid, which has a high rate of success.
Treatment of the excess hair growth associated with PCOS often consists of using the drug spironalactone and the use of birth control pills. Spironalactone is a very interesting drug used for decades as a salt depleting diuretic but also has an effect to block the action of the male hormone testosterone. The action of spironalactone to block testosterone was discovered when it was noticed that men using this diuretic developed tender nipples and breast enlargement (gynecomastia). Oral contraceptive agents are also useful to combat hirsutism because these agents also cause reduce testosterone levels by putting the ovary in a dormant “resting” state. Cosmetic procedures are always another option to treat unwanted hair growth. Laser hair removal appears to be replacing the older modality of electrolysis for this purpose.
Can PCOS be cured? Once PCOS develops it can be controlled but not cured unless the ovaries are removed. At menopause PCOS-related problems diminish as the ovary stops making sex hormones including testosterone which is one of the culprits during the reproductive years. A recent study published this year in the journal Pediatric Endocrinology showed that using metformin treatment in pre-adolescent girls thought to be at risk for PCOS reduces the risk and/or the severity of PCOS in later years. It may do this by blocking fat accumulation in the abdomen and liver which seems to set off the insulin resistance. Metformin is not FDA approved for this purpose and as a generic drug there is little profit potential in developing this treatment. I expect it will be many years before preventive therapy for PCOS will come before the FDA for approval .
This information is strictly for educational purposes. Due to high risk of toxicity of medical therapy in young women who can potentially become fertile under treatment for PCOS, no drug should be taken without the close supervision of a physician. The reader agrees to the Terms of Service of this website, metabolism.com
By Gary Pepper, M.D.
In the first article in this series, The HCG-Cancer Connection, I explained how HCG is made by some types of cancer and can serve as a marker for cancer activity. Now I want to explore another effect of HCG, the stimulation of male hormone (testosterone) production.
Just to review, there is no evidence that HCG will cause cancer although conceivably certain cancer responsive tumors may grow faster due to its effect to increase estrogen and testosterone. Every woman who has had a normal pregnancy has been exposed to high HCG levels for many months so if it did cause cancer that effect would be very obvious.
What concerns me is how HCG can influence the normal ovary and its hormone metabolism. HCG is a promiscuous hormone. It will hook up with different hormone “receptors” and masquerade as these other hormones. In the previous article I explained how at very high levels HCG can stimulate the thyroid to make thyroid hormone resulting in hyperthyroidism. Another hormone effect of HCG is to mimic LH (leutinizing hormone) which turns on the production of the sex hormones by the testicle in men and ovary in woman. Surprisingly the normal ovary makes testosterone which it then converts to estrogen. FSH (follicle stimulating hormone) from the pituitary helps the ovary change testosterone to estrogen. What happens when the ovary gets a lot of LH but not FSH? This is the situation when a woman gets HCG. Testosterone levels will rise more than estrogen levels. Research shows that after a single HCG injection a rise of 20% in testosterone levels occurs in normal women, confirming this theory. During pregnancy with HCG pumping in the blood from the placenta, testosterone levels can double, resulting in acne, oily skin and (in some women) an increase in sex drive. The situation would be far worse for a pregnant woman if the placenta wasnâ€™t also pumping out 100 times the normal amount of estrogen to counteract all the male hormones.
So why should women care if HCG makes their testosterone levels go up? Acne, oily skin and horniness are one thing but there are other effects which might be less acceptable. Testosterone is a mischievous hormone. While it causes hair growth where you don’t want it, it causes hair loss in places you want to keep it. Testosterone stimulates hair growth on the face, chest, back and abdomen. At the same time it causes hair loss from the scalp particularly at the temples and crown. This is referred to as male pattern baldness. Other effects of testosterone in women are the growth of the clitoris, known as clitoromegaly. A clitoris the size of a man’s thumb has been described in a woman due to excess testosterone exposure. Generally this degree of clitoromegaly is seen only in more extreme cases. So you may want to think twice before starting an HCG diet unless looking like Bruce Willis is your thing.
In the final installment on the hazards of HCG I will focus on other possible nasty hormone effects of HCG such as fibroids, infertility and bulging muscles.
by Gary Pepper, M.D.
Last week Helen, a friend of the family, called to brag she had lost 12 pounds in 4 weeks and also to ask if she had given herself cancer in the process. What was the connection between her supposed miracle metabolism and cancer? Helen was taking HCG injections and just read this hormone was somehow related to cancer. I reassured her that I didn’t think she was giving herself cancer by taking HCG but I did let her know that very soon she was likely to resume her normal metabolism and regain the weight she lost. Unfortunately her wallet was never going to recover what it lost in this process. Many services prescribing HCG treatment for weight loss are charging $400 or more for a course of treatment.
Now what about the cancer-HCG connection?
HCG is a hormone normally produced by the fertilized egg in the earliest stages of fetal development and then later by the placenta itself. Since rising HCG level is one of the earliest hormone changes during pregnancy, measuring this hormone is the basis for the everyday pregnancy test. HCG also causes the ovary to make progesterone which is essential for preparing the uterus to become a nesting ground for the developing embryo. HCG may also suppress immune function so that the fetus is not rejected by the mother’s immune system.
The placenta forms at the onset of pregnancy to support the developing embryo and later the fetus. If a sperm fertilizes an empty egg at the onset of pregnancy a Hyditidiform mole can arise in conjunction with or instead of the normal placenta. This is also referred to as a molar pregnancy. HCG levels can rise to extreme levels in the presence of the Hyditidiform mole particularly if it goes on to become an invasive cancer known as a choriocarcinoma. Body chemistry gets a little weird at this stage. HCG is slightly similar in structure to TSH, the pituitary hormone that stimulates the thyroid. The result is that when HCG levels are extremely high as with a molar pregnancy, the thyroid can be stimulated to make excess thyroid hormone resulting in hyperthyroidism in the mother. Typical symptoms of hyperthyroidism can occur including feeling hot, shaky, sweatiness, palpitations, vomiting (which can be severe) and diarrhea. Curing the cancer will cure the hyperthyroidism as well.
Other cancers of the reproductive system can make HCG as well. Certain testicular cancers can make HCG. Since HCG is the hormone responsible for a positive pregnancy test, testicular cancer can sometimes be diagnosed in men by a positive pregnancy test. For tumors making HCG, measuring levels of this hormone during cancer treatment can aid doctors in determining whether therapy is working or not.
Certain cancers are termed â€œhormone responsiveâ€. That means the cancer will grow more aggressively in the presence of a particular hormone. Tumors that grow faster in the presence of estrogen include receptor positive breast cancer and endometrial cancer. A tumor that grows faster in the presence of testosterone is prostate cancer. Since HCG is likely to increase these hormones, it is conceivable that should a hormone responsive tumor already exist in the body it could grow faster during HCG treatment.
So Helen, I don’t think HCG is going to give you cancer, but it may cause you to grow a beard. Why is that? I’ll be explaining my theory in the next article, “HCG is a Hairy Hormone”. Visit metabolism.com for more on this, in the very near future.