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
My boyfriend is in his early 40′s and has been taking testosterone therapy. Instead of his levels increasing, they have decreased…his total is now in the single digits. He takes very good care of himself as he is a fitness trainer and body builder (takes vitamins, etc.). Obviously, with his total level being in the single digits, he has all the “symptoms†of low-T and is frustrated that the therapy is having a reverse reaction. He also suffers from Migraines and has recently been in a car accident that he suffered brain trauma in. I’m wondering if there could be a connection between the trauma and low-T or lower T. Any advice or direction you can head us in would be much appreciated.
In reply Dr. Pepper writes:
Hi Lu
You can’t pour water into a cup and wind up with less water in the cup then what you put in. Likewise, if someone takes testosterone supplement they will have more testosterone in their body then they started with. However, some things can influence the blood levels so one person will have higher or lower levels then someone else taking an identical dose. I have seen a wide variation in how testosterone gels are absorbed through the skin. These products include Androgel, Androderm, Testim, Axilron and Fortesa. One person may not see much of an increase in blood levels of testosterone on one of these gels while another will see levels zoom up to a 1000. Absorption of testosterone that is injected with a needle is less variable. Levels go very high in the first few days after the the injection but after 2 or 3 weeks levels will be low again. Here’s an important point. Since testosterone replacement turns off the body’s production of testosterone, if you stop taking replacement your body will not be making testosterone for weeks to months after resulting in very low levels on blood tests. People who abuse testosterone know this and will have the doctor check their testosterone level a month or two after their last dose, so the doctor will see the low levels and give them a prescription for more medication.
Can head trauma effect the testosterone level? For that to occur the pituitary gland would have to be damaged and that will often be associated with other obvious brain damage. In children less severe trauma can hurt the pituitary.
Hope some of this information is helpful in trying to figure out what is going on with your boyfriend. Good luck.
John has recently been diagnosed with low testosterone levels and sends metabolism.com this inquiry:
John writes;
I’m so glad I found this site! About a month ago I was diagnosed with low T – mine is 140. Very, very low. Symptoms were NO libido, fatigue, massive weight gain (from 195 to 275 in 9 months), swelling below the knees. Not sure if the T is responsible for all of this, but would love your opinion (at the same time – the same day, actually – i was also told I had type 2 diabetes (blood sugar of 203). Is there a link here?
My endocrinologist put me on Enenthate shots, 1ml every 2 weeks (done 2 shots so far). Do you think this is a good dosage? Are the shots better than the cream? I’m concerned about see-sawing T levels – will they go up after the shot but creep back down again before the next treatment?
I’d really appreciate any insight, my doc did not spend a lot of time going into these kinds of details with me, it was a bit disappointing. I’m a white male, a little over 6′ and 42 years old. Naturally I understand you are only giving an opinion, not actual medical advice. Thanks so much.
Reply by Dr. Pepper:
Thanks for your inquiry John. My first thought about the situation you describe is why would a 42 year old man develop low testosterone? Personally, I never take it for granted that the cause of newly diagnosed low testosterone is “aging”. There are many significant medical conditions that need to be ruled out primarily disorders of the testicle, and pituitary gland. Additional blood tests such as LH, FSH and prolactin and possibly radiological tests are often needed to make that determination. I don’t want to go on a wild goose chase here but swelling of the legs, rapid weight gain, low testosterone and type 2 diabetes may all be caused by an excess of cortisol in the body, known as Cushing’s Syndrome. That could be one way to unify all the events you describe.
Testosterone is generally administered as an injection or rubbed on as a gel. In nature, testosterone levels are more or less constant from day to day, so applying testosterone gel every day mimics this environment pretty well. The injections given every two or three weeks cause a rapid increase of testosterone to unnaturally high levels followed by steady decline often to low levels again before the next shot. My opinion is that shots are much less desirable although they tend to be a lot cheaper and simpler than the daily gels.
You may want to seek a second opinion to find out if other problems exist to explain how you developed low testosterone in the first place.
Keep us posted and good luck.
These comments are for educational purposes only and are not intended to provide medical care or advise.
Gary Pepper, M.D., Editor in Chief, Metabolism.com
Puberty occurs when areas within the brain awaken beginning a cascade of hormone signals which conclude with the gonads (ovaries and testicles) increasing their production of the female and male sex hormones estrogen and testosterone. Under the influence of these hormones a child begins the transition from childhood to sexual maturity. In boys puberty is associated with a growth spurt, the appearance of facial, axillary (arm pit) and pubic hair, acne, deepening of the voice, growth of the testicles and penis while girls undergo a growth spurt, develop breasts, acne, pubic and axillary hair, and growth of the clitoris.
Historical data shows the average age of puberty today is many years sooner than in previous generations. Most experts attribute earlier puberty to better nutrition. A recent article in metabolism.com reviewed how “over-nutrition” accelerates obese children into puberty sooner (referred to as precocious puberty) than normal weight children. The latest studies on causes of precocious puberty suggests that a child’s social environment also exerts an important influence on the timing of puberty. Researchers in Madrid publishing in The Journal of Clinical Endocrinology and Metabolism 95:4305 2010 analyzed the age of puberty in normal children, adopted children and children whose families immigrated (children not adopted but subject to high levels of personal stress) to Spain. Adopted children were 25 times more likely than other groups of children to undergo precocious puberty (breast development before the age of 8 years in girls, and boys under 9 years of age with testicular growth). Over-all girls were 11 times more likely than boys to demonstrate precocious puberty.
Researchers speculate that socio-emotional stresses early in life of children who are later adopted result in changes in the brain that cause premature maturation of vital nerve pathways. This early brain maturation later results in stimulation of the pituitary gland, turning on the hormone pathways that cause puberty. This seems strange to me because various forms of deprivation in childhood can also delay puberty. For example, girls who have anorexia remain child-like in their body development and may fail to menstruate even into their late teens. A decade ago I studied hormone levels in adults during the stress of illness and surgery and found this lowered the sex hormone levels in their blood. This makes sense from an evolutionary point of view because during stressful conditions nature wisely cuts off the reproductive hormones. Why make babies if the environment is hostile in some way? Why the opposite occurs in children under stress of adoption is an interesting but unanswered question.
Gary Pepper, M.D.,
Editor-in-Chief, metabolism.com
One of our members notes loss of sex drive, strength, motivation. He is concerned that this could be due to low testosterone levels;
Here is his comment;
I’m 64 years old. Excellent health. 6 ft tall, 177 pounds, work out three times a week…….finding my self depressed, losing strength…..haven’t had any sexual desire in last 3 years……..I use the VA for all my health issues. My doctor said he tested my levels and they were normal, but he wouldn’t let see the results. Based on my info could someone tell me what my level should be at. Also, I noted someone said they got tested free…how is that ?? My only option without paying is to use the VA, and I’ve already noted that experience. Thank You.
My reply:
My first thought is to find out what the actual testosterone level is, as well as free testosterone. A doctor that refuses to share a patients lab results with them has lost credibility. Many “normal” results are subject to interpretation but the doctor may not want to be bothered explaining the finer points of diagnosis. This applies to many medical conditions but is particularly common when diagnosing low thyroid or gonadal (testicular) function. Additional testing may be necessary to make the diagnosis. If any of the pituitary hormones, prolactin, LH or FSH are abnormal then testosterone levels could be in the “normal” range and yet the patient can be suffering from significant disease. Finally, it is still possible that symptoms like those you describe are not related to testosterone deficiency and a search for other medical explanations seems appropriate.
As far as getting free testing for medical conditions I am not able to provide a clue. Perhaps one of our members knows of a way and I would welcome their comments.
Best of luck.
Dr. Gary Pepper, Editor-in-Chief, Metabolism.com
These comments are for informational purposes only and are not intended as medical advice or therapy.
The mission of the The Thyroid Project is to encourage sharing of information and experience between the public and the medical community about the treatment of hypothyroidism (low thyroid function). For at least the past few decades there is a growing awareness of “something missing†in the way suffers of hypothyroidism are treated for their disease.
Too many patients, as documented in an on-line study of 12,000 individuals conducted by the American Thyroid Association published in June 2018, (https://doi.org/10.1089/thy.2017.0681) , complain of persistent symptoms of hypothyroidism despite what their doctors believe is successful treatment with levothyroxine (brands include Synthroid, Unithroid, Tirosent, Levoxl). We believe something needs to be done to resolve this conflict between patients and their doctors.
Without effective intervention the early stage of type 2 diabetes known as prediabetes carries a high risk of progressing to outright diabetes. Metabolism.com provides an up-to-date summary of recommendations from national authorities, for preventing and possibly reversing this life long affliction
Diabetes can be defined simply as elevated blood sugar levels. What exactly is high blood sugar and when should someone be concerned about their level? Does having prediabetes mean diabetes is around the corner? Metabolism.com tackles this tricky but important topic in this comprehensive review.
By Gary M. Pepper, M.D. Ozempic, Rybelsus, Trulicity, Wegovy, Saxenda are the central players in the weight loss craze sweeping across the globe. Metabolisim.com has been monitoring this phenomenon from its beginnings in 2008 with its report “Lizard Spit Reduces Blood Sugar and Appetite”, regarding the first drug in this class, Byetta (exenatide). Caught In the middle of the current chaos are the medical experts who treat diabetes and have been prescribing these medications for more than a decade. Here is a brief commentary from one such board certified endocrinologist; “I started treating Type 2 diabetics with GLP-1 agonists more than 10 years ago. In some respects, these medications have revolutionized the treatment of diabetes by lowering blood sugar effectively and promoting weight loss at the same time, a unique combination of benefits. Not everyone benefits from these drugs to the same degree unfortunately, and I have seen lots of patients experience unacceptable side effects from them. Nothing though, has prepared me for what is happening now. Too often, I find myself confronting someone who expects me to prescribe one of these drugs just so they can lose weight. Sadly, one extreme example was someone who, despite battling a life threatening medical condition, was insistent on getting a prescription. At the same time my diabetic patients are scrambling to find a place to buy their medications if they can even afford it. It is disheartening, to say the least, and I dread the negative interactions with some of my patients I now face almost daily.”
Off- Label Use
The FDA is the U.S. government’s department tasked with evaluating and approving drugs for specific medical conditions. When a new medication is approved for treating a medical condition by the FDA the agency will, at the same time, set strict guidelines for exactly which patients may use the newly approved drug. When a medication is used “off-label” it means that these limitations are being overridden by the provider for a potential benefit which outweighs the drugs risks. It is a general misconception that off-label means illegal; it does not. This practice has been going on for ages and more than 20% of prescriptions in the United States are prescribed off-label. A common example is the use of beta-blockers (approved for heart problems) for the treatment of performance anxiety.
GLP-1 agonist drugs, as discussed recently by metabolism.com. were originally approved for the treatment of Type 2 diabetes in adults. In the past few years most of these same medications have gained unprecedented popularity for their “off-label” weight loss benefit. Of the 5 GLP-1 agents presently in U.S. pharmacies only Wegovy (semaglutide) and Saxenda (liraglutide) are FDA approved for treating obesity. Of these two, Wegovy is the newer and had been much more popular that its sister drug Saxenda, probably due to being dosed only once weekly compared to daily for Saxenda and less likely to cause side effects. Due to Wegovy’s soaring popularity, its manufacturer, Novo Nordisk, increased the price of Wegovy two times since its initial release.
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.
