Dear Dr. G,

I am really confused and hoping to get some help from you about my hormonal complaint.

My husband and I are newly married, and we are hoping to get a Tiger Baby this year.

Despite having heightened sexual desire, I am having issues with irregular periods and this is clearly making planning for a baby impossible

Clearly, this is making the planning for a baby impossible.

I understand I have been overweight since my teenage years; this is also coupled with excessive facial hair and acne.

I often think this is part of my growing pain, however I am now nearly thirty-years-old, and the “puberty” troubles don’t seem to diminish.

My husband and I went to the fertility specialist for help. We were told I most likely have trouble with excessive testosterone, and I may suffer from a medical condition called Polycystic Ovarian Syndrome (PCOS).

I understand the theme this month is sexual health and testosterone and as such I am hoping to put Dr. G on the spot about this confusing issue of testosterone in women.

Firstly, why do women even have testosterone? Isn’t this a man’s hormone? Also, is the elevated testosterone causing me to have horrible acne, unsightly facial hair while losing hair on my head? Is testosterone also causing me to have deranged menstrual cycles?

I hear testosterone is responsible for an enhanced sexual desire in women, is this happening to me? Can you also explain what exactly is PCOS, am I really turning into a man?

Mishap Mandy

Testosterone is the primary sex hormone in men and it plays a key role in the development of sexual and reproductive health.

Although, we generally perceive men are driven by testosterone and women by estrogen, the fact is both men and women produce bothhormones, and the dominance of one hormone over the others will determine the dominant sexual characteristics. In women, testosterone is produced in the ovaries, adrenal glands, and fat tissues. This makes up about 5% of the amount of testosterone in men.

Testosterone plays a crucial role in women for bone and muscle strength. The fine balance of the sex hormone also determines libido, menstrual health, and fertility. Most women do not develop secondary male characteristics because most testosterone is metabolized and converted to estrogen.

However, when the a woman produces an excess amount of testosterone due to PCOS and Congenital Adrenal Hyperplasia, masculinization of a woman with male secondary characteristics occurs.

As for the correlation between circulating testosterone and sexual desire in women, this is more complicated, and often a subject of debate. On one hand, testosterone at physiological levels in menopausal women or age-related decline in androgen is known to improve sexual desires.

However, on the other hand, the excessive levels of testosterone in women in PCOS has no significant impact enhancing libido. Sexual dysfunction is believed to affect up to 50% of women suffering from PCOS. Most studies demonstrated the impact of adverse bodily image of obesity and hirsutism, resulting in poor rates of sexual arousal, lubrication, and orgasm.

Polycystic Ovarian Syndrome, or PCOS is a common hormonal disorder in women, which was documented in Italian medical literature as early as 1721.The disorder is characterized bymultiple cystic formations in the ovaries due to an unknown trigger.

Around three quarters of PCOS sufferers have elevated levels of male hormones (hyperandrogenism) resulting in the derangement of their menstrual cycle. The prevalence ranges from 2%-26% of adult female population, with varying prevalence across countries.

The World Health Organization (WHO) estimates 116 million women worldwide suffer from PCOS with the manifestation of symptoms in women of reproductive years between the ages of 18 to 44.

The exact cause of PCOS is largely unknown, however the etiology is generally associated with the combination of genetic and environmental factors. Obesity and lack of exercise arewell recognized to be associated with PCOS, especially in individuals with such family history.

The manifestation of the disorder can range from mild symptoms of irregular periods, to excessive bodily and facial hair, acne, male pattern baldness, mood disorder, diabetes andobstructive sleep apnea.

In severe cases, the elevated testosterone in PCOS sufferers can even result in heart diseases and endometrial cancer.

PCOS is generally considered to be a chronic disease with no cure. Lifestyle changes, such as weight loss and regular exercise are known to minimize the overall symptoms. As the hormonal derangement can affect women in various forms and different degrees of severity, targeted measures aiming to treat specific symptoms suffered by the patients, plus a disciplined healthy life are key for a successful outcome.

Oral contraceptive pills and diabetic medications such as metformin are utilized to improve the regularity of periods. The issues of hirsutism can be treated with laser esthetic hair removal technology.

Apart from hair removal treatment, many patients would also accept medications such as anti-androgen are used to reduce acne, facial hair growth and the progression of male pattern baldness.

That said, not all women with PCOS encounter problems of infertility. Weight loss and dietary adjustment, especially the reduction of carbohydrate, are known to be associated with the resumption of natural ovulation. For women not responsive to such lifestyle changes, medications such as clomiphene and assisted reproductive technology, can often overcome PCOS induced infertility.

The intricate set-up of the female hormonal system is the fine balance of estrogen and testosterone. This is crucial for the bodily order of sexual functions, reproduction health and secondary female characteristics. Although the onset and progression of PCOS is largely unknown, unhealthy lifestyle and obesity are well-recognized to be the trigger that tip the balance. Clearly, the excessive supply of androgen is associated with adverse outcomes of an irregular period, skin complaint and overall health chaos in women. The American Historian,

Henry Adams once said: “Chaos was the law of nature; order was the of dream of a man”. When women with the chaotic hormonal issues of PCOS put Dr. G on the spot, his view is that “keeping a healthy lifestyle can restore the law of nature.”

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