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Can Your Androgen Excess Give You an Edge?

Discussion in 'Endocrinology' started by Hadeel Abdelkariem, Jun 26, 2018.

  1. Hadeel Abdelkariem

    Hadeel Abdelkariem Golden Member

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    AMY MEDLING WAS NOT living her best life. When she should have been thinking about an upcoming exam or the prior night's butterfly-inducing date, the teen was instead consumed with thoughts of the hair that swirled down the drain when she showered, the acne that freckled her jaw line and the stubborn chin hair she religiously plucked away. She was also gaining weight and had irregular menstrual cycles.

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    "It makes you feel a lot of shame and embarrassment. It can be debilitating – you don't want to engage; you want to retreat – and it's sad," says Medling, who, 15 years after her symptoms began, learned that "it" was polycystic ovary syndrome, a hormonal disorder that commonly causes an excess of androgens, or male sex hormones like testosterone.

    Today, however, Medling is living her best life. She's married with three kids in Nashua, New Hampshire, looks and feels energized and strong, and has built and grown a successful business called PCOS Diva. The website – which she launched nine years ago – aims to help women with PCOS thrive through lifestyle changes, resources and support. The kicker? Medling, who's also a certified PCOS health coach, podcaster and author of the book "Healing PCOS," suspects her success isn't in spite of – but in part due to – the hormonal effects of her condition.

    "My high androgen levels have led to being a successful female entrepreneur," says Medling, since testosterone specifically has been linked to personality traits like competitiveness and motivation that are common in leaders. "I'm decisive, I’m self-directed [and I] take more risks."

    A Silver Lining?

    PCOS, which affects about 15 percent of women of reproductive age, doesn't always involve excess androgens, and when it does, the increase is typically slight, explains Dr. Anuja Dokras, a professor of OB-GYN at the Hospital of the University of Pennsylvania who directs the Penn PCOS transdisciplinary research program.

    "Androgens are hormones, and they're present in both men and women, but the different testosterone levels in women compared to men is multifold," Dokras says. "In PCOS, women have slightly higher androgens – it's really the upper end of the [normal] range or a little more; it's never in the male hormone range."


    But even that slight uptick can have devastating consequences, to which Medling was not immune. Not only do PCOS and other androgen excess disorders often lead to confidence-shattering side effects like male-pattern hair growth, hair loss, acne and weight gain, but studies have also linked PCOS specifically to serious long-term health problems that are often related to the condition's effect on insulin resistance and link to obesity.

    In fact, research suggests that if left untreated, nearly 50 percent of women with PCOS will develop diabetes before age 40. They're also more likely to be hospitalized, to develop cancer and have a much higher risk for heart disease than women without the condition. PCOS is a leading cause of infertility, too, according to the PCOS Awareness Association.

    "These conditions were just considered cosmetic problems 30 years ago," says Dr. Andrea Dunaif, chief of the division of endocrinology, diabetes and bone disease at the Icahn School of Medicine at Mount Sinai and a past president of the Endocrine Society. "We now understand that … forms of [PCOS] are associated with an increased risk of diabetes at a very young age and other metabolic problems."

    But if managed effectively, women can live long, productive lives and aren't guaranteed to develop all, if any, of the related health conditions. There may even be some advantages to having naturally higher androgen levels, some research suggests. In one 2011 paper published in the journal Fertility and Sterility, for example, OB-GYNs and endocrinologists argue that, historically, women with PCOS have had an evolutionary advantage – or at least not an evolutionary disadvantage – due to their increased strength, stamina and reduced risk of dying from childbirth.

    Other research suggests lean women with PCOS may have higher pain thresholds than lean women without the condition, while one study showed that women's visual-spatial abilities improve after receiving synthetic testosterone. Another small study showed that women with PCOS have greater muscle strength. Perhaps the most accepted potential benefit of the condition, Dunaif says, is greater ovarian reserve, meaning women with PCOS tend to reach menopause later and have a longer window of time they can theoretically become pregnant.

    Still, such findings are tough to isolate from other components of the syndrome like insulin resistance and obesity because there's very little research on androgen levels in healthy women, Dunaif says. And, when balanced with the well-known health consequences of PCOS, any potential benefits are overshadowed, experts say. "These are deeply disturbing disorders for women to have," Dunaif says. "They markedly decrease quality of life."

    It's only in cases of rare genetic conditions in which women can have testosterone levels several-fold higher than other women (including those with PCOS) that some advantages become clearer. Some researchers have even argued that the athletic gains like muscle growth and endurance are so strong in these cases that they can provide an unfair advantage in certain elite sports. Research like this is the basis for the International Association of Athletics Federations' controversial April announcement that female athletes with such conditions must lower their testosterone levels to compete.

    Treat, Then Thrive

    Androgen excess alone isn't going to make you a great athlete or an exceptional business leader. Quite the contrary, it needs to be treated effectively for people with detectable forms of it to be able to live their fullest lives.

    "The first line treatment [for PCOS] is a combination birth control pill of estrogen and progesterone," Dokras says, which halts the body's natural production of both male and female hormones, and then replaces the female hormones synthetically. While there's no cure for PCOS, for some women hormonal pills can help regulate their periods and ease symptoms including hair growth, acne and weight gain, Dokras says. More recently, good evidence has emerged showing that diabetes drugs like Metformin can help treat the condition. "It improves the reproductive system by, we think, improving insulin sensitivity," Dunaif says. "That's really been the striking advance."

    Other treatments are symptom-specific, experts say. For example, women may work with a nutritionist to help with diabetes prevention or management, or a reproductive endocrinologist if their condition is causing fertility problems. Mental health specialists can also help women with the anxiety and depression that can come along with living with a chronic illness. "There are still ongoing studies to try to … identify [which] groups of patients work better for different treatments," Dokras says.

    For Medling, lifestyle factors like following an anti-inflammatory diet, doing a mix of interval-training type workouts and "feminine" exercises like barre or yoga, and getting plenty of sleep have most helped her manage her PCOS. "Your femininity is somewhat compromised because of these symptoms," she says. "Beginning a self-care regimen can be extremely helpful."

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