PCOS: a deep dive into insulin resistance and testosterone

Hey there. Welcome!  Do you have PCOS? Or do you think you might have PCOS? You’ve come to the right place.  

If you haven’t checked out our previous blogs, we highly recommend you jump over and give them a read before we deep dive. This one here is our intro to  everything PCOS – myths, facts and symptoms. And this one gives you the down low on androgens. They’re both written by our in-house naturopath expert and are the best place to start if you’re looking to learn more about your body.

But what’s on the agenda today? Today we’re learning more about androgens and insulin resistance. As we’ve already covered, androgens are a type of sex hormone that regulate our energy, libido, hair growth, ovulation, muscle growth, mood, bone density and more. They’re also required to make estrogen so they play a crazy important role in the maturation of ovarian follicles – aka our eggs.

Tell us more

Firstly, let’s discover more about the part insulin resistance plays in PCOS and your acne. Insulin resistance is the most common driver of PCOS cases and it’s this metabolic insufficiency to metabolise glucose that directly affects testosterone production, resulting in acne, irregular menstrual cycles and anovulation. 

Insulin is secreted when blood glucose levels are elevated. This might be during periods of stress, after a high carb/sugar meal, during extreme periods of fasting or through imbalanced macronutrient intake. 

When women have PCOS the cells within their ovaries have increased androgen responsiveness to insulin. This chronic insulin secretion leads to more and more androgens being produced and – you guessed it – more sebum production in the skin. 

In order to control our androgen levels we have a protein called sex-hormone binding globulin (SHBG). SHBG basically mops up the testosterone to reduce the amount of active free testosterone circulating around that could bind to cells. Insulin not only stimulates more testosterone but it decreases SHBG and affects its excretion. Also, fun fact: the contraceptive pill also depletes SHBG.

What else?

Well, further down the testosterone track we also have the potent metabolite 5A-DHT which is actually 10-100 times stronger than testosterone itself and can also be associated with your acne! 

Testosterone can be driven down this pathway by a few factors, including insulin resistance, obesity, inflammation and zinc deficiency. This is why just a few of our treatment goals when working on PCOS cases are targeted towards modulating insulin response, correcting deficiencies and reducing inflammation.

Anything more?

Well, we can also have elevations in another type of androgen called DHEA (or DHEA-S). This form of elevation can directly show us that your acne may be adrenal-related. DHEA is a precursor for testosterone, therefore elevations in DHEA may directly stimulate more testosterone production. That means a double whammy of androgens!

Are androgens the bad guys? 

Not at all. We need all our hormones to be balanced so that they can serve their important functions efficiently. It’s only when they’re out of balance that we see skin flare ups. Testosterone in particular is required to make estradiol (active estrogen) – important for bone density, building muscle, cardiovascular health, production of neurotransmitters (like serotonin), maintaining brain cognition, maintaining collagen, sleep quality and so so much more.

We love testosterone, because without it we’re missing out on all the estrogen benefits. What we don’t love is when it’s out of balance. That’s why we are here to figure out how and why it’s in excess in PCOS.

Need some skin love? Book your consult today.

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