Comprehending Hormone Levels in PCOS

Understanding Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome, or PCOS, is a common endocrine disorder affecting people assigned female at birth. It is characterized by multiple cysts on the ovaries, irregular menstrual periods, difficulty falling pregnant, and high levels of androgens (male hormones) in the body. PCOS can involve significant changes in hormone levels, and understanding them can help you learn more about your condition, advocate for yourself, and deal with bothersome symptoms and side effects.

What is PCOS?

PCOS is a syndrome of an unclear cause that can often go underdiagnosed. It is a result of hormonal imbalances, including hyperandrogenism (excessive amounts of male hormones such as testosterone). While it primarily affects the reproductive system, it is a systemic disease that can, among other things, increase the risk of type 2 diabetes and heart disease.

What are the symptoms of PCOS?

PCOS symptoms can vary wildly between individuals. However, the classic symptoms include:

• Irregular or absent menstruation
• Excessive hair growth of a typically male pattern, including facial hair (hirsutism)
• Male pattern baldness
• Weight gain
• Oily skin
• Acne that persists into, or begins in, adulthood
• Difficulty falling pregnant

Many people with PCOS only discover the problem when they attempt to get pregnant, while others may have stronger symptoms and be diagnosed in adolescence.

Diagnosing PCOS using hormone levels

PCOS is typically diagnosed based on a combination of signs and symptoms, as well as a hormone test and imaging results. There is no definitive test to diagnose PCOS.

Hormone levels and PCOS

The following reproductive hormones appear to be impacted by PCOS:

Luteinizing hormone (LH)

Luteinizing hormone is produced by the pituitary gland and plays a key role in normal sexual function. It triggers the release of eggs from the ovaries and induces the production of estrogen and progesterone from the ovaries. It is sometimes used to track ovulation, as the spike in the hormone right beforehand is obvious. It can also be used to confirm that you have reached menopause.

In people with PCOS, levels of LH tend to be higher than normal, although this does not appear to trigger ovulation. Instead, it may be connected to the elevated levels of testosterone found in PCOS patients.

Follicle-stimulating hormone (FSH)

Follicle-stimulating hormone stimulates the growth of an egg within the ovary. FSH is vital for the production of healthy eggs. Both FSH and LH are typically tested at the same time.

In people with PCOS, levels of FSH are normal or lower than normal, and there is an imbalance in the ratio of LH and FSH, with LH higher compared to FSH.

Total and free testosterone

There are two types of testosterone: total testosterone and free testosterone. Total testosterone is the total amount of testosterone in the blood and includes both bound and unbound testosterone. Free testosterone is the amount of testosterone that is not bound to a protein and is therefore available to enter cells and exert its effects.

In PCOS, the levels of both total testosterone and free testosterone may be elevated, and the levels of total testosterone are usually measured to evaluate the level of androgens in the blood. Some people with PCOS still have normal testosterone levels, and if you’re on oral contraception, your testosterone levels will be lower.

Sometimes, sex hormone-binding globulin (SHBG) is measured as an indirect way of measuring testosterone. SHBG binds and transports sex hormones such as testosterone and estrogen in the bloodstream, making them less available to target cells. High levels of testosterone seen in PCOS, thus, may result in low levels of SHBG.

Dehydroepiandrosterone sulfate (DHEAS)

DHEA sulfate is a byproduct of testosterone and is often used as a marker of androgen excess in the body. DHEAS is produced by the adrenal glands and its levels can be raised in PCOS. High levels of DHEAS can cause masculinization in AFAB individuals.

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