Four Common Types of Hormonal Imbalance – Elevated Androgens

If you have been following this blog series, you know we have covered progesterone, estrogen, and testosterone deficiency all of which are very common types of imbalance.  Lastly, as a provider that manages hormones you will frequently have patients with elevated androgens. These patients may or may not have been previously diagnosed with PCOS. They present with acne, facial hair and menstrual problems suspecting hormone imbalance. These women usually come in before menopause sets in usually between the late teens to mid-thirties and possibly even in the forties. 

The typical lab findings for elevated androgens is obviously elevated testosterone and or elevated DHT and possibly elevated DHEA. When one or more of the androgens is high it is usually accompanied by other hormones that are abnormal.  Other lab abnormalities may include low progesterone with low, normal or elevated estradiol, low progesterone-to-estradiol ratio as well as elevated glucose, fasting insulin and HA1c and poor thyroid function.

Signs and Symptoms of Elevated Androgens 

• Acne / Oily Skin
• Facial Hair
• Thinning Scalp Hair
• Excess Body Hair
• Mid-Cycle Pain
• Pain in Nipples
• Ovarian Cysts
• Hypoglycemia or Insulin Resistance
• Aggression / Irritability
• Irregular Cycles
• Infertility
• Weight Gain

Causes of Elevated Androgens

There are two factors that can lead to excess androgen production in women.  First of all, poor glucose metabolism from complex metabolic issues affecting glucose regulation (possibly genetic) that leads to elevated glucose, elevated insulin and insulin resistance. This scenario can be exacerbated by excess carbohydrate consumption. Elevated insulin in turn affects production of FSH and LH possibly inhibiting ovulation or even causing cysts to form in the ovaries.  Lack of ovulation results in a lack of progesterone production by the corpus luteum. Elevated insulin also causes an increased production of androgens by the ovaries. Excess insulin, which is inflammatory itself, along with additional systemic inflammation causes testosterone to get converted to its more potent form, dihydrotestosterone. 

Not all women with elevated testosterone have blood sugar issues.  One third to one half of women with PCOS are slim with normal glucose and insulin. Their elevated androgens may stem from the conversion of excess DHEA from chronic stress into testosterone and possibly dihydrotestosterone. Part of the stress response is increased DHEA which is needed to protect the body from elevated cortisol. 

Treatment

Elevated androgens are a bit more tricky to address yet quite common so you’ll want to get clear on this imbalance. When it comes to elevated androgens, ideally you want to correct the underlying cause. If you have determined that the elevated androgens are due to insulin resistance then dietary measures such as low carbohydrate anti-inflammatory diets and exercise are critical. You may need to prescribe progesterone or vitex to support ovarian function. Support these patients with supplement protocols that have been shown to help with insulin sensitivity.

Suggestions:

• Chromium helps maintain glucose levels.  Works well for hypoglycemia, increases insulin sensitivity and helps lower A1C. 
• Alpha Lipoic Acid improves glucose metabolism, lowers glucose, and increases insulin sensitivity.
• N-acetyl-cysteine increases insulin sensitivity and reduces elevated fasting insulin and glucose. Improves lipid profiles and is a precursor to glutathione. 
• CoQ10 helps regulate glucose.
• Cinnamon increases insulin sensitivity, glucose utilization, lowers glucose and improves lipid profiles. 
• Gymnema sylvestre slows absorption of glucose in the intestines and release into the bloodstream. 
• Berberine improves insulin sensitivity and supports fat burning. 
• Coffee Berry decreases and regulates glucose in the blood.

Patients with normal glucose and insulin that have elevated cortisol or you suspect chronic stress may require stress reduction measures, sleep support, exercise, healthy diets, as well as progesterone or vitex. Adaptagenic and cortisol reduction supplements are needed to address the HPA axis dysfunction. 

Suggestions

• Adaptogenic herbs – help reset the cortisol receptors, modulate stress response and normalize the stress response. 
• Ashwagandha –  modulates cortisol, reduces fatigue, improves sleep, it is anti-anxiety and supports thyroid function.
• Panax ginseng – helps people handle stress and prevents deletion of corticosteroids and epinephrine and is very helpful with energy and endurance.
• Holy Basil – modulates cortisol
• Maca – helps reduce adrenal hyperplasia and cortisol.
• Rhodiola – prevents depletion of catecholamines, supports serotonin levels and helps with anxiety and mental performance.
• PhosphatidylSerine – dampens stress induced ACTH and cortisol release, stimulates acetylcholine, dopamine and or epinephrine, and it has been shown to protect the brain from stress induced memory loss.

It is entirely possible with your intervention to help these patients resume normal menstrual cycles and reduce the symptoms of excess androgens. Your patients can experience resolution of acne or facial hair, improved moods and weight management. 

To get a handy tool to assess hormone imbalance for your patients – download my Signs and Symptoms of Hormone Imbalance Checklist. It’s an excerpt from the training manual of the BHRT Providers Program online training program. I think you will find it helpful.