How To Lower Testosterone When You Have PCOS

PCOS is a fairly common endocrine condition that is caused by hormonal imbalances. Elevated testosterone levels are a feature of PCOS, and bringing those elevated levels down can help manage symptoms.

What is PCOS?

Polycystic ovary (or ovarian) syndrome (PCOS) is a common health problem caused by a hormonal imbalance. It causes egg follicles to not fully develop, resulting in multiple small cysts on and in the ovaries and reduced fertility.

It also increases the risk of other health conditions, especially type 2 diabetes. Insulin resistance is a key feature of PCOS and can easily develop into diabetes over time. There is no cure for PCOS, but it is possible to manage the symptoms with lifestyle changes and medication.

With proper treatment, most people with PCOS are able to become pregnant and avoid the other complications of the condition.

Symptoms of PCOS

The symptoms of PCOS vary widely. The hormonal imbalance affects each patient a little differently. However, symptoms include:

• Irregular or absent menstruation. Some patients with PCOS do not menstruate at all. Others may have irregular periods. This can lead to fertility issues.

• Weight gain

• Hirsutism, particularly of the face. PCOS patients may grow hair in places normally associated with male sexual characteristics, including beards.

• Thinning hair or hair loss on the scalp, similar to male pattern baldness

• Acne, which persists into adulthood or develops in adulthood

• Darkened skin under the breasts and in the groin

• Skin tags, often on the neck

Many people with PCOS only find out they have it when they attempt to get pregnant, while others may have more obvious symptoms.

What are the typical testosterone levels in PCOS patients?

Firstly, some PCOS patients do not present with abnormal testosterone levels. Also, if you are taking oral contraceptives, this lowers testosterone levels. 

Testosterone testing can be done by different methods, and there’s no accepted standard among laboratories. An elevation above two standard deviations of the mean would be considered positive, as most laboratory reference ranges for androgens for women do not exclude women with PCOS. 

Furthermore, testosterone testing is difficult in women due to low levels, and liquid chromatography-mass spectrometry should be used. Thus, immunoassays that are most commonly utilized in labs and hospitals are not suitable for measuring testosterone in women.

However, testosterone values of over 150 ng/dL in women would require further evaluation for the most serious causes of hyperandrogenism, such as adrenal tumors. That is to say, hyperandrogenism in PCOS is not as severe as that caused by some other diseases.

But, for reference, normal testosterone levels via LC-MS would be expected to have a cutoff around 445-60 ng/dL, depending on the lab.

It is the high testosterone, among other androgens, that can cause hirsutism and acne.

How can you tell if you have high testosterone caused by PCOS?

High levels of testosterone can cause the following symptoms in people assigned female at birth:

• Hirsutism, i.e., hair growth in a male pattern, such as hair on the face, chin, abdomen, or back

• Acne

• Oily skin

• Male-pattern hair loss

Frank virilization is extremely rare with PCOS.

Causes of high testosterone in AFAB patients

There are several causes of elevated testosterone other than PCOS. These include:

• Ovarian and adrenal tumors. Natural testosterone is produced in the ovaries, and tumors can cause the ovaries to produce more testosterone than they are supposed to.

• Iatrogenic hirsutism¹

• Cushing's syndrome

• Congenital adrenal hyperplasia. This causes the body to produce too much testosterone, resulting in infertility and virilization.

• Complete androgen insensitivity syndrome. This is a condition in which the body cannot react to the androgens. People with this condition are genetically male and can have the external sex characteristics of females. But they do not have a uterus and have undescended testes. However, the illness spectrum can be broad if the disease is partial. Because they still produce testosterone, they have high testosterone levels, often in the typical male ranges.

Virilization, such as the expansion of the clitoris or deepening of the voice, is a warning sign of extreme hyperandrogenism associated with tumors and other severe diseases and must be investigated.

Best ways to lower testosterone

There are a number of ways people with PCOS can lower their testosterone levels.

Combined estrogen-progestin oral contraceptives (COC)

If you are not trying to get pregnant, hormonal contraceptives are one of the best ways to lower your androgen levels. You may have to try more than one brand or dose to find one which works for you.

Weight loss

If you have PCOS and are overweight, it's important to get your weight down. This is particularly challenging as PCOS tends to push your weight up.

To lose weight, try reducing your calorie intake and increasing exercise. PCOS patients often benefit from moderate exercise. 

You should work with a nutritionist and avoid fad diets. You need to make sustainable changes that you can maintain. It's particularly important to lose weight if you want to get pregnant, as obesity can aggravate fertility problems.

Antiandrogens

Spironolactone or finasteride can be used if the patient does not respond to COC. 

Eating more soy

While the research is mixed and has not shown a benefit for symptoms of PCOS, soy has been shown to lower testosterone levels. Soy contains phytoestrogens, chemicals that mimic the action of female hormones. This may or may not help rebalance your hormones. 

If increasing soy helps your symptoms, then it is worth trying, but it does not appear to work for everyone. It is, however, typically harmless unless you have been advised to avoid soy by your doctor or are allergic.

Drinking mint tea

Spearmint tea has been shown to have significant anti-androgen effects. It can be slightly harder to find than peppermint tea, but you can also make your own.

The cheapest option, if you have space, might be to grow some spearmint in your garden. Simply switch out one of your daily cups for spearmint. As it contains no caffeine, it's a great choice for later in the day when consuming caffeine might cause sleep issues.

Peppermint tea has also been shown to decrease testosterone levels in rats. Mint tea is safe, although. as with everything else, you should consume it in moderation.

Licorice root

Licorice root has been specifically demonstrated to lower serum testosterone in women. It blocks 11beta-hydroxysteroid dehydrogenase type 2, which can lead to licorice ingestion syndrome, marked with hypertension, hypokalemia, and metabolic acidosis. Licorice root is a specific medicinal plant.

However, due to this risk, you should not take licorice root without first talking to your doctor. Note that licorice candy is often flavored artificially, so eating it will not help your hormone levels.

Flaxseed

While more study is needed, a case study showed that daily flaxseed supplementation could reduce testosterone levels in people affected by PCOS. Flaxseed is also rich in fiber, heart-healthy fats, and important vitamins and minerals. In this case, the "active ingredient" is lignan, which flaxseed has far more than any other food. In the case study, flaxseed supplementation reduced hirsutism.²

Tell your doctor if you are taking flaxseed or any other supplement so they can monitor for interactions.

Flaxseed is typically mixed with other foods, and one great way to use it is to add it to your morning cereal.

Green Tea

Green tea is also pretty good for you; it's rich in antioxidants. Green tea supplements were shown in a study to not only decrease free testosterone but also decrease insulin resistance and help with weight loss. This makes it particularly beneficial if you are overweight or your PCOS is associated with weight gain.³

However, not all studies have demonstrated a benefit, particularly a causal one, and the effects may be more so modulated by caffeine.

As green tea is a healthy beverage, drinking it may help. Talk to your doctor before taking green tea pills because of the higher level consumed.

Zinc

Zinc is vital for the normal functioning of growth, tissue repair, and wound healing, as well as lipid and glucose metabolism and immunity. Zinc supplementation may be beneficial in PCOS, particularly in terms of reducing the risk of diabetes. The effect of zinc supplements on testosterone concentrations and hormonal imbalances remains unclear.

Furthermore, zinc supplementation in diabetic patients has been shown to worsen glucose intolerance and increase HbA1c.

Zinc is mostly found in animal foods, and zinc in animal foods (meat, dairy, fish, eggs, etc.) is easier to absorb. If you are a vegetarian or vegan, you should consider zinc supplementation. While zinc is found in cereals, nuts, and legumes, it's harder to absorb. Talk to your doctor or nutritionist about whether you should take a zinc supplement.

Cinnamon

In a mouse model, the herb cinnamon was shown to significantly reduce both insulin and testosterone levels. While this has not yet been tested in humans, cinnamon supplementation has been used to reduce the risk of type 2 diabetes. However, the data is conflicting.⁴

Again, you should talk to your doctor or nutritionist before taking it. This does not mean that sugary cinnamon buns are good for you!

Instead, take a cinnamon supplement or add it to meals. Make sure supplements are made from true cinnamon, not cassia, which contains more of a toxic substance called coumarin that can affect your liver in high doses.⁵

Omega-3 Fatty Acids

Omega-3 is one of the "good fats." Supplementation with omega-3 in people with PCOS reduced testosterone and hirsutism, as well as insulin resistance. It also showed an improvement in mood and mental health. 

Omega-3 fatty acids usually have few or no side effects. Most of these supplements are derived from marine sources, so be careful if you are allergic to fish or shellfish. Vegan supplements are available. 

The lowdown

If you have PCOS, then your levels of testosterone are most likely high. This can cause a variety of issues, including hirsutism. Looking into ways to lower your testosterone can help you deal with these annoying symptoms. This might include drinking certain teas, using oral contraceptives or antiandrogens, etc.

People with PCOS should consult a nutritionist on how to design their diet to support weight loss and overall health and naturally lower testosterone levels.