4 Causes of Androgen Excess in Women

If you suffer hair loss, facial hair (hirsutism), or acne, then you know all about androgen excess or high male hormones.

You may have been given the diagnosis of PCOS but there are actually several different reasons for androgen excess in women including androgen hypersensitivity, adrenal androgen excess, high prolactin, menopause, and hormonal birth control with a high androgen index.

Hormonal birth control with a “high androgen index”

The simplest and most preventable cause of androgen excess is hormonal birth control. Some types of birth control contain a progestin with a “high androgen index” which means it’s “masculinizing” and causes side effects such as hair loss and acne.

Are you taking a masculinizing type of birth control? Read the label.

Desogestrel is an example of a progestin with a high androgen index.

Progestins with a high androgen index include levonorgestrel (many pills, Norplant implant, Mirena hormonal IUD, and the morning-after pill), norgestrel, gestodene, desogestrel, norelgestromin, norethindrone, and etonogestrel (many pills, Nuvaring, Nexplanon implant).

Progestins with a low androgen index include drospirenone (which is the exact same drug as spironolactone), norgestimate, dienogest, cyproterone, and of course body-identical progesterone. Real progesterone has anti-androgen properties because it inhibits the enzyme 5 alpha-reductase. That’s why natural progesterone is good for hair.

Treatment is to switch birth control. Choose a less masculinizing progestin, or even better: Choose a non-hormonal method such as Fertility Awareness Method (FAM), condoms, or copper IUD. Once you stop the masculinizing progestin, your androgen symptoms should improve.

Hypersensitivity to a normal amount of androgen

Hypersensitivity to androgens means there are symptoms of high androgens despite normal levels on a blood test. When hair loss is the main symptom, androgen hypersensitivity is called androgenic (or androgenetic) alopecia.

Androgen hypersensitivity is supposedly genetic, but that explanation is not very satisfactory because previous generations of young women did not suffer the hair loss and androgen symptoms we see today.

There are other explanations:

Treatment of androgen excess due to birth control is to stop taking a progestin with a high androgen index.

Treatment of post-pill PCOS is to give it some time and consider taking a natural anti-androgen supplement.

Treatment of inflammatory hypersensitivity of the androgen receptor is to reduce chronic inflammation and consider taking an anti-androgen supplement such as natural progesterone.

Treatment of the testosterone dominance of menopause is to reverse insulin resistance and maybe take body-identical estrogen and progesterone.

Treatment of prolactin-induced androgen excess is with vitamin B6 and the herbal medicine Vitex.

Adrenal androgen excess (including adrenal PCOS)

If you have high adrenal androgen (DHEAS) but normal ovarian androgens (testosterone and androstenedione), then you have adrenal androgen excess.

High adrenal androgens can be caused by one of the following situations:

  • The genetic condition non-classic (or late-onset) congenital adrenal hyperplasia (CAH). It accounts for up to 9 percent of cases of androgen excess and is often misdiagnosed as PCOS. The test is 17-OH progesterone followed by genetic testing.
  • Elevated prolactin, because it increases DHEAS.
  • Adrenal PCOS, which applies to about 10 percent of women with a PCOS diagnosis. It quite a different condition from ovarian-androgen PCOS (see below), in that it’s not driven by insulin resistance or other factors that impair ovulation. Instead, it’s driven by factors that affect the adrenal glands, such as stress.

👉 Tip: The coming name change for PCOS may help to distinguish between adrenal-androgen PCOS and ovarian androgen PCOS.

Treatment of congenital adrenal hyperplasia (CAH) is low-dose hydrocortisone to down-regulate adrenal androgen production.

Treatment of adrenal androgen PCOS is to normalize the HPA (adrenal) axis function with supplements such as magnesium and B-vitamins (see the Adrenal PCOS section in Chapter 7 of Period Repair Manual).

Ovarian androgen excess (classic PCOS)

The defining feature of PCOS is anovulation and the over-production of androgens by the ovaries. PCOS is best defined as the situation of androgen excess when all other causes of androgen excess have been ruled out.

👉 Tip: Menopause is another time of relative androgen excess or “testosterone dominance.”

Treatment of classic PCOS is to correct the underlying driver of androgen excess (such as insulin resistance) and thereby reestablish regular ovulation and down-regulate androgen production. Cyclic progesterone therapy can also be helpful.

For more information, read:

480 thoughts on “4 Causes of Androgen Excess in Women”

  1. Hello Dr Briden. I believe I have androgen excess because I have suffered from facial hair and acne since I was 13. I’m turning 30 this month. I ovulate regularly, my cycles are usually 29 or 30 days long. I have had 3 children in the last 6 years with no problems conceiving. I am still breastfeeding my 11 month old. I cannot seem to lose weight and my acne and hirsutism seem to be getting worse. Any suggestions? Thank you for your blog, it gives me hope.

  2. Question if hormonal IUDs have high androgen index then why are they not the cause for PCOS? I had bo issues getting pregnant had three children and went on mirena after my last child. I had it for 10 yrs. Now I have hormone imbalances. My gynecologist says I have PCOS, pmdd, peri menopause. How can I now have pcos and pmdd when prior to the iud I had none of these issues??? My dhea is high my testosterone is normal no other issues but lie progesterone. My insulin is higher now along with my A1C but 6 months ago these were normal and good. I’ve been struggling with many issues for 2 years and they have gotten worse. I believe the iud caused all of these issues one leading to the other to the other. Can someone explain this?

  3. The iud is not healthcare. If heavy bleeding, esp due to perimenopause please consider all other options. More and more studies are showing levonorgestrel does not stay local. I have permanent severe and worsening hearing loss from the Mirena iud, ringing in the ears, etc. I’m going deaf. I also have clusters in my breast and a meningioma in my head. I have mammogram every six months and an mri every six months. All started with the iUD. Gyns prescribe the iud as panacea for everything related to the uterus without regard to potentially harmful side effects. They tell you there is no other option, not true,nthis site is chock full of options. Low dose = more potent. Stays local claim just means it’s not in the blood/serum like oral b.c. pills but it goes everywhere. Your uterus does not have an iron wall around it. They are marketing the iud to younger and younger women, and nobody is studying the long term effects of such concentrations of progestin in the tissues, organs. It’s found in breast milk, peritoneal fluid, etc. I wish a doctor would have discussed natural progesterone instead of the iud. The iud is not healthcare.

  4. Hello! I have non-classic CAH, and since having children I have pretty severe pain around ovulation time and unpleasant cramping leading up to my period. I do not take a steroid anymore (haven’t since I hit puberty) because other than some pain during my cycle, the symptoms aren’t bothersome. Slight excess body hair but not much and I’d rather just take care of hair as needed than be on a steroid everyday.

    My doctor has me on the progesterone only pill (started it when breastfeeding, so I think that was the reason for choosing that one over the other kind) to help with the pain. It does seem to help most of the time, but I am dealing with more mood swings and bloating now.

    I’m hoping to get off the pill. What do you think could help someone with non-classic CAH have a better cycle?

  5. I started taking dim and zinc when I came off the pill 2 years ago. It has been successful balancing hormones and cycle. Should I continue using them if I plan on trying to have a baby and pregnancy?

  6. Hi Lara!
    What day of the cycle should you test testosterone, sex binding hormone, and DHEA? Should those too be tested during roughly days 19-22, or are those consistent for women any day of the cycle?
    Thank you,

  7. Hello Lara, thank you so much for your informative blog. I always read your new post with enthusiasm, you’re so generous.
    I was diagnosed with androgenetic alopeacia and I also happen to have endometriosis.
    For my hair, I take finesteride, spironolactone and minoxidil, and do PRP treatments. It works but yikes, so much money and stuff! 😄 I was already overweight but I normally get close to a healthy weight using a low carb diet. I’ve recently had to take the smallest dose of sertraline. I gain a lot of weight and it’s become very hard to lose it.

    I’m not sure where I fall in the above examples, and I’d love your thoughts on a treatment to help with my weight and my hair. I’m feel like I’m seeing a difference in my insuline resistance when I take taurine (3g) that I take with 300mg of Mg Glycinate. I feel great taking them, I don’t feel as hungry. When I run out, I totally see a difference.

    I’m a big fan of yours. thank you!

  8. Hi Dr. Lara Briden,
    I have regular periods since I was around 16, never was on birth control, no cysts on my ovaries, but I still have hirsutism and androgenetic alopecia(in my family my dad, dad’s sister, my paternal grandmother and her mother also has/had very fine hair). I am the only person who has excessive hair on my face and body in my family.Before I hit 14, I had good long healthy and a lot of hair, and I didn’t have excessive hair on my body and face. I starved myself to lose weight and was on yo-yo diets when I was 14 and 15.In just couple of months I shed alot of hair, and a year later I started to grow thick hair on my cheeks, chin, nipples, belly and my chest. My breasts could not develop, and I have very small chest compared to my body(and my mother and grandmother have big breats) My total testosteron shows high on tests. When I read your book, it was very helpful but I never “perfectly” fit to any of those categories since I have regular periods. My question is which doctor should I see for my case, and which tests should I ask from my doctor to determine what is the root cause of my problems.
    Oh and for 3.5 years I’ve been suffering with chronic sinusitis and tonsil stones that are not allergic/seasonal.

      • Hi, I am a nurse. I am currently being evaluated for late onset congenital adrenal hyperplasia. Look it up. You can also have the classic kind from birth. I have had horrible acne / minor excess hair growth / issues with weight. I also had horrible tonsillitis after having mono. I got my tonsils out by an ENT last year and that changed my life / improved my facial acne. Currently waiting to see if I have late onset CAH to explain my high DHEA levels. Hope this helps – find a good endocrinologist and also ENT to then evaluate your tonsils. Please email me if you’d like to chat more. [email protected]

    • Hi, I am a nurse. I am currently being evaluated for late onset congenital adrenal hyperplasia. Look it up. You can also have the classic kind from birth. I have had horrible acne / minor excess hair growth / issues with weight. I also had horrible tonsillitis after having mono. I got my tonsils out by an ENT last year and that changed my life / improved my facial acne. Currently waiting to see if I have late onset CAH to explain my high DHEA levels. Hope this helps – find a good endocrinologist and also ENT to then evaluate your tonsils. Please email me if you’d like to chat more. [email protected]

  9. This is so ridiculous. The general public cannot just “find a doctor who thinks like this. We can’t tell a doctor what to do. Primarily because of health insurance but also because doctors get offended if the patient tells them what to do. I have been dealing with acne, hairloss, unbalanced hormones, menopause since 2013. I’m 50 now. Been to numerous endocrinologists, pcp, obgyn, dermatology, holistic dr, plastic surgeons, & even psychiatrist & rheumatologist. NOTHING any of them ever did or prescribed or recommended worked.
    I’ve been on numerous birth control, spiro, thyroid meds, otc supplements, hormones- synthetic & bio. Had PRP, used rogaine….. nothing has ever helped. I wish I didn’t waste thousands of dollars & many many days of my life trying to figure out my ailment.

  10. I am so confused! If androgen levels are high, doesn’t that mean estrogen would be low? If high levels of estrogen can be a growth factor of fibroids, then why am I showing symptoms of high androgen such as facial hair, acne and hair loss, but also showing symptoms of high estrogen at the same time? Is that even possible? 😩

    • It’s possible (in fact common) to have high androgens at the same time as high “unopposed estrogen” (too much estrogen compared to progesterone).

  11. Hi Lara,
    I’m 64 years old and still suffering with acne despite having an aesthetician’s license for the past 20 years. Menopause for me happened at 43. A dermotologist has me on spironolactone. Any thoughts on alternatives to spironolactone? Thanks

  12. Hi Lara, thanks for all the useful information. I’ve just stopped taking femme/tab ( ethinylestradiol 20 microgram / levonorgestrel 100 microgram) which I’d been taking about 3 years. I stopped and started the pill earlier in the year and experienced hair loss around that time too. The hair loss has continued this year. I am wondering though – if the pill was having an androgenetic effect on me over these years, would you expect higher androgen levels to appear on blood tests (they didn’t)? Or does the BCP skew blood results to the point they are unreliable?

  13. Hi,
    How do you find a doctor willing to look for the underlying causes of testosterone excess? None of the doctors I have seen so far care to test anything let alone do anything about it. I have been diagnosed with pcos. I have had trouble with testosterone but have low blood pressure and low blood sugar/a1c problems. I am on spironolactone, the side effects suck, but the couple times I have tried to go off of it my testosterone shoots up and my emotional wellbeing goes into a tailspin. I am taking a magnesium supplement and am on a compounded progesterone cream. Still fighting for normal range testosterone despite all the above. Any ideas?

  14. I have elevated DHEA, low fasting & non-fasting insulin, low testosterone and borderline low cortisol. Symptoms of panic attacks and elevated heart rate and insomnia that all comes and goes. Could this all be due to being 4 months after stopping birth control or do I need to be looking at underlying causes?

  15. Hi Lara!

    I’m currently trying to find out if I have PCOS because I’m losing hair. This seems to be my only sign of high androgen, and maybe occasional acne on my forehead. I take medication for hypothyroidism as well, but I don’t know if that has any effect.

    Despite currently being on the pill (Apri brand) for five years now, my recent blood test said that my testosterone is 35 and my DHEA-S is 336. This felt high to me because my ob/gyn said that most women on the pill have lower levels. I’m also 27, and would like for my DHEA-S to be below 270 by the time I’m 30, but mine seems to always be in the 300s. Should I be worried about my DHEA-S level and if so, how can I reduce it? My only hunch is stress reduction and supplements recommended in your book.

    I’m essentially concerned that I either just have a genetic sensitivity to high androgens because I’m losing hair, or that my blood test results appear normal right now because I’m on the pill. I’m getting married soon and want to stop the pill in the next year or two, but my ob/gyn warned me that doing so will make me lose even more hair than what little I already have!

  16. Hi! I am having such a hard time figuring out where my jawline acne is coming from I don’t believe it’s insulin resistance as my glucose and a1c and avg glucose all normal…my free T is 58 my 17oh-progesterone is 140 and DHEAS is 203 my doctor suggested trying vitex!

  17. Hi Lara I got off my birth control in January of this year I had been on it since I was 17 on the birth control pills and I am now going to be 28 I got off of it because my fiance and I are trying to have a baby I must be very sensitive to the hormones because I developed very very bad hormonal acne It’s horrific and my scalp and face are a lot greasier and for some reason I started developing a lot of scalp pain and flakes is this correlated? I also have a burning sensation on my scalp.

  18. Hi Lisa,
    I started taking ssri (citalopram) 13 years ago(20 years old), got it from my gynecologist to help my pmdd.
    1,5 years ago a started lower the dose, and stopped completely 1 year ago. Almost the same month i stopped taking the pills my period was going strange, i had spottings 1 week before expekted time and I started to get dark hair on my chin. After a month i also started to loose hair.
    This has been a terrible year, i am so sad and insecure to suddenly look this way. Every day i remove the chin hair and feel such sadness.
    I have a very stressful job(dentist) that I do not love, and a 4 year old son who is amazing but also intense.
    My theory is that my body got used to high serotonine level and when i quit at a time when i was very stressed my bodys hormonesystem collapsed. And here I am, so close to start taking ssri again but also so eager to find another solution.
    Do you think ssri can interrupt the hormonesystem?
    Can I ever be free from the chin hair?

  19. Hi Lara

    I was on the pill for about 10 years (age 14-24), for my acne. During that time I struggled with lots of excess androgen symptoms, like hair on chest, chin, stomach and nipples. I was on Yasmin which is meant to be a low androgen index pill, but still had these symptoms. Is this normal? I’m now off the pill, and I have regular periods so I don’t think it’s PCOS. I understand coming off the pill (at 5 month mark) will cause a surge in this, but what concerns me is that I have always had these symptoms.

    What tests are used to determine this, and is excess androgen caused by an actual problem in my body, or does it come about due to lifestyle choices?

    Thank you!

  20. I finally got my results. I am super skinny and have insulin resistance, but my testosterone is very low, SHBG high, DHEAS is normal (lowish), but DHEA and androstenedione are slightly elevated. What does that mean? Which type of pcos do I have? Could it be adrenal hyperplasia?

    • It would be unusual to have insulin resistance with high SHBG. What are your insulin readings and are you on the pill or spironolactone?

  21. Lauren, sounds like you may have insulin resistance according to your fasting insulin. Laura said above 8 indicates insulin resistance (I know this because I have stalked all of her articles and comments trying to figure out what is going on with my own hormones). 🙁

  22. Hi Lara,

    I have been dealing with elevated androgens since going of Ortho Tri Lo 3.5 years ago. I’ve done pretty much every possible natural intervention you’ve recommended, at some points or another. Regular cycles, so PCOS has been ruled out. In my most recent DUTCH test, my androgens seemed to have stabilized a tiny bit compared to the one I took a year ago. DHT, Androstedione, and testosterone were all found to be in normal range. DHEAS were on the lower end, and Androsterone was still soaringly high (this has always been the metabolite giving me issues it seems….) 1912 ng/mg. Because my DHEAS are normal this seems to rule out adrenal androgen excess and prolactin issues, based on your info above.

    In the past year I’ve focused intensively on nutrition, blood sugar balance, exercise, and stress reduction, but I still have cystic acne (never before the pill) and chronic hair loss. Is there anything I can do to address the androsterone specifically? I take saw palmetto and drink tons of spearmint tea, focus on nonstarchy carbs and only occasional starch, no sugar gluten or dairy, and incorporate strength training into my exercise routine. It just seems ridiculous that 3.5 years after the pill I am still in the same exact boat, regardless of the multitude of interventions and treatments……am I crazy to think the damage will be irreversible?

  23. I have…….. and it hasn’t gotten any better the loss (but def. hasn’t gotten worse). Hair feels softer and less dry.

  24. I had mirena for over 5 years, a year after insertion my hair started to thin. I didn’t pay attention, I was planning my wedding! 2 years later it got really bad and thinned on top of my head. I asked and asked to have the coil removed and was sick of being told it wasn’t the cause of my hair loss. So eventually it was removed (I’m 3 months post removal). I went back on the pill (cilest) I took it previously for years with no problems. I’ve become obsessed with how my hair looks. Will any of it come back? What can I do to help it? I’m 36 with 5 children.

  25. Good Morning Lara! My body has gone through some severe changes. It did not appear initially in Menopause, but rather like ten years later. I have been diagnosed with Hashimoto’s Disease. I exercise daily. I have completed a marathon and a few tris and ran five daily most of my life. I have developed facial hair, (lovely) and neck hair sometimes, my back has blown up and I now look like a line-backer. I have a fat stomach now too and never did. I have recently been taking Synthroid again with Liothyronine. It seems to make me bigger. I have recently joined a gym and got a trainer. Once I was able to put these in submission by rubbing cortisol on my wrists. My Gyn. has indicated that my testosterone is normal. I am interested in obtaining your progesterone and your cortisol. I wish you had an office near here. This has left me so sad, and mirrors are now my enemy. I was once 125 and now cannot get my weight below 168. I am 5’8. I am venturing a guess that I have androgen excess. My fingers have become fat too. My feet have changed and now look like male feet. I really am unable to find anyone to help and have waited for docs for months who make no recommendations other than Synthroid. I was once so upbeat and happy and out going and I have now become the opposite. I am guessing there is indeed a stress component and a genetic component. When I put this in remission once I used hydrocortisone and black Himalayan sea salt. Thank you so much for your research. Can you recommend what I should do? I was the person who always went over and beyond the distance. I was also diagnosed with Adrenal failure.

  26. Dear dr. Lara,

    I’m desperate. I don’t even know what the reason for my case is. Gynecologist said to me that is PCOS (because of cysts on the ovaries and high testosterone). But i am having regular period all the time.
    I have had two years ago high DHEA and normal but high prolactine, high testosterone (hair loss, acne on face, arms, back, neck, neckline and hairsutism) but i have period every month.

    Values are changing, because when i stopped eating Diane35 four years ago(2015) i had low TSH, high LH, high testosterone.Then just four months later TSH normal. Two years ago (2017)TSH normal, low vitamin D, prolactin normal but high, high DHEA, high testosterone. All the time testosterone is elevated. Thyroid hormones change all the time, now (2019)i have high TSH.
    I can say that i am not happy in my life and i guess that stress can cause many things. Morning cortisol levels two years ago 399.0 nmol/L (morning: 101.2-535.7)

    Pill-induced PCOS can’t be, because in these years testosterone should fall.
    I have taken vitex all the time, but testosterone still have been high. I tried inositol, DIM,NaPro, Zinc, saw palmetto and nothing. I also tried licorice and it helped just few months when i have taken it with DIM. I tried taking licorice this year, because of my skin and it did not help at all. I have taken DHTblock and it helped a little bit, because in that time i have had less acne and not so oily skin.

    I have taken antidepressant for four years, but now not anymore for five months. I take Aldactone now, because if not, my back is full of acne and my skin and hair oily, incereased hair, hair loss. 🙁
    I don’t it processed food, i am not vegetarian, i have enough iodine (because salt in my country is iodinated), i don’t eat sugar (except in fruit and bread), i eat enough starch.

    I am 170cm and 50kg. I am very thin from ever. I don’t think that i have problems with insulin. I have taken Metformin for 2 weeks and i almost fainted. I have had headache when taking it, so i stopped inmediately. I eat many fruit and bread every day. I don’s smoke, don’t drink cofee, don’t drink alcohol.

    I have no problem with tension when I eat bread or fruit. I’m inflated and I have digestive problems sometimes when I eat milk products, but not always. So I avoid milk products, I only eat raw butter which does not cause me problems.

    I am a little bit confused, because i don’t know what else could be the cause. I would stop eating gluten for two months and i will see.
    My doctor checked tTG IgA (for gluten) but it was negative: 0,5KU/L (normal is to 7,0).
    I have no celiac. I already knew that before. I may have gluten intolerance. But given the fact that I do not have any problems when I eat food with gluten, I’m not sure.

    Do you think that it could be gluten?
    Androgen hypersensitivity ?
    congenital adrenal hyperplasia?

    Here there in no naturopathic doctors in Slovenia and doctors have no idea of anythig what you are talking in your articles. Just general medicine and tablets, sadly.

    Please, help me!
    Best regards.

  27. Hello Dr. Briden.

    I will be ordering your book this week, and I sincerely thank you for all the research and work you have done – because it is so phenomenal for women. =D Thank you kindly!

    I haven’t had luck with doctors in my life thus far. I am very curious about something. I’ll begin by saying that my mom has been an R.N. for fifty years, and she recently commented about how she believes I have been showing symptoms of hormonal changes. In a year I have gained 15lbs, and over time my face has become less feminine.

    I was prescribed two entire durations of Accutane by a male dermatologist beginning when I was only 12. I used to have extremely feminine facial features and was a ballerina and gymnast from age 4-13. I did not have regular periods- and never have (because of competitive athletics, likely). Age 13 I developed anorexia and then Bulimia from 15- onward. I seriously abused diet pills from age 16-18, and then again from age 26-33 occasionally. Needless to say, I know inflammation is an issue, and something I must address fundamentally for my health moving forward. I know that Dr. Andrew Weil discusses many natural solutions for inflammation, but he doesn’t specialize in the female hormones like you do! I was divorced with two young children (both under 3) when I was 25, and the male OBGYN put me on the Mirena IUD immediately after my son was born. It was unnoticeable to me for two years, and then the next 2.5 years were nightmarish until I removed it myself in the bathroom. I had not completed a college degree and was a displaced homemaker following divorce, so the quality of medical care became lower, understandably.

    I have spent years neglecting my health, and I am ready to change this. Until age 31, I practiced much more physical fitness than the average American, as teaching yoga, pilates, and cycling classes was my profession. At age 30, my Grandma passed, and I changed drastically- began smoking and social drinking (Dad was an alcoholic and smoker). I’m now 34, and I had another Mirena IUD in six months ago. All the symptoms- thinning hair, increased facial hair, and now drier skin and body acne. I have stopped smoking completely (still shocked that I was a smoker for 4years). I also no longer drink alcohol. I take fish oil supplements.

    As I am finally able to seek medical care with my health insurance, now as a teacher, I do not know where to even begin. OBGYN or Endocrinologist? Ear Nose and Throat specialist? I have scar tissue and very swollen glands from years of bulimia.

    I believe the Accutane may have impacted my development, because I had severe depression and anxiety beginning the year after I was on it- and it only stopped when I was 21-25 with my (now-ex) husband and children. Then it returned…

    Knowing this, if you have any advice, I am very open and appreciative. And thank you again for your book and website!

  28. For the past 12 months, I have been taking Spironolactone to help control and get rid of hormonal acne I got after going off the pill. I only had 1 side effect and that being no period.

    I just recently stopped taking it (about a month ago) as my priority is to get my period back (its been 12 months of no period).

    Any advice of how to get my period back? And what to do/use if my skin gets bad again?

  29. Hi my daughter is 21 she has PCOS and was given YAZMIN birth control pill by the doctor, so started her journey, the pill caused massive anxiety and depression, we have seen an endocrinologist who is next to useless and refuses to believe there are any endocrine disruptors or that there may be different types of PCOS his answer take the birth control pill, anti anxiety medication and loose weight……my daughter is 1.8 metres and 70k’s and after suffering acne for the last 5 years was shattered that someone could be so cruel….I am convinced that the drug my mother took while pregnant with me (DES- Diethylstilbestrol) which caused me to have a good many health problems is now evident in my daughter – so thankyou for validating that there are endocrine disruptors and unknow hidden genetic underlying causes, it has given me hope of finding non drug treatments for my daughter.

  30. Love this article! I have been having a ball figuring out my cause. I had high prolactin, high DHEA-S, Low progesterone, Low estrogen…they found a pituitary adenoma so now my prolactin is very low thanks to medication. My question is, do you recommend progesterone and estrogen creams (used correctly based on time of cycle) for someone who is 22? I have symptoms of both and would like to help my body out. I wake up with patches of eyebrow hair missing at times and scalp hair has been shedding for 3 months. Endocrinologists don’t know how long it’ll take for my body to regulate itself and suggested BC, which is not a route I want to take…

  31. If I understand correctly testosterone is the ”precursor’ for estrogen. In other words; estrogen is made from testosterone through aromatase. If aromatase is inhibited there will be less estrogen and more testosterone.
    Estrogen also increases SHBG. DHT and testosterone are bound by SHBG.
    Birthcontrol ( ethinylestradiol) and estradiol raise SHBG and when you stop taking BCP’s SHBG remains high, sometimes for a very long time. Maybe not only binding testosterone but also, to a lesser extend, estrogen. In other words; can estrogen deficiency be a cause for androgen excess to?
    Excuse my grammar, I’m not a native English speaker.

    • Interesting question. Yes, lack of progesterone could potentially always cause some degree of androgen (DHT) excess or androgen sensitivity.

      • i wonder if bio hrt (mine is 1mg estradiol & 40 mg progesterone in cream form) will help my hairloss. Considering I’ve had low E & P for over 4 yrs. & I’m just now getting this rx. They made me wait til I stopped monthly bleeding. It doesn’t seem right, when a woman’s estrogen & progesterone drop so low that it causes high dht that cause hairloss, no dr wants to give an rx to supplement it bio identically. It’s not heroin or gold, it’s our own bodies depleting a hormone. I am livid it took 4 1/2 yrs & 11 dr’s for me to get bhrt. My estradiol was below 10 & I’m only 48. This whole 10 yrs of going thru premenopausal/menopause & hairloss is insane.

      • Thank you for your reply, Lara. I am reading your book and loving it! So informative and full of great suggestions and detail. I think every woman should read it! 🙂

  32. Lara, I have been given PCOS diagnis, but I am not sure it is correct. My total testosterone is 44, where the range is 2-45 ng/dl and free testosterone is 4.9 where range is 0.1-7.4pg/ml. My DHEA is 263 where range is 102-1195 ng/dl. My fasting insulin is 9, fasting glucose is 95 and prolactin is 7.4. I have acne in folicular phase, hair loss and facial hair, but regular period and no ovary cysts. Do I have androgen exess and PCOS?

  33. Dr. Lara, At 29, and 13 years on several types of birth control pills, so relieved to find your book. 2 years ago was prescribed LoEstrinFe and now have hairline thinning (& acne). Desperate to quit after researching its androgen index, yet terrified to quit suddenly due to the after shed, given the choice of desogestrel or norgestimate, which is best to not worsen the hair receding, until I can eventually discontinue? (have tried drosperinone in the past and did not like the diuretic effects). Any preference on high progestrin vs high estrogen being better for hair? (Second to natural progesterone). Thank you!

  34. Hi Lara,

    I have been experiencing hairloss for the last 3 years. At first I thought it was caused by switching from Yasmin to Evra patch but at the end of 2016 I was diagnosed with a micro adenoma on my pituitary gland. Did a 6 month treatment with with dosinex as I wanted to have a baby. I delivered my baby 4 month ago. My hair loss hasn’t stopped all this time. It’s not coming out in clamps, I have regular amount of hairloss but the hair that falls doesn’t grow back. My hairline is going back and I am developing defused hairloss all over my scalp. My Enzo said my prolactinoma doesn’t cause this but after readying your article my thoughts were confirmed. What can I do to recover from my micoadenoma and hair loss?

    Thanks, Ani

  35. I need help. My dhea last time I had blood work was 937 . My other hormones seem to be balanced my progesterone is around 11 right after ovulation. And my BS seems to be good and I did have an insulin sensitivity test done and I’m actual insulin sensitive not resistant at all. My main problems are I’m so tired. My hair falls out and I have gained 30 lbs and no matter if I eat no sugar drink no coffee and eat literally just meat and veggies I can’t seem to loose any weight. I do take rhodiola and will cycle on and off with ashwagandha because at times it seems I develop a tolerance. My doctor doesn’t know what to do. I had him draw a oh- progesterone do pelvic and abdominal ultrasound and also a brain mri and they all came back normal. Now I’m doing hypnotherapy to work on any past issues and I like it but we haven’t had any breakthroughs yet. I’m just feeling lost. I don’t like my body lately and feel just so tired of being tired and also not sure of the next step. Advice??

    • Also I haven’t had any birth control in over 10 years. And I have a very regular yet painful cycle and I do ovulate each month bc I monitor cervical mucus and temp. Any thoughts are so appreciated!!!

  36. Hi Lara,

    I’m 34 years old and started losing hair about 2 years ago, initially due to a very stressful life event. A year later I decided to stop taking Yaz to remove it as a factor. It has been 9 months off birth control, and my hair continues to shed. My periods are regular, I eat healthy, exercise, all my blood work is within normal ranges. I have gotten a scalp biospy that revealed mild minitaurization.

    I am considering going back on Yaz since it has anti-androgen properties, and as far as I can tell did not initially cause or worsen my hair loss.

    What do you see as the negatives or positives for using a birth control like Yaz to help with Genetic/Female Pattern Hair Loss? In my case, do you think it is more beneficial I stay on it?

    And to the readers: Has anyone gotten back on birth control and had an improvement in their hair loss?

    Thanks in advance!

    • Hi Emily, I would love to know if going back on the Yaz helped with your hair loss? I went from Microval (mini pill) to Qlaira and have been experiencing consistent hair loss for a year now. You can now see the effects of it on my hairline. Not sure whether to go onto a different pill or off completely.
      Thanks, Sally

  37. Hi Lara.i am 39 years old.my Dheas levels are 176.2 ug/dL.high estrogen and low progesterone.testosterone and free testosterone levels are ok.for my age I don’t know about exact Dheas levels. Is they are high.can i beneficial using vitex?my prolactin levels are ok.two times my LH levels are tested both are lower than FSH.but they didn’t test on day 3 of my period. I have irregular periods.and with pills or progesterone cream only I will get period.my fasting glucose is 90 and fasting insulin is 7.
    But my 1 hour ogtt is 90. 2 hour ogtt is 62. I am lean.currently taking ovasito,Berberine,chromium,dim,sawpalmetto for hair loss,Reishi mushroom and l Theanine,magnesium,zinc,multivitamin.still not getting period with this supplements.what other things have to take.

  38. Hi Lara! I am an acupuncturist in Los Angeles, California and I refer patients to your blog all the time. Thank you for providing such solid information in easy to understand ways. I have a question – do you have any specific suggestions for patients who want to come off of spiro for acne, but not hair loss? Thank you!

    • Hi Holly, Do you mean how to manage acne as they come off the drug?

      I’m going to be in LA next month for a few events.

  39. My dear god… you have summarized YEARS of research in a single MAGNIFICENT article. The information you give here has the potential to help so many women. It is SPOT ON and so much of your information is scattered about or missing from other sources where it should have beeen headlined. To anyone that made it to this point, I don’t know if you need to look any further than this all-inclusive, extremely informative summary of issues.

  40. Hi Lara!
    I bought your book some months ago, and I finally left the pill after 13 years taking it.
    I was diagnosed with PCOS when I was 17, and straightly prescribed birth control pills. I suffered hirsutism, ovaries were poliquistic in ultrasound.
    After so long taking the pill, I recently went to a nutritionist for a digestion problem, and after telling her that I had PCOS and took the pill because otherwise I didn’t have my period, she told me about your book and I read it.
    I left the pill two months ago, and just got my blood test results. I was also happily surprised to get my period 34 days after leaving the pill :). My blood test shows high levels of prolactin and testosterone. Also, after leaving the pill I am experiencing higher hair loss, acne and hirsutism. I am pretty thin and don’t think I have insulin problems, although I didn’t get it checked this time.
    I am finding difficult to classify my case in one of the types and therefore start the right treatment.
    Could you please advise?
    Thanks in advance

    • Even though you’re thin, it’s really worth testing for “fasting insulin” just to see if insulin is an issue, or not. If it is, then avoiding sugar is the priority. Beyond that, you can look at inositol and peony&licorice treatments I discuss in the book. (They can work regardless of the type of PCOS)

  41. I was just told I have high androstenedione levels which upon further testing are caused by my ovaries. My endo told me to take yah to help. My main concern is that I have extreme and rapid hair loss. TSH, testosterone, estrogen etc were all normal. Progesterone was low but not off the charts low. Not getting my period now. Had mirena which I suspect caused all this but it was removed one year ago. My question- how do I lower Androstenedione specifically since this appears to be the only hormone problem I have at this time. Insulin is normal as well.

    • Hi Amy/Lara,

      I also tested for elevated andrestenedione, but my testosterone was in normal range. Is there a different treatment for this hormone or would it be the same general anti-androgen treatment? My progesterone also on the low-ish side but nothing acute according to my naturopath. My scalp sebum, hair loss, acne, oily skin has been going on for over two years now and I think perhaps the androstenedione could be part of the problem? I have already integrated quite a few holistic treatments in an effort to balance hormones, but the same symptoms persist.

      Periods pretty much normal and painless for the past 2+ years since quitting pill….

  42. I came across your blog in a PCOS support website. And I can safely say you’ve helped me more than my own physician just by your articles. Now, I have a question that I would love for your professional opinion on:

    I became a mom in 2015 and after having him had the DEPO shot because I felt that was a quick option to make sure I did not have any surprises and then decided on the Mirena IUD (with my mid-wife’s insistence on it) for long term use, had it for almost a year when I had it removed and switched for the copper IUD due to the side effects of weight gain, no period, acne, mood swings, fatigue and loss of libido- in other words it affected my life and not in a good way. Now that I’ve had it out for a year now I am still struggling with the same symptoms except having my period back on a very regular cycle. I’ve went over my concerns with my physician and everything was fine but I did have somewhat high testosterone and he made a comment of it being a “mild” case of PCOS and prescribed me Spironolactone (which I only took 2 days and saw your post about it and decided I did not want to risk anymore hormone imbalance) … After reading as much as I could about the condition I am not so sure I fit into any type or phenotype of PCOS because my only symptom is high testosterone. Do you think I have PCOS or just a hormonal imbalance of some sort?

  43. I did not know that. I suffer from hair loss due to stress and female pattern baldness. I found this article really informative and interesting. Does this cause hair to thin gradually or does it come out in clumps leaving bald spots? Losing your hair either way is devastating.

  44. HI Dr. Lara,

    I have been dealing with terrible hair loss and scalp problems since quitting Ortho Lo almost 2 years ago. I never had greasy hair before taking the pill or while on it, but my hair has transformed since discontinuing in December 2015. My periods fluctuate between 28-35 days, but are regular otherwise, so I don’t think I have PCOS. My main symptoms are acne, hair loss, and excessive oil/sebum production on my scalp. I have a greasy waxy spot on the back of my head after only a few hours of washing, and I absolutely have to wash my hair daily. It’s not quite seborrheic dermatitis (I don’t have scales or flakes), but the grease is fully visible. This was never the case in the past – I could skip a shampoo no problem and my hair was still soft, full, and clean looking.

    I have been gluten dairy sugar caffeine soy and alcohol free for the past month, no slips. In the past year, I followed this diet more or less but was less consistent. Now I am fully dedicated the past month but have not seen any results for my scalp.

    Does the pill permanently alter testosterone balances? What about SBHG? I have seen this come up in some medical articles, and wonder if the pill irreversibly altered that as well, which maybe accounts for the seemingly increased androgens and persistent sebum production. Two years seems like way too long to still be recovering from the pill. What can I do?

  45. hi lara,

    i dont know if i have pcos or not. my period cycle is normal, but i get cystic breakouts during the same times during the month. its almost always predictable when i’ll get them. i am currently taking the following supplements:
    -Estroblock DIM (one capsule a day)
    -Evening Primrose Oil (one capsule a day)
    -Zinc (one capsule every other day)
    -Caprylic Acid and Grapefruit Seed Extract (alternate every day for any gut issues or candida i may have)

    i eat a very clean paleo diet with very little carb intake. and my skincare regimen is very minimal (no harsh chemicals)

    i took a saliva test (taken on the 19th/20th day of my cycle) a few months back and my results said that my Progesterone/Estradiol was Low and my Androstenedione was High. i dont know what these indicate. do i have pcos? am i insulin resistant even though my carb intake is low? should i try berberine?

    please help!

  46. I just came across this blog and i will be ordering your new book on September 14th. Can’t wait! A bit about me. When i was 17, I was given the birth control pill to control very heavy periods. After taking it for a few days, i didn’t like the side effects like nausea so i stopped taking them and didn’t tell the doctor. My hair begun falling off after that for many years. I went to so many doctors who dismiss it as stress and that it would grow back. I used to have so much hair. Anyways, in my thirties i saw a doctor who diagnosed me with androgenic alopecia. My testosterone level was .44. He told me i was sensitive to testosterone. I was put on the birth control pill and Aldactone medication.

    I am now 49 and i been very sick. i have leaky gut so i decided to stop taking medications in June 2017, and my period hasn’t returned yet but i am getting the symptoms of too much testosterone such as hair on my upper lip, oily face and tiny pimples, hair loss (more than before) and the hair i have left seems to have changed from normal to very fine and weak. My vagina is very dry. It hurts there to even clean it. I think is menopause. I am also depressed and irritable and I have insomnia.

    I will be seeing a doctor in a couple of weeks. I am afraid she will dismiss my complaints like most doctors seem to do and i prefer to go the natural route so I was wondering if it’s too early to take any of the supplements that you describe on your blog for my symptoms? such as Vitex. On June 2017, i started a very healthy diet, no gluten, no dairy, no sugar or soy. Only vegetables, healthy fats and organic meat and grass fed. I been working out gently five days a week. I do yoga, meditation, Tai Chi and light Pilates. I am a seeing a therapist to help me deal with my anxiety. Help please. Any suggestions would be really appreciated.

    • Hi Dr. Please could you help me. I am experiencing growth of thicker and darker chin hairs for the past year. When I was pregnant I also lost some hair (4 yrs ago) and it has not totally grown back. My periods are regular and I have not been on birth control for 10 years. What’s interesting from your advice is that you mention all this could be linked to androgens and genes and maybe cortisol and adrenal function. My 8 year old son had high levels of testosterone inside him due to a tumour on his adrenal gland which was removed 2 yrs ago. He now gets puberty hairs even though no test shows testosterone inside him. I also give him cortisol every day as well (as his adrenal gland needs help making this). So I’m wondering if touching the cortisol might have an effect on my androgen levels and why it seems both of us have male type hair when it’s not appropriate? Also would it be wise for both of us to stop drinking the tap water as we maybe ingesting the pill from that?
      I’ve done a thyroid test but no problem.

  47. Very interesting post, thanks for all these informations! I also bought Laras book, really really helpful 🙂
    I’m french, 23 years old and since my pill (that contained levonorgestrel and that I stopped 3 years ago) have high level of delta-4-androstenedione. Testosterone and the rest is ok, no insulin-resistance or adrenal-gland problem etc, but I also have hypoestrogenism, amenorrhea, acne, hirsutism and alopecia.
    I did many analysis and the doctors here things I have PCOS but I didn’t want to take an other pill or spironolactone.
    Do you thing I can try peony and liquorice ? The naturopaths here didn’t recommend me these plants and I don’t know how to take them and how much…
    Thank you in advance for your help!

      • No, I had no periods since february..

        My case is a little special (I wrote you a quite long email to explain every analysis I did during the last 4 years, I also saw many specialists who couldn’t tell me what I suffer from and what to do..)
        But to summarise :
        – hyperandrogenism, alopecia, acne, hirsutism and hypoestrogenism since 4 years, amenorrhea since last february ;
        – LH, FSH, progesteron (I did’nt know in which part of my cycle I was but in every part it was ok), TSH/T4/FT3/FT4, ACTH stimulation test, 24 hours cortisolurie, 17-OH-progesteron, DHEA, SHBG, fasting insulin/glucose tolerance test, abdominal ultrasound normal ;
        – Delat-4-Androstenedione high level (14,4 in 2013, 15,3nmol/l for 2 months – normal: 1,4-12)
        – Hypoestrogenism (17 pg/ml)
        – New ultrasound last month that may shows PCOS.

        I think a suffer from pill-induced PCOS (my periods were regular before that pill).. What do you thing I should do next ? :/
        (Acne was better after I stopped dairy and processed sugar like normal sugar/ white or white flour in general.)

  48. Hi – I’ve had problems with chest/back acne for many years, especially while on various types of “the Pill” (in college, 20’s, early 30’s). I was either pregnant or breastfeeding for 3 years, and had very clear skin. That recently finished and I’ve tried the IUD, Caya, various “oral BC”, and am now on the implant. I’m at a loss – if it doesn’t cause dramatic mood swings, or not be ideal for another reason – as with the implant now – it worsens back/chest acne. I start Vitex a week or so ago (for this reason), and my acne is dramatically worse. Now reading more, it looks like this might be expected given I am on Nexaplon. Given I’m out of BC options, I am trying to work this acne issue out. Any help would be much appreciated. Thank you!

    • Hi. May I ask did you have boys or girls? And your skin was clear while pregnant and breastfeeding but acne came back just as severe when you stopped? I’m struggling too but mine was worse with pregnancy!

  49. Best explanation on hormonal imbalance (regarding androgens) i found on internet. I ll definitively start following this blog!

  50. Hi.
    Any advice would be welcomed.
    I’m 23. I have heavy periods, when I get them. Most of the time I will go 3 months between them. I get bad pain weeks before, during and after.
    I have extreme anxiety. Terrible mood swings. Depression.
    I have excessive hair growth: chin (I have to pluck my chin daily), belly, upper lip, chest etc.
    I have a deep voice. I’m always tired.
    I’m not on any birth control right now.
    I had an ultrasound for PCOS, and it came up clear. My doctor is refusing to test me for anything else. And is trying to fob me off with going on a contraceptive pull. Saying There’s nothing else they can do.

    All these symptoms make my depression even worse. I can’t live a normal life.

    • I’m sorry to reply to this comment but there’s no other button to leave a comment except the “Reply” option on each comment. (I’m on an iPhone.) Lara, I see that you get many comments but I hope you will respond to my question!

      I’ll try to be short. I’m 23, chronic insomniac for 4 hours. Induced by stress: severe sleep deprivation, regular all-nighters during college and six months of CrossFit with a strict Paleo diet. But before this I always had a problem of oily skin and excess hair growth. 3 years into the insomnia, acne appeared. The doctor tested only total testosterone which was high. Saliva test showed DHEA depleted, cortisol low all day, high at night. (Fasting insulin a few months before this was less than 3!) Hair growth briefly increased but now is back to my “normal.” Now, a year later, testosterone is normal high, DHEA (blood test) very high – 464. Very oily T-zone, same acne as a year ago. I ALWAYS have regular periods (praise God!). Never used BC.

      Fasting insulin was 10 a few months ago. Horrible news 🙁 Tested again at 7 recently.

      What kind of PCOS is this? I assumed initially adrenal-dysfunction-induced, but I think my ovaries are dysfunctional now too. My progesterone-estrogen ratio was 20 according to a saliva test six months ago. Started progesterone cream daily. Now according to blood test it’s 80. My doctor says this is ideal?? (I’ve read 200-300.)

      I used to always be skinny, now I’m 5’3″ at 143 lbs. 🙁 Gaining weight rapidly it seems.

      Would love your help!

  51. I am so confused! I’m 66, had a total hysterectomy @ 34 & have had severe hot flashes ever since. There is more hair on my face than there is on my head 🙁 Hair loss on my head is quite noticeable.Now I’m wearing an estrogen patch to try to control the hot flashes 0.0375. My stress level is over the moon.

    • I know this is old and hope you got help. You might need to ditch the patch and add progesterone instead. Doctors can be complete idiots sometimes.

  52. Dr Briden, I thank God for your knowledge about female hormone, I found your book extremely helpful and follow every recommendation to resolve my cystic acne and restore my natural period.After reading this article I believe I finally understood the reason for my cystic acne might be HYPERSENSITIVITY TO ANDROGEN RECEPTORS (on skin level).I was on Yasmin for 15 years which worked the wonder but nothing else seems to work.One year since stopping the pill I still have terrible cystic acne but all of the blood test results seems to be normal (apart of progesterone which is low).I’m on whole food, gluten & dairy & sugar free diet, Berrberine did not work for me at all.I also tried Vitex, Evening Primrose Oil, Zinc, Magnesium, DIM with no success. Currently I’m trying Saw Palmetto, Nettle & Spearmint but can’t see much of results.So after reading the comment from Hailey I think I should try myo-inositol and d-chirp-insoitol as her story seems to be similar to mine.I would also like to try progesterone cream. Can I take all of it in the same time (Saw Palmetto + Inositol + progesterone cream)?

  53. I wish someone had told me this sooner. I’ve struggled with acne for years and years. I’ve had my bloodwork done and checked So many times. I’ve always thought my acne was because of estrogen excess even if my estrogen was fine on my bloodtests. Cause I’ve read that estrogen can be difficult to measure. I’ve eaten a clean diet without gluten og cows milk. No sugar. And the results never came like I wanted them to. Been of trillions of different supplements to lower my estrogen, but all my symptoms felt like I was low on estrogen. Now I’ve found out it is because of my androgenes I get acne. My testosterone was slightly elevated on my tests. So I started taking myo-inositol and d-chirp-inositol every day as you recommend in your book, and I’m now acne free. I’ve been tested for pcos and had ultrasound, but my tests came back negative. I’ve been on these supplements for a week and I have no acne. I’m thrilled and happy, and can’t believe this is happening. It’s too good to be true!! Lara, Could this mean I have Pcos?

    • Thanks for sharing your story. I’m glad you brought this up because there’s a weird idea out there that estrogen excess causes acne. It does not. Estrogen is good for skin.

      Yes, elevated testosterone is a possible marker for PCOS.

    • Hailey, thank you so much for your comment, you gave me a hope as I struggle with cystic acne and my story is similar to yours.Could you please kindly let me know what brand did you choose for myo-inositol and d-chirp-inositol?I would really appreciate your help.Thank you in advance

  54. Dr. Briden, I’ve seen references that DIM can block T -> DHT conversion, which helps androgenic symptoms, but that it can also lead to higher circulating testosterone levels by inhibiting conversion of testosterone to estrogen. I have high-normal total and free T and am about to start weaning off birth control pills. I strongly suspect liver overload / inability to detoxify both testosterone and estrogen may be contributing to my issues. I was planning to incorporate DIM into my regimen before I’m off BC completely. Would you be cautious with using it for someone with higher serum testosterone? Any comments are helpful. Thank you!!

    • Very interesting comment.
      I’m taking DIM (and calcium d-glucarate) for my excess estrogen. All my symptoms have gone (especially my anxiety and sore boobs) but I’m more aggressive and confident than normal.

      I have a journal going back 2 years and every week is almost identical until I started taking DIM. I wonder what the studies show.

      • I have the same response to DIM, I couldn’t stand the aggressive mood shift so I discontinued using it. I wonder why it’s such a common side effect.

  55. Hi Dr. Briden,
    After reading your book and taking the advice you offer in it I was able to regain my period back after almost 2 years without it. One of my main issues with PCOS was hair loss. After having my period back now (gonna be 2 years in May), I see little baby hairs starting to grow in. However, the hairs are growing in are grey. Is this normal? I’m only 26 years old and both my parents did not grey that early or early at all.
    Looking forward to hearing from you 🙂

  56. Hello! I went to the endocrinologist because of elevated prolactin (I went to the lab a couple of times before that, and also discovered high LH – that’s why I suspected I’ve got PCOS)… I had been taking peony&licorice for about two months, when I went to the endocrinologist… So, the results showed normal prolactin levels, also testosterone, DHEA, androstendione… SHBG was elevated (151) As I read, in case of PCOS SHBG levels should be lower than normal not opposite? My question is what does my high SHBG mean? Is it due to peony and licorice and is it then a good sign or…? I also have hypothiroidism and have been taking euthyrox for the last ten yrs…Thank you very much for your reply!

  57. Hi Dr. Briden,
    Thank you for such an informative website. I have found many useful articles here.
    One thing I can’t seem to find an answer to is with regards to an instance of androgen excess I had several years ago, the cause of which was given was PCOS – despite not having any symptoms.
    I was on Ortho Tricyclen for 2 years (2003-2005). I went off the BCP in May 2005. In July of that same year, I was admitted to hospital for internal bleeding in my abdomen. The cause was never discovered but during the laparoscopy the surgeon saw a cyst on my Fallopian tube and lesions on my cul de sac and bladder. He thought he also saw endometriosis however a gynecologist later looked at the images and determined there was no endometriosis.
    At a follow up appointment with the gynecologist in Oct 12, 2005 I had been without a menstrual cycle since coming off the BCP in May. The gynecologist prescribed the provera challenge. I had a successful withdrawl bleed. She advised me to have bloodwork run to try to determine the cause of my absent period. In January of 2006, I was finally able to have bloodwork run. It was a random test as my period was still absent. That bloodwork showed Total Testosterone elevated at 4.9 nmol/l (range <3.1), but a normal free testosterone level at 4.0 pmol/l (normal rangeL 0.8-12.1). Fasting insulin was normal, TSH was 2.59, LH was 7 and FSH was 2. The gynecologist diagnosed me with PCOS despite having no symptoms and normal ovaries. I was prescribed me Orto tricyclen until I was ready to conceive.
    Over the years I have never felt the PCOS diagnosis fit me. In fact, that blood work in January 2006 was the only time in the past 11 years that my total testosterone has come back elevated. I've had more thorough bloodwork done since then and nothing lines up with a PCOS diagnosis (no elevated androgens, normal insulin sensitivity, normal ovaries).

    Do you have any insight as to what could have caused temporary elevated levels of total testosterone but normal free testosterone?

    Thank you for your time and help!

      • Thank you for your reply.
        I’ve actually seen studies indicating that progesterone does no impact androgen levels. https://www.ncbi.nlm.nih.gov/pubmed/12057716 – “CONCLUSION(S):
        We conclude that the administration of OMP(oral micronized progesterone) (100 mg in the morning and 200 mg before bedtime for 7 days) to induce withdrawal bleeding in women with PCOS does not significantly alter circulating androgen or 17-OHP levels, and can be used to time blood sampling in these patients.”

        In addition, the blood work showing high Total Testosterone and normal free testosterone was not run after the withdrawal bleed. It was run 3 months later and taken at random.

        Do you know any other reason why Total Testosterone might be elevated while free testosterone is normal?

        • Provera (medroxyprogesterone) is different from micronised progesterone and has different effects. But in your case, no it couldn’t have been from the Provera 3 months later. It could be that your SHBG (sex hormone binding globulin) levels were elevated. Was that tested?

          • Thanks again for taking the time to reply! I really appreciate your insight.

            Unfortunately my SHBG was not tested. The only things tested were total tesosterone (4.9 nmol/l or 141ng/dl), free testosterone level at 4.0 pmol/l (normal rangeL 0.8-12.1). Fasting insulin was normal(5.9), TSH was 2.59, LH was 7 and FSH was 2.

            What can cause temporary elevations in SHBG?

          • Hi Dr Borden!
            I just wanted to update here. After 11 years of carrying around a PCOS diagnosis I saw an endocrinologist who specializes in PCOS and insulin regulation disorders. After going through my entire clinical history (bloodwork and ultrasounds) and my medical history since puberty until now she told me I don’t now have nor did I ever have PCOS. Her explanation for the elevated Total Testosterone and normal Free Testosterone was elevated SHBG cause by coming off the pill. Despite not having SHBG levels from that time (2006), she was able to calculate shbg based on my total T and free t. That calculation showed shbg would have been high at the time of the bloodwork.
            Thank goodness for knowledgeable practitioners like you sharing that there can be multiple causes of elevated androgens.

          • thanks so much for sharing your story. Yes, I have also seen patients whose main issue was elevated SHBG. I need to blog about that!

  58. Thank you so much for your reply. Im battling with excessive peachhair and bad pms for many years. So this really gives a good direction to find some answers!! What time is best (cyclewise) to test androgens in a cycle which varies from 24 to 26 days.. many thanks!!!!

    • Androgens can be tested on any day. But I find that peach fuzz is often not the result of androgens, but rather the result of stress or an eating disorder. Do either of those apply?

  59. Hi Lara,

    I was curious about your thoughts on a combination of elevated SHBG (119 nmol/L), and normal Free T (7 pmol/L) when I have not taken oral contraceptives for over 10 years (I am now 37). I have been trying to sort out symptoms of hair loss for several years. I do not have characteristics of AGA, more of a chronic TE but with added symptoms of oily skin, seborrheic dermatitis, and acne like breakouts on my face and chest. I do not have excess hair growth and have been ruled out for PCOS several times (normal weight, exercise, ultrasound normal).

    The SHBG came up in recent blood work and my GP said not to worry about it. It got me wondering however if I could be either low in testosterone, or if perhaps I have high estrogens not from BCP but from the environment perhaps? Is that possible? Wondering if there is a link between the SHBG and my hair loss these past few years. I have also read about low progesterone but my cycles are pretty regular, I ovulate etc., but I do have monthly cramping.

    My ferritin is low at 15 and Vit D dropped to 51 (I supplement, and had it at 80 last time i tested). Plasma zinc also in normal range at 12.4. I have attempted to halt hair loss by supplementing iron and vit d for several years but it has not really improved my hair. Highest I managed my ferritin was 45. My TSH tends to come in around 0.9 mIU/L.

    It is so difficult understanding the hormonal interactions in the female body and there isn’t much info out there regarding elevated SHBG in women unless they are on BCP or HRT. I’m not sure what I should be focusing on. I currently supplement magnesium, vitamin D, and was taking zinc until the results came back in the normal range. I am considering going gluten free and reducing dairy consumption to see if it helps. Perhaps the SHBG is a red herring.

    Anyway, your feedback is much appreciated!

    Thanks again.

    • Causes of high SHBG include:
      – post-Pill (but usually only for a few years)
      – vegetarian diet
      – androgen deficiency
      – overactive thyroid
      – under-eating/eating disorder.

      • Do you have a blog post of SHBG? Elevated levels of SHBH have been the only constant issue in my bloodwork throughout the years.

  60. Im so happy to stumble upon this article!

    Im 44 years old and suffer from heavy periods and bad pms. And I have some hairy issues..that is: the peach fuzzy hair on my upperlip is slowly turning into ..well..something less peach fuzzy. (although no corse hairs)

    I always had a regular cycle of 28 days, but the last two years my cycle shortened to 24 days (still regular). My PMS became way way worse and as a bonus the hair on my face began to grow.

    Im off birth controlpills for many years. Normal to thin posture. Living green for years. Stressful 5 years, although I meditate. Melasma on my face is also getting worse.

    Last year I had my female hormones checked in a bloodtest. My doctor told me my values are in the normal range. So with my 44 years I think im entering perimenopause. And a bit hesistant of using natural progestrone cream: I would like to try a more gentle way first and make more of it myself.

    Guessing I have excess estrogen and low progestrone I tried to balance my hormones naturally trough seedcycling. In the first part of the cycle I ate: 1 tbsp flaxseed and 1 tbsp pumpkin seed and took an omega 3 supplement. In the second part (from ovulation to menstruation) I ate 1 tbs sesameseed and 1 tbsp sunflowerseed and a evening primrose supplement. This routine really helped: it lengthen my cycle with two days and my PMS was really less severe. Yay! Only…the hair on my face started to grow!!!

    1) So first of all: How can this be? I thought the seeds were suppose to help with the progesterone and the primrose oil with the facial hair.. Is it because they are phytoestrogens??

    2) Is it still usefull to test androgen hormones (and progesteron levels) during perimenopause?

    3) Do you have any other suggestions keeping facialgrowth in check with perimenopausel women? Is Vitex an option if you don’t want to use natural progesterone cream..?? You also mentioned zinc and magnesium?

    Thank you so much!

    • I don’t use or recommend seed-cycling, so I can’t really comment on that.
      Yes, it’s still worth testing androgens during perimenopause, and also testing for the main cause of elevated androgens, which is insulin resistance.

    • I suggest you head over to the Vitex blog written by Lara.
      Seed cycling did f*ck all for me. Yam products are crap.

      Calcium D-glucurate
      Stop exercising except walking
      Stay away from any carb free diets.
      Stop caffeine and any pre-workouts
      Eat gentle carbs like rice and potatoes daily
      Get away from anything that has you worrying too often.
      Eat two carrots daily for fibre. You need to help your bowels expel the estrogen.

      • Jestagurl- I am trying to better understand your reply. What are yam products? Also, the list that you mentioned, why and where did those come from? I am trying to figure out my issues here and am desperate and take pre-workout drinks every day before my workouts. TIA!

  61. I’m a 27 y/o female and I’ve been slowly losing hair for approx 6 years now with the most concentration being the crown of my head. It resembles male pattern baldness in my opinion, however I do notice general thinning overall though it’s not as extreme as the crown. Additionally I have a couple chin hairs grow in the same spot mostly on the right side of my chin every 4-5 days or so I’d say. They’re thick and stiff hairs and generally grow from the same limited locations on my face every time. I am currently taking Spironolactone 100mg prescribed by my dermatologist . Also taking a DHT blocker due to my suspicion that it is male-hormonal related. I have not noticed much improvement as far as re-growth however believe perhaps the process has been slowed down from taking these pills. Additionally I use topical Rogain foam.

    I recently got blood work done:
    DHEA-Sulfate 258.8 (range 84.8-378)
    Testosterone, Serum 29 (range 8-48)
    Free Testosterone (Direct) 2.2 (range 0.0-4.2)
    TSH 1.600 (range 0.450-4.500)
    T4, Free (Direct) 1.13 (range 0.82-1.77)
    Androstenedione Lcms, Endo Sci 139ng/dL (there was no reference range given)
    Sex Hormone Binding Glob, Serum 75 (range 24.6-122)
    Iron (88 (range 27-159)
    iron saturation 23 (range 15-55)
    iron binding capacity 376 (range 250-450)

    My questions are:
    1. Is there anything from reviewing these results that’s indicative of a specific cause for hair loss?
    2. I plan to start birth control for the first time and am wondering if that would hurt or help with hair growth? My MD prescribed Blisovi Fe 1.5/30 however I don’t think that was specifically prescribed was with my hair loss issue in mind. I have yet to start the pill.
    3. Are there any further blood work or general tests that I should get done in attempt to pinpoint a cause?

    I should add that I am very healthy and eat a well-balanced diet. I am on the thin-healthy side with no known illnesses.

    Any advice you could offer would be much appreciated!!

    • If you have made the decision to go on hormonal birth control, I would consider a more “hair-friendly” pill with a low androgen index (lower androgen progestin) and potentially higher estrogen than the Lo-Estrin pill your doctor recommended. After my own experience, I would probably not go on contraceptives at all, but many doctors do prescribe a birth control like Desogen or Ortho Cyclen or even Yasmin for hair loss combined with spironolactone. This is worth discussing with your doctor.

  62. I have high DHEA and my testosterone is normal. I have taken vitex before but it started giving me hot flashes at night. Is this normal and does it go away in time or should I stop taking it? Vitex also gave me acne and I was wondering if that will go away in time also.

  63. Hi Lara,
    I’ve been struggling with cystic acne, folliculitis and hair loss for a long time. I went to several dermatologists and they say its hormonal, and also tried several Gynecologists and they say everything is fine with my tests results. First Gyn didn’t take my blood at the right time, should be 5-7 days after ovulation, then the second Gyn took at the right time, but based my results on the lab range numbers, and I know that isn’t always accurate. I am just so frustrated, I’ve been doing some research on my own and I know something is off, maybe I have high androgen, or testosterone is being transformed in DHT… The last doctor even said I should go back to taking pills. I’ve tried DIM, barberine, low carb, dairy free, almost sugar free(still eat fruits and juices), I take zinc chelate, Magnezium…. I don’t know what I could do…

    just taking a glance at my results do you think something is off? Androstenedione LCMS:18 ; DHA-Sulfate: 152.3 ; Estradiol: 194.3 ; Free Testosterone (Direct): 0.9 ; FSH: 2.9 ; LH: 5.9 ; Progesterone: 18.8 ; Prolactin: 9.4 ; Reverse T3, Serum: 19.5 ; T4, Free (Direct): 1.03 ; Testosterone, Serum: 15 ; Thyroxine (T4): 6.9
    Triiodothyronine (T3): 95 ; TSH: 1.900

    or maybe you can give me a more accurate range that I can base my results on?

    I ovulate regularly.

    any suggestion or guidance will be appreciated.
    thank you so much

  64. Hello Lara.
    Could DIM supplements cause freequent urinating? I’ve had acne for years, but after starting on solaray dim 100mg, zink and berberine, probiotics I’ve started urinating all the time. But I can’t stop cause my skin finally is perfect! All my bloodtests are fine, also my hormonal levels. I have regular period and I ovulate.

    • Potentially, DIM it could decrease estrogen enough to cause more frequent urination. It might also be the berberine. It’s ok to take a break from supplements. Your skin will likely hold.

      • When I took bloodtests at my doctor last month my estrogen was 0,57 and my progesterone 26. What does this mean? I took the blood tests on day 21 of my cycle when my progesterone is supposed to be high. I have a regular cycle and ovulate regularly

          • My period came a few days earlier. 2 to be exactly. I don’t understand? My estrogen that was testes came back 0,57.

          • Aah sorry Lara the units are nmol/l on my estrogen test. Are my estrogen levels high or low on this bloodtest? I read in your book that progesterone should be higher than 25 nmol/l. Mine is just 1 over. This means I’m low in progesterone? I’m supplementing with magnesium, but nothing else to boost my progesterone. Please answear. I would highly appreciate it:))

          • A progesterone of 26 is good, especially considering you were past mid-luteal (just a few days from your period).

  65. I found his article very interesting, as I was diagnosed with PCOS when I was 16 (I’m 34 now) and hadn’t started a period, I don’t remember ever getting an ultrasound done, so I don’t even know if they saw cystic ovaries. I’ve often wondered if I even have cystic ovaries. My only symptom of PCOS is no periods. I’m currently on a 6-month streak not pregnant, I’ve went as long as 15 months without a menses. Not that I’m complaining cause they absolutely suck when they come with no warning whatsoever. I am overweight but I’m a lazy person, that doesn’t eat well I don’t have a problem losing weight when I diet either. I used to be really skinny as a kid. The women in my family have all had Menses issues, but all had children with relatively no problems, I’ve neve been pregnant once. I’m curious if my issue is more cause androgen issues vs ovarian issues. I’ve been put on B.C. and never even had a pill bleed. What should I try talking to my doctor about regarding tests to investigate if it is a testosterone issue.

    • blood tests are a good place to start. Find out if you have insulin resistance, and please see Chapter 7 of my book, which is all about PCOS.

  66. Hi Lara, I sent you an email yesterday, thank you so much for reading this!
    I’ve been struggling with cystic acne, folliculitis and hair loss for a long time. I went to several dermatologists and they say its hormonal, and also tried several Gynecologists and they say everything is fine with my tests results. First Gyn didn’t take my blood at the right time, should be 5-7 days after ovulation, then the second Gyn took at the right time, but based my results on the lab range numbers, and I know that isn’t always accurate. I am just so frustrated, I’ve been doing some research on my own and I know something is off, maybe I have high androgen, or testosterone is being transformed in DHT… The last doctor even said I should go back to taking pills. I’ve tried DIM, barberine, low carb, dairy free, almost sugar free(still eat fruits and juices), I take zinc chelate, Magnezium…. I don’t know what I could do…

    just taking a glance at my results do you think something is off? Androstenedione LCMS:18 ; DHA-Sulfate: 152.3 ; Estradiol: 194.3 ; Free Testosterone (Direct): 0.9 ; FSH: 2.9 ; LH: 5.9 ; Progesterone: 18.8 ; Prolactin: 9.4 ; Reverse T3, Serum: 19.5 ; T4, Free (Direct): 1.03 ; Testosterone, Serum: 15 ; Thyroxine (T4): 6.9
    Triiodothyronine (T3): 95 ; TSH: 1.900

    or maybe you can give me a more accurate range that I can base my results on?

    I ovulate regularly.

    any suggestion or guidance will be appreciated.
    thank you so much

  67. Hi Dr. Lara,

    I have been suffering hair loss and sebum rebound since stopping the Pill a year ago. No improvements whatsoever, even with a combination of healthy diet, zinc/iron supplements, and lots of patience. I was on hormonal birth control before, but did not experience side effects while on it or after discontinuation. This time around has been a nightmare.

    Can stopping the pill cause someone to develop “androgenetic hypersensitivity” or did I probably always have that?

    I have a low-carb, low-sugar and low-dairy diet…..and my testosterone levels are all normal. (But my progesterone is abnormally low, so could that be making it seem like testosterone is high?)

      • Yes, I have had a period consistently every month since stopping the pill little over a year ago. And my low-carb, I don’t mean no carb….I eat whole wheat bread probably once a day, but have cut out things like pizza dough, rice, starchy potatoes, white breads.

        It seems clear that I have androgenetic sensitivity, but it also seems clear that this was brought on by starting and stopping the pill. I never had any any kind of oiliness or hair loss before this last brand of Pill I was on. Will I be forever cursed with this kind of sensitivity?

  68. Hi, I was diagnosed with PCOS at the age of 18 (currently 30). I have had all my exams normal except androstedione that was a bit high. I did the progesterone 17.oh exam and also came back normal…No insulin resistance, never been overweigth. Still, I have no periods (about 3 per year), and im loosing my hair…

  69. Hi Dr. Briden!
    Your article has me very very interested in your work. I currently see a fertility doctor that has diagnosed me with PCOS. I do not have all the classic symptoms of PCOS so my doctor told me I am “lean pcos.” All my lab work looks great according to him but I continue not to have cycles on my own. I am just at a loss. Clomid made me have an ectopic pregnancy with loss of a fallopian tube and letrozole at 7.5mg didn’t give a proper 21 day progesterone reading. I am new to this natural remedy thing and I need your help!!

  70. Thank God for this article! Finally something insightful. Thank you so much. I have hormonal acne and cysts all over my ovaries, but no hairloss or PMS. My cycle is regular. My doc did a blood test and all the hormones were normal. He says I do not have PCOS but didn’t know what to do about the acne, he said to just wait it out and exercise more which I do. Still no improvement, so after doing some research I figured I might by hypersensitive to testosterone (my DHT levels are at the higher end of the normal range). Is this plausible? Should I just follow the treatment plan you described or would you add anything? I do not wanna take hormones or plant hormones or anything that messes with my hormones because I do a have a regular cycle and everything seems to be fine except for my skin. Thanks so much!

  71. Hi Ms. Briden,
    I’m 17 and have had a Mirena IUD since early July. I haven’t had any weight gain, unusual acne, or depressive moods/mood swings that are out of the ordinary. But the hair loss is really becoming an issue. It is not localized to particular patches but it seems there is slightly more loss at the temples.
    Since I’ve read that it takes forever to get your natural hormones back in balance and that the hair loss gets worse after you remove the the IUD i’m not sure what the most reasonable course of action is? Is there any more research into the recovery time for teens in particular and is there a continued risk of hair loss if i switch to the Paraguard? Would there even be a point to get rid of this expensive little T if the hair loss is going to continue anyway for years after it is removed? And is there any possibility that my body will adjust to the androgens and the hair loss will stop? I really love my IUD but the hair loss is definitely not worth it.
    Thank you for your time. <3

    • Yes, some women notice hair loss from the little bit of levonorgestrel in Mirena. But fortunately, removing Mirena does NOT trigger hair loss like stopping other types of hormonal birth control (because no estrogen, so no estrogne-withdrawal). Changing to the copper IUD might be a good option for you, but of course please speak to your doctor. There is also the Daysy contraceptive device.

  72. I have problem with too much hair on arms and legs face etc.and some hairloss on the scalp. Irregular cycles as well. (Was tested for PCOS but they ruled it out.) However after reading this It might be a sympthom of high androgens even though the blood test showed they were normal. Trying to find a good treatment is my concern now . I have read about DIM. It is supposed to reduce extra estrogen levels but does it help to lower androgens as well? And how does effect the chances of getting a regular ovulation since you need estorgen to get it?

    • I was warned by a DIM manufacturer not to take it if you have high androgens because it can raise testosterone. I took it for a month and my acne only continued to worsen and it did nothing for my hirsutism. I don’t even have elevated testosterone but I have high DHEAS and that’s an androgen too.

    • So, you definitely do not have elevated androgens such as testosterone, or androstenedione or DHEAS? You’re not on hormonal birth control, are you?

      • No I am not on hormal birth birth control. It did not work for me. Became another person. Just need to know why I have a mustache a lot of hair on arms and legs and a thinning scalp – my biggest problem. What is the the underlying cause and where do I start to help myself..? Maybe I should try spearmint and beta-sitosterol. I hope it is safe and does effect homones. I am sad today over my situation, thank you for support Regina and Lara xxxx

    • Elisabeth, I wish you the best with this! It has been a struggle for me as well. My DHEAS goes up and down but it’s always elevated when I am going through stressful times. I have found spearmint and beta-sitosterol to be helpful with the hirsutism on my chin (particularly spearmint) and I also have recently added inositol to help my mood and keep sugar cravings down.

      From what I understand, DIM is supposed to be useful only in estrogen levels that are too high. However, I have also read that DIM is an androgen “blocker.” The whole thing confuses me because, as I said, I took DIM for a whole month and my acne continued to worsen but I guess that is because it raised my already elevated androgens?

      I am planning to add flax seed and black cohosh as well since spearmint and inositol have not been the absolute silver bullet (but have helped). I am thinking I may even need a bit of an estrogen boost and hoping the flax and black cohosh can help. I ovulate consistently so I obviously have enough estrogen and I have a normal luteal phase so I have enough progesterone too… but the PMS symptoms are awful. I get sleep disturbances, crying spells and other menopause-like symptoms when my estrogen drops so low right before my period.

  73. thank you so much for posting this article . the entire concept of hormones and PCOS and Birth control is so confusing and I was really happy to find this information in such a concise article.

    • Also…

      I have the Implanon in my arm. Until a week or 2 ago I was working abroad for 3 months in Germany. During that time I had abnormal bleeding to the point of being terrified enough to pay to see and OBGYN and take a translator with me ( i have had the implant for 6 years wo an issue so i was surprised and scared)… I was told I have PCOS about a year ago by an Endocrinologist in Houston. I told the German OBGYN about my PCOS and she advised me to get the implant out when I got home and said that form of BC is not good for my PCOS. Only now after reading this article did I discover what she meant. To top it all off – I went to planned parenthood a week ago and they told me all I need is more BC in a pill form to reset my cycle and said that the implant is fine for PCOS. Well obviously this is not true. I am so frustrated and will now get the implant out asap!

      • Implanon has the progestin etonogestrel which has androgen (testosterone) effects. But the Pill is not good treatment for PCOS. Have you read my book Period Repair Manual? that will give you some more answers.

  74. I read that DIM isn’t actually a 5-alpha reductase inhibitor (the way beta-sitosterol is) but actually competes with DHT at the receptor level. So it’s not exactly blocking the transformation of T to DHT the way 5-alpha reductase enzyme works but it directly competes with DHT by blocking the androgen receptor itself. So it appears to not only be an aromatase inhibitor for estrogens (which isn’t the same as a 5-alpha reductase inhibitor) but simultaneously is an androgen receptor blocker. Could this mechanism mainly be DIM’s primary mode of action for acne and hair loss?

    “Results of receptor binding assays indicated further that DIM is a strong competitive inhibitor of DHT binding to the AR (androgen receptor).
    (BTW thank you for this study link)

  75. I haven’t seen anything about the use of saw palmetto instead of spironolactone to improve sensitivity to androgen. I believe my daughter has the inflammatory type of PCOS. I s there a reason you don’t recommend it?

  76. Hello Dr. Briden! I love this post, I can’t tell you how many times I have read it and re-read it. I have been in touch with you in the past regarding my hirsutism and use of birth control pill (came off Feb 2016) and spironolactone (came off June 2016) to control it. 🙂 I have your book, and per recommendation to reduce hirsutism, I have added berberine to my daily supplementation, dosing at 500 mg per day. Last month I managed to ovulate, with 21 CD day progesterone levels at 7.7, estrogen at 81. This month, however seems different. I feel as though I haven’t had enough of an estrogen surge to ovulate and have been very emotional and depressed since my last period. Your book indicates that berberine reduces testosterone production in the ovaries…would this perhaps also reduce estrogen production as well? I don’t believe my hirsutism isn’t a result of insulin resistance, as my fasting insulin levels were very good. I’m beginning to suspect that I just don’t produce enough estrogen in general-my doctor was thinking of a soy based phytoestrogen supplement to help boost estrogen (product of DoTerra oils) What are your thoughts on this? My last flow was scanty, I have been retaining water and I am anxious and depressed. I have no interest in sex, or actually much of anything anymore. Any suggestions that you have would be welcome. Thank you so much for your dedication to us women who need hormonal assistance!! 🙂

    • I forgot to add a question to the post regarding the supplement DIM- if I am estrogen deficient, would DIM create further problems, or would it help reduce adrenal androgen excess? Please help…..

      • From what I understand DIM is not for women who have low estrogen or high androgen (I have happen to have both). It didn’t help my acne or hirsutism at all after a month of being on a high dose.

        • Thank you for your reply, Regina! I discontinued the use of berberine as well, and feel as though my estrogen levels are better. I just had an appointment with a new OBGYN doc who will be testing me for late onset congenital adrenal hyperplasia, which fits my physiological profile perfectly, right down to the low blood sugar (62) and extreme inability to handle stress. I’m hoping to have answers soon and begin a treatment plan. 🙂 Blessings!

          • Re: soy to boost estrogen. No, it doesn’t work. Soy is anti-estrogen and can cause or worsen estrogen deficiency.
            You need to ovulate, and then you’ll make lots of estrogen. And if you do have CAH, then yes, that will be the answer (and treatment will be the solution).

  77. Dear Dr Briden,
    First thank you for your work. When i first heard the word PCOS 10 years ago there was virtually no information whatsoever about it. I noticed everything go downhill for me when i went off birth control. I slowly gained weight that i have not been able to put off, my hair thinned out and i got hirutism. It took us over 5 year to conceive by IUI and it wasnt till we were going through fertility problems that the word pcos kept getting thrown around but nobody ever said for sure i had it or how to fix it. I went from one doctor that cared to do nothing about it to another one that just wants to medicate me with spironolactone and metformin. Ive since had a total hysterectomy as i had precancerous cells on my cervix (i still have my ovaries)
    if i could jump on a plane and come see you i would in a heart beat but it’s just not so simple so i am hoping you can recommend someone in western canada that i could see to get the proper test and narrow down exactly what type of pcos i have so i can be treated and become my old self again!!!

    thank you kindly,

    • There’s a brilliant PCOS doctor in Toronto (Fiona McCulloch). I know that’s not western Canada, but if you contact her, perhaps she can refer you to someone local.

  78. My Androgen levels are on “the high side of normal” by my endocrinologists account. I have a lot of facial hair(no pcos) and a little hair loss on my head. The Dr’s first thought was spironolactone, but o already have serious anxiety about taking medications like that. I am looking for the best way to lower the androgens and stop the facial hair. I’ve read about saw palmetto and am wondering if you have any info on that. Or any other more natural ways to reduce the androgen levels and stop these side effects. She said that she’d be on board with more natural ways if I could find them

    • I don’t know about saw palmetto, but I have been drinking Spearmint tea 2 cups per day and have noticed a dramatic decrease in facial hair. From what I have read spearmint lowers androgens

  79. Hello,
    Thanks for this thoughtful and informative post. I was just diagnosed with PCOS last week. I have high testosterone and high DHEA-S. DHEA-S has increased 70% in 6 months, and I’m not sure about testosterone’s increase. In this case, do I treat for both adrenal and ovarian androgen excess?
    P.S. I’m a little concerned about the DHEA-S jump in only 6 months. I’m not sure whether or not I should be, though!

  80. Hi i recently took a blood test and was told my estrogen was really low and that i have a high amount of testosterone is why i have hair in places a woman wouldnt. I was placed on Minastrin 24 fe and was told it would balance out everything. Ive been on these pills for a month and to be honest i feel great. I dnt get so irritated as usual and for the first time in my life in gaining weight and i look amazing. But like a few days ago i noticed my hair line is fallin out and im black and i have great hair and i dnt want to lose it. Its not super long but its thick and nice. So i stopped the pill immediately. Now i feel like the old me sad depressed hair everywhere and i lost all the weight. What should i do because ive been like this since i was 15 now im 27 and still look 15 but like a 15 year old boy.

  81. Dear Lara,
    I’m 34. I was diagnosed with PCOS 14 years ago and had been on the low dose birth control pills since. I was also prescribed Metformin, taking it on and off. I stopped the BCP and was still on Metformin until I was pregnant. I am now 5 months postpartum. I started taking the minipill (Microlut) at 3 month post partum. I have been loosing my hair a lot. I know it is common for hair loss after childbirth. But it is so much and my hair is normally thin already. I also have occasional acne. My sleep has been worse the last couple months also. My baby sleeps through the night already but I am not able to get more than 4 hours of sleep in a night. I also have hives (I think stress related) and feeling down at times. Would you recommend stopping the minipill? My doctor also advised me to get the Merena. What is your thought on that with all my symptoms? Should I get any other blood test done to confirm which PCOS I have? Thank you. Melissa

    • You’ll know from reading my blog and my book, that I almost never think the Pill is the right solution for PCOS or any other period problem.
      Chapter 7 of my book is all about PCOS.

  82. Hello, Dr. Lara Briden!

    I’m 19 and i have acne. I had my DHEA-S level tested twice by the recommandation of my dermatologist. The first time(March) it was 482.4 ug/dL (134.2-407.4 ug/dl) and the second time(July) it was almost 600 ug/dL. I have to mention the value of testosterone is normal. She wants to give me birth control pills but i think it’s not the best option. Are there any alternative solutions which can help me to lower my DHEA-S level ?

    Thank you and greetings from Romania!

    • Elevated DHEA-S is exactly the “Adrenal Androgen Excess” that I discuss in this post. I list some treatments, and also link to Fiona McCulloch’s post: Treating adrenal androgen excess.

  83. I’m so confused! I’m a 58 year old female who has had a hysterectomy because of an overgrown fibroid tumor which was benign; they left me with one of my ovaries during the surgery. My GP doctor told me my blood test shows excess androgen levels, which I suppose explains my male pattern baldness and facial hair (hirsutism). He will not give me any estrogen because my sister had breast cancer. Is there some supplement I should be taking? zinc, magnesium? I’ve tried Rogaine and other hair grown treatments. I’m taking Biotin. What can I do, my thinning hair is scaring me!

  84. Thank you so much for sharing your knowledge with us. My situation is the hypersensitivity issue. My hormone levels are normal yet I’m losing my hair rapidly on the temples, crown, and my hairline has receded dramatically.

    I really hope your treatment plan for reducing inflammation is the answer to restoring my hair! I have been on Spironolactone for a year and it’s not helping.

  85. Hi Lara,

    I just had a baby 3 months ago. Ive always had acne and oily skin but it got worse in pregnancy (i also have hashimotos and hypothyroidism). I had a saliva hormone test done. Low progesterone (32 pg/mL) and estrogen (.5 pg/mL) and high testosterone (58 pg/mL). I had insulin, glucose, LH and FSH blood tested and all normal. Dheas are also normal (5.6 ng/mL). My doctor said im not ovulating. I took this test 2 months after my baby was born. I always had normal periods before even after birth control (every 32 days). I have been having periods 2x a month (but also on spironolactone now). Do I have PCOS? Could i have gotten it after pregnancy or are my hormones just out of whack from pregnancy? And is pcos a permanent condition? My skin keeps getting worse and I dont want to go back on the pill 🙁 HELP PLEASE 🙁

    • Firstly, a saliva test is not an accurate way to measure testosterone, so PCOS cannot be diagnosed with saliva test.
      Secondly, did you say the test was done 2 months after delivering a baby? It’s normal to not be ovulating at that time. And it’s normal to have low estrogen and progesterone then too.
      Why are you on spironolactone?

      • Hello thanks for your reply! Im on spironolactone to lower my testosterone and help my acne! It has gotten bad since pregnancy and my dr said it would be better than going back on the pill. And that is good to know about the estrogen and progesterone being low and not ovulating being normal 2 months post baby. I am now 4 months post baby. Im having periods every 2 weeks from the spironolactone though. My dr said im having anovulatory periods… i need help and cant find a good naturopath to helo me balance my hormones!

  86. I wanted to ask you if taking Vitex alone and possibly adding in a magnesium supplement is a good treatment to target both irregular periods (every 30-50 days) and also targeting a possible androgen excess. I have a concern about unwanted body hair (my score on the ferriman gallaway chart is about an 11) but all my blood lab work is normal (dhea sulfate 181, testosterone free, testosterone, tsh 3rd generation, prolactin, lh, and fsh). I really hope I can find a natural treatment to stop the hair from growing in areas that are mostly common for males to grow hair on without having to go on birth control or any prescription medications.

  87. Hi Lara, I have a history of PCOS but it was much better for the past 2 years. I had period every month. I took Plan B (levonorgestrel) mid February with so many bad side effects that shocked my digestive system also. Had no periods since, until a week ago I had spotting and now it is getting into more of a mensuration bleeding and I am happy! 2 months after the pill in May, I started to notice hair shedding mostly on the top crown of head and sides of head and I never had any hair loss before in my life even with pcos. I know you said it is high in androgen and can cause hair loss. But if I had it just once is this hair loss temporary, and how long do you think it would take to see it stop and regrow? (I have depression and seeing all this long hair falling is really worrying me) I am taking vitamin d and b12 and iron.

    • yes, the levonorgestrel (plan B) pill can cause hair loss. It would typically start about 2-3 months after, which is exactly what you found. It should start to recover as soon as you’ve had a couple of real periods, but you probably won’t see the improvement for another 2-3 months. So I might predict that you’ll stop shedding and see substantial new growth by September or October.

      • Thank you so much for replying Lara, this gives me great hope. My period finally happened and got heavier. I never use any birth control pills, and will never use Plan B again. I hope I can have period every month like I used to, in order to see improvement in hair shedding, hopefully in 2-3 months. I will write back to you about my progress. I am insuline-resistant and your amazing article made me quit sugar.
        Thank you

  88. This has been such a useful article to help me understand what no one else has been able to explain to me. Thank you so much for sharing your knowledge on this topic Lara.

  89. Hello
    I am in desperate need of some Berberine and have been comparing products to the PCOS Diva product…however I cant find one I can get my hands on it Australia…That’s as pure and same dose etc…
    Can You please recommend a product I can access in Australia

    Thanking you in advance


  90. Lara, this information is spot on! I think I have androgen excess. Almost 30 with cystic hormonal acne, excess facial hair, some hair loss/thinning on head, overweight, heavy, sometimes painful, but regular periods, inflammatory diet, highly anxious person, family history of diabetes… How do I go about having this confirmed? Do I go to a naturopath or doctor? My doctor has only ever prescribed the pill for my acne, which I’m not on at the moment, and I feel like I’d have to be quite persuasive for anything else. What would I say/ask for? And how is cortisol and the thyroid related to androgen excess?

    Thanks for the great article.


  91. Dr., after being on zovia 1/35 continuously for 4 years or so, I started
    having bad acne. i was put on spiro. after being on both for about a yr, i noticed hairloss. that was almost 3 yrs ago. i went off both in early 2015. hair never got better. ive been on levo since oct 15 & cytomel feb this yr. tsh has been 1.5-2 ranges since oct. now, my ob put me on desogen bcp becuz of low estrogen & periods coming 16-23 days apart. hoping this truly is a no or lowest androgen pill.
    but only 12 days on bcp, now my tsh is a 10. & my dr’s seem baffled. any thoughts or comments on any of this would be greatly appreciated. im so frustrated & confused. im scared to increase levo from
    12.5 to 50/day for fear of losing more hair 🙁
    Jennifer C.

  92. Dr Briden, I love your book and website – super helpful in untangling and understanding my recent and upsetting hormonal issues. One question I had was about phytoestrogens other than soy. Do you advocate that anyone with PCOS / adrenal androgen excess (likely exacerbated by extreme stress in my case) avoid other phytoestrogenic foods such as flax, wine, other legumes, especially when going off contraceptives and trying to see if my own body will ovulate / produce its own estrogen and progesterone? I believe these may have suppressed my androgenic symptoms in the past to an extent but I’ve stopped consuming at least the flax and beans and am drinking wine in moderation. Thanks for any thoughts you can share.

    • Hi Alison, Moderate consumption of phytoestrogens should be beneficial because it buffers from harmful xenoestrogens like BPA. Moderate consumption is amount occurring in a varied diet that includes beans and vegetables and small amount of wine (too much wine is a problem for other reasons).

      I’ve only ever seen a problem (period-suppression) with high dose soy (soy milks, soy proteins etc).

      • Thank you so much for your reply! I know you don’t have time to respond to all the inquiries you get, but just in case I’d love any advice you can share. I am 35 and in the last 6 months developed hair loss, skin darkening, acne resurgence, hair growth and other issues after being on the Nuvaring with NO issues for 5+ years. I had irregular mid-cycle bleeding before the contraceptive, so may have already had an imbalance but think recent extreme stress may have tipped the androgen scale for me, and at the same time I cut down dramatically on wine, beer, soy, as mentioned which may have further exacerbated my situation from an estrogen perspective.

        In any case, my recent labs while on the Ring showed high SHBG as expected (184) and high in-range testosterone (between 35-48 total and from 1.8-4.4 free T, which seems to have declined since I started spearmint tea several months ago) with androstenedione at 90 and DHEA-S at 225. I was shocked to see that I have impaired glucose tolerance / insulin resistance just at the borderline given my healthy BMI and lifestyle. My serum cortisol has been high, but I recently had salivary testing done that showed depressed cortisol and DHEA and one doctor has suggested I may be in early stages of adrenal fatigue due to recent stressors in addition to the hyperandrenogism. The recommendation has been for me to go on a different lower androgen BC, Desogen, because if I do not my symptoms will almost guaranteed get worse given I already have androgen symptoms and higher hormone levels while on a BC. The hair loss in particular will almost certainly get worse as I understand it, at least for the 3-6+ months after I stop artificial hormones. In any case, I am actively managing my stress, eating a very healthy diet per your recommendations, and supplementing with a quality multivitamin, vitamin D, vitamin C, magnesium, zinc, probiotic, fish oil, spearmint tea / green tea and am considering adding red reishi and ashwagandha or rhiodola to the mix.

        My question for you is this: if the salivary testing is accurate and my adrenals are in early stages of fatigue, would you recommend NOT going off contraceptives until my system has had a chance to heal a bit, and has a better chance of making its own estrogen and progesterone? I really want to go off birth control vs. switching to Desogen, which may make my insulin resistance worse and cause other problems, but I want to give myself the best chance I can to see what my body is capable of producing at 35 and do whatever I can to mitigate the estrogen shock / make my periods start again as quickly as I can.

        Thanks so much in advance.

  93. Hi Lara, I have a little bit of an update (I posted a few days ago). I went to see a derm specialized in hair loss since I’ve been shedding for 9 months and he diagnosed me with TE (I suspect from attempt to stop bcp) and early AGA. He recommended I stay on BCP, start Rogaine and in a few months add Spironolactone (200 mg). After reading your blog, I’m a paralyzed about making a decision. Losing my hair has been devastating and for my sanity I feel like I should do everything I can to get it back. BUT, I’m also 37 and still hope to have kids one day (maybe I’m naive!) and going on these drugs would make things more complicated. I could try to just come off the pill again like you recommend but I’m worried that the high testosterone that the pill is currently “curbing” will make the genetic hair loss worse.

    Here are my latest labs:
    Total Testosterone: 50 (2-45 ng/dl)
    Free Testosterone: 1.0 (0.2-5.0 pg/ml)
    Testosterone bio available: 2.1 (0.5-8.5 ng/dl)
    SHBG: 242 (17-124 nmol/dl)
    Cortisol: 30.7 (4.6-20.6 mcg/dl)
    DHEAS: 209 (23-266 mcg/dl)
    Insulin: 6 (2-19.6)

    I feel like I’m at a crossroads and don’t know what to do. Is there a chance that going off the pill might help regulate my testosterone? Is there something else going on based on my readings?

    • Lili, just so you know, you are so not alone – I am in the exact same situation with very similar readings, trying to decide whether to switch pills from Nuvaring (high androgen) to Desogen, or go off completely. All doctors I’ve seen do recommend staying on BCP + Rogaine given my T is high in range on birth control, and once I stop SHBG will likely decrease and testosterone / other androgens only increase, and thus I will likely lose more hair and grow more hair elsewhere. Like you, I’m almost 36 and thinking about my future fertility, but also wanting to not make the situation worse with birth control causing other issues longer-term. I don’t have the solution but wanted to let you know I’m in the same boat and it’s agonizing.

      • Hi Alison, thank you for your comment! We are in very similar situations (with very similar readings!) and agonizing is definitely how I would describe it! I honestly don’t know what to do. I am actually on Desogen and have been for years. Last year, I had a lot of stress as well and like an idiot decided I would stop the pill at that time. The hair loss could have been from several different factors but I’m sure going off the pill was a big component. I went back on but it didn’t change anything for my hair. And now with the aga diagnosis, I’m a little doubtful that going off the pill again could help but who knows. I’m just not sure I’m ready to take that gamble and go thru another TE right now. But I’m also not ready to start using Rogaine either!

        I read your other comment. How do you know you are insulin resistant? What marker is that?

        For my cortisol, mine was high in the morning and I also did a saliva test that showed high in the morning but in range the rest of the day. My ND recommended phosphatidylserine for that.

        Also, if you are on any kind of T4 meds, I would stay away from Ashwaganda. It made me hyper and triggered more hair loss for me.

        If you decide to go off the pill, I would love to stay in touch to know if it worked for you.

        • Thanks for responding Lili! I was also diagnosed with TE that may have triggered early / mild AGA (mild at this point, but not if it continues).

          Quick note on the insulin point – I had normal / healthy fasting insulin (3) and glucose (71) but I did a two-hour glucose tolerance test where you drink a really sweet beverage and they check glucose and insulin and 1 and 2 hours post-drink. My 2 hour levels for both were high – 142 for glucose (just above the normal cut-off of 140, so pre-diabetic) and my insulin was at 148 when the normal is 55 or less! Though my fasting levels and HAC were ok, this showed me that whatever has been going on with my body is impacting my metabolism, and I know that extra insulin / insulin resistance can be one of the prime causes of your body producing more androgens. So, this may not apply to you, but I’m determined to get my insulin sensitivity back to normal-ish through diet and exercise if I can. I don’t need to lose weight and am not overweight, so I need to look at other changes to help make this happen.

          If you’d like to stay in touch I’d welcome that. You can email me at [email protected] if you’d like. Thanks for sharing your thoughts on the Ashwagandha – at this point I am hoping to try to heal my adrenals over time through magnesium, rest, diet, exercise and stress management and see how that goes.

          All my best, Alison

          • Hi Alison,
            Sorry I never emailed directly. I wanted to know how you were doing and if you were off the BCP. I’m still on it, have been using Rogaine for 6 months now – with mixed results- and am still considering spiro. My shedding has gone down but it is still higher than pre-hairloss and I have a little bit of regrowth. My next move is to get a hair mineral analysis and to see a kinesiologist to see if there is anything else that could be off. Unfortunately, I can’t find a good naturopath in my area (Boston)…

          • Lili, thanks for asking! I have recently switched from Nuvaring to Ortho Cyclen, which I plan to take continuously for 3 months followed by a 3-4 day break. I haven’t seen any improvement in the hair loss and in fact it’s worsened since starting the new BC. I want to give the new pills a full three months, and if it’s still continuing, explore adding spiro and/or starting Rogaine. Like you I’d love to be off all contraceptives but I’m not willing to take that risk at the moment with my hair issues. I am speaking with a fantastic naturopath who does phone consultations – if you’re interested, happy to share more info via email. Hope you are doing well and always interested in any updates!

  94. My dermatologist discovered my high dhea-s four years ago, it was around 400. By the time I followed up with an endocrinologist it had jumped to 560. I was put on spironolactone 50 mg twice a day and after 6 months I was shocked it had gone up to 850! I stopped taking this immediately against the advice of my doc. When the level was rechecked a few months later it dropped to 650. My doc actually prescribed this to me again in a higher dose but I refused to take it until I understand what’s going on. Why would my level go up while taking spironolactone?

  95. I have slightly elevated total testosterone (just enough to be out of range) but normal DHEA-S and androstenedione. What does this mean? I didn’t see this case in your article.

    I’m on a low androgen pill but ultimately want to come off.

      • Hi Lara, I’m sure you’re incredibly busy but I’d love to understand what my readings mean.

        Are my androgens going to be too high if I stop the pill? My hair is already falling out from trying to come off last year. I’m worried about what would happen if I try again 🙁

  96. Hi there Dr. Lara,

    First, I just want to say Thank you so incredibly much for sharing your knowledge with us! I have purchased your period repair manual and found it so helpful in the early stages of my PCOS diagnosis. Reading blog after blog of yours has been incredibly empowering as I wade through the torrential waters of PCOS.

    Initially, I was told by my endocrinologist that my PCOS was due to ovarian androgen excess. I was frustrated because in reviewing my labs and doing research, I found that only my DHEA-Sulfate levels were elevated. Your blog helped me discover that it’s my adrenals, not ovaries, and it was also your book that informed me of the different types of PCOS.

    In trying to uncover how to best treat my body, I’m wondering how I can figure out whether I have Inflammatory PCOS or a thyroid disease that has lead to my PCOS. Thyroid disease runs in my family. I also know the DHEA-S are only made by my adrenals. So it seems that my thyroid and adrenals are playing a part in my PCOS as well.

    Do you think that Inflammatory PCOS could correlate with thyroid and adrenal dysfunction or a HPA axis dysfunction?

    Some of my symptoms include: androgenetic alopecia, random break out of welts, ezcema, chronic constipation, carpal tunnel syndrome, Luteal Phase Defect (my basal temperature never remains elevated), hirsutism, heavy menstrual cycles, and severe cramps.

    My blood labs also show low platelets, Vitamin D deficiency, low T3. Interestingly, my blood glucose (non-fasting) came back high, though I’m not sure how reliable that is. II’d appreciate any of your thoughts as to blood labs I could run and questions I can ask my natropathic doctor.
    Thank you again!

    • Hi Lynette,
      Yes, Type 3 inflammatory type of PCOS is essentially a kind of adrenal androgen PCOS. And yes, it can correlate with autoimmune thyroid problems. In the post, I give the example of elevated thyroid antibodies being a feature of inflammatory PCOS. So that is definitely a test to ask your naturopathic doctor for, if she hasn’t done it already. You might also want to test for zinc deficiency and for gluten. Finally, the welts and heavy periods could be a sign of histamine intolerance. Please see my histamine post.

  97. This was so helpful to read, thank you. At age 40 my skin exploded and my periods got heavier with spotting so I was bleeding half the month. I went on the pill (low androgen Alesse) and it helped my skin and my periods but 3 years later my sex drive is almost gone so I’ve stopped taking the pill (exactly 30 days ago). My dermatologist suggested I try drinking a cup of spearmint tea morning and night to see if that keeps the androgens in check for my skin. So far my skin is good but still waiting on my sex drive. Have you heard of spearmint tea working as an anti-androgen?

  98. Thanks you so much for this. I’m going to get the blood test done for that 17 hydroxyprogesterone. I take DIM, will this interfere with the results?

  99. Dear Dr. Lara,

    I have been deling with pregnancy acne my entire pregnancy. I have her next month and am tired of doing antibiotics since they contributed to my autoimmune thyroid disease. I was going to do spironolactone… but id like the natural route. Which supplements can you recommend to get rid of the acne caused by pregnancy? Thorne Berberine i just bought! I have very oily acne prone skin that has only gotten worse since starting thyroid medication and getting pregnant.

  100. Dear Dr Lara,

    When you need to address adrenal androgen excess/sensitivity (and thus concern about acne) coming off anti-androgenic birth control pills, when would you recommend starting taking DIM? A month before coming off the pill, when you stop the pill, or at another stage? This is, of course, in addition to a dairy-free, sugar-free diet and zinc and magnesium supplementation. Also, would berberine be a helpful supplement in addressing acne due to adrenal androgen excess/sensitivity or is it really DIM that is appropriate?

    Many thanks,

    • I would not normally give DIM while still on an anti-androgen Pill. But dairy-free, sugar-free, zinc etc can be started asap.

        • For what it’s worth, both Berberine and DIM worked wonders for me. I took DIM for about a year and for whatever reason it stopped working, then I took Berberine and after about six months it lost its kick for me, that was doing 2 months on, one month off with zinc. I don’t think it will help to take these at the same time, I’d suggest trying one and use it as long as it works 🙂

          • Hello… what brand of dim did you use and which berberine?? Did you use them at the same time?? And what are you doing now to keep your skin clear since they stopped working?

          • Hi Elizabeth,

            That’s super helpful – thank you!

            If it’s not too much trouble (or too private), can I ask what your underlying issue was (if any) and if you have found anything else helpful? My issue (I think!) is acne due to adrenal androgen excess/sensitivity (the tests show it’s not my ovaries producing too much testosterone, but it’s clearly hormonal as the anti-androgenic pill I’m on works wonders for my acne – sigh!).

            Amber – I haven’t used either DIM or berberine, but the other supplements I use are from Thorne, which I think is a very good brand and, indeed, one which Dr Briden recommends. Thorne has both DIM and berberine.

          • I too think i have adrenal androgen excess…. karen did you say you were on spironolactone?? And that cleared your skin?? Have you goneoff of it and acne has come back? Thanks!

          • Karen i think i have adrenal androgen excess as well.. i am going to be tested after i have my baby…. did you say you were on spiro and it cleared your skin? Are you off of it now and acne came back worse than before?? Thanks!!

  101. Hi, Lara. I had a 24 hour urine test with DHEAS very elevated at 4958 μg. Testosterone says normal at 23.1 μg. Androsterone is high at 5868 μg. My “Enzyme Phenotype Assessment” says Androsterone/Etiocholanolone Ratio: 2.64. HGH 803 pg. Estradiol 3.7 μg. I was on day 11 of my cycle during collection. Do you think my Estradiol is low and do you think I fit Adrenal PCOS?

    By Blood on cycle day 8 my FSH was 4.4 and my LH was 5.1…is this good or bad?

    Thank you

  102. Dr. Lara, how do you decipher how to treat your stress? How does one decide L-Theanine or Rhodolia. I have seen this asked and wonder myself. Do you have to try both or are there certain things that make you more inclined to a particular thing?

  103. Hi! I have been struggling with full-body hirsutism and especially facial hair in recent years, as well as acne on the face, chest and back. I have tried laser hair removal and electrolysis as well as topical acne medications. I am now taking Spironolactone and Minocyclone for hirstutism and acne. No results so far but lots of side effects: spotting, headaches, fatigue, just expererienced a crazy chest cramp today.
    Any ideas? Thanks!

  104. Dear Lara. I’m writing to you because I don’t know where else I can ask for help. I’m 35 years old. Years ago I’ve been diagnosed with PCOS (I had many cysts on my ovaries and an elevated testosterone – I wasn’t on the pill then). From approx 2006 until 2010 I was taking the contraceptive pill. The reason for that was to regulate my periods and also I’ve had problems with severe acne and started to show the sign of hirsutism – on my chin. When I stopped it I luckily fell pregnant with our daughter. When our daughter was born I was put back onto the pill. I’ve had severe acne and also my hirsutism has gotten worse (much worse). I’m on the pill now for about 5 years and I really want to stop taking it. For the last year or maybe even more I’ ve started to feel extremely anxious, depressed and had many anger outbursts. I think it’s the side effect of the pill. I’m anxious about it. I don’t know if I can just stop taking the pill. My hirsutism is bad (all chin area is very hairy) and I’m also worried about acne. I went to see my GP (I live in Scotland) and I’ve had some tests done while on the pill. My LH U/L is 0.5, FSH U/L is 0.5, Prolactin mU/L 195, Progesterone nmol/L 3.0, Oestradiol pmol/L 50, Testosterone MS nmol/L 0.8. I also had insulin checked – it’s been fine. An ultrasound scan of my ovaries has been carried out – this time my both ovaries appeared normal (maybe because I was taking the pill for so long?). I’ve asked my GP if I could have any other treatment for my condition apart from the pill and I’ve been said thad in UK contraceptive pills are the only treatment for my condition. They don’t care if my symptoms gets worse (hirsutism or acne) – the only way to treat it is the pill. Please tell me what else I can do to improve my health. I would love to have another baby but not until I get my health back . I don’t want to take the pill any more. It has actually ruined my health.


    • Your skin broke out during pregnancy?? But you cleared it up with the pill again once you delivered?? And your scared to come off the pill because your skin is clear and you dont want the acne to come back???

  105. Hi lara,

    Just wondering what effect do thyroid meds have on your other hormones and androgens? I started them and feel they have increased acne for me! And when i increased my dosage it seemed to get worse. Please help!!

  106. Hi Lara, instead of excess, could the following lower levels cause hair loss in an otherwise normal, 30yo female?
    Testosterone 7ng/dL, DHEA-S 108.7 ug/dL, Androstenedione 43 ng/dL

  107. I took Metformin and ALLLLL of my hair fell out. I do not recommend it for WOC. At least do thorough research before you take that mess.

  108. Hello,
    I need some insight. I have struggled with acne for years. I have very oily skin. It has been controlled with birth control and antibiotics on and off since i was 12 and now i am 22. I got the mirena in august of 2014 and by february 2015 had terrible acne that I hadnt dealt with in years! Then had an ovarian cyet rupture in july after 4 months off of the mirena and i had quit the pill as well. The acne was treated witha. Course of antibiotics and tazorac gel and cleared up about 2 months after the mirena. Then i was diagnosed with Hashimoto’s and subclinical hypothyroidism (tsh 4.3) in july. I was put on armour thyroid and got pregnant a month later. I notcied an increase in acne again once I started the armour thyroid. And even more in pregnancy it has gotten bad again. I wonder what can i do for the acne? I dont think i have pcos as i have always had normal periods and even did each month every 32 days after the mirena and birth control. And i think the ovarian cyst was also caused by the mirena since i read it can cuase them in women…. i know i have a thyroid issue but my acne was under control for years till the mirena and pregnancy. I am wondering if you think the thyroid meds can increase acne? As well as ways to treat it during and after pregnancy? (I plan on going back on the pill right afterward and i am on oral antibiotic course safe for pregnancy right now to help it as well because it got cystic and painful). Help!

  109. My daughter is extremely hairy all over her body and is very conscious of it, she is 14, is there anything she could take to reduce the hair growth. Thank you xx

    • Hi Elaine,

      I would take her and have her hormone including androgen levels checked. These can fluctuate daily in women so you might want to ask the practictioner how often these should be checked to get a good idea of what is in balance and out of balance and at what point of the cycle. I would find a naturopath to work with of a D.O. instead of an M.D. And it could very well be that to have more body hair might be a natural trait for her based on her genetic makeup and not her hormones. 🙂

    • Hi Lara,

      I was diagnosed with PCOS 4 years ago, after consultation with my Dr she advised me to take mercilon. I stopped using it a year ago and my symptoms have gotten worse from excessive facial hair, weight gain, hair loss and only two periods in the past year.

      I consulted a homeopath mainly for my irregular period, he has prescribed medication (carbacol, rosmor, ginsec), which I cannot seem to find these on google. According to him these pills and drops will help balance my hormones and i should eventually have regular periods. I’m concerned that he has done so without knowing the current status of my hormone levels.

      What would you advise me to do? Should I consult a Dr for tests. Should I take the medication n hope for the best?

      I’ve also read a lot about the use of maca to help with ovulation, would you recommend this?

      • I do think it’s important to know the state of your hormones. For example, how high are your androgens? And which androgens are elevated? Is your thyroid function okay? Are you insulin resistant? I discuss all of these tests in Chapter 7 of my book.

  110. Hi Dr. Briden,
    I’m a 30 yo female. Just got off of Loestrin in October 2015 and still have not seen my period since the last withdrawal period same month. I was on the pill for 14 years. I got off the pill because my husband and I are trying to conceive soon. I recently saw my doctor and he ruled out preovarian failure (had ultrasound to see) and pcos. My endometrium was thin even though I haven’t had my period for 3 months. He thinks it might be hypothalamic amenorrhea. However, I don’t have a lot of stress in my life. I eat well; my BMI is 20. I got some bloodwork back. Tsh, LH, Prolactin, FSH all normal. A1C was fine. The only thing that was not was my testosterone level which was 60 and my estradiol was 43. My doctor hasn’t gotten back to me yet on how we’re going to treat my loss of period. I have no other symptoms, maybe just some mild pimples. Do you think Vitex would be helpful for me? What do you think is going on with my body? Androgen excess is what I was leaning towards. I’ve been battling hair thinning for many years also. I never knew what kind of long term side effects oral contraceptives could have or else I would have never been on it. So glad I found your blog. It’s been so informative! Please help.
    Thank you so much!!

    • When you say TSH, LH and prolactin are all “normal”, are they in the optimal range? For example, TSH should be less than 2.5, LH should in a 1:1 ratio with FSH, and prolactin should be mid-range.

      It’s early days still (only 3 months off the Pill). Your periods might yet return on their own. Vitex might help (as long as your LH is not high). I discuss lack of periods in Chapter 7 of my book.

  111. Hi Lara, I loved you post. I was researching about hormonal acne and about androgen levels and your post is very informative. Thank you. I am suffering from acne and hair loss and I think the cause is my mirena that I had for a year. I put it in on 8week postpartum. I had no period yet after a baby. I stopped breastfeeding last week. so I don’t know if I had no periods due to breastfeeding or mirena.
    I am struggling to figure out my next step. Should I take mirena out first and then go to the doctor to adress my imbalance or should I get the blood work done already? I am also taking DIM and progesterone cream after learning mirena’s affect on hormones. Please help, I’d really appreciate your respond.

    • Yes, it is possible that the acne and hair loss are from Mirena. But it’s complicated because childbirth also causes hair loss. And of course, both breastfeeding and Mirena stop periods. (Mirena stops bleeding, but it doesn’t stop the underlying hormonal fluctuation, so it is possible to still test hormones while on Mirena.)

      If you were my patient, I might ask you to have blood work right away, even while you still have Mirena. That way, you can identify whether there is thyroid, or prolactin or other problem that might be contributing to the hair loss.

  112. Hi, Lara.

    I am 33 years old, with normal weight (5’0″ – 117lbs). I was diagnosed with PCOS in my early twenties, and the doctor started me on the birth control. I took it for many years, and the periods were regular on the months I took it diligently. Meanwhile, my symptoms were getting worse – chiefly Hirsutism. At the end of 2013, I stopped taking my pill because I could not afford it anymore. The result was that, in the years 2014 and 2015 I only menstruated 5 times. My physical symptoms were off the charts. In October last year, I independently started to research about my condition and came to your blog. I cannot explain how relieved I was to know that I was not the only one suffering from this.
    We women feel so ashamed about this condition, keep our mouths so tightly shut, that we don’t we even discuss conditions like PCOS, Uterine Fibroids etc. among ourselves. I think it is sad, because we can learn so much about our bodies from the collected wisdom of womenkind.
    Anyway, on January 1st. I started taking Magnesium, and Myo-inositol. I am exercising and watching my weight too. I have reduced sugar intake and am drinking Spearmint tea 1-2 cups everyday. I have also reduced my meat intake (to avoid any extra hormones from meat). Other than that I am eating regular Indian food, that I cook myself. it is too early for results but I will continue this regiment and wait.
    I do have one request, if you don’t mind. I have been researching on Inositol, and there are two kinds – Myo-Inositol and D-Chiro-Inositol. I was wondering if you could discuss what are the differences, benefits or harms of these. Which one is better for PCOS?
    Thank you. I appreciate your guidance and support for us girls.


  113. Hi Lara

    Do you have any experience with (or opinion on) the supplement T-Clear (Metagenics brand) to lower testosterone?

    I’m currently taking it, as prescribed by my functional doctor.

    Thanks : )

      • Hi Regina

        Here you go:

        Each tablet contains:
        Extracts equivalent to:
        Glycyrrhiza glabra, root dry (Liquorice) 1.5g
        Paeonia lactiflora, root dry (White peony) 1.5g
        Inositol 1.0g
        Chromic chloride 256µg
        Equivalent Chromium 50µg
        Folic acid 100µg

        Directions for use:
        Adults: Acute: Take 2 tablets twice daily.
        Maintenance: Take 2 tablets once daily to maintain general wellbeing, or as directed by your healthcare professional.

        I’m currently taking the acute dose.

        I’m interested to hear your thoughts!


    • Hi Anna, Yes, it is one of the main peony & licorice products that I use. I prescribe it all the time. I find I can often get better results with just one or two per day — rather than the 4 per day acute dose.

      • Hi Dr Briden, do you think this would be effective as I also have hormonal acne; however, low testosterone with elevated DHEA-S. I read that licorice can actually increase cortisol and DHEA-S so that something I am completely confused about. Maybe I should stay away from that? I know licorice is an androgen blocker but can it lower DHEA-S paradoxically somehow?

        • Hi Regina, Yes, licorice raises cortisol but lowers DHEA. Dr Fiona McCulloch explains is quite well earlier in this comment thread. She basically says: By supporting cortisol, licorice allows the brain stop “pushing” the adrenal cortex along. It will therefore stop pushing the adrenal androgen pathway.

  114. Dear Dr Briden,

    I try to be a detective and feel very alone here in Europe 🙁
    I have some questions again, and would be very happy to hear your advice:

    I have a DHEA-S of 247,5µg/dl and a 17-OH-Prog. of 1,1 µg/l (on a random day with no periods 14 days later).
    It seems to be in a normal range if I´m right.

    Is it enough to exclude “adrenal PCO”?
    Which more information would give us the measure of DHEA and DHT?

    I have high androstendion, high testosteron and high SHBG (pill). If the SHBG reduces after beeing on the pill, would it be aggravate the symptoms of PCO (more free testosterone)?

    What is the signification of a Vit. B12 deficit (I can´t remember I read it in your book)?

    All I want for Christmas is…….my period 😉

    Many thanks and best regards


  115. Hi Lara! I’m back and I wanted to send you a note of thanks. Since I found this website, it made me realize that the cause of my hair loss HAD to be hormonal (even though I was never on birth control pill) but none of the Drs I went to agreed. This led me to find a naturopathic dr in Boston who agrees with me! She believes that my progesterone is too low and my cortisol is sky high, thus hair loss, insomnia, etc. I have more faith in her than the 5 MDs I have visited prior. They want to pump you full of synthetic hormones as a band aid to the problem rather than finding the cause. I haven’t been this optimistic in months and finally see a light at the end of what has been a horribly dark tunnel. I know the road to recovery will be long, but at least I believe I am on that road. Thank you, thank you, THANK YOU!

  116. Hi Lara, I have read your articles with interest, and wanted some advice on the pill I have been on for 5 months, I am 37 am 100% certain that I am losing my hair. Its thinning on top , especially where my part is, and around one of my temples, I have very thick hair so this is quite noticable ( to me anyway)! I am quite concerned that it could be my contraceptive pill. I am on Triregol, which is 21 pills. Before this I was taking Rigevidon. Would my current pill come under the high androgen index? It may be worth noting I do have spotting between my ‘period’. Any comments would be greatly appreciated.

  117. Hi Laura!
    I am menopausal-and during perimenopause I lost a lot of hair. I just had my labs done- everything (iron, TSH etc) is fine-except my hormones are predictably low. My Gyn put me on natural bi-est-will this help my hair/
    I am so depressed over this.

    • Estrogen is good for hair, so it’s possible. Without knowing all the details on your case, I can’t say whether that is all you will need to do. Did your doctor also give you some natural progesterone?

  118. Hi Lara,

    I have a problem with my testosterone and SHBG-levels, which I hope you can help me with. I was on the combined pill (Mercilon) for about seven years and stopped taking it in April. I haven’t had a period since my last withdrawal bleed and been having problems with acne, hair-loss, and mood swings. Because I have a history of depression, I became quite diligent about recording my moods and realised, from my notes, that I am more prone nowadays to episodes of anger and irritation than sadness (which, for me, is a departure from the norm).

    I went to the gynaecologist in August about my amenorrhea and she ordered a round of tests. My results look like this:

    LH 9 IU/l
    FSH 8 IU/l
    Prolactin 0.33 IU/l
    Progesterone 1.2 nmol/l
    Estradiol 179 pmol/l
    Testosterone 2.2 nmol/l
    SHBG 163 nmol/l
    Free testosterone 0.012 nmol/l
    DHEA-S04 4.3 umol/l
    TSH 3.6 mIU/l

    I am not overweight (my BMI is 18 and has always been around 18/19), don’t have much acne (I had breakouts for three months after stopping the pill but my skin has since calmed down a lot), and have no problems with hirsutism. An ultrasound showed that I do have “polycystic” ovaries, but as you mentioned in your PCOS post, I don’t believe that it absolutely means that I have PCOS. However, my testosterone levels are a lot higher than they should be and so are my SHBG levels. My gynaecologist couldn’t suggest anything other than a wait-and-see approach and a batch of Primolut N tablets to induce a bleed, which is not what I want at all. In fact, I’m a little leery of taking any more synthetic hormones.

    Upon consultation with a naturopath, I have been on Vitex for just over four months, plus magnesium, and a vitamin/supplement mix for women. She also prescribed me Lady’s Mantle after our last consultation a month ago and a couple of homeopathic granules, which I took for a few days. On my own, I am taking a drop of iodine (650mcg per drop) every morning (which I told my naturopath about) and a couple of brazil nuts for my thyroid because reading your articles made me aware of the problems iodine insufficiency/excess might cause. I exercise moderately – yoga three times a week, a light run every week or two). I eat well – fats, fibre, protein, carbs, greens and fresh fruit by the armload.

    This last month, I hoped/thought I was finally going to have my period after seven months because I had very, very minor spotting one day -just the tiniest of a drop, really- and then indigestion and lower back pain, both of which lasted for about a week. It’s been three weeks since the spotting and nothing has happened and I got quite down about it. My partner and I would like to have a child soon but from the way things are going, I’m not sure we will be able to conceive naturally.

    Could you please give me your thoughts on how I should proceed? Should I finally take the Primolut and see what happens? I like my naturopath but I have the feeling that this case has her flummoxed. Given how much I have written here, I would be more than happy to pay to have a Skype consult (I live in Holland). I would appreciate any thoughts you might have on this.

    • hi Chris, first of all, your testosterone actually falls in the normal range for a woman: 0.5 – 2.4 nmol/L. Also, high SHBG basically equals low testosterone (because SHBG is the binding protein for testosterone). With PCOS, SHBG is usually too low. In your case, SHBG is high from having been on the Pill in the last 12 months. It should come down. None of it looks like PCOS, but if you’re worried, you could test for other androgens such as DHEA-S and androstenedione.

      Finally, a TSH of 3.6 strongly suggests under-active thyroid. Please speak to your Naturopath more about that. That’s probably the key to getting your periods. I cannot imagine why you would need Primulot.

      I may be able to help you further. Please send me a private message.

  119. Hi Dr. Lara,

    You’re articles on hair loss are great and it was great to see how responsive you are to the comments. I am 25 and have been experiencing hair loss for a little over a year. Thyroid and iron levels have been normal. No major life stressors. The dermatologist I had been seeing recommended going back on birth control to manage my hormones (when I am not on birth control I do not get a period). My gynecologist prescribed Loestrin (which my endochronologist said was a good choice). My dermatologist also prescribed me spironalactone and was giving me growth hormone injections in my scalp. The combination of everything seemed to slow down the hair loss, but not back to normal. I continued the spironalactone and Loestrin until a couple of months ago when I stopped taking the spironalactone because I thought it was making me tired. I am still constantly fatigued, so I think now that it may not have been from that medication.

    I found online that Loestrin contains androgens, which I would like to avoid. My gynecologist changed my prescription this week to Lutera, but I’ve read that it has Levonorgestrel, which seems to be bad in helping hair loss. I told her I found articles about Levonorgestrel and asked if she recommended a different medication. She said she can Desogen/Ortho-cept. Do you think this is the better option?

    Thank you!!!

    • Hi Kellie,
      When you say “going back on birth control”, do you mean you were on it before? In other words, is it possible that the Pill, or coming off the Pill the original cause of your hair loss?

      As you’ll see from my posts and my book, I think the Pill is never a good solution for hair loss. It’s also not a good solution for “having periods” because pill bleeds are actually not periods.
      The best solution for your hair is to figure out WHY you’re not having periods, and then fix that. And then once you’ve re-established your own ovulations and your periods, you will make the estrogen and progesterone that your hair so desperately needs.

      Pill bleeds are not periods.

  120. Thanks again for replying! I’m sure you are extremely busy and I am very appreciative for your time. TSH w/reflex to FT4 was 0.98. I mentioned the antibody test was negative and I believe my endo ran 1 additional test which I was told was fine, but don’t have the exact figure. They wouldn’t tell me over the phone but have mailed me the results. I did find out today from my GYN that my ANA test came back 1:40. That is just on the cusp, but certainly worth mentioning. Don’t know if this is due to androgenic alopecia diagnosis or something else. I have started taking zinc today to hopefully reduce some of the scalp inflammation.

    • hi Jessica, I’m interested in the “heavier period than you’d ever had” back April. Has your iron been tested? What is your “serum ferritin” reading?

        • That looks good. Jessica, I’m not sure what caused your original hair loss. Something definitely happened with your hormones back in March-April, but it’s not clear now what that was… I know that makes it difficult to treat going forward. As everything looks normal now, this episode of hair loss may just resolve on its own.

          • Thank you again Lara for taking the time to respond. I’m going to try and clean up my diet, get out of this depressed state and try to get back to exercising (which I used to do quite a bit before this). Started zinc & magnesium, so I hope this helps. Still can’t wait to read your book and see what else I can learn.

  121. Thank you for the reply! The only thing was a very strange cycle I had at the end of March. I was a week late, tender breasts (very unusual for me) lots of cramping and 1 day of spotting midway through cycle. I was convinced I was pregnant (have 2 beautiful boys, so I’ve been there). Took 2 home tests that were negative. Once my cycle began, it was much, much heavier than I’d ever experienced. I was convinced I had a miscarriage and went to my GYN for pregnancy test so I’d know for sure. Came back negative and was told I probably had an anovulation cycle? Never happened before. Was 1 week late on August, but not other symptoms than just late. Could it be related?

  122. It’s me again 🙂 I’d like to add the only new things I can think of that were introduced to my system were a cortisone injection in my knee (first week of June) and then I took Osteo-Biflex Triple strength for joint relief for my knee. This was in late June into early July. I discontinuitied because it gave me a psoriasis break out. I have been told by every doctor this would not contribute to my problem. Just thought I’d mention it.

  123. Hi Lara!
    I’m so happy I found your website! I ordered your book last night and look forward to reading it. I’m a 43 year old with no prior history of hair loss or use of any type of birth control pill. My hair began shedding in late July (only when I showered) and somewhat calmed down in late August. I lost a lot of density but was happy to stop cleaning it out of the shower! One day in early October, my hair looked like I stuck my finger in an electric socket. The ends were sticking out in different directions and it looked extra dry. A couple of days later it began shedding like crazy and has not stopped since. I can’t even touch it when it’s wet because the fallout is too much for me to handle. I have lost so much hair in only a few months and I am depressed, scared and confused. Of course I have been to several doctors and the blood work all came back “normal”. I had a scalp biopsy and sadly it showed androgenic alopecia. I was beyond devastated with the diagnosis as I had no prior hair loss, thinning whatsoever. I went back to my GYN cause I thought I may have early menopause symptoms (my FSH was normal) such as occassional night sweats, dryness, cycle becoming irregular. I still menstruate monthly, but sometimes it’s late, lighter, heavier or longer lasting. Also, I could always tell my fertile times of the month due to CM but that has somewhat decreased as well. My GYN told me I had low estridiol and prescribed me 0.5mg daily of estridiol. I DO NOT want to take these. They scare the heck out of me. So, I went to my endo today to discuss this and she informed me my estridiol was NOT low (205, 18th day of cycle) and that I should not take them as I don’t need more estrogen. However, she did prescribe Apri BCP. I am so confused! I don’t want to take any synthetic hormones or birth control. I just want my hair to stop falling out and I don’t now where to go from here. I had my thyroid tested and everything was within range and I tested negative for antibodies. Do you have any suggestions? I truly am at my wits end with this whole situation.

  124. Hi Dr. Lara. Thanks for the great post. I’m wondering if you have any insight for me. I’m 35 with a history of PCOS but have kept it under control for years with diet and lifestyle. My testosterone levels are low and I’m estrogen dominant. I had great hair until I took the Plan B pill and have been losing tons of hair since. It’s been a year. I also really think the dedicated thyroid I started taking contributed. Even iodine makes my hair loss worse. I’ve gone of thyroid and am using natural progesterone and good supplements and while the hair loss has slowed I’m still losing a lot. I wonder if I’m missing something here?

    • A levonorgestrel pill (morning after pill) is a common trigger for hair loss. Coming off the thyroid medication might have made things worse (I know you said you thought the desiccated thyroid was a contributing cause, but your hair follicles wouldn’t have liked the sudden drop in thyroid hormone.) What’s your current thyroid status? To recover, you need to line up all the parts of the hair puzzle: iron, zinc, thyroid. See if your doctor feels it’s suitable to test “iron studies” and serum zinc, if she hasn’t already.

  125. Dear Dr. Briden,

    I have now the diagnose PCOS after beeing on the pill during 13 years. I don´t have my periods since I´ve stopped the pille (3 months ago).
    I read your interesting book and wanted to have a blood test for my hormones to know which type of PCOS I have.
    My doctor said, that it is only possible to make it after having my periods (blood test possible then on day 3,4 or 5). She prescribes me Cyclo-Progynova (Estradiolvalerat 2mg/Levonorgestrel 0,15mg) and assures me that it helps to get an ovulation and then after the bleeding, she will do the tests.

    Here my questions, with the hope you can help me:
    1) do I really need to take this drug to have a blood test? How can I interprete the results on a random day?

    2) How does this drug work (for me it´s like the pill = no real ovulation)? What are the dangers?

    3) I don´t want to take levonorgestrel because of his androgen effects. I have hair loss and leight hirsutism: could it make it worse?

    4) It is possible to have both adrenal and ovarian pcos? How is it possible to know that?

    Many many thanks in advance and best regards from Germany


    • I would never ask a patient to take hormonal birth control before doing the tests. In my thinking, that would completely defeat the purpose. Hormonal birth control suppresses androgens, and you want to know if your androgens (male type hormones) are elevated or not. It’s fine to take a random blood test. Because you’re not having periods, you are essentially in your follicular phase continuously. If it turns out that you DO get a period within two weeks after the test, then you will have to interpret as if you were in your luteal phase.

      Yes, it’s possible to have both ovarian (testosterone and androstenedione) and adrenal androgens (DHEAS). Test all three and see which are elevated.

  126. I have high prolactin, facial hair growth and hair loss my doc prescribed bromocriptine and i had a severe reaction..and can’t take any form of birth control as they cause unwanted side effects…can i continue vitex? Can it be taken for a long period of time? What else could help?

    • If your prolactin is well above normal, you should speak to a doctor or naturopathic doctor before using vitex. I discuss prolactin in chapter 9 of my book.

  127. Hi
    I am in utter dispair. I am 44 years old and for 20 years have taken the combined pill logynon. Last year I stopped taking it . Since then I have terrible acne for the first time in my life , ovulation pain that lasts 5 days every month , facial hair growth , and have lost so much weight I look ill . My doctor won’t let me go back on logynon again due to my age . What can I do ?

    • Post-pill transition can be hard, especially during perimenopause. Do you know anything about the state of your hormones? What is your day 2 FSH for example? Are your cycles now regular? are you definitely ovulating? I discuss perimenopause in my book.

      • Thank you so much for replying Lara . I know nothing about my hormones except my doctor said they are ok . My periods have always been regular and have never caused me any problems either now or in the past . Only since I have come off the combined pill after so long , am I getting all these symptoms . There was no reason for me to stop taking it , just that I thought I didn’t need to any more to prevent pregnancy . In retrospect I should have thought it through as am still ovulating . I have just ordered your book today so will read and obviously learn a lot more . Do you think I’ve done damage to my body ? Would you recommend that I started taking Logynon again ? It’s been a year and it feels as if my body has aged 10 years .

        • These are the first real periods you’ve had in 20 years. As you’ll learn in my book, Pill bleeds are not periods so we can’t compare them. You’re suffering a combination of withdrawal from the synthetic estrogen and a surge in androgens. I discuss both things in the book. The best way to improve things is to start to ovulate regularly so you can make estrogen and progesterone. (Progesterone is a natural anti-androgen.)

  128. Hello,

    First of all, thank you for providing us with such amazing information. I would like to ask if you could suggest a good zinc supplement which is safe to use. Also, i was very keen on supplementing with “Garden of Life- Raw Zinc” but it has rice hull- phytase and some of the reviews said that phytic acid inhibits the absorption of zinc and iron in the gut- is it true?

  129. I should also add to the comment above that I had a CT Adrenal scan done about 6 months ago as well to check for tumours & that was normal too. Thanks,

  130. I have been getting laser treatment for facial hair for several years. I also had hair loss. I had a blood test to check my hormone levels & I have high DHEAS. All other hormones are within normal range. They tested for pcos. My US was normal. The Dr said to go on the pill Diane which would even out my hormone level. I have been on the pill for two years. My DHEAS is still high. I am still getting laser treatments although this has improved greatly. I was against going on the pill & had stopped taking it for years as I got thrush very frequently while I was on it. I want to stop taking the pill & even out my hormone levels naturally. I suffered from PMS before going on the pill. I had irritability, mood swings, food cravings & fluid retention. I felt a bit like three different people in one body! I don’t really know why my DHEAS is high. Dealing with Drs has been frustrating as they go for a bandaid option.
    I have started taking magnesium & I take a probiotic as well. I stopped smoking & drinking 2 months ago. I have also lost 20kg in the past 3 years. I have about 8kg to go to be within a healthy weight range. I am apple shaped, holding majority of my weight in my abdomen area. I have had a fasting glucose test which came back within the normal range. Just hoping you can suggest next steps, supplements I can take that will help stopping the pill. I am 33 years old. Thanks!

    • Adrenal androgen excess is caused by a combination of stress, chronic inflammation, and exposure to endocrine disrupting chemicals. Having stopped smoking and drinking will probably make a big difference, but you may need to wait a few months to see the benefit.

      • Thanks Lara,

        I thought stopping such bad habits would help eventually. I have been told I have generalised anxiety disorder & I was using smoking & drinking to relax. I have since found out they were not helping & I already feel calmer since quitting.

        On a side note, I have a friend who has gone through menpause & suffers from quite severe anxiety. She didn’t get anxious before. She has low estrogen & has been put on hormone replacement & anxiety medication. I know she doesn’t want to be on it. Is there anything natural you suggest for her?

        I also got your Period Repair Book which is great! My friend gets bad PMS & I am excited to show your book to her as I think your suggestions could really help!

        Thanks very much!

  131. Hi Laura, I’ve been dealing with chronic hair loss and mild acne along with a host of other health problems for about four years now. The entire downfall of my health occurred after I had four old mercury based fillings removed from my mouth. It took 12 doctors and two years to figure out that I was heavily toxic with mercury. I’ve been doing low dose chelation with dmsa and ala for almost 2 years now. Although I’m slowly recovering my mind and most of my functions, my hair is still thinning and falling, and I’m still dealing with acne, etc. I recently had some expensive tests done that revealed that my adrenals are functioning rather well, just a little above normal, but I have no lactobacillus in my gut, nor do I have any evidence of the enzyme that breaks down carbohydrates. I know that mercury seriously inhibits enzymatic activity and causes gut dysbiosis, but the problem is that when I take probiotics and digestive enzymes, I get the same side effects that I had from the mercury; burning body, depression, rashes, acne, brain fog, and a dramatic increase in hair shedding. I thought that probiotics and enzymes were good for you? Do you have any insight into this strange phenomenon? I don’t know how to fix my gut function without taking probiotics and enzymes – I do not digest my food! Thanks,

  132. Hi Lara,
    I’ll keep this as short as possible! I was diagnosed with PCOS at 17,I’m now 23, and was on an off birth control but could never find the ‘right’ one for me..I refused to take any more around a year ago and in the last 6-9 months all my PCOS symptoms have flared up. Hair growth, hair loss, oil skin etc, throughout the month spotting and frequent periods. Paid my gynecologist a visit who did an ultrasound and said my ovaries were enlarged and covered in cysts. As I am 5’6 and 118lbs he said I am the ‘hard’ kind of PCOS to treat and just gave me Dianette BCP which I obviously don’t want to take as I am looking to cure the mysterious underlying cause.

    I had previously had my vitamin levels and TSH (but not T3/T4) checked (all within range) but I would now like to get all my hormones/other PCOS indicators checked so I can better understand how to tackle my case. I feel I have to be my own advocate and state which tests need to be done, could you please give me a list of the things I should be testing? (e.g. I’m unsure if my insulin levels need to be checked given my healthy weight) Also, when periods are irregular, does it matter at what point in my cycle I get these tests done?

    Thank you!

    • Hi Sarah,
      I list all the blood tests for PCOS in Chapter 7 in my book. And yes, you still need to be tested for insulin resistance. Slim women can be insulin resistant.

      • Dear Dr. Lara,

        I have pcos for years. But I don’t know which Androgen is high in my case. I followed IR way of treatment, and get my period back for 2 times now(above45 days for each cycle), and working on the third now. However, after reading this post I start to think maybe I’m Adrenal Androgen Excess Pcos. Please help.

        this is the test I did 2013-3-26
        T 1.6 nmol/L (now 0.27nmol/l)
        LH 20.88 iu/l (now 6.83 miu/ml)
        FSH 8.38 iu/l (now 7.64mIU/ml)
        PRL 254.7 MIU/L (now 18.4ng/ml)
        E2 202.6 pmol/l ( now 63ng/ml)
        COR 317.6 NMOL/L
        AD 1.9 ng/ml
        DHEAS 210.4ug/dl
        SHBG 79.30 nmol/l
        Now, my T has down to 0.27, I still suffer hair loss, and hair grow on breast,and belly area. I think the androgen is still high.
        Please suggest me which one to look into. And is IR treatment still work me? Where does the androgen come from?

        I haven’t had any sign of O yet, and now is the 23nd of this cycle. I don’t where goes wrong?

        Please help. Thank you.

        Love your book.


        • That looks like a normal DHEAS (adrenal androgen), and your testosterone has come down with insulin resistance treatment. So very likely you were the classic IR type of PCOS. But it would have been nice to see a test for insulin resistance like fasting insulin.
          Even once your testosterone is better, it will take many months to see a change with your hair and body hair.

  133. Lara, on a urine test my growth hormone came back 803 pg. I was vegan & 22. I know a vegan diet can cause a lower growth hormone, but is it low enough to suspect something is wrong such as a tumor? I can’t get anyone to help me determine what I need to look for. I have high DHEAS as well. Thank you

  134. Hello Lara! I am 25 years old. I was diagnosed with PCOS last week. I have been losing my hair for over two years now, ever since I got off birth control. I have regular periods. I have been doing a lot of research, and Ovasitol keeps popping up as an effective way to combat PCOS. I desperately want to stop losing my hair!!! Do you recommend Ovasitol to your patients?

      • Is there a risk of DIM reducing estrogen too low in women who have already normal ranges and ovulate regularly? Would the average dose be 100 mg per day? Thank you

        • That’s a very good question about DIM reducing estrogen too low. I think that it is theoretically possible, so I am cautious prescribing DIM for low-estrogen women. Typical dose is 100-200 mg.

  135. Hi Lara,
    I have been reading your posts and find them very helpful. I just had a question regarding DHT. I went off Birth Control pills in 2012 (Tri-cyclen) and had been on them for 16 years. At that point, my hairloss began as well as an increase in acne on my face, chin especially and back. I had my hormones tested and everything came back normal (blood test), my testosterone was even a little on the low side. Last year I had my DHT levels tested and they were EXTREMELY high, double what they were supposed to be. Can you recommend treatment for high DHT levels? I had heard that Saw Palmetto is a possible treatment but would like your opinion.
    Thank You

    • Testosterone converts to DHT via an enzyme called 5 alpha-reductase. 5 alpha-reductase is up-regulated (made worse) insulin resistance. It’s down-regulated (made better) by progesterone, and many natural substances such as zinc, turmeric, green tea, and yes, also saw palmetto.

  136. Dear Dr. Lara,
    I have pcos for years. But I don’t know which Androgen is high in my case. I followed IR way of treatment, and get my period back for 2 times now, and working on the third now. However, after reading this post I start to think maybe I’m Adrenal Androgen Excess Pcos. Please help.
    this is the test I did 2013-3-26

    T 1.6 nmol/L (now 0.27nmol/l)
    LH 20.88 iu/l (now 6.83 miu/ml)
    FSH 8.38 iu/l (now 7.64mIU/ml)
    PRL 254.7 MIU/L (now 18.4ng/ml)
    E2 202.6 pmol/l ( now 63ng/ml)
    COR 317.6 NMOL/L

    AD 1.9 ng/ml
    DHEAS 210.4ug/dl
    SHBG 79.30 nmol/l

    Now, my T has down to 0.27, I still suffer hair loss, and hair grow on breast,and belly area. I think the androgen is still high.
    Please suggest me which one to look into. And is IR treatment still work me? Where does the androgen come from?

    Thank you.


  137. Dear Dr. Lara,
    I am 45 and have been dealing with losing high amounts of hair for about 2 years. At one point the anxiety got so bad I lost 17lbs (i got down to 97lbs – this was about 1.5 yr. ago). I am currently 5 4″ and weigh 109lbs (my normal in the past is probably more around 112-114lbs). My DHEA-S blood levels have been elevated for at least the last two years. My periods have been pretty light for 3-4 years, although still regular. My derm prescribed spironolactone (100mg right now, been taking for about 1.5 yrs) but things haven’t changed much, in fact I think the hairloss is more now than when it started and the DHEA-S is still up. I also am taking 5mg of Lexapro for anxiety. My questions are, could the elevated DHEA-S be a result of stress? What supplements would you recommend, and can I continue the spiro with the supplements? Also, I was up to 20 mg of lexapro during the height of all of my anxiety. Could the decrease in the Lexapro cause an increase in DHEA-s?

    I am exhausted,


    • Hi Robin, Yes, stress can cause elevated DHEA-S, but I doubt the decrease in Lexapro would have been a major factor. For anxiety, please consider magnesium (see my magnesium post). And for hair, you might want to also rule out thyroid and iron issues.

  138. Hi. I am so emotional from reading your post about pcos and estrogen. When i was 15 i lost my period. And i was told that it wasn’t a big deal, i just had high testosterone levels. I am 26 now and have period maybe 2 times a year. I been to doctors a lot but none take me seriously and they don’t know anything other than giving me birth control pills. I need your help. How much does your service cost? I need help desperately. I want to be pregnant and i cant. My bloodtest result comes back for the third time showing low levels of estradiol. I feel this site can help my life. But i could need some personal guideance. Do you do appointments over skype?

    • Hi again Dr. Lara.

      I would also like to say i got my period when i was 14 and started with birthcontrol pills, i went on them till i was 15 which was the age i lost my period.

      I then got a note from my doctor saying my testosterone levels were higher than normal. And maybe that could be the reason i had lost my period.

      I was without my period for years till i started birth control pills again due to heavy acne and also hoping my period would come each mont like normal. I started with Diane pills, which i know now are high in estrogen compared to other pills on marked?

      I tried to combat my acne issue and didn’t care too much about my period cause i had friends and doctors saying i should think of myself as lucky not having period given the stress with tampong and other:/

      I am 26 now and know better! I am starting to think serious about my health. I want to be pregnant and have hormonal balance.

      I got diagnosed with pcos at 25, finally, cause this was something that was on my mind for years. And my levels of estradiol are low.

      I also have cysts on my ovaries and for the past two year i been called for check up every 6 months cause they find cell changes in my cervix.

      I am suffering with depression, clogged skin, hair loss, and some extra hair over lip and arms.

      That was my story. But i wonder if you do appointments over skype? I feel i need some personal guideance and how much would such appointment cost?

      Thank you!!!!

      • Hi Veronica, You need further blood tests to know the details of your PCOS diagnosis. I discuss that in Chapter 7 of my book. Please send me a private message.

  139. Hello!

    I am wanting to switch over to treat my Pcos naturally. Im taking taking ovasitol and metformin, wanting to replace Metfomin with something natural. I’ve heard Berberine and NAC are both similar to metformin, but wanted to get your opinion on which is most like Met. Also, just wanted to say, you have inspired me so much, to try and live healthier. You have helped me immensely! I wish I lived closer to your practice. 🙂

    • Hi Joy, thanks for your feedback.
      The #1 supplement for insulin resistance (and therefore insulin-resistant PCOS) is magnesium. Please see my insulin resistance post and Chapter 7 in my book. Berberine also helps insulin resistance.

      If you’re not insulin resistant, then you need a different kind of treatment for PCOS. Please see my 4 Types of PCOS post.

  140. Hello Dr Briden,

    I have been taking rhodiola as an adaptogen to help lower cortisol. Is it possible that this could raise androgen levels? I have been having hairloss so want to be very careful with what I am taking.

    Thank you!


  141. Dear Dr Briden,

    thank you a lot for your helpful blog and answers. I´m very exciting to read your book (I order it last week)!
    I am suffering under hair loss and a light hirsutism after taking a levonorgestrel pill.
    I have problem to get back my period, have pains in my left ovary, as well as a bad blood circulation in the legs.
    I try to avoid dairy, wheat and sugar, takes magnesium, zinc, iron.

    My experience is very similar to Luiza.
    You mention that you were writing a paper about this topic…Is it already available?
    Do you think that the “damages” are reversible?

    Thanks again for helping us

    Best regards

  142. Hi Dr Lara. It seems like female hairloss is one ginormous metabolic nightmare. This post is great, but what do you do when you are that person who:

    Has Hashimotos disease.
    Elevated ANA’s.
    An underactive thyroid.
    PCOS (of SOME sort!— high DHEA sometimes, high testosterone at others)
    Blood sugar issues
    Sensitive to sugar
    Cortisol issues
    Adrenal issues
    Allergies to “certain foods” like gluten
    And has been diagnosed TWICE with the dreaded “female androgenetic alopecia” by scalp biopsies.

    Its seriously is enough to make any desperate twenty something year old crazy. Where do you even start with all these different metabolic issues? What do you treat? Especially when all you wanted in the first place is to GROW HAIR. Do you start with thyroid? Autoimmune? Hormonal? Blood sugar? Adrenals? Diet? Supplements?

    Also, if you can get pregnant, does that mean you aren’t the ovarian PCOS, but the adrenal one or the oddly sensitive to androgens option? Thanks

    • Hi Dr Lara, what do you do if you have more than one type of “PCOS”? If you are adrenal AND ovarian? How would you know for sure either way and how do you treat? Also, how long after giving birth do I need to wait to see where I’m at blood work wise? (Without all the weird pregnancy hormone level elevations). Thank you!

  143. Hi Dr. Briden,

    I have been following your blog for a while now and appreciate all of your great insight! I hope you can provide a bit of help. I decided to come off the pill in February of this year 1) as I had grown to not like the effects on me and did not want to be on synthetic hormones any longer after being on them for about 11 years and 2) my husband and I were getting ready to start trying for a baby. The first three months were fine – regular 32-33 day periods. At the three month mark, I began to experience the dreaded massive telogen effluvium hair shed from coming off of the pill and also developed acne that has continued to get worse and is cystic at times, especially around my mouth and jawline and also on my forehead. I had been experiencing diffuse hair loss over the past few years – undoubtedly due to the pill – and also partially due to low ferritin of 8 at one point that I have since gotten back up into the 100s. I have never had issues with acne before, aside from a few errant pimples as a teenager; I did have very irregular cycles as a teenager before going on the pill at 18. I am hypothyroid, which is controlled with 90 mg of Armour and I am a healthy weight.

    To help re-balance my hormones, I began taking maca supplements in June (Femenessence MacaHarmony – supposed to be specifically for women) and saw palmetto for what I suspected was androgen access due to the hair loss and acne. I have been taking a prenatal since I came off the pill and also added in zinc, vitamin D, biotin, and in the last few weeks, magnesium. I have been avoiding (but not completely cutting) dairy, gluten, and sugar.

    In July and August, my periods got significantly shorter and lighter (i.e. 1-2 very light flow days and then some spotting). Additionally, I had some fairly significant spotting midcycle as well as bleeding during intercourse at that time. This concerned me that my hormones were further getting out of balance and that perhaps I had PCOS or something like that. I requested a full hormone panel and metabolic panel from my doctor, which I had done on Day 22 of my cycle this month (September). My doctor called me yesterday and asked if there was a chance that I could be pregnant due to some of my levels. I tested yesterday evening and lo and behold – I got two positive pregnancy tests! While I am very excited about the (very early) pregnancy, I am concerned about a few areas from my blood work.

    Here are my results:

    Total Testosterone: 220 ng/dL (this is what really worries me as this is ridiculously high for any female – it would explain the acne and hair loss but is this potentially harmful for a baby?)
    Estradiol (Sensitive): 1153.6 pg/mL
    Estrogens, Total: 2607 pg/mL
    Progesterone: 41.7 ng/mL
    DHEA-Sulfate: 104.2 ug/dL
    Prolactin: 34.9 ng/mL (this is also flagged as high but could that be due to the pregnancy?)
    FSH and LH: <0.2 mIU/mL
    Insulin: 5.9 uIU/mL
    Hemoglobin A1c: 4.9
    **There were several other tests from the metabolic panel that came back normal, but my Protein, Total Serum was low at 5.8 g/dL. This is strange because I have been making an effort to eat more protein each day.**

    The good news is that I am not insulin resistant and that even if I do have PCOS, I was able to ovulate and get pregnant. I am just extremely worried about how high my testosterone is. Is there anything that I can do while pregnant to get my testosterone to a healthier range? My doctor doesn't seem too concerned. I will certainly continue to avoid dairy, gluten, and sugar, avoid having dramatic spikes or drops in my blood sugar, and will stay active (I'm a runner), but is there anything else I can try? I know I need to drop the maca and saw palmetto now that I am pregnant.

    Any guidance you can provide would be so, so appreciated! Keep up the good work educating women on their hormones and periods!


      • Thank you SO much for your response! I had not been able to find anything online about normal testosterone ranges during pregnancy so this really helped to put my mind at ease that my levels are not quite so bad after all. I will definitely keep eating starches – it’s hard to run and be active when my carbs have gotten too low and I’m sure eating adequate amounts of good starches is even more crucial during pregnancy.

        • Hello laura! Just wondering…. did you have clear skin on the pill and armour??? Or did you notice your acne started after taking armour? I worry my armour thyroid is causing acne! But i got pregnant 3 weeks after starting it so hard to tell!



          • Hi Amber,
            I don’t think my acne was/is related to the Armour. My skin was very clear while on the pill and Armour together. I suspect the acne has been from hormone imbalance after getting off the pill and then hormonal fluctuations during pregnancy. My skin has calmed down some now that I’m at the end of pregnancy but I still have some eruptions and now scarring 🙁 I’m nervous to see what happens postpartum, but I will remain on Armour as it helps my hypothyroidism way better than Synthroid ever did.

          • Hi laura, thanks for your reply. I too was pregnant and just delivered a few days ago! Had acne the entire pregnancy as well… im glad to know that you did have clear skin on armour before pregnancy that gives me hope that maybe it is all pregnancy for the acne and not the meds since i started meds and got pregnant within weeks of each other… email me [email protected] if you wanna talk about it cuz im working on clearing my skin after baby now!

  144. Hi Lara
    I am 22 year old girl that have the problem of acne on my face and lots of hair loss androgenic alopecia and excess hair in my stomach area is it the cause of excess androgen in my body ? and what is the beneficial drugs i should use to treat all the problems ???
    and is estrogen and progesterone cream really regrowth the hair ???

    • am sorry Lara that i forgot to tell you that my doctor gave me the capsules by the name of panplus for my hair loss i think this capsules increase my face acne can it be possible ?

    • As I explain in the post, the most common cause of androgen excess is a hormonal condition caused PCOS. The cause of PCOS is usually a problem with insulin or sugar. You can read more in Chapter 7 of my book Period Repair Manual.

  145. Hi Lara,

    I’m so glad i found your page! I am in the UK and concerned about hairloss related to birth control. I currently have the Nexplanon implant (have had it since March this year) and had been getting on fine. No moods/weight gain/headaches/bleeding. I though it was a miracle! Then my hair stared shedding in around June/July. I went to my GP to see if was my iron levels as i had previously had hair loss that was maybe linked to low ferritin levels (I was never anaemic). I was borderline low (Ferritin was 40) and argued for Ferrous Fumarate to help raise my levels back up to 90-100 (I’m yet to get re-tested, so not sure what they currently are, but i take 65mg tds). The last time (2years ago or so) i had iron supplements my hair loss stopped quite quickly. this time it has continued. I’m worried i’ll need a wig!

    Anyway, i researched a bit more, and checked the SMPC for the Nexplanon and noticed that hair loss affects between 1 in 100 and 1 in 1000 women on the implant. This isnt listed in the patient leaflet, by the way! so i asked my GP if i could have the implant removed as it lists hair loss as a side effect, and im currently experiencing hairloss, it seemed sensible to rule it out as a cause, and have it removed. After seeing my 3rd Dr, i finally got one to agree with me. he prescribed me Dianette, which i know has anti-androgen properties, to see if would help with my hair regrowth too. I was on Dianette when i was a teenager for bad acne, and tolerated it well. i also had Yasmin for a few years too, immediately before the implant. I had no hair issues or anything else with that. Other than headaches that may have been linked as i no longer get them since having the implant.

    So…. my question is this: is it worth me trying Dianette for a duration? How long before i would see results (hair loss stop/slow) I am keen to have a longer lasting contraceptive and think maybe a IUD with copper may be best as it doesnt have hormones. Would this be a good option?

    Meant to also say that I am autoimmune hypothyroid, taking 125mcg levothyroxine a day. Both TSH and fT4 were normal in May.

    Any advice would be most appreciated!

    Chrissie x

    • Hi Chrissie, Nexplanon definitely does cause hair loss as its progestin is etonogestrel, which is a very androgenic (male-like) progestin. I would estimate it to affect more than 1 in 100 women.
      As you can read in my book and my latest hair loss post (9 Things to Know about Female Hair Loss), I do not think hormonal birth control of any kind is the solution for hair loss. Hair prefers real estrogen and progesterone, that you can only get from a natural cycle.

  146. Hi Dr. Briden,

    Slightly related to androgens, I was wondering if you have any recommendations for lowering a woman’s libido. My sex drive is significantly higher than my husband’s, and it is causing problems. Not just in not having enough intercourse, but I am frustrated at feeling aroused all the time. I would like it to calm down.

  147. Hi Lara

    I am 31 and was on the Pill (Diane then Yaz) from the age of 16 to 29 with no breaks. During that entire time I had beautiful clear skin. As soon as I stopped Yaz, I have had consistent moderate-severe adult acne all over my face & neck. I suspect I may have androgen excess and was thinking of starting spiro, but what throws me is that my periods are like clockwork (every 28 days, 5 days of bleeding and no pain, spotting NOTHING!). It did take me 6 months to get regular periods though after Yaz. I am already completely off gluten and have dairy/sugar/alcohol only once a week and not large amounts.

    I am confused because I can see something must not be right with my hormones because of my acne, but on the other hand, why don’t I then also have issues with periods, hair loss etc like everyone else? Why are my periods perfect if I have a hormonal issue? One thing is that I have depression (and have had for the last 2 decades) so I am a very anxious/stressed person but I’m not sure how that fits into the equation because again, you’d think it would also affect my periods somewhat if it was throwing out my hormones.

    Is there anything you could think of that I am missing here? I have a prescription for Spiro but have been too scared to take it so far.

    Thank you so much

    • Hi Barbara, dairy and sugar once per week is probably too much for skin. You might want to try eliminating dairy completely until it clears (butter and goat cheese are usually okay).

  148. How do I determine what came first?
    The DHEAs or the IR, so I can affectively treat the cause? Would drinking green tea & taking L-theanine help either or both?

    • I believe androsterone is a metabolic breakdown product of a few different androgens, but mostly adrenal androgens. I’ve never seen it measured before. Are you sure it wasn’t dehydroepiandrosterone sulfate (DHEA-S)?

      • It just says Androsterone. It was a 24 hour urine profile through Meridian Valley.

        In my case, I have normal Testosterone, High DHEA & DHEAs, High Androsterone. I do have Insulin Resistance, but it is mild and I have had hirsutism since I was a young teen and I am now in my 20’s, so maybe the Insulin developed later as a result of the high androgens. Would that be possible?

        Do you think Myo Inositol or D Chiro Inositol is helpful for me? Also, do you think my results might be high enough to indicate an adrenal tumor or would this be an ecpected profile for adrenal pcos?
        By urine:
        DHEA 4958 μg
        Androsterone 5868 μg
        Testosterone 23.1 μg

        My DHEAS was by blood and I don’t have it with me. My Estrogen and Progesterone seem to not be rising, and the same with my LH & FSH.

        • Oh, it’s a urine test. That makes more sense. The DHEAS is coming from your adrenal glands, but I’m not sure how to interpret total androsterone because I don’t have a lot of experience interpreting urinary androgens.

          In answer to your question: Could adrenal androgen excess cause mild insulin resistance? The answer is Yes.

          Given your high DHEAS, it might be worth pursuing strategies to reduce adrenal androgens. I would encourage you to speak with your referring practitioner.

          • So, in conclusion, you don’t feel that Myo or DCI would benefit someone like me?

            Would that be more like treating the Insulin Resistance rather than the cause of the Insulin Resistance? Does it even help adrenal androgens?

          • Myo-inositol treats insulin resistance, and D-chiro-inositol reduces ovarian androgens (even for non-insulin resistant PCOS-sufferers). I am not yet aware of research using either type of inositol to reduce adrenal androgens, so the short answer is: I’m just not sure yet. Hopefully, we have some new research soon, and if any reader out there has an answer, please leave a comment!

  149. Hi Lara,

    I’m 38 and just went off Nuvaring last October. I had been on it for many years. I’ve been on one form of hormonal birth control or another since I was 18. My periods have remained normal ever since stopping BC. However, I have lost over half my hair. My thyroid, iron, B12, etc are all normal. My testosterone, total, LC/MS came back 65.5 ng/dL which they list as “High” but everything else was in the normal range. Well, my Vit D came back slightly low. My doctor thinks this is genetic hair loss. It just doesn’t make sense to me. No women in my family ever lost their hair in their 30s. My grandmother had a small bald spot on the back of her head but she didn’t get that until she was in her 60s. My hair loss is mostly on the sides. I also have acne on my back. Even prior to the pill I have never had acne. My scalp is also super itchy and I have dandruff. My derm diagnosed it as seborrheic dermatitis. I feel dry all over though. Even though I hardly ever go out in sun my nose is always peeling and my lips are bleeding from cracking. This is all started last year. I don’t feel like myself at all. So, genetic hair loss as a diagnosis just doesn’t feel right. They told me to use Rogaine 5% and said I could try spiro. Any suggestions would be greatly appreciated!

      • I don’t see any other androgens listed on my results. My other numbers were TSH 2.260 uIU/mL, Glucose, Serum 95 mg/dL, LH 5.6 mIU/mL, FSH 7.9 mIU/mL, Testosterone, Total, LC/MS 65.5 ng/dL, Prolactin 12.6 ng/mL, and Estradiol 71.5 pg/mL. I was on my period when the test was done.

        • I would think about having further investigations to determine if you’re insulin resistant or not, and also look at SHBG, free testosterone, androstenedione.

  150. Wonderful blog!

    Your insight would be must appreciated. I’ve been on Yaz for 10 years due to severe acne. Over time I’ve noticed that my hair has slowly thinned and over the past year my hair loss have moved to severe ( I’m 29). Blood tests came back normal, but I’ve been on 100mg of Spironolactone daily for 6 months now. I recently saw a hair loss specialist that recommended I get off of Yaz completely and only use the Spironolactone because they can work against one another? Do you have any insight here?

    I’ve been off Yaz for a week and my hair is falling out in buckets. Do you agree with my doctors recommendation to stop Yaz and use 100mg of spiro, or are there other treatments I should consider to fight acne and more importantly hair loss?

    Thanks – you’re amazing!

    • The progestin drospirenone in Yaz is just spironolactone by another name, so perhaps your specialist thought your were doubling up. If you see my spironolactone post, you’ll see that I’m not a fan of the drug because it can impair normal production of female hormones (which you need for hair!).

      With my patients, I work to promote ovulation and the production of progesterone which is the best hormone for hair.

  151. Hello!
    I am very excited that I found your site, it’s wonderful that there are people who share very important information like these for free. And I can’t wait to get your book!
    In my country articles on the internet are very superficial (I didn’t find something so clear and easy to understand) and the doctors don’t look for the roots of the problem, they just give a treatment they trust, “to see how it’s going”, without making any serious research.. I don’t say that all are like these… but I saw several doctors.

    So, now I’m trying to quit dairy, wheat and sugar but.. I have a question:
    When you say to give up sugar, you mean sugar or everything is sweet like honey, fruits, etc.? I know they have a similar effect on the insulin but what should I eat when I feel that need of something sweet?

  152. Hi Lara,
    I’m 25 years old, and reasonably healthy and have never had any problems with acne or uncomfortable periods. I have been on the Pill Levlen ED for nearly 10 years without a break. About 4 years ago I began to notice my hair thinning significantly. I have seen a dermatologist however they never tested my blood but instead diagnosed me with Androgenetic Alopecia and prescribed cyproterone acetate. The hair loss may have slowed down but over the last year it has gotten progressively worse. It maybe also have something to do with stressful work life, however I’m beginning to consider more and more that I should stop hormonal treatment altogether.

    However I’m nervous that I will loose the little hair I have left if I do this. What is your recommendation?

    • You’re not still on Levlen, are you? Its progestin levonorgestrel is known to cause hair loss.
      It is true that stopping or changing any hormonal medication can trigger temporarily worsened hair loss. However, my experience with many patients has taught me that in most cases the best plan is to get off hormonal birth control, and to reestablish normal hormones (estrogen and progesterone) which are both very good for hair. Please see 9 Things to Know About Female Hair Loss.

  153. Hi Lara, I was diagnosed with PCOS in spring. I am a thin cyster with a BMI of 18, I know its low. It is genetic and I never been able to put on much weight. My mom and sister of similar size have perfectly normal cycles, not me! Mine are irregular. I went off the BCP a year ago and have gotten 4 periods. Although they are getting closer together, the first one took 5 months to get post pill. Then 4 months. Then 2 months. Then I was curious and took natural progesterone cream (I read if you don’t bleed from it you might have estrogen deficiency and hypothalamic amenorrhea) and had another period at the end of the month. Then a little over the month from my last natural period I got another bleed. When I went to the doctor my DHEAS was elevated at 374, but my 17 hydroxyprogestorone results were normal so he didn’t do anything for it. Basically said you will have problems conceiving someday and walked out the door! Ugh. There was also follicles on my ovaries found on an ultrasound, mild acne, mild hirsutism, and have ovary pain sometimes! I am at a loss. I have researched with increased DHEAS you can have LOCAH, but my results came back normal. I feel like I am stuck in between. Do you have any recommendations for elevated DHEAS but not high enough to have LOCAH? My testosterone is on the higher side of normal at 55 as well.

    • I also have low estrogen and historically high DHEA-S. I am awaiting my androstenedione test. I wonder if DIM would be harmful if estrogen is low already?