female alopecia
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  1. #1

    PCOS - Elevated Testosterone or free testosterone?

    I hope there's someone in this community who can help me with a question that's bothering me...

    I experienced hairloss after getting off the pill six months ago... It started about three months after stopping. Four months after stopping the pill I went to my OB/gyn to get my hormone levels checked.

    They showed I had really low estrogen (I'm only 25, btw), normal testosterone, but elevated free testosterone.

    I immediately jumped back on the pill due to being scared it wouldn't stop and now I can feel the shed tapering off.

    However, I was left really worried that I had PCOS that was unmasked by getting off the pill - although I had gotten off the pill many times before that and it had never happened before.

    My endocrinologist told me I didn't have PCOS (the ultrasound showed no cysts at all, and I don't have any other symptoms). She blamed my low estrogen on extreme weight loss (I lost a lot of weight right before stopping the pill due to a traumatic experience, so that now my BMI is too low). That would be logical bc I didn't get my period for three months after getting off the BCP. That had never happend before, my periods were always regular (and I'm not talking about years in between stopping the BCP... I stopped it when I was 24 for example - then started again - and nothing of that kind happend).

    She said low estrogen can cause low SHBG which can cause a rise in free testosterone. She also said to stay on the pill for now until I feel better and have regained weight (and hair ;-)), and that then later on even if I got off the pill I would be fine.

    However, I'm still very worried.

    So I wanted to ask you:

    If you have PCOS, are your levels of testosterone or FREE testosterone elevated? Or both?

    Is your estrogen and SHBG low?

    I've read that usually when you have PCOS your testosterone level is elevated; however most of the time it doesn't state if it's "normal" or free testosterone that's high...

    Thanks for any help or info! I'm very new to this...

  2. #2
    Experienced Member
    Join Date
    Aug 2011

    Re: PCOS - Elevated Testosterone or free testosterone?

    Hi Canterella,

    The information your doctors gave you is accurate as far as my understanding goes. You can lose hair due to sudden drops in estrogen. Your estrogen levels can stop from sudden dramatic weight loss or from going of a BCP. These things often self correct, though not always. The comment about the SHBG sounds reasonable too and that would explain the elevated free testosterone.

    I have more symptoms of PCOS than you do (hair loss, hirsutism, acne and irregular periods) and my endo still didn't classify me as having it. You can have hormonally related hair loss and not have PCOS. If you have no other symptoms besides 3 months of hair loss and elevated testosterone levels that can be traced to a reasonable explanation, I really wouldn't worry too much about PCOS.

  3. #3

    Re: PCOS - Elevated Testosterone or free testosterone?

    Thanks both of you for your answers.

    As of right now, I wouldn't believe I'm sensitive to normal hormone levels, as my hairloss started when my hormone levels where NOT normal ;-)

    Thanks, Bummer... I hope my doctors are right. I also went to a dermatologist who told me I had Telogen Effluvium due to a sudden drop in estrogen levels. He basically told me to forget about my free testosterone index (?) as it was not extremely elevated (1.6 while the normal range would be 0.1 to 1.0) (?). I guess you can have high free testosterone if your estrogen and SHBG are low even if your total testosterone is normal.

    I've read up on PCOS and it seems common to have a high level of testosterone or free testosterone (or both), and a low level of SHBG. However, afaik estrogen levels in PCOS patients are mostly normal... Can anybody give me some more information on this?

  4. #4
    Experienced Member
    Join Date
    Aug 2011

    Re: PCOS - Elevated Testosterone or free testosterone?

    Hi C,

    This is just a guess based on what I know of hormones and PCOS so don't take this as the "right" answer as I'm too lazy at the moment to check my facts to make sure I'm stating something that is 100% accurate.

    PCOS often comes with insulin resistance and obesity. I'm not sure of the exact reason, but this problem often leads to elevated testosterone levels and weight loss can help reduce testosterone levels... however it's difficult to lose the weight due to the previously mentioned insulin resistance.

    I'm not totally sure that women with PCOS always have normal levels of estrogen. Estrogen fluxuates pretty drastically throught a normal cycle as it is produced by the ovaries mainly during ovulation and then slowly declines until the next time you ovulate. Many doctors will test your estrogen levels on a specific day of your cycle to get a result that is more comparable against the levels of others. If you were to test someone with PCOS on the 3rd (just a random day for an example) day of their cycle, they would likely have "normal" estrogen levels. The problem is that they might not have another period for 2,3,4 months (or longer). During this time the estrogen levels would drop significantly. Estrogen is what triggers the liver to produce SHBG, and SHBG is what binds with free testosterone and "inactivates" it in your body.

    Hope that made sense.

  5. #5

    Re: PCOS - Elevated Testosterone or free testosterone?

    Thanks for answering.

    You're right, obviously estrogen fluctuates a lot during the cycle.

    However, my estrogen was measured on the 1st day of the cycle, where it should be low, and it was lower than low (out of the normal reference range).

    I guess what contributes to low SHBG in PCOS patients is insulin resistance then... so a PCOS patient can have a low SHBG even if estrogen is normal, and therefore a high level of free testosterone.

    PCOS is a very complicated condition...

  6. #6

    Lightbulb about PCOS


    I have PCOS, so I thought I could share something on this thread. PCOS doesn't always come with insulin resistance. For sex hormones, CD3 is chosen for drawing blood. The hormones keep fluctauting through the cycle and day 3 hormones are checked with normal range of hormone levels. Cysts are not a criteria to decide PCOS. Just like insulin resistence, cysters may or may not present with cysts.

    A blood test on CD3 determines PCOS. LH:FSh should normally be close to one. A ratio of 3:1 indicates PCOS. Elevated testosterone is also a sign of PCOS. But other conditions like LOCAH have to be ruled out as they have same symptom as PCOS.

    It is thought that most women with PCOS have high estrogen but a cyster may present low. normal or high estrogen.

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