EP.185/ Hormones and Endo: Testosterone 101
Okay, so today is my last instalment on my series about endo and our hormones and today we’re talking about testosterone.
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Now, you might think that testosterone doesn’t matter to people with ovaries and a uterus, but it really, really does. Whilst testosterone is much higher in people with testes, it actually plays a significant role in ovulation.
So, let’s take a closer look.
So, remember how we previously talked about the importance of oestrogen? Well, without enough testosterone, you won’t have enough oestrogen. Why? Because most of the testosterone that we make is converted into oestrogen, by an enzyme called aromatase.
Let’s do a quick cycle recap. During days 3-5 of your cycle, a hormone called follicle stimulating hormone, recruits a couple of follicles, which are like water balloons filled with an egg, to begin maturing, with the intention that one will eventually go on to ovulate. The follicles which were selected by FSH begin making testosterone, which is in large part then converted into oestrogen (so when we say oestrogen is made in the ovaries, this is what we mean). The rising oestrogen let’s the brain know that it’s time to lower FSH because the follicle chosen for ovulation is happily growing away. This then triggers the rise in luteinising hormone, which in turn stimulates more testosterone and androstenedione production, which again is converted largely into oestrogen, though testosterone peaks during this time too.
Testosterone then drops down again after ovulation and remains fairly low for the remainder of the cycle.
Now, whilst most of your testosterone ends up as oestrogen, the rest that does remain helps to boost libido, and from a biological standpoint, that’s so we increase our chances of conception around ovulation. Testosterone also has a positive effect on our mood, by increasing confidence, drive and motivation. In short, it gives the body and mind the determination to go after a mate.
On top of that, testosterone helps to build muscle mass, increases the happy hormone dopamine, supports the health of reproductive organs and the bladder and aids with brain function.
So what can go wrong with testosterone?
One of the more common issues we can see in our community is high levels of testosterone, often caused by a condition called Polycystic Ovary Syndrome, which is a condition that is very prevalent in people with endo. PCOS is normally defined by the presence of high testosterone levels, cysts on the ovaries and a lack of ovulation or delayed ovulation, among other symptoms. It’s important to note that PCOS varies from person to person and not everyone with PCOS will have cysts or high testosterone levels, for example, but more often that not, high testosterone levels will be present. There are a couple of different types of PCOS and causes of PCOS, and I’ve linked to articles for further reading in the show notes.
A key cause of high testosterone and PCOS is high insulin levels from dysregulated blood sugar. I bang on about this a lot, but for a quick recap, blood sugar is the measurement of glucose, released from carbohydrates, in the blood. Glucose is our body’s primary source of fuel, but too much of it can cause a lot of problems. Insulin is the hormone responsible for delivering glucose to our cells, and when we have high levels of glucose, the body pumps out more of it. The issue being that insulin has a direct effect on the ovaries, and high levels of it stimulate the ovaries to make too much testosterone. It also lowers sex hormone binding globulin, which is a protein that binds up testosterone in the blood until we need it, and so without sufficient levels of SHBG, we have a lot of testosterone floating around. This excess testosterone actually prevents ovulation, and the follicle that was going to ovulate, becomes a cyst – which is how we end up with cysts on our ovaries.
Insulin issues with PCOS may not always be caused by diet directly, but rather genetic issues, though balancing your blood sugar is important to help regulate insulin, even in the presence of genetic problems.
There is also a condition called Congenital Adrenal Hyperplasia. Whilst testosterone is made in the ovaries, it’s also made in your adrenal glands, and this condition causes the adrenals to make too much testosterone, creating delayed or lack of ovulation.
High testosterone levels can cause multiple symptoms, including:
· Irregular cycles
· Hair loss
· Dark hair growth on chest, abdomen, back, chin and face, nipples
· Weight gain
· Acne and oily skin
· Insomnia and sleep disturbance
· Blood sugar imbalances
· Ovulatory pain
· Cysts on the ovaries
· Body odour
· Mood swings
So now let’s look at our other common problem, low testosterone.
Low testosterone is most commonly caused by birth control and I see this a lot in my clients who are coming off birth control. Most forms of birth control stunt ovulation, and the lead up to ovulation is what aids in testosterone production, so when we halt the natural cycle, the production of testosterone is lowered. Additionally, the pill specifically raises levels of that SHBG, which as we discussed earlier, binds to testosterone. These levels can stay elevated post-pill for years, so even though testosterone production is occurring, the testosterone can’t be used because it’s bound up. We can test for this by checking our ‘free testosterone’ levels, which is the measure of unbound testosterone, and I’ll give you more guidance on how to do that shortly, but even seven years post-pill, my SHBG is still high and my free testosterone is low.
Now of course, birth control isn’t the only thing which would stunt ovulation or ovarian function. As we discussed earlier in this series, stress is a key culprit and high cortisol can lower the output of all sex hormones, including testosterone. And that stress can be in the form of lack of nutrients, inflammation, illness and mental or emotional stress.
Signs of low testosterone include:
· Increased pelvic pain
· Fatigue
· Low moods and low self-esteem
· Brain fog and slow cognitive function
· Low libido
· Painful sex
· Vaginal dryness
· Difficulty building muscle
Now, like the other hormones, you can test your testosterone levels with a simple blood test, but the dried urine sample test, DUTCH test, will be most accurate and in-depth, whereas the blood test will give you a snapshot (but it’s a good starter!).
For the blood test, you should take your test in the morning, between 7am and 10am, as that’s when testosterone is at its highest. You can take your test at any point in the cycle but if you’re testing your other hormones on day 3 (apart from progesterone, remember that test comes around day 21) then you can do them all together.
For the DUTCH test, you need to follow their timings and instructions accurately, and they may vary depending on what type of DUTCH test you do. My preferred DUTCH test is the Cycle Mapping one, because it literally tests what your hormones are doing on every day of the cycle.
Now the DUTCH test will check all of your hormones, but the blood test won’t, so what you need to ensure is that your test takes is free testosterone, which looks at the amount of testosterone which is not bound by SHBG, total testosterone, which is the total amount of free testosterone and bound testosterone and then if you can, SHBG too. I’ve linked to a couple of tests in the show notes that provide these.
Ideally, if you can, you want to test all of your androgens, which are the group of hormones that testosterone belongs too, and these can also have effects on your testosterone levels or mimic the symptoms of high or low testosterone.
If your test results come back with high testosterone levels, I would suggest doing further testing into PCOS – however, blood sugar imbalances can be responsible for elevated levels, so focus on addressing this root cause too.
If your free testosterone levels are low and your SHBG is elevated, it may be from a history of birth control, so I would suggest you work with a practitioner to help address this. If your total testosterone levels are low, it’s important to support healthy follicular and ovulatory phases as we need the ovaries to be functioning optimally for testosterone to be made. Because some of your testosterone is also made in your adrenal glands, which control your stress response, addressing stress and possible HPA axis dysfunction is important here too. We address all of these root causes in my Live and Thrive with Endo course and in my one and one work, but the course isn’t out until autumn this year. I’ve linked to a couple of my podcasts and extra resources to help you learn more and start tackling these issues.
Now because blood sugar imbalances stress the body, whether your testosterone levels are high, or low, or actually great, balancing your blood sugar is one of the best ways to keep testosterone levels healthy or get them back on track. I’ve linked to some of my resources and my masterclass on blood sugar in the show notes.
Show Notes
Testosterone references
https://www.ncbi.nlm.nih.gov/books/NBK279054/
https://pubmed.ncbi.nlm.nih.gov/4685386/
https://pubmed.ncbi.nlm.nih.gov/28847480/
https://pubmed.ncbi.nlm.nih.gov/9609208/
https://www.yourhormones.info/hormones/testosterone/
https://drbrighten.com/when-is-the-best-time-to-test-hormone-levels/
https://nicolejardim.com/my-1-post-for-2013-the-pill-your-sex-drive-how-to-start-reclaiming-your-va-va-voom/
https://www.ncbi.nlm.nih.gov/pubmed/8005293
https://drbrighten.com/high-testosterone-women/
https://nicolejardim.com/balance-hormones-naturally/
PCOS
https://www.floliving.com/a-womans-guide-to-pcos/
https://drbrighten.com/natural-solutions-treatment-of-pcos/
https://nicolejardim.com/the-pcos-protocol/
Blood Sugar
Masterclass: https://www.thisendolife.com/nutrition-for-endo-advanced-masterclass
HPA Axis Dysfunction
https://www.thisendolife.com/this-endolife-podcast-episodes/hpa-axis-dysfunction-healing-tips-endometriosis
https://endometriosisnews.com/2020/06/11/stress-management-hpa-axis-dysfunction/
https://endometriosisnews.com/2020/08/27/hpa-axis-dysregulation-recover-tips/
https://www.thisendolife.com/live-and-thrive-with-endo-the-course
Testing
https://dutchtest.com/info-cycle-mapping/
https://medichecks.com/products/female-hormone-check-blood-test
https://medichecks.com/products/female-hormone-check-advanced-blood-test
https://thriva.co/tests/TPKD3E
https://instagram.com/futurewomanhq?utm_medium=copy_link - sign up to be able to order tests
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