Watch Dr. Friedman's webinar on “How can Blue Zones and Maimonides’
principles be applied to lead a healthy life for patients with endocrine problems?

Watch Dr. Friedman: CBS Early Show | National Geographic Special on Obesity and Cushing's
Iron Deficiency and Fatigue | PCOS | Weight Loss Drugs | GH Stim Testing
APPOINTMENTS CAN BE MADE HERE

HealthFlex
×
  • Meet Dr. Friedman
  • Blog
    • Adrenals
      • Your Adrenal Hormones
      • Fludrocortisone Replacement and Adrenal Insufficiency
      • Stress and the Adrenal Glands
    • Anti-Thyroglobulin Antibodies and Hashimoto’s
    • Berberine versus metformin for prediabetes and mild diabetes
    • Cushings
      • Does Having a High Morning Cortisol Mean I Have Cushing’s Disease?
      • Cushings Testing | Am I High
      • Ketoconazole: Therapy for Cushing’s syndrome
      • 🌙 Night-Time Salivary Cortisol Testing for Diagnosing Cushing’s Disease
      • Patient Guide: 24-Hour Urine Cortisol Collection for Cushing’s Syndrome Diagnosis
    • Dr. Friedman’s Guide to New And Old Weight Loss Drugs
    • Glucocorticoids and Sleep:  Dr. Friedman’s NIH Research
    • Oxytocin for patients with pituitary dysfunction?
    • 7 Overlooked Endocrine Causes of Fatigue
    • Supplements to Lower TPO Antibodies
    • The Ins and Outs of Glucocorticoid Replacement
    • Thyroid
      • 7 Common Myths about Thyroid Disease
      • 7 Reasons To Take Desiccated Thyroid
      • Can I Take My Desiccated Thyroid or T3 Once a Day
      • Graves’ Disease vs Hyperthyroidism
      • Hashimoto’s Versus Hypothyroidism 
      • Hypothyroidism Overview, Diagnosis and Individualized Treatment
      • I Have Been Diagnosed with Thyroid Cancer, Do I need My Thyroid Removed?
      • Iron Deficiency Fatigue and Thyroid Disease
      • Optimizing Thyroid Hormone Replacement
      • Should I take T3 only for my hypothyroidism?
      • T4/T3 Combination
      • TPO ANTIBODY: THE MOST IMPORTANT TEST FOR MILD HYPOTHYROIDISM
      • Using rT3 to Assess Hypothyroidism
      • Vitamin D Deficiency and Thyroid Disease
    • Womens Health
      • Hair Loss in Women
      • Women’s Health
  • Endocrine Conditions
    • Dr. Friedman’s Weight Loss Guide
    • Hyperthyroidism Treatment
    • Cushing’s Syndrome
    • Hashimoto’s and Hypothyroidism
    • Menopause and Peri-menopause
    • PCOS
    • Weight Loss
    • Iron Deficiency and Fatigue
  • Telehealth
  • Hormone Testing
    • Cushings Testing
    • Hypopituitarism and Growth Hormone Deficiency
    • Growth Hormone
    • Symptoms of Hormone Problems
  • Appointments

High and Low Testosterone in Women

High and Low Testosterone in Women
December 25, 2013

Measurements of testosterone in women are quite important for Dr. Friedman’s patients as it enables him to help distinguish between 2 types of conditions, both of which lead to irregular or absent menses. High testosterone is associated with a condition called polycystic ovarian syndrome (PCOS). Women with PCOS have high total and bioavailable testosterone and irregular periods and often do not ovulate. They also have extra hair growth on their face and acne. This is quite a common condition that is often associated with being overweight and insulin resistance. In PCOS, cortisol secretion is mildly elevated.

Endocrinologists and gynecologists diagnose and treat PCOS differently. Gynecologists look for the cysts of the ovaries and often perform a pelvic ultrasound. Endocrinologists rely more on measurements of testosterone and a high total and bioavailable testosterone is a hallmark of PCOS. According to endocrinologists, PCOS is part of the metabolic syndrome which includes insulin resistance, abnormal lipid measurements, obesity, and high blood pressure. When Dr. Friedman measures the bioavailable testosterone, he gets the measurement of both the total as well as the active form of testosterone, which is the bioavailable form and the sex hormone-binding globulins (SHBG). The bioavailable testosterone is very important to measure in women because the assays for free testosterone are not that good in women, and the bioavailable testosterone, which represents testosterone that can act on tissues, is more easily measured. Additionally, the SHBG being low is a marker of insulin resistance and is probably asgood a measure of insulin resistance as any other test. Dr. Friedman can also measure insulin resistance by measuring a fasting insulin and glucose level, and this can be done in parallel with measuring SHBG.

Once the diagnosis of PCOS is ascertained by elevated bioavailable testosterone levels coupled with low SHBG, as well as symptoms of irregular periods and extra hair growth and acne, Dr. Friedman usually has a two-pronged treatment approach. He uses the drug often used for diabetes, metformin, to improve the insulin resistance. This can often lead to lowering the testosterone to improve irregular periods and extra hair growth and acne. Secondly, he uses antiandrogen drugs to block both the action of testosterone as well the levels of testosterone. These drugs include flutamide, which is a drug that is FDA-approved to treat men with prostate cancer but is quite effective at blocking the actions of testosterone in women. The main side effect of flutamide is an occasional increase in liver function tests, which is reversible, and it is also recommended that women do not get pregnant while taking flutamide. The second drug that could be used to lower testosterone is spironolactone, which blocks both the action of testosterone as well as blocks the action of a hormone called aldosterone. Blocking aldosterone could be beneficial, because spironolactone acts as a diuretic, in which it causes extra fluid retention to be relieved. However, in patients with a low blood pressure the blocking of aldosterone is unfavorable as this could drop the blood pressure. Therefore, Dr. Friedman ofte uses flutamide, which is a more specific drug and has less side effects.

Gynecologists often treat PCOS with birth control pills. Birth control pills are effective in that they decrease the LH and FSH which regulates the testosterone and does lower testosterone. They also increase the SHBG which then leads to a decrease in the bioavailable testosterone. The problem with using birth control pills is that they make it hard to follow the clinical course of PCOS as women get a period on the birth control pills, which is one of the main outcomes you are tracking if you are treating the underlying cause which is the insulin resistance and the elevated testosterone. Birth control pills do affect various liver functions including SHBG, cortisol-binding globulin, and thyroid-binding globulin. Additionally, some birth control pills also have androgenic properties, which means they act like testosterone. Finally, birth control pills lower estrogen as they are often low on estrogen and this may lead to menopausal-like symptoms in women. Therefore, overall, Dr. Friedman tends to use a combination of metformin and flutamide in most patients with PCOS.

Low testosterone is also a problem in women and can be the result of hypopituitarism. Furthermore, Dr. Friedman published a study showing that in Cushing’s syndrome most women have low testosterone, while in PCOS women have higher testosterone. His paper shows that a testosterone level of 30 is able to distinguish PCOS, which usually has a level of above 30, from Cushing’s syndrome, which usually has a testosterone level of less than 30. Since hypopituitarism, Cushing’s syndrome and PCOS all can lead to irregular periods, Dr. Friedman measures the testosterone and specifically, the bioavailable testosterone level, in all women that are having irregular periods. In PCOS, the LH/FSH ratio is often elevated while in Cushing’s syndrome or hypopituitarism, both LH and FSH are usually low.

Because the treatment for PCOS, Cushing’s syndrome and hypopituitarism are quite different, it is very important to make the diagnosis of each condition, which is often aided by measuring the bioavailable and total testosterone.

For more information about Dr. Friedman’s practice or to schedule an appointment, go to www.goodhormonehealth.com.

Add Comment Cancel


Follow Us On Youtube

Dr Friedman Subscribe Youtube Button
  • TikTok
  • Instagram
  • Facebook
  • Mail

Quick Links

  • LATEST POSTS
  • ADRENAL CRISIS LETTER
  • CONTACT
  • CURRICULUM VITAE
  • STAFF
  • HEALTH LINKS
  • TESTIMONIALS
  • WEBINARS
SCHEDULE APPOINTMENT

Patient & Visitor Guide

Plan your visit to our Clinic

More

Recent Articles

  • Patient Guide: 24-Hour Urine Cortisol Collection for Cushing’s Syndrome Diagnosis
  • 🌙 Night-Time Salivary Cortisol Testing for Diagnosing Cushing’s Disease
  • Dr. Friedman’s Weight Loss Guide
  • T4/T3 Combination
  • Supplements to Lower TPO Antibodies
Woman Looking at Newsletter - Sign up for GoodHormoneHealth Newsletter Graphic

Archives

Presentation Library

  • Had Your Surgery Now What?
  • Determining the Type of Cushings
  • Diagnosing Cushing’s Disease
  • When Cushing’s Persists
  • What is Pseudo-Cushing’s
  • Cushing’s Disease Is Not Necessarily a Progressive & Fatal Disease
  • Using Blood Sugar Levels To Determine When To Test Cortisol Level
  • Cushing’s Post-Op Information
  • Adrenal Crisis
  • What To Do When Cushing’s Symptoms Return
  • Familial Cushings: Could Be Genetic
  • Cushing’s Help Blog Talk Radio Pt 1
  • Cushing’s Help Blog Talk Radio Pt 2
  • Extreme Makeover: Weight Loss Edition
  • Dr. Friedman Cushing’s Disease Chat
  • Chagas’ Disease and A Suprasellar Mass
  • Cerebral Aneurysms Impinging On The Pituitary
  • Adults Need Growth Hormone Too!
  • Is Taking Growth Hormone Enough?
  • Things Your Doctor Never Told You About Pituitary Hormone Replacement
  • How Pituitary Hormones Affect Weight And Sleep
  • Everything You Wanted To Know About Pituitary Hormone Replacement
  • Adrenal Insuffucuency How To Diagnose, Treat and Manage
  • Live To Be 100

Refer Us

Had a good experience with Dr. Friedman?  Tell others about it by submitting a review on Google and Yelp.

To help us make the Good Hormone Health website a positive place for everyone, we've been using the Web Content Accessibility Guidelines (WCAG) 2.1. These guidelines explain how to make web content more accessible for people with disabilities, and user friendly for everyone.

How are we doing?

We've worked hard on the Good Hormone Health website and believe we've achieved our goal of Level A accessibility. We monitor the website regularly to maintain this, but if you do find any problems, please get in touch via email at mail@goodhormonehealth.com

Contact:

(310) 335-0327

mail@goodhormonehealth.com

  • Facebook
  • Instagram
  • TikTok

Quick Links

  • LATEST POSTS
  • ADRENAL CRISIS LETTER
  • CONTACT
  • CURRICULUM VITAE
  • STAFF
  • HEALTH LINKS
  • TESTIMONIALS
  • WEBINARS

Latest News

  • Patient Guide: 24-Hour Urine Cortisol Collection for Cushing’s Syndrome Diagnosis

    A 24-hour urine collection (also known as a urinary free...

  • 🌙 Night-Time Salivary Cortisol Testing for Diagnosing Cushing’s Disease

    Night-time salivary cortisol testing is an essential, non-invasive tool that...

  • Dr. Friedman’s Weight Loss Guide

    Dr. Friedman's main approach to weight loss is to rule...

Goodhormonehealth ©2024 all rights reserved.