Do you have signs, symptoms, or health issues related to PCOS? Are you wondering what is the main cause of PCOS is?  In this video, we look at what some of the driving forces are for elevated androgen levels, low sex hormone binding globulin, and genetic environmental things surrounding PCOS. 

Main Cause of PCOS

What are the driving factors or indicators behind your PCOS?  There are many key abnormal labs that are indicators of PCOS.  What's causing these lab values to go up or go down? What are the underlying changes that are seen in women with PCOS.  First off, PCOS is a syndrome polycystic ovarian syndrome.  This is characterized by androgenization (more male characteristics) like more facial hair, hair falling out on the top of your head, increased acne.  There can also be changes in ovulation, menstrual cycles and difficulty with fertility.  Most of the time there is also insulin resistance, weight gain, pre-diabetes etc.  There seems to be two main things going on with PCOS driving these abnormalities. 

There is a decrease in estrogen production and with this an increase in androgen production.  Because PCOS is a syndrome you may not see both of these variables in extremes in every person with PCOS.  For instance, you may have high total testosterone but normal free testosterone and vice versa.  You may not have super low estrogen it may just be on the low side of normal.  Keep that in mind when you are looking at lab values.   Another thing to remember is that lab values change at different times in your cycle. 

How and when to check hormones for imbalance.  

As you will see below, there are both environmental and genetic things driving this decreased estrogen production and higher androgens.  On the androgen side it is not just testosterone, it's androgens in general.  Many times the aromatase enzyme which is shown in the video decreases its activity in women with PCOS.  That decrease in the aromatase activity then cause testosterone flow in the direction towards more androgenic compounds.  The slow down on one side creates a vacuum or suction in the opposite direction.  Testosterone has two main fates.  (there are other pathways too that are not as common. ) It can turn into estradiol or Dihydrotestosterone (DHT).  DHT can also turn into androstanadione.  Both the DHT and and the androstanadione are androgenic.  DHT is somewhere around ten times as potent as testosterone.  Androstanadione is less potent than testosterone but still contributes to androgen load.  Having more of these androgens around increases the binding to androgen receptors.  Relatively speaking, there is only so much of these hormones to go around.  So if they're going in androgen direction there is less estrogen.

We should also note that androstenedione is different than this androstanadione.  They are different molecules with androstanidione being less androgenic than androstanadione.  So what is causing women with PCOS to make more androgens?  Genetic are playing a role but which enzymes are involved?  The slow down in aromatase activity is causing more androgens to be produced.  In addition to that there also seems to be an increased activity of this five alpha reductase enzyme.  This acts like a vacuum sucking all the precursor (testosterone) into more of these androgenic hormones (DHT and androstanadione). 

Another thing as we said that's common with PCOS is insulin resistance. Insulin resistance increase the aromatase activity but it also increases this five alpha reductase enzyme activity.  So you may have a net balancing out if you do have insulin resistance.  However the genetics may be driving things to go toward the androgens in those with PCOS.  The other thing with insulin resistance is the higher insulin levels causes the sex hormone binding globulin to go down.  In addition the low estrogen or relative low estradiol and other estrogens creates low sex hormone binding globulin.  This makes whatever testosterone, DHT, or androgens are around more bioavailable.  These hormones are then able to more easily bind to the androgen receptors.  This binding stimulate those androgen receptors on the skin in the ovaries and other parts of the body.   So what is the main cause of PCOS?

Well it is both genetic and environmental.  It is clear there is both increased production and bioavailability of androgens.  We cannot say conclusively i think there's environmental things that can be controlled to help improve the lab values with PCOS and the overall hormone balance.  There's also genetic things that we can use that information to also improve the lab values and overall hormone balance.   The main cause of PCOS appears to be more androgen production and more androgen bioavailability.   What's driving your unique situation with your androgen production and your PCOS may be slightly different.   You have to take all this into the context of what your lab values are.   Those lab values inform you what needs to occur in your body to help those things balance out.

That should give you a better understanding of what the main cause of PCOS is.  If you have questions about the content in this article, please ask it in the comment section below.

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