The Two Flavors Of PCOS

Until relatively recently, I was of the understanding that Polycystic ovary syndrome (PCOS) was simply one condition, with many different degrees of severity. Some women had very irregular cycles, while others were fairly normal. Some had terrible facial hair, some cystic acne, some thinning hair, some were obese while some couldn’t put on a pound. Variety abounded!

While all of that remains true, it turns out that there really are two quite different conditions, with many similarities, yet with foundational differences. The two distinct types of PCOS are the type with high levels of testosterone, and the other type, characterized by high levels of DHEA-S. This is not “new” news. We’ve known for a long time that different androgens can be elevated in different women with PCOS. But all were still lumped together under the single umbrella of PCOS.

Here are my observations. Please understand that these are generalizations. Women with high testosterone PCOS are easier to treat regarding their acne and weight issues compared with the elevated DHEA-S group. The women I see with very high DHEA-S tend to have recalcitrant cystic acne, often very severe. And their excessive fat tissue is very difficult to burn. Though I am opposed to the use of oral contraceptives in general, I’ve had women with high DHEA-S go on oral contraceptives and in general they do poorly. Their skin doesn’t improve and they gain more weight. Similarly with Spironolactone, it simply doesn’t help.

I’ve treated the high DHEA-S women group in the same ways I treated the high testosterone group, and I now think that may not be the best approach. They are indeed different.

I believe that the women with the high DHEA-S need to work on reducing stress and improving sleep more than the high testosterone group. Getting to bed by 10:30 PM, getting some sun most days, and controlling stress should be very beneficial and high priorities.

The DHEA-S comes from the adrenal glands, not the ovaries, and it’s the adrenal glands which respond so dramatically to stress. It’s so essential for those women to keep stress levels low. Exercise would be even more important for the women with high DHEA-S, in part to lower stress and also to increase metabolism. Getting on a diet with low amounts of animal meats and high amounts of varied vegetables, should be a mainstay of treatment as well. I’ve also found a high percentage of women with elevated DHEA-S levels to be poor detoxifiers. Emphasizing cruciferous vegetables and taking a great B vitamin complex, with methylated B’s, should be tried. And be sure the levels of Vitamin D are around 50. Getting genetics checked is also reasonable.

I’d like to end by saying that much more needs to be learned about these two quite different types of PCOS. But one thing which has been found out is that women with high DHEA-S have no higher risk for diabetes and heart disease than does the general population. This is amazing and encouraging news! The unpleasantness of today will be the anti aging foundation of the future. There is indeed much to celebrate and to look towards. There is, to put it simply, much hope and much happiness ahead.