PCOS - A Proposed Root Cause

Possibly Relevant for Males with Similar Symptoms (fertility issues, hair loss..)

PCOS, or polycystic ovarian syndrome, occurs in women and has a slew of unfortunate symptoms including but not limited to, fertility issues, mood issues, hair loss, acne, facial hair growth and weight gain.

There are many theories out there on what is behind PCOS, I will propose my own thoughts on this that have been strongly influenced by the writings of Ray Peat Ph.D., Georgi Dinkov (haidut.me blog), and Danny Roddy, to name a few.

To start off the article let’s look at two Ray Peat Ph.D. quotes:

“Estrogen itself can sometimes stimulate the growth of whiskers, by over-stimulating the adrenal glands.”

“In the polycystic ovary syndrome, an excess of estrogen stimulates the adrenal glands to produce a large amount of the androgenic steroids, probably to balance estrogen in the way progesterone does when the ovaries are functioning properly."

This will be important to understand as the overactive adrenals are central to PCOS.

The way I see it (at a very high level and very simplistic overview) you can be run by good thyroid, liver and gonadal (ovarian/testicular, depending on your gender) function (TEAM A) or by your hypothalamus, pituitary and adrenals (TEAM B).

TEAM A: Thyroid, Liver, Gonads (ovaries for women)

-T3 (active thyroid hormone), Pregnenolone, Progesterone (main relevant hormones)

TEAM B: Hypothalamus, Pituitary, Adrenals

-TSH, Prolactin, Adrenaline, Cortisol, Aldosterone (main relevant hormones)

(excess Estrogen is here as in excess it hinders TEAM A and amplifies TEAM B)

To paraphrase Ray Peat, when your thyroid, liver and gonads (e.g ovaries) are performing well, there is little need for pituitary and adrenal action. For example, the pituitary produces TSH (thyroid-stimulating hormone). You can tell from the name, it is meant to “stimulate” the thyroid, in other words, this is a signalling hormone. I like to refer to pituitary hormones as alarms. Your pituitary ramps up different hormones (LH - luteinizing hormones, FSH - follicle stimulating hormone and TSH as examples) when they need something in the body to work better. If you are a male with low testicular (gonadal) function, you may see that you have high LH, because your pituitary is trying to send an alarm telling your gonads to produce more testosterone. We need the pituitary and its various signalling hormones, but in excess, they are very damaging.

Prolactin is another pituitary hormone, it has direct anti-fertility effects and it opposes dopamine leading to a varying amount of mood and motivation issues, and is involved in things like PMS, hair loss and even gynecomastia in men.

When your active thyroid levels (T3) are low you can have a massive increase in adrenal hormones like adrenaline to make up for the low thyroid function. This of course involves the liver as most of the conversion of inactive thyroid hormone (T4) to active thyroid hormone (T3) depends on the liver. So in other words, if the thyroid and liver are not working well, the adrenals ramp up. Keep in mind, excess estrogen can increase adrenal output, leading to more DHEA and other adrenal hormones.

When the adrenals ramp up we have all sorts of hormones in excess, which causes problems. For example, we have higher levels of cortisol and as a response, the body needs to produce more hormones that oppose cortisol, namely DHEA. Dehydroepiandrosterone (DHEA) is a weak androgen mainly produced by the adrenals. One of its main roles is to counteract the effects of high cortisol. But in a body that is producing lots of adrenal hormones, DHEA will be high and this is often shown in women with PCOS, and men with hair loss can have high DHEA levels. DHEA can turn into other androgens as well, like testosterone and DHT, and this is likely part of the reason why women with PCOS can have facial hair growth. What is worse is that DHEA can easily be converted into estrogen by virtue of the aromatase enzyme. Higher estrogen will hinder the thyroid and liver function leading to a vicious cycle of high estrogen, high adrenal output and high pituitary output. This is all the expense of TEAM A.

When your thyroid function is low your gonadal function suffers. For women, this will mean that they produce far less progesterone. During the luteal phase, the corpus luteam must create sufficient amounts of progesterone, which is a very beneficial hormone and a natural antagonist to excess estrogen, so progesterone keeps estrogen in check. If women have lower progesterone production lots of issues can happen, such as every symptom of PCOS. The lower progesterone also makes the estrogen problem worsen.

Is PCOS then a situation of high androgens?

This is not the root cause. It is a situation of poor thyroid, liver and ovarian function leading to less progesterone. This causes high adrenal and pituitary hormones. The high estrogen (as a result of low thyroid and low progesterone) stimulates adrenal production of androgens like DHEA. Cortisol also increases the aromatase enzyme, which turns other hormones (like DHEA) into estrogen.

Thus, lowering excess estrogen, calming down the adrenals and pituitary, and supporting the thyroid, liver and ovaries can help with PCOS and help you to naturally lower the excess hormone productions like DHEA (and testosterone).

If a woman cannot adequately protect against excess estrogen with progesterone, the androgens (like DHEA) are used instead. This is not ideal and can have side effects like the symptoms seen in PCOS. That is why it is “TEAM B”, the body wants to use TEAM A but it needs some help.

So what is the solution?

Improve TEAM A and tell TEAM B to take a back seat.

Trying to lower excessive pituitary and adrenal output is a must because it will likely be hard to get TEAM A working when TEAM B is in control.

First, make sure your thyroid function is optimal. When thyroid levels are good your TSH can calm down, in my opinion, a TSH of 2 or above is too high, and ideally you want it lower than 1. High cholesterol can indicate low thyroid function because T3 is needed to convert cholesterol into steroid hormones. Also, low temperature and pulse rate are classic signs of hypothyroidism. The topic of what to do about thyroid function is vast and not within the scope of this article. However, eating at least 70-120g of protein a day can help your liver do the things it needs to do, such as detoxifying excess estrogen and converting T4 to T3. Eating enough carbohydrates is also important so the liver has enough energy to make these conversions.

As a woman, taking progesterone dissolved in vitamin E (very important to be dissolved in vitamin E) orally during the luteal phase (the second half of the menstrual cycle) can really help. You see, when taking progesterone dissolved in vitamin E this actually stimulates a woman's own production of progesterone. Even taking it for one day can have long-lasting benefits. Progesterone supplementation is very calming and can be useful for anxiety, but it can make you sleepy. Please read Ray Peat’s books and articles on progesterone to learn more. One fantastic option is “From PMS to Menopause” and another is “Progesterone in Orthomolecular Medicine”. There are many options of progesterone dissolved in vitamin E, Progest-E, Ona’s Oil (Luna Oil), LifeBlud and Health Natura also have products. (Discount Code DEAN for all except progest-E).

You can also increase your progesterone production by eating well, especially by consuming enough vitamin A (retinol) which is essential for the production of progesterone. Vitamin B6 can help lower prolactin, and by doing this you are helping to improve ovarian function. Keep in mind, high estrogen depletes vitamin B6 and zinc. Progesterone (and maybe oral pregnenolone - the first hormone to be produced from cholesterol) may be able to “calm down” the adrenals. If the adrenals are calmed down you get less, adrenaline, aldosterone, cortisol and DHEA. This can be very useful. In fact, the popular drug for female acne and hair loss is spironolactone and this drug is thought to work in part by acting like progesterone and calming down the adrenals, one effect is lowering aldosterone.

Eating eggs (always with the yolks!), oysters (and similar shellfish like shrimp and mussels), dairy (goat is best or A2 cow, cheese, yogurt, milk), fruits and roots can all be part of a nutritious diet. To get enough vitamin A try consuming organ meats like liver, if you can. Try to eat Ray Peat’s daily raw carrot salad. This is shredded raw carrots, olive/coconut oil, vinegar and salt eaten daily. It acts like a broom, sweeping the intestines and helping you to remove estrogen bound to the bile in the intestine.

Now how does this relate to men? Men can’t get PCOS right?

Men can’t get PCOS but they can have symptoms that are likely caused by the same thing, low activity of TEAM A and high activity of TEAM B to compensate. If men have a low gonadal function, they have a high adrenal function, and so on. Men with fertility issues and men with hair loss tend to high have adrenal and pituitary output, especially things like prolactin. A man should do things to increase his thyroid, liver and gonadal function and keep down excessive adrenal, pituitary and hypothalamus activity just like women. Some of the same advice applies to men, such as the fact that they should eat a nutritious diet containing things like Vitamin A, enough protein, good sources of carbohydrates and so on. Getting the thyroid function up is central to the ability to be driven by TEAM A.

This article is only a brief overview, but in my opinion, if you do things to improve TEAM A (thyroid, liver, gonads/ovaries) and calm down TEAM B (avoid fasting, try to eat enough, eat a nutritious diet filled with vitamin A (liver)) then PCOS should improve. Taking progesterone dissolved in vitamin E orally during the luteal phase may be able to improve TEAM A and may calm down TEAM B, and pregnenolone as well. For oral pregnenolone, you can shop at Health Natura, for topical go to Ona’s: discount code DEAN for either option.

There are many things that seem to be helpful for PCOS that I haven’t gone over in this article, such as vitamin E, taurine, myoinositol and vitamin C. I think these can be helpful albeit ancillary to addressing the root cause. Reach out to Andra Sitoianu ND or Keith Littlewood for more info on PCOS. And of course, look into Ray Peat’s writings, I have compiled some Ray Peat, and Gerogi Dinkov quotes on PCOS below.

The following are some select Ray Peat quotes on PCOS from:

FROM PMS TO MENOPAUSE (BOOK)

“By stimulating the adrenal glands. estrogen can increase the production of the "male" hormones that are associated with whiskers and chest hair. [E. C. Ditkoft: et aI., "The impact of estrogen on adrenal androgen sen sensitivity and secretion in polycystic ovary syndrome," J. Clin . Endocrinol. Metab. 80(2), 603-607, 1995.] This usually happens when a progesterone deficiency is combined with an excess of estrogen, as in the polycystic ovary syndrome and sometimes at menopause. In animals, polycystic ovaries are caused by a deficiency of the thyroid hormone, and the same regulatory mechanisms seem to operate in women. The polycystic ovary syndrome is the most common endocrine disorder in women during the reproductive years, and may occur in 10% of them. [A. Dunaif, et aI. , eds. The Polycystic Ovary Syndrome. Cambridge, MA: Blackwell Scientific; 1992.]

“In the polycystic ovary syndrome, an excess of estrogen stimulates the adrenal glands to produce a large amount of the androgenic steroids, probably to balance estrogen in the way progesterone does when the ovaries are functioning properly. These anabolic/androgenic hormones apparently have some of the good effects of progesterone, such as reducing the incidence of cancer, but many women are disturbed by the increased growth of body and facial hair; facial features also tend to be masculinized. In France, progesterone lotions have been in use for several years for reversing some of these effects of the adrenal hormones, and for balancing estrogen.”

“Estrogen itself can sometimes stimulate the growth of whiskers, by over-stimulating the adrenal glands.”

“But a recent observation that a surge of estriol production precedes the onset of labour, and that its premature occurrence can identify women at risk of premature delivery (McGregor, et ai. , 1995) suggests that the estriol surge might reflect the mother's increased production of adrenal androgens during stress. (This would be analogous to the situation in the polycystic ovary syndrome, in which excessive estradiol drives the adrenals to produce androgens.)”

THE FOLLOWING IS A GREAT BLOG ON HAIDUT.ME

Estrogen directly causes polycystic ovary syndrome (PCOS)

http://haidut.me/?p=1165

“The fact that infertility is almost always present in those women as well as the well-known connection between infertility and estrogen should have given a hint to endocrinologists a long time ago that estrogen may be a causative factor in PCOS”

"Peat has written extensively on the topic, and has repeatedly told people over email or during interviews that estrogen is the main causative factor for PCOS and anti-estrogenic interventions are highly therapeutic.”

*None of this is medical advice. I am not a medical professional, always talk to your doctor*

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