The production of steroid hormones from cholesterol occurs in the ovaries, testicles, adrenal glands and, to a much lesser extent, in the fat tissue of the body. Lower-level body fat produces predominantly oestrogen in the form of oestrone, whereas upper-level body fat produces predominantly male hormones. This is why women with excess weight in the upper part of their body, around the trunk and abdomen, often have quite high levels of male hormones, even years after the menopause.
After the menopause occurs, the ovaries no longer produce adequate amounts of the sex hormones. If the adrenal glands are healthy, they will continue to produce some of these steroid hormones, especially pregnenolone and DHEA. This is why women who have healthy adrenal glands will have less severe hormonal symptoms during the menopause. In patients with adrenal gland exhaustion, the hormones DHEA and pregnenolone can be administered, often with excellent results.
The following table gives you, at a glance, the symptoms of imbalances in the hormones oestrogen, testosterone and progesterone.
| HORMONE | SYMPTOMS OF EXCESS | SYMPTOMS OF DEFICIENCY |
| OESTROGEN | Fluid retention Breast pain and swelling Heavy menstrual bleeding Painful menstrual bleeding Weight gain in the hips and thighs Headaches and migraines Aching legs and aggravation of varicose veins Growth of fibroids and endometrial hyperplasia Growth of endometriosis Increased risk of cancer of the breast and uterus | Hot flushes Night sweats and insomnia Vaginal dryness and discomfort Vaginal shrinkage Vaginal infections Painful sexual intercourse Loss of libido Inability to orgasm Urinary frequency and/or incontinence Dry and wrinkled skin Depression and anxiety Memory loss Lack of menstruation Bone loss and loss of teeth Muscular aches and pains (fibromyalgia) |
| TESTOSTERONE | Hair loss from the scalp Excess facial and body hair Pimples or acne Greasy skin and hair Excess sex drive Weight gain, especially in the trunk and abdomen Elevation of cholesterol Aggressive moods | Shrinkage of muscles Weakness of muscles Loss of sex drive Inability to orgasm Depression and anxiety Loss of confidence and panic attacks Muscular aches and pains (fibromyalgia) Bone loss Fatigue |
| PROGESTERONE | Depression Sleepiness and feeling too relaxed Fluid retention Abdominal bloating Constipation | Breast pain and lumpiness Hair loss Heavy menstrual bleeding Growth of fibroids Growth of endometriosis Endometrial hyperplasia Increased risk of cancer of the uterus and breast Premenstrual mood disorder, depression and anxiety Premenstrual fatigue Menstrual irregularity Absent menstruation Exacerbation of premenstrual asthma and epilepsy Exacerbation of multiple sclerosis |
What Can You Do If You Have Too Many Male Hormones?
If you have excessive amounts of male hormones (androgens) in your body, you may notice several things:
excess facial and body hair (hirsutism)
loss of scalp hair, especially in the male pattern of balding
greasy skin and/or pimples
difficulty losing weight, especially from the trunk and abdomen
The hormonal profile of a woman going through the menopause, and after the menopause, can vary greatly, and this is why blood and/or saliva tests are so useful, to pinpoint your individual hormonal profile. Some women will have elevated levels of androgens even many years after they go through the menopause. These androgens are produced from the fat in the upper body and abdomen, and also from the adrenal glands. Obviously women with elevated levels of their own natural androgens do not need to receive any testosterone therapy, and usually find that synthetic progestogens make their hormonal imbalance worse. This is because synthetic progestogens may exert a mild androgenic effect. Natural progesterone does not have any androgenic effects, and should be used in women with excess androgens who need HRT.
The blood test that is most accurate to detect raised levels of the androgens is called the Free Androgen Index (FAI). This measures the amount of active androgens, which are unbound to proteins and are thus free to exert their effect in the body. If your FAI level is elevated, it is definite that you have excessive male hormone activity in your body. If you do not have any troubling symptoms and are not overweight, then this is not really a problem and you do not need to worry about it; however very high levels of male hormones should always be investigated by a specialist endocrinologist.
I have found that many women with an elevated FAI have normal blood levels of total testosterone, and thus just by measuring total testosterone levels alone you cannot get an accurate diagnosis of androgen excess. You must ask your doctor to order a Free Androgen Index (FAI) test if you want an accurate diagnosis.
Strategies for Women with Symptoms of Excess Androgens
Weight loss from the upper body and abdomen will reduce the production of androgens from the fat tissue.
Creams or troches containing natural oestrogens and progesterone can reduce the dominance of the androgens, thus making the hormonal profile more feminine.
If the androgen excess is severe and is producing marked symptoms, the anti-male hormone called Cyproterone acetate can be prescribed. Cyproterone acetate comes in the form of 50-mg tablets. The dose of cyproterone can vary from 1/4 of a tablet (12.5 mg) to one tablet (50 mg) daily. Cyproterone also acts as a progestogen, and as such can be given along with oestrogen to balance the effect of oestrogen on the uterus. If cyproterone is given every day, then there will not be any bleeding; if you desire to have a regular period, then the cyproterone can be given cyclically, for 18 days of every calendar month, along with your oestrogen. You must avoid pregnancy while taking cyproterone acetate. Generally speaking cyproterone is well tolerated, especially if the dose is tailor-made to match the patient’s blood tests and the severity of her symptoms. If the correct dose is used, then cyproterone will reduce the action of the male hormones so that we achieve a big improvement in all the symptoms of excessive androgens. Interestingly, we find that in women whose obesity is associated with excess androgen levels, the use of cyproterone will aid weight loss. This is because high levels of androgens will aggravate the high insulin levels found in Syndrome X. Syndrome X is a chemical imbalance that makes your body store fat and prevents your body from burning fat. If too much cyproterone is given, the level of the body’s androgens will be reduced too much and the patient may complain of fatigue, depression and loss of libido. As with all forms of hormone therapy, it is vital to tailor-make the correct dose for each patient, and over time the dose may need further adjustment.