PCOS is the most common hormonal female disorder, affecting 6-20% of all women and girls. Elevated levels of androgens (male hormones) play a major role in causing the symptoms, including hair loss, acne, hair in places you don’t want, irregular periods and difficulty getting pregnant. The good news is that nutrition and lifestyle can play major roles in lowering androgens, decreasing symptoms and health risks. There are even specific foods that lower androgens in PCOS.
PCOS 101
For many years, PCOS was thought to be only a reproductive condition, but we now know it’s also a complex endocrine disorder with metabolic and psychological features. PCOS can affect the entire body, including the brain, ovaries, adrenal gland, heart, pancreas, skin, liver, gut microbiome, and more. PCOS puts people at increased risk of infertility, type 2 diabetes, fatty liver, obesity, heart disease, depression, anxiety, and eating disorders. The symptoms can range from annoying to life-threatening.
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Elevated androgens in PCOS
It’s helpful to have a basic understanding of androgens, since they tend to be at the heart of PCOS. It’s normal for women to have some male hormones, as they play a role in mood, libido, and bone health. However in PCOS, most people either have elevated levels of androgens or clinical signs of it (acne, hair low, and/or hair growth). While there are many different androgens in the body, these are the ones usually tested in PCOS: calculated free testosterone, free androgen index, or calculated bioavailable testosterone. Androstenedione and dehydroepiandrosterone sulfate (DHEA-S) levels can also be used if total or free testosterone are not elevated.
Since POCS is a condition of androgen excess, it can be helpful to know where your androgens are coming from. This may play a role in your symptoms and how you manage your PCOS. In PCOS, there are two different sources of androgens: the ovaries and the adrenal glands.
Ovaries: People who have higher levels of testosterone coming from the ovaries tend to have more insulin resistance, metabolic complications, and trouble with their weight. Low DHEA-S and high testosterone suggest ovarian production of testosterone.
*Insulin resistance tends to be a main driver of this.
Adrenal glands: It’s estimated that 20 to 30 percent of people with PCOS have mildly elevated DHEA-S. Since DHEA-S is exclusively produced in the adrenal glands, it’s a good indicator of adrenal androgen activity. Insulin resistance doesn’t play a big role in increasing adrenal androgens. Reference
*Stress tends to be a main driver of this.
Note: Many people with PCOS have both sources of androgen production.
Foods that lower androgens in PCOS
Before getting into specific foods that may play a role in lowering androgens, what’s most important is your overall dietary pattern. Consuming balanced meals consisting of protein, fat, and high fiber carbs will help prevent blood sugar and insulin spikes. As you control these spikes, your insulin resistance should improve. And as your insulin levels go down, your testosterone levels should go down as well. This is especially important for people who are insulin resistant.
While no food has a “magical” effect of lowering androgens, certain foods, when combined with overall healthy diet and lifestyle have been shown in studies to lower testosterone.
Spearmint tea, known for its anti-inflammatory, antioxidant, and antimicrobial properties, has been shown to have anti-androgen effects in PCOS. In a study done examining the effect of spearmint tea on androgens, individuals were randomized to take spearmint tea twice a day for a one month period. In those consuming the spearmint tea, free and total testosterone levels were significantly reduced in the 30 day period, compared to the placebo group. Patient’s subjective assessments of their degree of hirsutism was also significantly reduced in the spearmint tea group. Further research is needed to understand exact mechanisms, but this research was promising that spearmint tea has the potential for use as natural treatment for hirsutism in PCOS.
Flaxseeds, which are high in fiber, contain omega 3 fatty acids, and have antioxidant and estrogen properties, have been studied for their role in PCOS. A clinical case study examined the effects of 30g/day of flaxseed supplementation on hormonal levels in a 31 year old woman with PCOS. After completion of the study, total testosterone and free testosterone levels were significantly decreased with flaxseed supplementation. The patient also reported a reduction in hirsutism at the end of the study.
Fatty fish (salmon)
Nuts are known to have anti-inflammatory effects due to their monounsaturated and polyunsaturated fats. A study looked at the effect of MUFA rich almonds and PUFA rich walnuts on metabolic and endocrine parameters in PCOS. Thirty one people with PCOS randomly received either walnuts or almonds containing 31g of total fat for 6 weeks. The walnuts were shown to increase sex hormone binding globulin, and the almomds significantly reduced the free andrgoen index.
Vitamin D
Lifestyle factors that lower androgens in PCOS
In addition to diet, other lifestyle habits such as exercise, sleep, and stress management play important roles in managing PCOS by improving insulin resistance, lowering testosterone and the adrenal androgen, DHEA-S.
Multiple studies have examined different types of exercise regimens in improving health and outcomes in women with PCOS. One study looked at aerobic exercise, specifically cycling, in women with PCOS for 30 min three days per week at 60-70%. Results significantly decreased fasting insulin levels. HIIT training, involving several minutes of high intensity exercise, has indicated changes to several hormones in those with PCOS. Studies using HIIT as an intervention also presented results in lower DHEAS levels. Cardio, whether this includes aerobic or combined exercise, appears to improve numerous hormones, particularly with more vigorous activity.
Yoga
All exercise, even light exercise can decrease androgens, but strength training seems to have the greatest effect on reducing testosterone. Examples of strength training include free weights such as barbells or dumbbells, weight machines, exercise bands, weight machines, or using your own body weight for resistance. A study looked at 43 women with PCOS and 51 women without PCOS. After week 16 of completing resistance training, the people with PCOS had a significantly lower testosterone level. Personal trainers are great to create a strength training plan that works best for you and your goals!
Stress can worsen your symptoms of PCOS, and for some, stress is the major driver of PCOS. Chronic stress can play a role in increasing cortisol and DHEA-S, an androgen precursor. It’s important to find stress reduction techniques that work for you, including getting adequate sleep, movement, yoga, meditation or other coping techniques.
Bottom line
While PCOS can be a frustrating condition, the good news is that diet and lifestyle can play a major role in decreasing the symptoms and health risks. Dietary patterns are most important, but even certain foods can lower androgens in PCOS.
I’d like to thank Arielle Faria for helping me research this blog post!
