Got PCOS and Hirsutism?  Here are Two Other Causes of the Problem

Any symptom of PCOS is complex, including hirsutism.  Usually, there are a number of causes of any symptom.

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For example, on another page, we discussed the role of male hormones and insulin imbalances.  Here, let's review two additional factors causing your hairy problems.  The first factor is your 5-alpha reductase enzyme system.  The second is your level of sex hormone binding globulin (SHBG).

5-Alpha Reductase, Hirsutism and PCOS

"5-alpha reductase" refers to a small family of enzymes in your body that causes certain biochemical processes to take place.

One of those processes is the conversion of the testosterone hormone into another hormone called dihydrotestosterone or DHT. DHT is about three times more powerful than testosterone itself.

Why should you care?

DHT has been implicated in hirsutism, which is unwanted hair growth on the face and elsewhere on the body. DHT may also play a role in hair thinning and acne

Women with PCOS and Hirsutism Have Overactive 5-Alpha

The problem is that several medical studies show that both lean and overweight women with PCOS have higher activity levels of 5-alpha reductase than other women do. The higher activity of 5-alpha reductase leads to increased production of DHT, which creates hair problems.

5-alpha reductase also is present in your ovaries, and some researchers suspect it may play a role in developing problems related to polycystic ovary syndrome.

Therefore, if you can inhibit 5-alpha-reductase, you may be able to reduce the severity of excessive hair growth as well as other symptoms.

So what might you do to inhibit 5-alpha reductase?

Here are several things which have been shown to inhibit 5-alpha reductase:

  • Improved diet to reduce insulin resistance
  • Natural progesterone
  • Finasteride (Proscar, Propecia) and dutasteride (Avodart).
  • Vitamin D3
  • Zinc
  • Saw palmetto extract
  • EPA (fish oil concentrate.

There's a close association between insulin resistance (poor utilization of the hormone insulin) and 5-alpha.  Proper diet has a profound positive effect on reducing insulin resistance.  An additional benefit of the correct diet is loss of fat weight. Regular exercise should be combined with diet for maximum impact on insulin resistance.


Progesterone inhibits 5-alpha. However, some women with PCOS do not produce enough progesterone partly because they don't have a normal cycle. Chaste tree berry (vitex) extract is believed to encourage the body to produce progesterone.  

In addition to taking vitex extract, you could also try bio-identical "natural" progesterone.  You don't really know what you're getting in natural progesterone creams so it's best to have the cream prepared by a compounding pharmacist.

Finasteride is a pharmaceutical that is sometimes prescribed.  It's fairly well tolerated but shouldn't be used if you are trying to get pregnant or are pregnant.

Nutritional Supplements May Help with 5-Alpha and Hirsutism

Vitamin D is super-important. Get a blood test to make sure your level is optimal. If not, take vitamin D3, which is far superior to vitamin D2. Vitamin D3 is found in the d-pinitol formula.

Zinc is helpful but don't go overboard with it. Taking too much zinc and induce a copper deficiency. Zinc in a high-quality multi-vitamin/mineral supplement may be enough.

Saw palmetto extract has been use for many years to reduce 5-alpha in men. Women with PCOS are using it as well. Saw palmetto extract is one of our most popular supplements, which suggests that some are getting some benefit from it.

EPA is a component of oils obtained mainly from marine animals, especially fish.  For maximum effectiveness, it should be concentrated.  You can obtain EPA/DHA capsules, or you can purchase cod liver oil. The EPA/DHA capsules have fewer calories per unit of EPA compared to cod liver oil.

Please note: 5-alpha reductase is not intrinsically "bad" -- if it is kept in balance.  Too much is not good, and too little is also not good.  If you have symptoms of PCOS, it's likely your 5-alpha level is too high, so the methods outlined above should help to bring it down to a more normal level of activity.

Sex Hormone Binding Globulin: A Missing Link for Controlling Hair Growth?

SHBG binds itself to hormones such as testosterone and dihydrotestosterone (DHT). The result is that the hormone is rendered "inactive" and will have no hormonal effect until it separates from SHBG.

(By the way, DHT is thought to be the main stimulus for the growth of coarse hairs. DHT is made from testosterone. Both are androgens.)

It's like SHBG is "holding hands" with these hormones, just like you would hold your child's hand before crossing a busy intersection or walking around in a dense crowd. When you reach your destination, you release your child's hand and he or she is "free" from you. That's what SHBG does. It helps to regulate the amount of "free" androgens in circulation.

Free androgens are the active hormones leading to hirsutism. But, thank goodness, SHBG is there to keep most of these hormones inactive.

But -- what if your SHBG levels are too low? Then you don't have enough mothers to keep tabs on all the children crossing the street or milling about in a crowd.  You have too many androgens "doing their thing" and causing symptoms of PCOS, such as the growth of male-type hair.

Women with PCOS Need to Cut Out the Sugars

Low SHBG levels are quite common among women with PCOS, so it's advisable to raise your level.

Birth control pills help to raise SHBG. But is there anything else you could do?

Well, the University of Texas studied the diet of 295 women 30-40 years old. They found that those women consuming the most sugars had lower SHBG levels compared to women who didn't consume sugars. This finding has been confirmed in studies of rodents.

So you definitely want to minimize added sweeteners, especially those found in processed foods and beverages. Manufactured fructose, especially high fructose corn syrup, should be avoided like the plague. Fructose in whole fruits is OK in moderation. If you must sweeten something, use stevia.

Another reason for reducing fructose is that it causes the liver to convert sugar into fat. This fat can accumulate in the liver, leading to "nonalcoholic fatty liver disease" or NAFLD. According to some estimates, as many as one-half of all women with PCOS also have this disease. It doesn't have any obvious symptoms so you could have NAFLD and not even know it.

One of the many problems with NAFLD is that it appears to reduce SHBG levels. SHBG is manufactured in the liver. But when your liver is plugged up with fat and becoming inflamed, how can it do its job?

In the Texas study, the women whose diet contained the highest amount of B-tocopherol (a type of vitamin E) also had the highest SHBG levels. So does that mean you should run out and get the cheapest vitamin E you can find? Not quite. There are eight types of vitamin E. From what I've seen, it appears that a blend of all eight is the best option. Four of the eight are called tocopherols.  The other four are called tocotrienols.

Diet-wise, eat mostly whole, fiber-rich foods that naturally contain some of the various types of vitamin E, and cut out the sugars. Move away from refined starches, which are rapidly converted into blood sugar. The preferred carb is vegetables, 5 servings a day. Have occasional fish or fish oil.

There's much more to the SHBG story. And there are other factors affecting hirsutism. For now, take care of your liver by eating a super-healthy diet.

Related Articles

Source: Nayeem F et al. Dietary beta-tocopherol and linoleic acid, serum insulin, and waist circumference predict circulating sex hormone-binding globulin in premenopausal women. J Nutr. 2009 Jun;139(6):1135-42

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