A Male Version of PCOS
Polycystic Ovary Syndrome (PCOS) is the most common endocrinopathy of reproductive aged women and it is nowadays legitimately regarded as a hidden epidemic. Male PCOS is not a widely recognized concept yet but this PCOS prevalence may be a major contributor to both male and female fertility issues. I often meet a couple where both the man and woman are exhibiting clear signs of PCOS.
A hypothesis published by Kurzrock et al. stated that the primary defect underlying PCOS may be an upstream endocrine and/or metabolic disturbance, rather than a defect in the ovaries themselves, so it is perfectly possible that this same aberration of PCOS can also arise in men. The absence of polycystic ovaries in men who have other stigmata of the disorder should therefore not eliminate this diagnosis.
For women with PCOS, the underlying hormonal disturbances include:
- elevated insulin
- increased adrenal androgen synthesis (more testosterone and/or DHEA),
- decreased sex hormone binding globulin (SHBG)
- increased luteinizing hormone (LH)
- decreased follicle stimulating hormone (FSH)
This hormonal milieu manifests a constellation of signs & symptoms across the board:
- Obesity focused on the waistline
- Development of diabetes and metabolic disorders
- hair loss of head and hairiness (hirsutism) elsewhere
- Infertility, miscarriage, pregnancy complications
For male PCOS, hormonal disturbances include
- A chronically raised insulin level
- Decreased sex hormone binding globulin (SHBG),
- High levels of testosterone turning into dihydrotestosterone (DHT)
This hormonal milieu adversely affects men in similar ways across the system:
- Insulin resistance
- Central obesity
- Increased risk for diabetes and cardiovascular disease
- Early onset androgenetic alopecia (male-pattern baldness) with excessive body hair
- Erectile dysfunction
- Benign prostatic hypertrophy (BPH) – enlargement of the prostate gland
Is early balding the first sign of hormone imbalances?
The condition of scalp and body hair is affected by hormonal status and is associated with various disease manifestations. In young men, early onset balding (androgenetic alopecia: AGA) may be an indication of insulin resistance which is otherwise hidden. Cannarella et al performed a meta-analysis of hormonal profiles in young men with early-onset AGA (Androgenetic Alopecia). Compared to men without alopecia, males under 35 years of age with AGA had higher fasting insulin, HOMA-IR, and triglycerides, with slightly higher BMI, and lower HDL-C—all indicators that the men with AGA were affected more severely by insulin and more susceptible to metabolic disorders. The study’s authors wrote, “Early-onset AGA might represent a phenotypic sign of the male PCOS-equivalent.” They concluded that the acknowledgement of this syndrome would be of importance to prevent long-term consequences on health in the affected men.
Erectile dysfunction may be another sign of this “male PCOS”. When erectile dysfunction (ED) has no obvious cause such as depression, chronic stress or physical trauma, then insulin resistance should be suspected. ED is indicative of impaired blood vessel endothelial function and it is essentially a cardiovascular problem.
People with poor blood glucose regulation and chronically elevated insulin are more susceptible to metabolic disorders. Those with a raised blood glucose level are prone to glycation which is a process where sugar molecules caramelise the pristine protein tissue with resulting oxidative stress and inflammation. This results in glycation of the blood vessels and blood vessel inflammation and dysfunction. The degree of glycation can be measured via haemoglobin A1c.
Researchers have noted that ED may be the first clinical sign of insulin resistance in young men—meaning that for young men ED could be the very early warning sign where no other signs and symptoms of metabolic derangement are present. ED can be considered an early marker of cardiovascular disease. One study found that in men under 40 with ED there was significantly higher HOMA-IR and systolic blood pressure and significantly lower flow-mediated dilation compared to men without ED. The researchers stated that “Subclinical endothelial dysfunction and insulin resistance may be the underlying pathogenesis of ED in young patients without well-known aetiology.”
Hair loss, Benign Prostatic Hyperplasia (BPH: prostate enlargement) and insulin resistance
BPH is yet another insulin-driven condition and there appears to be a strong correlation between early-onset balding and benign prostatic hyperplasia (BPH). Men with BPH tend to have more inherited baldness and an increased severity of baldness. Some studies also point to an increased risk of prostate cancer. Common signs and symptoms of BPH include a frequent or urgent need to urinate, increased frequency of urination at night (nocturia), difficulty starting urination, a weak urine stream or a stream that stops and starts, dribbling at the end of urination and an inability to completely empty the bladder. Among men with BPH, fasting insulin levels were positively correlated with an annual increase in the growth rate of the prostate gland: the higher the insulin, the faster the growth. Prostate growth was faster in men with type-2 diabetes, hypertension and obesity and the growth rate negatively correlated with HDL—all signs of hyperinsulinemia.
Chronically high level of insulin and insulin resistance is the root of so many modern chronic diseases and it is time as female insulin resistance syndrome is identified so should male insulin resistance syndrome.
A man with early-balding onset has a genetic susceptibility for this. By identifying this predisposition in those young men and proactively balancing hormones earlier in life by adopting low-carb, low insulin, low inflammatory lifestyle, not only can more drastic health decline in the future be prevented, but further hair loss can be successfully forestalled.
Be aware and wary about the sexual side effects, often trans-generational in nature that many pharmaceutical medicines have. Propecia (finasteride) that is used widely for hair loss is one of them. I discussed the problem of Propecia in a separate article.