Can PCOS Women be Thin?

Absolutely!  If your doctor has told you that you don’t have PCOS because you don’t “look like it”, then he or she is wrong.  You cannot diagnose PCOS or rule it out based on what someone looks like.  You can have a suspicion that a woman has PCOS if she’s overweight, has acne, thinning head hair and excess facial hair, but even then there are other conditions that need to be investigated such as adrenal hyperplasia. Up to 40% of PCOS women are thin.  Does that mean that these women aren’t insulin resistant?  Not necessarily, even thin women with PCOS can be insulin resistant.  Confusing isn’t it?  Sometimes, partly because everyone is different and PCOS can manifest many different ways and have several different root causes.  This is why it’s best to consult with someone who is well versed in PCOS, not all family doctors or even endocrinologists are.

Signs and Symptoms of Hormone Imbalance

How would you know if you had a hormone imbalance? Most of the women I see already have an inkling that something is out of balance by the symptoms that they are experiencing:

  • Hair loss
  • Acne
  • Irregular periods
  • Night sweats
  • Hot flashes
  • Infertility
  • Heavy periods
  • Painful periods
  • Fibroids
  • Ovarian cysts
  • Uterine polyps
  • Excessive facial or body hair
  • PMS
  • Premenstrual migraines

Most often they have already visited their family doctor who “checked their hormones” and told them “everything is normal” or offered them the birth control pill.

There are three main problems here:

  1. By checked their hormones, most doctors mean they’ve done a very superficial screening of hormones, LH, FSH, maybe estradiol and maybe progesterone, but often not measured on specific dates of the menstrual cycle that make the results clinically meaningful.
  2. When “everything is normal” even though you feel that hormones are imbalanced, it’s because the “normal” ranges for hormones are extremely wide and so even abnormal people fall into the “normal” range.
  3. Birth control pills only mask the existing hormone imbalance, they don’t correct it.

If you feel like you have a hormone imbalance, always ask for a copy of blood work results so that you can see exactly how extensive testing was and exactly where your results fall in the “normal” range (normal is always in quotes because lab ranges rarely refer to what is actually normal, it is more often an average of unhealthy people).  99% of the time you will find that either: a) only a very few hormones have been tested and/or b) one or more of your results were borderline.

Polycystic Ovarian Syndrome or Not?

Irregular periods, acne, hair loss, fatigue, weight gain, sluggish metabolism, at first glance these symptoms seem to point to PCOS. However, blood tests show a different story, in PCOS you would expect to see high androgen levels (testosterone, DHEAs) but this patient has low testosterone, low DHEAs, low estradiol and here’s the kicker – high cortisol! Her doctor had refused to do the cortisol testing which ultimately provided the solution to the puzzle of her symptoms which she has complained to her doctor about for years. It still remains to investigate why her cortisol is elevated. There are herbs that can be used to lower cortisol, but we’ll refrain from that until we can collect more data on why it’s elevated.

It’s easy in medicine to make assumptions and jump to conclusions, but this patient is a perfect example of why doing our due diligence and thoroughly investigating through diagnostic testing is important.

Your Hormone Levels are “Fine” (Not!)

Many of the women that I see every day feel like there is a problem with their hormones, however, they’ve been to their family doctor who has told them that their hormone levels are “fine”. These women are suffering from infertility, hair loss, irregular periods, excessive facial or body hair, acne, peri-menopause, mood swings, low libido and PCOS, all of which are fairly obvious signs of hormone imbalance.

Here’s why you may be told that your hormones are “fine” when they’re actually not:
1. Countless patients haven’t even had the tip of the iceberg measured when it comes to their hormones. They’ve been trying to conceive for 3 years, yet no one has ever thoroughly measured their hormones. They’ve never had testosterone, DHEAs, androstenedione, and DHT measured. These are all hormones that can impact fertility.
2. Hormones vary from day to day and certain ones are really only clinically relevant at certain points of the menstrual cycle, but no one specified what day to have them measured. LH, FSH and estradiol should be measured on day 3 of a menstrual cycle. Progesterone should be measured 7 days post ovulation. If there is a hormone related problem, the relevant hormones should probably be measured more than once to confirm if they’re normal or not.
3. Hormone “normal” ranges are actually “abnormal” ranges. The lab ranges for hormones are particularly unreliable as indicators of good hormonal health. As a lab insider (I worked in one for 20 years), I know how normal ranges are set. Lab technologists average the results from a given number of samples and the average of those samples becomes the “normal” range. The problem with this is that doctors only order hormone blood work from people with a hormone related condition like infertility, hair loss, irregular periods, excessive facial or body hair, acne, peri-menopause, mood swings, and low libido. So if you average the results of an abnormal population and then call that your normal range, what you’ve actually got is an “abnormal range” and abnormal people will fit nicely into it so that their results look “normal” even though they clearly have a hormone related problem.

When I’m looking a patient’s blood work, I use my own optimal range, rather than the lab’s abnormal range to interpret whether the hormone blood tests are normal or not. I also like to see thorough hormone blood work and have it done at specific points in the menstrual cycle.