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Suggest Treatment For Cystic Acne And Multiple Cysts On Ovaries
Question: I am training for a fitness competition but recently was tested for PCOS. I have struggled with cystic acne but my testosterone level is 8. Putting on muscle is difficult for me but I am not overweight. I do have all symptoms including multiple cysts on my ovaries. I am taking Spironolactone (to help acne) but also want to get a testosterone implant. Will the two block each other out? Also, why do I still have acne if I have no testosterone? I've seen 3 physicians but received conflicting answers. Please help.
Brief Answer:
Hormones
Detailed Answer:
Yes, taking testosterone and spironolactone will have opposing effects.
There is no strong evidence of benefit in women by taking testosterone.
Regarding acne, some people have a 'hyper-sensitive' male hormone receptor in the 'polo-sebaceous unit' i.e. the place in the skin where acne form. So despite not having high testosterone levels some women are still prone to acne problems.
It seems quite possible you have PCOS but the diagnosis requires further systematic assessment to confirm the diagnosis. When I see someone like you in my practice, I consider ordering the following tests in addition to a comprehensive physical examination :
CBC
CMP
TSH
Free T4
Prolactin
HbA1c
Lipids
IGF1
Midnight Salivary Cortisol
17 hydroxy Progesterone
DHEAS
Androstenedione
Not all of these need to be done directly. You will be best served by seeing an endocrinologist in person who will determine which of these tests are necessary. Moreover, some of these tests cannot be done while you are already taking certain types of medications such as the testosterone.
Hormones
Detailed Answer:
Yes, taking testosterone and spironolactone will have opposing effects.
There is no strong evidence of benefit in women by taking testosterone.
Regarding acne, some people have a 'hyper-sensitive' male hormone receptor in the 'polo-sebaceous unit' i.e. the place in the skin where acne form. So despite not having high testosterone levels some women are still prone to acne problems.
It seems quite possible you have PCOS but the diagnosis requires further systematic assessment to confirm the diagnosis. When I see someone like you in my practice, I consider ordering the following tests in addition to a comprehensive physical examination :
CBC
CMP
TSH
Free T4
Prolactin
HbA1c
Lipids
IGF1
Midnight Salivary Cortisol
17 hydroxy Progesterone
DHEAS
Androstenedione
Not all of these need to be done directly. You will be best served by seeing an endocrinologist in person who will determine which of these tests are necessary. Moreover, some of these tests cannot be done while you are already taking certain types of medications such as the testosterone.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for that information Dr. In the past when I've received the testosterone pellet, it literally makes me feel like a new woman. My overall energy is up, my libido is VERY healthy and I have a much easier time in the gym. Not to mention it makes me have enough energy to keep up with my small children. I can feel when the pellet is almost absorbed and want to return to the dr. immediately for more.
I would say all of the results I spoke of are definitely beneficial but are you saying that could all be in my head and not proven to be the result of the testosterone implant?
I just want to feel good again, have energy, develop muscles and balance my hormones without having acne.
I think I will contact another endocrinologist as you suggested to get the additional testing for PCOS. My GYN said I seem to have all the symptoms but she thinks I don't have the 'syndrome.' What could she have meant by that do you think?
I would say all of the results I spoke of are definitely beneficial but are you saying that could all be in my head and not proven to be the result of the testosterone implant?
I just want to feel good again, have energy, develop muscles and balance my hormones without having acne.
I think I will contact another endocrinologist as you suggested to get the additional testing for PCOS. My GYN said I seem to have all the symptoms but she thinks I don't have the 'syndrome.' What could she have meant by that do you think?
Brief Answer:
Follow up
Detailed Answer:
Testosterone itself can cause acne. so if you want relief from it you may wish to reconsider the necessity for testosterone treatment.
The improvements you perceive could be real as some studies have shown such benefit but overall expert guidelines do not encourage this practice owing to risk-benefit ratios being skewed towards more side effects than the likelihood of significant benefits.
PCOS diagnosis can pose challenges. There are systematic criteria laid down for it. The tests listed above are helpful and sometimes a USG of the ovaries is also ordered.
A general adult endocrinologist or a reproductive endocrinologist will be able to assist in this process of making a diagnosis or otherwise
Follow up
Detailed Answer:
Testosterone itself can cause acne. so if you want relief from it you may wish to reconsider the necessity for testosterone treatment.
The improvements you perceive could be real as some studies have shown such benefit but overall expert guidelines do not encourage this practice owing to risk-benefit ratios being skewed towards more side effects than the likelihood of significant benefits.
PCOS diagnosis can pose challenges. There are systematic criteria laid down for it. The tests listed above are helpful and sometimes a USG of the ovaries is also ordered.
A general adult endocrinologist or a reproductive endocrinologist will be able to assist in this process of making a diagnosis or otherwise
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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