High testosterone problem hard to diagnose

to be driven by a resistance to insulin (the substance in our body that helps us to metabolise sugar), and results in higher levels of testosterone production in the ovaries than normal.

The hormone imbalance leads to the development of multiple small follicles (or cysts) on the ovaries.

These cysts are not usually painful, but unfortunately can sometimes interfere with the ovaries’ ability to produce an egg each cycle, and regulate menstruation.

The main symptoms of PCOS can include:

Irregular, infrequent or even absent periods. Light periods. Acne – this may be either a worsening or simply a continuation of ‘‘teenage spots’’.

Unwanted hair growth – typically on the face, abdomen and chest.

Thinning of hair on the scalp (‘‘male pattern baldness’’).

Problems conceiving – sometimes the infrequency of periods can make conception difficult.

Weight – often people with PCOS will be overweight or even obese; this is partially due to the underlying insulin resistance. Losing weight definitely leads to an improvement in symptoms of PCOS.

Some patients with PCOS will have all of these symptoms, but some may only have one or two. Similarly, not everyone will have definite findings on an ultrasound scan, or definite hormone changes in the blood tests – making it a difficult condition to diagnose sometimes.

There are some possible longterm risks associated with PCOS. You are more likely in the future to develop diabetes (from the insulin resistance), have problems with high blood pressure, heart disease and strokes (from the weight gain), and possibly struggle to conceive naturally. It is important, therefore, if you feel you do have some of the symptoms above, that you talk to your doctor about what tests, if any, you should have.

Your doctor might consider trying blood tests, an ultrasound scan to look for cysts or follicles, and will also get you to track your cycle to see if there is an obvious irregularity that might help confirm a diagnosis.

Once you have been diagnosed with PCOS, treatment is to manage your symptoms as there is no cure. One of the most effective treatments is to start a combined contraceptive pill that reduces the levels of androgenic hormones in your body, lessening many of the symptoms of PCOS.

The pill will also give you a ‘‘regular’’, though ‘‘artificial’’, cycle. Obviously this treatment is not an option if you are hoping to get pregnant, but for other women it can be the most effective medication available. The usual combined pill prescribed for PCOS is ginet, as it has good effects on not only skin problems but also unwanted hair growth. Another option, although more expensive, is Yasmin.

If you can’t or don’t want to take the combined pill, your options include:

Weight loss. This will help to reduce the increased levels of insulin associated with PCOS; which in turn will reduce the level of testosterone, and lead to an improvement in period problems, fertility, acne and hair growth.

Medications for acne. If your skin is a problem, using traditional acne treatments can work well. This includes topical treatments, as well as long courses of antibiotics such as doxycycline.

Medications for hair growth. The combined pill can work really well for excess hair growth, but if you can’t take it you may find that medications such as spironolactone or cyproterone are effective; these medications need to be taken for several weeks before you notice a result, and unfortunately the hair growth may recur when you stop the treatment.

Electrolysis, laser treatment and hair-removing creams can also be effective for unwanted hair growth, but can be expensive for long-term use.

Metformin, a medication currently used to treat diabetes, can also be trialled. It may reduce the level of insulin in the body, thus reducing the symptoms of PCOS, including weight gain, period problems and hair growth.

Other than the treatments mentioned above, you may need to seek help for your PCOS when/if you decide you would like to get pregnant. Many people with PCOS will conceive without any problems whatsoever, but if your cycle is very infrequent or you don’t get periods at all, you will probably need some medication to help stimulate your ovaries. This is usually relatively simple, but may require a visit to a specialist.

I hope this is helpful, Kate – if you are still struggling, you could ask your GP for a referral to your local endocrinologist who may be able to help.

Cathy Stephenson is a GP and medical forensic examiner.