PCOS, Facial Hair & Testosterone: A Functional Medicine Take That Changes Everything
You’ve probably been told your PCOS is “too much testosterone.”
Full stop. End of story.
When you finally see how these hormones actually interact, you start to understand why chin hairs, cystic acne, mood swings, and stubborn weight don’t just disappear when you try to “lower testosterone.” And you also see why so many women stay stuck in the same frustrating cycle for years.
So let’s get real:
If you’ve Googled “how to lower testosterone,” “stop facial hair PCOS,” or “PCOS hair loss cure,” you’ve probably been handed the same starter pack: a low-calorie diet, birth control, and metformin.
Sure, they can put symptoms on mute for a while. But here’s the fine print they don’t tell you:
They deplete key nutrients like magnesium, B12, folate, and zinc (all critical for hormone balance).
They slow down your detox pathways, so your body struggles to clear old hormones. Yup, your liver is going to be screaming at you.
And when you do stop taking them? Symptoms often come back with a vengeance.
That’s why we need to ask bigger questions:
Can you be estrogen-dominant and have high testosterone?
What’s progesterone got to do with PCOS symptoms?
Which labs actually matter, and which ones are a waste of money?
How do your blood sugar and insulin fit into all this?
Grab your matcha or your electrolytes (you know I love both), because we’re about to break it all down.
The Real Engine of PCOS: The Insulin–Hormone Loop
Here’s what no one tells you: PCOS isn’t just a hormone imbalance; it’s a metabolic imbalance first.
And that matters because if you only treat the hormones without addressing the metabolic piece, you’re basically scooping water out of a sinking boat without fixing the hole.
Here’s how the loop works:
Step 1: Insulin rises
When your cells stop responding well to insulin (aka insulin resistance), your body pumps out more insulin to get the same job done. And yes, this happens in “lean PCOS” too. You do not have to be overweight to have insulin resistance.Step 2: Ovaries get the message to make more testosterone
Insulin is not just a blood sugar hormone; it’s also a powerful signal to your ovaries. Think of insulin as a pushy coach shouting from the sidelines, “More testosterone, faster!” Your ovaries respond by cranking up production.Step 3: SHBG drops
Sex Hormone Binding Globulin is like a sponge that soaks up excess testosterone so it can’t cause trouble. High insulin tells your liver to make less SHBG. Less sponge equals more “free” testosterone floating around, causing acne, chin hair, and scalp hair loss.Step 4: Aromatase joins the party
Your fat cells contain an enzyme called aromatase that converts testosterone into estrogen. This sounds helpful, but here’s the catch: without consistent ovulation, you’re not making enough progesterone to balance that estrogen. That’s called estrogen dominance.Step 5: The vicious cycle begins
High estrogen can actually signal your ovaries to produce more testosterone.
So now you’re stuck in what I call the Both-Hormones-Stuck Loop:
High insulin → more testosterone
Testosterone → more estrogen (via aromatase)
Low progesterone → estrogen dominance
Estrogen dominance → even more testosterone
Repeat… until we break the loop.
The Sneaky Roots of High Testosterone (That Aren’t Just Ovarian)
Here’s the thing: if your PCOS symptoms are stubborn, it’s probably not just your ovaries making testosterone. There are other hidden sources and triggers, and unless you address them, you’re playing hormone whack-a-mole.
1. Adrenal Androgens (DHEA-S)
When you’re chronically stressed (hello, modern life), your adrenals can pump out androgens like DHEA-S, which behave a lot like ovarian testosterone.
This is why some women with PCOS feel worse during periods of intense stress; the adrenal contribution is stacking on top of the ovarian production.
Now, layer in the Standard American Diet (I don’t think it’s “S.A.D.” by coincidence), and you’re basically handing your hormones a megaphone and saying, “Go ahead, shout louder!”
The result? More inflammation, more insulin resistance, and even more androgen overload. Over time, this triple hit can send your hormone balance spiraling (think acne, chin hair, irregular cycles, stubborn weight, and mood swings) until the root causes are untangled.
2. Endocrine Disruptors
These stealth chemicals in your everyday life mimic estrogen, hijack your hormone receptors, and scramble the messages your body is trying to send.
Some of the worst offenders:
BPA – in receipts, canned food linings, and plastics
Phthalates – in perfumes, scented lotions, nail polish, and cleaning supplies
Pesticides – on conventional fruits and vegetables
Here’s the problem: these toxins lower SHBG (Sex Hormone Binding Globulin), which means more free testosterone roaming around. They also mess with how your body metabolizes estrogen, and when estrogen metabolism is off, testosterone balance follows.
Bottom line: Switching to glass containers, buying more organic (especially the Dirty Dozen produce), and cleaning up personal care products is not “woo-woo.” It’s hormone protection.
3. Liver & Thyroid Function
Think of your liver as your hormone recycling plant. It processes and packages old hormones so your body can eliminate them. But if it’s sluggish, from nutrient deficiencies, alcohol, a high toxin load, or poor bile flow, estrogen builds up.
Your thyroid sets the pace for your metabolism, including hormone clearance. If it’s underactive (hypothyroidism, which is skyrocketing in women), your body slows down production of SHBG and estrogen detox pathways. This means testosterone hangs around longer, fueling the very symptoms you’re trying to fix.
4. Aromatase Overload
This one flies under the radar, but it’s key. Aromatase is an enzyme that lives in fat tissue and converts testosterone into estrogen. Sounds helpful, right? Less testosterone? Not so fast.
Here’s the twist: the extra estrogen can tip you into estrogen dominance. And estrogen dominance feeds back to your ovaries, telling them to make even more testosterone.
It’s the classic PCOS feedback loop — and the reason why “just lowering testosterone” doesn’t break the cycle.
That’s why step one in getting your hormones back in balance isn’t guesswork: it’s data. And not just any data. If you’ve ever had labs run and been told “everything looks normal” while your symptoms scream otherwise, you’ve already seen the flaw in the conventional approach.
Here’s the truth: most standard hormone tests aren’t looking at the right markers, in the right way, at the right time of your cycle. And they almost never compare those numbers to optimal ranges, only to “normal” ones (which, frankly, are based on averages of a very unwell population).
What to actually ask for (and why it matters):
Total Testosterone – Tells you the full amount circulating in your blood. High levels can confirm the androgen picture, but by itself, it doesn’t tell the whole story.
Free Testosterone – This is the active form that’s not bound to proteins, and the one directly responsible for symptoms like acne, hair growth, and hair loss.
SHBG (Sex Hormone Binding Globulin) – Think of this as the “taxi” that carries testosterone around. Low SHBG means more free testosterone is roaming and triggering symptoms.
DHEA-S – Produced by your adrenals, not your ovaries, so it helps you figure out where the excess androgens are coming from.
LH:FSH Ratio – In many women with PCOS, LH runs higher than FSH (often around 2:1 or more). This ratio gives valuable insight into whether your ovaries are being overstimulated.
Fasting Insulin – Often skipped, but critical. Elevated fasting insulin is one of the earliest red flags that your blood sugar is driving the androgen surge.
HbA1c & Fasting Glucose – Longer- and shorter-term snapshots of your blood sugar regulation.
Vitamin D & Ferritin – Not technically hormones, but deficiencies here can worsen PCOS symptoms and cycle irregularity.
How to read the results like a pro:
Don’t just look for an “H” or “L” next to your lab value. Compare your results to optimal ranges, which are often narrower than the lab’s printed reference range.
Look at patterns instead of single numbers — for example, high free testosterone and low SHBG paints a different picture than high free testosterone with normal SHBG.
Remember that timing matters — most reproductive hormone labs should be drawn in the early follicular phase (days 2–5 of your cycle) while fasting and well-rested.
What’s not worth your money (at least at the start):
Genetic and isolated tests for ‘PCOS risk’ — These often don’t give actionable insights and can’t replace functional lab work.
Expensive at-home kits that don’t measure the right markers or lack clinical interpretation.
Overly broad “hormone panels” that skip insulin or SHBG.
Random-cycle-day testing for sex hormones — it muddies the data.
When you know what to ask for and how to interpret it, you stop being a passive patient and start being your own best advocate. That’s the shift; from wondering what’s happening to finally having a map.
Labs & Ratios: Your PCOS Detective Work
If you’ve been told “your labs are fine” but you still feel like your body is waging war against you, it’s time to look deeper, not just at the numbers, but at the ratios. Most standard workups for PCOS are either too basic or too narrow, which means root causes get missed. And that’s when the Band-Aids come out: metformin for insulin, the pill for “regulating” cycles, and spironolactone for hair growth, without ever fixing why your hormones went haywire in the first place.
The “Bare Minimum” Panel to Ask For (even if your doctor says you don’t need it):
Fasting glucose + fasting insulin → You’re looking for both, because a “normal” glucose can hide sky-high insulin.
HbA1c → Your 3-month blood sugar report card.
Total & Free Testosterone → Both matter; free T is what’s bioavailable and causing symptoms.
DHEA-S → The adrenal androgen — key for spotting stress-driven PCOS.
SHBG (Sex Hormone Binding Globulin) → Low SHBG often means high free testosterone.
LH & FSH → The classic PCOS “tell” is an LH:FSH ratio over 2:1, but there’s nuance here.
Estradiol + Progesterone → Take in the luteal phase (about 7 days post-ovulation) if you’re cycling.
TSH + Free T4 + Free T3 → Thyroid issues can mimic or worsen PCOS symptoms.
Vitamin D & Ferritin → Nutrients your hormones need to function.
Why Ratios Matter
Numbers in isolation are like puzzle pieces in a drawer; they don’t tell the full story until you see how they fit together. For example:
High LH with normal FSH can point toward classic ovarian-driven PCOS.
Normal LH/FSH but high DHEA-S suggests an adrenal-heavy picture.
High insulin with low SHBG means insulin resistance is pushing up your free testosterone.
Lab to Symptom Cheat Sheet
(For educational purposes only. Always review results with your healthcare provider.)
| Lab Pattern | Possible Root Cause | Common Symptoms |
|---|---|---|
| Low Testosterone + Low SHBG | Metabolic or insulin resistance | Fatigue, weight gain around middle, low libido |
| Low Testosterone + High SHBG | Thyroid issues, undernutrition, OCP use | Low libido, hair loss, mood swings |
| Normal Testosterone + High SHBG | Hormonal birth control, thyroid dysfunction | Symptoms of low free T despite normal labs |
| Low Free Testosterone | High SHBG binding up testosterone | Poor energy, decreased muscle tone, brain fog |
Interpreting Without the Panic
I don’t want you playing doctor; I want you to be an informed patient so you can have a different kind of conversation in the exam room. If you’re spotting patterns that point toward insulin resistance, inflammation, or adrenal overload, those are your root cause breadcrumbs. And when you understand the why, you can take targeted, effective action.
The Big Picture Takeaway
If there’s one thing I want you to walk away with, it’s this: PCOS is not just a “too much testosterone” problem. You are not a single lab number or a “broken ovary.” You are a complex, beautiful system of interconnected biology: metabolic health, adrenal balance, thyroid function, detox pathways, nutrient status, and gut health—all talking to each other every single day.
When we zoom out and see the whole map instead of one road, healing becomes possible. We stop slapping on Band-Aids. We stop chasing symptoms. And we start restoring the body’s natural rhythm, so you don’t have to be on metformin, birth control, or spironolactone for life just to keep your head above water.
Hormonal health is complex, but my hope is that I’ve helped untangle a small part of this tricky—yet beautiful—world we have inside us as women. Bioindividuality is real, and it’s why I’m such a strong advocate for personalized attention.
And when it comes to advanced hormone insight? The DUTCH test can be a game-changer. It shows not just how much hormone you’re making, but how you’re metabolizing it—a missing piece in many PCOS cases, especially when estrogen dominance or adrenal androgens are part of the story.
This is also why working with a practitioner who specializes in women’s health (Hi! Nice to meet you!) — someone who understands the hormone-metabolism connection is worth their weight in gold. Someone who can read your labs in context, see the patterns, and tailor a plan to your unique body. That’s exactly why I do what I do, and why my private practice waitlist is open for women ready to work this way.
From my heart to yours, I want you to know you’re not alone in this. Your symptoms are not “in your head,” and there are real solutions. If you have more questions, my DMs are always open—I get a lot of them, but I love hearing from you, learning your top concerns, and creating the content you truly need.
You deserve to be heard and supported. You deserve a plan that works with your biology, not against it. And most importantly, you deserve to feel at home in your own body again.
