Many young women present with skin problems related to absolute or relative increase in male hormone concentration. Acne, excessive hair growth in a male pattern of distribution, hair recession and androgenic alopecia are examples of such conditions. In many patients only the free fraction of androgens is increased despite having normal total androgens level. This could follow low levels of the carrier molecule (SHBG) which is produced by the liver.

Low SHBG production by the liver could be caused by obesity, high blood insulin, low thyroid hormone level and certain types of medication.

Increased end tissue (skin) sensitivity has been described as the cause in cases usually diagnosed as idiopathic. In fact there is rapid turnover of male hormones at the skin level due to increased number of androgen receptors or increased conversion rate of testosterone to the more biologically active dihydrotestosterone by increased enzymatic activity. This is reflected by increased urinary metabolites of dihydrotestosterone as shown in such cases.

Psychological effects of PCOS

Women with PCOS are at risk of developing minor psychological problems and reactive depression. This neglected aspect of the syndrome is more common in younger patients with skin problems and irregular periods. It is reflected biochemically with increased catecholamines response to provoked stress. To improve the compromised quality of life of this subgroup of patients more attention should be paid to the psychological impact of the disorder.