The Link Between PCOS, Insulin Resistance, and Testosterone
Understanding the Hormonal Imbalance Behind PCOS
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women today, impacting metabolism, fertility, and overall health. PCOS affects 8-13% of reproductive-aged women worldwide according to the WHO, yet it is suspected that up to 70% of women who are affected remain undiagnosed. While PCOS is often associated with high testosterone levels and irregular cycles, there’s a deeper metabolic component at play: insulin resistance. Understanding this connection is key to addressing the root cause of hormonal imbalances and improving long-term health. In this article, we’ll explore how insulin resistance contributes to PCOS and why some women with PCOS may experience low testosterone instead of high levels. We’ll also cover practical strategies to balance hormones naturally.
PCOS: An Overview
PCOS is a complex hormonal condition that affects each woman differently. It is diagnosed based on the Rotterdam criteria, meaning a woman must have at least two of the following:
Irregular or absent menstrual cycles,
Hyperandrogenism (elevated androgens leading to symptoms like acne, excess facial or body hair, or hair loss), and
Polycystic ovaries seen on ultrasound.
However, not all women with PCOS have ovarian cysts, and symptoms can vary widely. Some women struggle with weight gain and insulin resistance, while others have lean PCOS and experience metabolic challenges without visible weight changes. This variability highlights the need for a personalized approach when managing PCOS, as treatment strategies may differ based on the unique hormonal profile of each individual.
What is Insulin Resistance?
Insulin is a hormone produced by the pancreas that helps regulate blood sugar levels. When you eat carbohydrates, your body breaks them down into glucose, which enters your bloodstream. Insulin helps transport glucose into your cells to be used for energy.
However, when the body becomes insulin resistant, cells no longer respond properly to insulin’s signals. This leads to higher insulin levels as the pancreas tries to compensate, resulting in elevated blood sugar and increased fat storage. Over time, insulin resistance contributes to metabolic dysfunction, weight gain (especially around the midsection), and an increased risk for type 2 diabetes.
Signs of Insulin Resistance:
Intense sugar cravings or energy crashes after meals
Weight gain, particularly around the abdomen
Fatigue and brain fog
Darkened patches of skin (acanthosis nigricans)
Skin tags
Irregular menstrual cycles
How Insulin Resistance Fuels PCOS
While PCOS is often thought of as a reproductive disorder, insulin resistance is a major underlying factor for many women with PCOS. Research shows that up to 70% of women with PCOS have some degree of insulin resistance, regardless of their weight. High insulin levels disrupt the normal balance of reproductive hormones, leading to excess androgens (male hormones like testosterone) and menstrual irregularities.
How This Affects Your Hormones:
Increases testosterone production: Insulin stimulates the ovaries to produce more testosterone, which can cause acne, hair thinning, and excess facial or body hair (hirsutism).
Disrupts ovulation: High insulin levels prevent the normal maturation of follicles in the ovaries, leading to irregular or absent ovulation.
Increases estrogen dominance: Many women with PCOS experience unopposed estrogen, which contributes to heavy or prolonged periods.
How PCOS Affects the Menstrual Cycle
Because PCOS disrupts normal ovarian function, it can cause a variety of menstrual irregularities, including:
Oligomenorrhea: Infrequent periods (cycles longer than 35 days).
Amenorrhea: Missing periods for months at a time due to lack of ovulation.
Anovulation: Ovulation does not occur, making conception difficult.
Heavy or prolonged bleeding: Irregular cycles can lead to unpredictable and excessive menstrual bleeding.
Why Tracking Your Cycle Matters: Many women with PCOS assume they can’t track their cycles, but using fertility awareness-based methods (FABMs) can help identify patterns, ovulation status, and hormonal shifts. Monitoring cervical mucus, basal body temperature (BBT), and LH surges can provide insight into whether ovulation is occurring, even in irregular cycles.
The Overlooked Issue: Low Testosterone in PCOS
While high testosterone is commonly associated with PCOS, not all women with PCOS have elevated levels. Some actually experience low testosterone, leading to symptoms such as:
Chronic fatigue and low motivation
Difficulty gaining muscle or losing weight
Brain fog and mood disturbances
Low libido
What Causes Low Testosterone in Some Women with PCOS?
Chronic stress and high cortisol levels - Excessive stress can disrupt the HPA axis, reducing testosterone production.
Overuse of hormonal birth control - Birth control pills lower androgens, sometimes to levels that cause deficiency.
Nutritional deficiencies - Low levels of zinc, magnesium, and vitamin D can impact testosterone production.
Poor metabolic function - If the body is struggling with insulin resistance, it may also struggle to produce optimal androgen levels.
How to Balance Insulin and Support Hormone Health
The good news? Insulin resistance and PCOS symptoms can be improved with nutrition and lifestyle changes. Here’s how:
1. Nutrition for Blood Sugar Balance
Prioritize protein, healthy fats, and fiber in every meal to stabilize blood sugar.
Reduce processed carbohydrates and added sugars, which spike insulin levels.
Incorporate nutrient-dense ancestral foods, as recommended by Lily Nichols, RDN.
Consider limiting dairy and gluten, as some women with PCOS see improvements in symptoms when they remove them.
2. Exercise to Improve Insulin Sensitivity
Strength training and resistance exercises help build muscle, which improves insulin sensitivity.
Walking after meals can help stabilize blood sugar.
Avoid excessive cardio, which can increase stress hormones and worsen hormone imbalances.
3. Prioritize Sleep and Stress Management
Aim for 7-9 hours of quality sleep to support hormone regulation.
Use stress-reducing techniques like deep breathing, stretching exercises, or nature walks to lower cortisol.
4. Targeted Supplements
Make sure to work with a trusted doctor before supplementing. With tailored lab testing, you can discover what deficiencies you may have, then work with your doctor to create a targeted approach. Some recommended supplements may include:
Myo-inositol & D-chiro inositol – Support insulin sensitivity and ovulation.
Magnesium & zinc – Help regulate blood sugar and support hormone production.
Omega-3 fatty acids – Reduce inflammation and support hormonal balance.
Ashwagandha – Supports adrenal health and stress response.
Conclusion: A Holistic Approach to PCOS and Insulin Resistance
PCOS is more than a reproductive condition—it’s deeply connected to metabolic health. By addressing insulin resistance, supporting ovulation, and balancing androgens, women with PCOS can experience significant improvements in their cycles, energy, and overall well-being.
Instead of focusing on symptom suppression alone, a root-cause approach to blood sugar regulation, lifestyle shifts, and hormone balance can make a profound difference. If you're looking for personalized guidance, consider working with a trained doctor, hormone coach, or fertility awareness educator to create a tailored plan. Check out my services in the tab above to learn more. :)
Resources:
Real Food for Fertility, by Lily Nichols RDN
Natural Support for Hormone Balancing, Weston Price Foundation
Interpreting your cycle with PCOS: A Fertility Awareness Guide, The Fertility Awareness Project
What Are the Symptoms of PCOS, and How Do You Treat It? Natural Womanhood
Insulin Resistance, PCOS, and Fertility Health: Are you at risk? Natural Womanhood