Can men have PCOS?

Polycystic ovarian syndrome is a complex disease affecting the female reproductive organs. It is the most common female reproductive disease worldwide, affecting an estimated 5-15% of women. However, these numbers may not be completely accurate, as PCOS is known to be underdiagnosed, and it may take years for a woman to get a definitive diagnosis (1).

But in this blog, we aren’t talking about PCOS for women. We are discussing the male counterpart to PCOS. A 2020 review in the International Journal of Endocrinology addressed this usually unaddressed endocrine syndrome, posing the fascinating question, “Does a male equivalent of PCOS exist? (2).

Inherently, PCOS is a female condition due to the involvement of the ovaries. However, researchers have observed a strikingly similar pattern of hormonal imbalance in men.

The male equivalent of PCOS involves imbalances in the endocrine and metabolic systems. The proposed criteria for this potential syndrome are (2):

Early onset *androgenic alopecia (<35 years) presenting with at least one of the following:

BMI greater than 25
Insulin resistance
Sex-hormone binding globulin (SHBG) less than 25 nmol/l
Increased DHEAS

*Early-onset androgenic alopecia (AGA) is a form of hyperandrogenism, resulting in hair loss. Other symptoms of this hormonal imbalance include acne and hypertrichosis (excessive hair growth on the body).

Similarly to PCOS, men with this syndrome are more likely to have an altered gonadal profile, including low total testosterone and increased DHEAS. Additionally, they may have an increased risk of type 2 diabetes and cardiovascular disease later in life (2).

And, of course, that begs the question—could these hormonal imbalances lead to male infertility?

Let’s dive in and learn more about the male equivalent of PCOS and what we can do to improve health outcomes for men with this particular hormonal and metabolic profile.

What causes early-onset androgenic alopecia (aka baldness)?

The accepted mechanism behind androgenic alopecia is the excessive accumulation of dihydrotestosterone (DHT, a metabolite of testosterone) at the hair follicle. Within the hair follicle, androgen receptors bind to DHT, shrink the follicle, change the hair shape, and eventually cause it to stop growing (3).

Like most complex syndromes, there isn’t a clear-cut explanation for why this happens, either later in life or early on. Instead, there are many factors at play.

For early-onset baldness, factors to consider are diet and lifestyle, insulin resistance, inflammation, and genetics.

Dietary patterns, including a Western-type diet and increased alcohol consumption, may be a contributing factor to hair loss before age 30.

A 2021 study of male university students found that unhealthy nutrition and lifestyle habits, particularly smoking and imbalances in the intake of meat and produce, were more common in young men with early-onset androgenic alopecia (4). Another study found that regular alcohol consumption is associated with hair loss at an earlier age in men (5).

Frequent consumption of sugar-sweetened beverages is linked to early-onset balding, as observed in a novel 2023 study of men aged 18-45 years. Those who reported drinking a sugar-sweetened beverage seven times or more a week had two times the odds of having hair loss (6).

Notably, these results were adjusted for confounding factors such as BMI, smoking, alcohol, family history, hair dyeing, nutrient intake, sleep, and physical activity. Interestingly, when the researchers adjusted for a history of PTSD, the odds became less significant, indicating the influence that mental and emotional health may have on this condition (6).

Something that PTSD and a high-sugar diet have in common is the development of oxidative stress and systemic inflammation (7, 8). Not surprisingly, oxidative stress is elevated in those with androgenic alopecia (9, 10). Oxidative stress occurs when there is increased production of reactive oxygen species, free radicals, and insufficient antioxidants to quench them. This results in heightened inflammation and damage to cells and DNA. For older men, this is a plausible factor behind hair loss—increased oxidative stress is associated with aging (11). However, for young men, oxidative stress isn’t attributable to the natural aging process and is likely created by other circumstances.

Erdogan et al. (2017) observed that young men with early balding had significantly increased oxidative stress markers and suggested that an antioxidant protocol would be a promising treatment for early-onset androgenic alopecia (12). Men with a family history of AGA had even higher levels of oxidative stress, which may indicate a genetic role in not only AGA but also redox potential (12).

Insulin resistance is part of the symptom cluster that defines the male equivalent of PCOS.

However, it’s not clear whether it precedes and contributes to AGA. Matilainen et al. (2001) suggested that AGA may be a clinical marker of underlying insulin resistance (13). A 2019 case-control study observed that 39% of men with AGA (age 20-30 years) had metabolic syndrome, as compared to 4% of matched controls (14).

A recent study also found a minimal connection between insulin resistance and AGA but a stronger link to imbalanced pro-inflammatory and anti-inflammatory adipokines and vitamin D deficiency (15).

The genetic links behind PCOS and male hormonal imbalance (If your mom has PCOS, are you more likely to be bald?)

For a woman with PCOS, her mother likely had PCOS or hormonal imbalance, and the next generation of women may be predisposed to PCOS. This pattern occurs because PCOS has a known familial component, meaning genetics are involved.

But what about men born to a mother with PCOS? You guessed it (or maybe you didn’t because this is seriously out there stuff!) – those men are more likely to have early onset baldness!

“First-degree female relatives of affected individuals [women with polycystic ovaries] had a 51% chance of being affected. Early onset male pattern baldness (MPB) was found to be an accurate phenotype for obligate male carriers” (16).

This is mind-blowing, but it’s not new information. A 1989 paper observed this genetic link, with their finding that 19.7% of male first-degree relatives of women with PCOS had early baldness or excessive hairiness, as compared to 6.5% of relatives of controls (17).

A 2022 study examined this further by creating a genetic risk score based on data from women with PCOS. They then looked at the genes of 176,000 men to see if they had the same high-risk genes for PCOS. They found that men with multiple genes for PCOS had increased odds of androgenic alopecia, type 2 diabetes, and coronary artery disease. And there’s more—multiple PCOS genes in men meant higher hemoglobin A1C and lower SHBG (18), overall a profile that may indicate the male equivalent of PCOS.

Infertility and male PCOS

Although the male counterpart to PCOS and infertility have not been explicitly studied, several of the symptoms associated with this condition are independent risk factors for infertility or poor sperm health.

Young men with moderate to severe AGA may have significantly lower semen quality than healthy controls. This includes sperm motility, volume, and morphology (19).
Insulin resistance is linked to poor sperm quality and male infertility (20).
Obesity is linked to male infertility, which can be reversed with weight loss (21, 22).
Men with infertility and low sperm count have lower levels of SHBG than their healthy counterparts. Additionally, low SHBG may reduce sperm motility (23).

What can you do? Diet and lifestyle make a difference!

Based on the available literature, I have found a few useful and practical strategies to improve biomarkers for the male PCOS profile. As with female PCOS, exercise, therapeutic foods, and toxin avoidance are essential factors to consider to improve male hormonal and metabolic health.

Resistance training increases SHBG and decreases the free androgen index (24), a marker of early-onset androgenic alopecia (25).

According to a 2013 study, practicing resistance training three times a week for one hour effectively increases SHBG, reduces the free androgen index, and improves glucose regulation in young men with a high BMI (24). Below is the training regime used in the study.

Two different programs were rotated between days:

Workout 1: Dumbbell squat, cable row, dumbbell front lunge, barbell deadlift, dumbbell row, curl, and tricep extension

Workout 2: Barbell chest press, dumbbell step-up, machine squats, dumbbell overhead press, dumbbell incline chest press, dumbbell reverse fly, dumbbell side raise, abdominal crunches

Phase 1 (Week 1-2): Two sets of 12-15 reps for each exercise, with individualization so the participant could ONLY complete 12-15 reps due to the heaviness of the weights
Phase 2 (Week 3-7) Three sets of 8-12 reps
Phase 3 (Week 8-12) Three sets of 6-8 reps

Workouts were conducted on three non-consecutive days of the week, and the weight increased as participants adapted.

A Mediterranean-type diet, emphasizing fresh vegetables and herbs, may prevent the onset of hair loss in men (26).

A 2018 case-control study found that men who consumed raw vegetables and fresh herbs three or more times a week were around 65% less likely to develop androgenic alopecia. These protective effects remained after controlling for confounding factors like family history, smoking, and BMI (26).

Abundant evidence supports a Mediterranean-type diet for its anti-inflammatory qualities and effectiveness in reducing the risk of metabolic syndrome, type 2 diabetes, and cardiovascular disease (27, 28).

Endocrine-disrupting chemicals, such as BPA, are linked to insulin resistance and metabolic dysfunction and may contribute to the development of PCOS in women (29, 30).

BPA affects male reproductive health, as well, and may be a factor in male infertility (31, 32). In a study of 218 men, those with BPA in their urine had more than 4x the risk of low sperm count and 2x the risk of poor sperm motility when compared to men without detectable BPA (33).

In vitro studies have shown that in addition to the disruptive effects of BPA on hormones, it also increases oxidative stress, contributing to mitochondrial dysfunction and damage to the sperm cell (34). Therefore, dietary antioxidants may help alleviate the harmful effects of endocrine disruptors like BPA. In vitro and animal studies suggest this may include vitamins C & E, N-acetyl cysteine, taurine, melatonin, and phytochemicals like flavonoids and adaptogens like cordyceps (36).

Above all, focusing on simple foundations will benefit men who meet some or all of the criteria for the male counterpart to PCOS. This can look like regular physical activity and resistance training a few times a week, prioritizing various high-antioxidant foods, including fresh vegetables and herbs, and avoiding endocrine-disrupting chemicals like BPA.

Click here if you need help navigating these dietary and lifestyle changes! This link allows you to sign up for a free discovery call where we can discuss the best way to address your unique symptoms and concerns.

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