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Found elevated testosterone and TSH level. Experiencing hair fall and weight gain. Cause and cure?

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General & Family Physician
Practicing since : 1986
Answered : 458 Questions
Dear Doctor,

We did our annual medical tests a couple of days ago, and my wife's testosterone level was repoted to be 84.3 ng/dl. I understand that the normal range for testosterone in women is 14 to 76.

Her TSH levels were reported to be 6.10 micro IU / ml. This is also outside the normal range of 0.3 to 5.5.

She's also been experiencing hairfall and weight gain.

Can you please suggest what could be the cause of high levels of testosterone and TSH? And what do we need to do to get this under control?
Posted Tue, 14 May 2013 in General Health
Answered by Dr. Nirmala P 13 hours later
Thanks for asking in Healthcare Magic.

Your wife's high testosterone, high TSH levels and the other symptoms like hair fall and weight gain are suggestive of Poly Cystic Ovarian Disease (PCOD). 1 to 5% women suffer from PCOD and it is the most likely cause of her symptoms.

PCOD is a multiple endocrinal (hormonal) problem involving alteration in the functions of many endocrine organs. It is due to hormonal imbalance. The common symptoms are
1. Disruption of menstrual cycle (usually irregular and scanty).
2. Loss of scalp hair (male pattern baldness in some women), excessive facial, and body hair.
3. Weight gain.
4. Acne, dry skin and dandruff.

In PCOD the level of estrogen and progesterone are low whereas the level of testosterone is high causing irregular menstrual pattern and hair fall. Weight gain is due to insulin resistance and hypothyroidism (high TSH and low T4). These hormonal irregularities often coexist.

Some more investigations need to be done for her to confirm the diagnosis. Her LH, FSH, Prolactin, GTT, blood glucose, insulin and lipid profile values are required to help in the diagnosis and to decide about further course of treatment. In PCOD, there will be insulin resistance (improper action of insulin) resulting in altered GTT and abnormal values of blood glucose, insulin and lipid profile. Ultrasound of ovary will confirm the diagnosis.

If PCOD is confirmed, then she may need Metformin to improve insulin action, OCP to regularize the period and Aldactone (spiranolactone) to reduce testosterone level. You should visit your treating Dr to confirm the diagnosis and for further course of treatment.

I hope this helps.
Above answer was peer-reviewed by
Follow-up: Found elevated testosterone and TSH level. Experiencing hair fall and weight gain. Cause and cure? 9 hours later
Hello Doctor,

Thanks for your reply. I've attached my wife's medical report with this thread now. Please take a look at it.

I have a few more queries:

My wife's blood sugar level was normal and I therefore presume that her insulin action is normal too. Her lipid profile suggests normal levels too. Given this situation, is it possible that she has PCOD?

Her testosterone level was high, and she is experiencing scanty periods. So, almost all other symptoms except for insulin resistance is there.

I understand that the following tests need to be performed for my wife: LH, FSH, Prolactin, GTT, insulin profile. Are there any criteria for performing these tests? (like empty stomach, after food, during menses, etc.)

(Lipid profile has already been done just 3 days ago, which seems normal and so I presume that doesn't have to be repeated).

Kindly advise.

Answered by Dr. Nirmala P 2 hours later
Welcome back to Healthcare Magic Forum.

Thanks for sending all the reports and I went through the details.

I am happy to note that Mrs. Sushma's blood sugar, lipid profile values are normal. Since HbA1C value (5.2) is well within normal limits, there is no need for GTT and insulin test as she does not have insulin resistance.

I also noticed that her TSH is high but her T4 is in normal range indicating that she is having only Subclinical Hypothyroidism (minimal deficiency of thyroid hormone). So the weight gain and hair fall are due to increased testosterone level.

Yes it is still possible that she has PCOD and to rule out PCOD we need to know her LH, FSH, Estrogen and Prolactin level. As I mentioned earlier, ultrasound of ovaries will reveal if there are multiple cysts. So you can do ultrasound first and if need be the other blood tests can be done.

There are 3 phases in a menstrual cycle namely follicular, midcycle (ovulation) and luteal phases. The secretion of LH and FSH are pulsatile and this is essential for maintaining normal menstrual pattern. So the level of these hormones vary depending upon what time of month you take the test.

You can consult your treating Dr to decide about the time of test. There is a mid cycle surge (increase during ovulation, on the 14th day in 28 day cycle) of these hormones and so it will be better if they are estimated during that time. Prolactin test can also be done at the same time. However, fasting is not required for these tests.

I hope that I have given you a satisfactory reply. I will be happy to assist you if you have further queries.
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