From the Guidelines
Combined oral contraceptives can suppress the levels of DHEAS, 17-hydroxyprogesterone, and testosterone in women, primarily through the suppression of androgen secretion by the ovaries and an increase in the level of circulating sex hormone binding globulin. The use of combination oral contraceptive pills is a common long-term management strategy for polycystic ovary syndrome (PCOS) due to their demonstrated benefits in reducing androgen levels and the risk of endometrial cancer 1. These medications work by suppressing the secretion of androgens by the ovaries and increasing the production of sex hormone-binding globulin, which binds to free testosterone and reduces its bioavailability.
Key benefits of using combined oral contraceptives for hormonal suppression include:
- Suppression of androgen secretion by the ovaries
- Increase in the level of circulating sex hormone binding globulin
- Reduction in the risk of endometrial cancer
- Improvement in symptoms associated with androgen excess, such as hirsutism and acne
The optimal formulation and duration of treatment may vary depending on individual patient needs and responses, with those containing anti-androgenic progestins potentially providing more significant reductions in androgen levels. As noted by the American College of Obstetricians and Gynecologists (ACOG), the use of medroxyprogesterone acetate can also suppress circulating androgen levels and pituitary gonadotropin levels in women with PCOS 1. However, the choice of progestin and the duration and frequency of treatment should be tailored to the individual patient's needs and medical history.
From the Research
Effect of Combined Oral Contraceptives on Androgen Levels
- Combined oral contraceptives (COCs) have been shown to decrease levels of androgens, including testosterone (T), dehydroepiandrosterone (DHEA), and DHEA-sulfate (DHEA-S) 2, 3, 4, 5, 6.
- The decrease in androgen levels is due to the inhibitory effect of COCs on ovarian and adrenal androgen synthesis, as well as the increase in sex hormone-binding globulin (SHBG) levels 5.
- Studies have reported a significant decrease in total T levels, with a mean decrease of 61% in free T levels, and a significant increase in SHBG concentrations during COC use 5.
Restoration of Androgen Levels by Adding DHEA to COCs
- Adding DHEA to COCs has been shown to restore total T levels to baseline levels, and free T levels to near-baseline levels 4, 6.
- The addition of DHEA to COCs increases all androgens measured, including total T, free T, DHEA-S, and Δ4-androstenedione (AD) 4, 6.
- However, the daily dose of DHEA required to normalize free T levels completely may depend on the type of COC used, with 50 mg/day being insufficient for COCs containing drospirenone (DRSP) 4.
Specific Effects on DHEAS, 17-Hydroxyprogesterone, and Testosterone
- COCs decrease DHEA-S levels, which can be restored by adding DHEA to the COC regimen 2, 4.
- There is limited information available on the specific effects of COCs on 17-hydroxyprogesterone levels.
- Testosterone levels, including total T and free T, are decreased by COC use, but can be restored by adding DHEA to the COC regimen 4, 5, 6.