Male or Female? A Mystery to be Solved! by Merina Guiste

Have you ever walked pass an individual, and at a glance they appeared to be male, but on a second appraisal they have breasts? Now I am not speaking about ‘man boobs’, known as Gynecomastia. I’m speaking about real breasts in a brassiere! The individual has the appearance of a fully grown man who is tall, broad shouldered, deep voice, facial and chest hair, and even appear to have bald spots or thinning hair. But on the other hand, they have boobs!

I once had an encounter with such an individual. A close family friend, in truth and in fact, my neighbor. As a young girl growing up this was a mystery to me, one I was intent on solving. A question I asked myself repeatedly to the point of headaches, ‘Is such a person male or female?’. However upon observations, that clearly didn’t stop her from being a normal person interacting with others. She never appeared to be socially awkward and uncomfortable and fitted right in with both the male and female gender.

One day, I gathered the courage to ask the question which would solve the mystery which had become my own private demon, What gender are you? She simply laughed and told me she was female, but had a condition named Polycystic Ovary Syndrome, PCOS, which was caused by hormones. To my little 12 year old self, this was all utter gibberish to me (and may I add, I still held my belief that she was both male and female), but now deep in my biology studies it finally made sense and I researched it further.

  

Polycystic Ovary Syndrome is a condition in which a woman’s hormones are out of balance. Women with PCOS grow many small cysts on their ovaries, hence from where the name arose. The cysts themselves are not harmful, but they cause overproduction of the sex hormones in women which leads to hormonal imbalances which can have a few detrimental effects. One might ask, how does a few inconsequential cysts on the ovaries causes such drastic physical changes in appearance, diabetes and heart disease and also alter the body menstrual cycle?

Hormones are chemical messengers that trigger many different processes, some of which includes growth and energy production. Often, the job of one hormone is to signal the release of another hormone. For reasons that are not well understood as of yet, in Polycystic Ovary Syndrome the hormones get out of balance. One hormone change triggers another, which changes another hormone. The cysts causes an overproduction of a hormone. In polycystic Ovary Syndrome, the sex hormones get out of balance. Normally the ovaries make a tiny amount of male sex hormones, androgens. In PCOS, the ovaries start making slightly more androgens. This increase in production of the male sex hormone causes women to stop ovulating, get acne, grows extra facial and body hair. It can also cause infertility, diabetes and heart disease if left untreated. 

The female body may also have a problem using insulin, called insulin resistance. When the body doesn’t use insulin well, blood sugar levels rise, overtime this increases chances of having diabetes. Polycystic Ovary Syndrome can stop ovulation. Follicle-Stimulating hormone, a hormone which stimulates gamete (egg or sperm) production, along with Luteinizing Hormone causes the maturation of the ovarian follicle. Luteinizing hormone also work alone to trigger ovulation which is the expulsion of the egg from the follicle. But a woman with POCS doesn’t ovulate as the cysts inhibits the production of the egg by producing increased levels of androgen, the male sex hormone. No ovulation will lead to no menstrual cycle as the egg was never released. The increased male sex hormone will suppress the female hormones putting a halt to ovulation. This lack of ovulation overtime will lead to infertility.  Androgens will cause the female to develop the secondary sexual characteristics of a man resulting in the deep voice and increased body hair to name a few.

Polycystic Ovary Syndrome is genetically caused. It appears to run in families and if you have irregular periods and diabetes.  PCOS can be passed down from both your mother’s or father’s side.

To be diagnosed with Polycystic Ovary Syndrome a series of test must be taken and also medical history of both the individual and family must be considered. Also a physical exam and a pelvic ultrasound to see if cysts are present. Lab tests include blood tests to check for testosterone, which is an androgen. Androgens at high levels can block ovulation, cause acne, male-type hair growth on the face and body, and hair loss from the scalp.  Test for Prolactin, which can play a part in a lack of menstrual cycles or infertility. Test for cholesterol and triglycerides, which can be at unhealthy levels with PCOS. Test for Thyroid-Stimulating Hormone to check for an overactive or underactive thyroid. And lastly a test for glucose tolerance and insulin levels, which can show insulin resistance.

Treatments for Polycystic Ovary syndrome are a healthy lifestyle which includes exercise and a good diet, hormone therapy to balance off hormones and allow ovulation to occur, having regular checkups and surgery can also be undertaken to remove the area with the cysts. One can also take medicines such as a combination of estrogen and progestin hormones in birth control pills, vaginal rings, or skin  patches. These hormones correct irregular menstrual bleeding or absent menstrual cycles. They may also improve your androgen-related acne problems, male-type hair growth, and male-pattern hair loss. Another is Synthetic progestin if you are not able to use the hormone estrogen : The progestin makes your endometrial lining build up and shed, similar to a menstrual period. This monthly shedding is what prevents uterine cancer.  Also Androgen-lowering spironolactone (Aldactone) can be used. It is a diuretic which is often used with estrogen-progestin therapy. This reduces hair loss, acne, and abnormal hair  growth on the face and body . Another important medicine is Metformin (Glucophage). This diabetes medicine is used for controlling insulin, blood sugar levels, and androgen levels.  To increase female hormones Clomiphene  can be used, as they are fertility medicines, and gonadotropin injections (LH and FSH).