Dr. Tabatha Barber clarifies that PCOS isn't actually about ovarian cysts, which are often unrelated to the condition. The real issue is hormonal imbalance causing small ovarian follicles, and doctors should measure free testosterone and SHBG instead of just total testosterone to diagnose it properly.
The problem came that a lot of people didn't understand the mechanism behind what was happening with PCOS and what was driving these symptoms. Women were getting diagnosed incorrectly and cysts on the ovary were probably the biggest one. And I still hear that today. Women will tell me, oh yes, I, I had a 4 centimeter cyst. I have polycystic ovarian syndrome and my doctor put me on a pill that is not pcos. We create cysts on our ovaries for other reasons. So I really wish they wouldn't have named it PCOS because it confuses people. It's not that you are making cysts on your ovaries that's driving the issue that those tiny little follicles are there because of hormone imbalances, which I'm going to explain. So if you have a bigger cyst, usually it's over 2cm or you get these repeated cysts. That's probably not PCOS. Those are termed functional cysts, corpus luteum cysts, hemorrhagic cysts, dermoids, endometriomas, cystadenomas, and then there's obviously malignancy, which is a whole different ball game. But you make cysts every month. Like I said, when you do ovulate and sometimes that leftover area can turn into a cyst and fill up with fluid. That's a corpus luteum cyst. You can get fluid filled cysts on top of the ovaries. Those are adenomas. You can bleed into that corpus luteum area. That's called a hemorrhagic cyst. You can have endometriosis and get endometriosis. Endometriomas, which are filled with a brown liquid substance, it looks like liquid chocolate. Those are endometriomas. So those are different cysts and they have nothing to do with pcos. So please make sure that if you are getting the diagnosis that it's actually the correct diagnosis. The second part of it, the androgens. So testosterone and dhea, you don't always have to have grossly elevated hormone levels. I'll often see women who seem to fit this picture of pcos. They have acne, they have hirsutism, they're only having their period a couple times a year. But because their total testosterone wasn't elevated, they get dismissed and they're told that's not an issue. But androgens are very complex. Not only are they made in the ovary, they're also made in the adrenal glands. And so you have dhea, which comes from both the ovaries and the adrenal glands, that can get converted into testosterone. Testosterone gets converted into dht, which is a very potent androgenic form. And that's the kind that you really don't want because that usually causes acne and abnormal hair growth and scalp hair loss. It can deepen the voice, cause your clitoris to become enlarged, all these things. But it's not only about the total testosterone or the total dhea, because our hormones, they get bound to proteins and they get carried around our body connected to these proteins. And as long as they're connected to those proteins, they're not available to bind to a receptor on a cell and send the signal. And so if you have a lot of sex hormone binding globulin around oralbumin, those hormones will bind to that and not be available to send a signal. So it's really important to know what your free available testosterone is, because I've seen women with normal total testosterone, but because their sex hormone binding globulin is so low, they have a ton of free available testosterone to bind to receptors and cause all these symptoms. So there's definitely multiple pieces to the puzzle. You need to know what is your sex hormone binding globulin? What is your free available testosterone? What is your D A S meaning sulfated version level? All of those.
