I have excessive body hair and obesity. Please help.

Question

Hi doctor,

I have had PCOS for over a decade now. I initially saw a gynecologist who tried oral contraceptive pills, microgynon, and spironolactone. She did a battery of blood tests and ultrasounds to confirm I have the condition. A general physician prescribed Metformin a few years back. All of the medications had little to no effect. Recently, I was referred to an endocrinologist and it was discovered that I have a missing 21 hydroxylase enzyme. Other tests were done but were normal. My cortisol was fine. However, my testosterone levels were high and it was found that I was indeed Insulin resistant.

The endocrinologist has put me back on Metformin 500 mg, three times daily and has requested that I return and see them in six months. I suffer from severe hirsutism, thinning of hair on the scalp, and obesity. Despite me being active and having a fairly good diet, it has been extremely difficult to lose weight. I cannot help but think that they have missed something. Can you have adrenal hyperplasia with insulin resistance? They have said no more to me with regards to the missing enzyme. None of the doctors seem to be able to treat my condition.

Answer 1

Hello,

Welcome to icliniq.com.

I just read your query and from what you have mentioned, it appears that you have a 21-hydroxylase deficiency and that causes an excess of testosterone and androstenedione causing virilization of females and PCOS. This is the cause of your hirsutism and insulin resistance as well. The treatment of Metformin is alright, but you also need oral contraceptives to combat these excess androgens produced. The missing enzyme cannot be replaced. Only the resultant issues arising from its deficiency can be dealt with. Since your cortisol was fine, the doctors are not worried about the missing enzyme anymore. Yes, you can have adrenal hyperplasia and insulin resistance together. Please try to exercise as well as to lose some weight as it helps with your symptoms.

Hope you find my advice of some benefit. Good luck.