# PCOS

Category: Conditions

Also known as: polycystic ovary syndrome, polycystic ovarian syndrome

PCOS is fundamentally a condition driven by excess estrogen, not an excess of androgens as mainstream medicine claims. Ray Peat argued that the elevated androgens characteristic of the syndrome are a defensive adaptation; when the body is shocked by a dose of estrogen and lacks…

10 passages · 3 authors · 2006–2022 · Most-cited: [Danny Roddy](https://bioenergeticoracle.com/md/voices/danny-roddy/index.md)

Canonical page: https://bioenergeticoracle.com/concepts/pcos

## Synthesis

**PCOS** is fundamentally a condition driven by *excess estrogen*, not an excess of androgens as mainstream medicine claims. [Source 1, 3] Ray Peat argued that the elevated androgens characteristic of the syndrome are a defensive adaptation; when the body is shocked by a dose of estrogen and lacks the resilience to produce sufficient **progesterone**, it responds by increasing androgen production. [Source 1] This framing inverts the standard "hyperandrogenic anovulation" model, identifying a **progesterone deficiency** as the core failure that allows the pathology to proceed. [Source 1, 5] Georgi Dinkov has pointed out the contradiction in official descriptions, noting that while the condition is labeled hyperandrogenic, medical literature also admits to an incredibly high production of estrogen and a near-universal presence of central obesity, which is indicative of high cortisol. [Source 2]

The mechanism of estrogen-driven ovarian damage involves a direct induction of the syndrome. Animal studies demonstrate that administering estradiol valerate—the same estrogen ester used in most contraceptive pills—reliably produces PCOS in just a few weeks. [Source 3, 4] Dinkov has highlighted that the doses used in these experiments are often lower than what women take daily for years, suggesting a direct link between the epidemic of PCOS and the widespread use of hormonal contraceptives. [Source 4] Peat detailed a specific neurological pathway where estrogen induces the production of nerve growth factor in the ovary, causing an invasion of **sympathetic nerves**. [Source 8] This sympathetic overgrowth suppresses the number and activity of mast cells, which are required for follicles to rupture, thereby preventing ovulation and creating the cystic morphology. [Source 8]

The metabolic context for this estrogen dominance is a state of low thyroid function and stress. The pituitary hormones **luteinizing hormone (LH)** and **follicle stimulating hormone (FSH)** have estrogen-like actions and are increased by a perceived energy deficiency, which is fundamentally a problem of low thyroid-driven oxidative metabolism. [Source 9] Prolactin, another pituitary hormone elevated in stress, inhibits ovarian progesterone production and reduces the cell's ability to consume oxygen, pushing metabolism toward *glycolysis* and lactic acid production instead of oxidative energy. [Source 9] Dinkov has noted that the largest studies on PCOS found elevated **DHEA-S**, an adrenal androgen, rather than DHT, tying the condition to excessive adrenal activity that kicks in when thyroid and gonadal function are insufficient. [Source 6] This explains why PCOS is considered the female analog of premature male pattern baldness, as both conditions share a hormonal environment of low thyroid, high estrogen, and high stress hormones. [Source 4, 10]

Therapeutic approaches consistent with this model focus on reducing estrogen's effects and restoring oxidative metabolism. Peat emphasized that anti-estrogenic interventions are highly therapeutic. [Source 3] Dinkov has reported that aromatase inhibitors can stop PCOS, and that high doses of **progesterone**, aspirin, or vitamin E can be helpful. [Source 7] He has also observed that **cyproheptadine**, a drug with potent estrogen receptor alpha-inhibiting effects, has fully stopped PCOS and reversed fibroid cystic effects in some cases. [Source 7] However, the most systemic approach targets the root cause: thyroid supplementation to calm the pituitary and reduce the stress response, rather than chasing individual stress biomarkers. [Source 6] Danny Roddy has summarized that the cell's inability to produce oxidative energy and its shift toward glycolytic cell division under estrogen's influence is the fundamental pathology, making the restoration of proper metabolic function the central therapeutic goal. [Source 9]

## People also ask

### What does Ray Peat identify as the root cause of PCOS?

Peat argued that PCOS is fundamentally driven by excess estrogen and a resulting progesterone deficiency, which forces the body to defensively increase androgen production.

### How does estrogen directly damage the ovaries to prevent ovulation?

The entry describes how estrogen induces nerve growth factor in the ovary, causing a sympathetic nerve invasion that suppresses mast cells needed for follicles to rupture, thereby creating cystic morphology.

### Why is thyroid function considered central to reversing PCOS?

The corpus explains that low thyroid-driven oxidative metabolism increases pituitary stress hormones like LH and prolactin, so thyroid supplementation is proposed to calm the pituitary and restore proper metabolic function.

## Related concepts

- [Adrenaline](https://bioenergeticoracle.com/md/concepts/adrenaline/index.md)
- [Acetylcholine](https://bioenergeticoracle.com/md/concepts/acetylcholine/index.md)
- [Alkalosis](https://bioenergeticoracle.com/md/concepts/alkalosis/index.md)
- [Cellular respiration](https://bioenergeticoracle.com/md/concepts/cellular-respiration/index.md)
- [DHT (Dihydrotestosterone)](https://bioenergeticoracle.com/md/concepts/dht-dihydrotestosterone/index.md)
- [Diphenhydramine](https://bioenergeticoracle.com/md/concepts/diphenhydramine/index.md)

## Cited passages

Passage numbers match the `[Source N]` markers in the synthesis above.

### Source 1 — #86 - The Estrogen Industry, the magic of progesterone and the importance of thyroid with Dr Ray Peat & Kate Deering

Ray Peat · Interview · Jan 31, 2022

> **Kate Deering:** I see. So just to sum that up, PCOS is normally characterized by excess androgens, but that's certainly how it's described in the medical world. And also maybe some sort of insulin resistance that goes along with it. But essentially you're saying that it's an increased amount of androgens, but usually those are converting into the estrogens and that's creating the issues.
>
> **Ray Peat:** Yeah. Failure to produce enough progesterone was really part of the problem that let it go down that pathway.
>
> **Kate Deering:** Gotcha. So sum that up. Estrogen is bad. Not bad. I want to say, I don't ever say bad. So estrogen, excess estrogen is certainly not what you want. And progesterone is like the superhero of all of it. Yes?
>
> **Ray Peat:** Yes.
>
> **Kate Deering:** I love when you agree with me. Well, Dr. Peat, that was awesome. Kitty, are you still there? I know I like love to talk.
>
> **Kitty Blomfield:** No, it's so good. I'm here and listening and learning so much. That was amazing.
>
> **Kate Deering:** Yeah. Ray, that was, I, I, I, Kitty's, I always get very honored. Kitty lets me come on her show and I get to talk to you and she just lets me take it. Cause I, I'm a, I'm such the super fan.

### Source 2 — PMS, PCOS, and Breast Cancer [Generative Energy #17]

Danny Roddy · Interview · Dec 30, 2015 · https://www.youtube.com/watch?v=sDu-bLKwnSI

> **Georgi Dinkov:** So it's funny to me that officially it's basically, if you look at Wikipedia, which like Ray Peat is the consensus of modern medicine, they say the disease is likely genetic and basically there's no cure. Even the Wikipedia page says everybody, almost everybody with PCOS has obesity, central obesity, which is indicative of high cortisol, hyperinsulinemia, hypercortisolemia. And of course, now they're saying, they also admit that there's also an incredibly high production of estrogen in PCOS. But it's still, I think officially, it's still called hyperandrogenic anovulation. It tells you how twisted the reality is. Nobody really, I guess, officially understands what it is. And I don't know which one is worse, to be so wrong or to be so misguided.

### Source 3 — Estrogen directly causes polycystic ovary syndrome (PCOS)

Georgi Dinkov · Article · Jul 26, 2020 · https://haidut.me/?p=1165

> The worldwide rates of PCOS are skyrocketing, and have more than doubled over the last 10 years. Currently, about 12% of women in child-bearing age living in “developed” countries have PCOS and as a result struggle with infertility, diabetes, CVD, acne, bone issues, and even cancer. The fact that infertility is almost always present in those women as well as the well-known connection between infertility and estrogen should have given a hint to endocrinologists long time ago that estrogen may be a causative factor in PCOS. However, not only has this simple connection escaped the minds of endocrinologists but they usually claim the exact opposite – i.e. that estrogen is a protective factor and it is elevated androgens that cause PCOS. The fact that androgens are actually known to improve insulin sensitivity, fertility, bone health, etc in BOTH men and women, and have been used clinically for decades to correct those issues is conveniently ignored by th emedical gurus in their lofty public statements. Peat has written extensively on the topic, and has repeatedly told people over email or during interviews that estrogen is the main causative factor for PCOS and anti-estrogenic interventions are highly therapeutic. There has been a lot of criticism in regards to his views and I have also gotten hate mail for “defending” his views. I am not defending anybody, I simply look at the available evidence and make conjectures based on the known metabolic effects of various steroids. Almost 3 years ago I did a post on 2 articles implicating estrogen in PCOS, but I received criticism about that post too since the studies in it were observational. Recently, an article reviewing the role of estrogen in “metabolic” diseases (of which there are very few according to mainstream medicine) popped up in my news feed and it raised the alarm that the current epidemic of PCOS may be linked to the rising rates of hormonal contraceptive use among young women. The article did not directly say estrogen is the cause of PCOS, opting instead for the more popular statement that the issue is “controversial”.

### Source 4 — #34: Endotoxin and Isolation | Topical Vitamins | Estrogen, PUFA, and PCOS | Doxycycline and Stress with Georgi Dinkov

Georgi Dinkov · Interview · Aug 15, 2020 · https://open.spotify.com/episode/5LJEavAabKUJdcj1xYMpdN

> **Georgi Dinkov:** But if you start peeling the layers of the onion, eventually you get nothing, just like an onion. You can't even get to the core. There is no core. But quite a few other independent groups are saying, well, there may be different types of PCOS, but we know for sure that... The standard one with all of the constellation of symptoms that we know as PCOS can very reliably and easily be produced by really not that high dosages of estrogen valerate, which most women that are taking birth control pills take doses that are two to three times higher on a daily basis, often for decades. So there is one possible cause or, you know, one cause that will probably explain a double digit percentage. of the current epidemic of PCOS that we're seeing everywhere, like worldwide.

### Source 5 — #104 - Q & A with Danny Roddy

Danny Roddy · Interview · Apr 4, 2022

> **Kitty Blomfield:** They usually suffer from insulin resistance that they have clients with PCOS. Yeah, yeah. They'll have like high free fatty acids,
>
> **Danny Roddy:** but that will keep the blood sugar relatively high, I think. Yeah, that's a new one. I'd ask this person more questions. I'd ask them about other blood levels they had, their pulse and temperature and things. There are a few articles that talk about PCOS being a result of progesterone deficiency and obviously thyroid deficiency because they go together.
>
> **Kitty Blomfield:** And so, yeah, I'd ask more questions, I think. Can you ask Danny how he optimized testosterone when he said it was once low? Oh, no, he's frozen. Oh, there we go. It was really low.
>
> **Danny Roddy:** It was like 120, which is like an old 90-year-old man. Just Danny. Okay, we're back. Sorry. Hang on.
>
> **Kitty Blomfield:** We'll start that again. We're having a bit of internet issues. So start again from the start. You know what?
>
> **Danny Roddy:** I could pause this and turn on my VPN, but it might just like kill our connection. Do you think? but it's up to you. You're going to probably have to like edit this or something.

### Source 6 — IdeaLabs Forum Q&A — 11-keto DHT

Georgi Dinkov · Forum Q&A · Jul 21, 2016

> **whit:** (2016-09-11) Has anyone seen this study? The effect of androgens on ovarian follicle maturation: Dihydrotestosterone suppress FSH-stimulated granulosa cell proliferation by upregulating PP... - PubMed - NCBI It may be how prolactin/serotonin manifests its effects in women where as men lose hair and have prostate inflamation.
>
> **Georgi Dinkov:** (2016-09-11) Women also lose hair, they actually get the same "male pattern baldness" (MPB) as men. Hypothyroidism (Cortisol, Prolactin And Adrenal Hyperactivity) Causes Balding The MPB term is little by little becoming just as laughable as "androgen-driven prostate cancer" or "estrogen-negative breast cancer".
>
> **unexamined_whimsy:** (2016-09-12) Women with PCOS frequently have elevated androgens, particularly DHT. Their estrogen levels are clearly through the roof though since they usually have bad water retention.
>
> **Georgi Dinkov:** (2016-09-12) Actually, the largest studies on PCOS did not find elevated DHT but rather DHEA-S. Similar to the baldness in men, PCOS seems to be tied to aromatizable steroids and excessive adrenal activity. If you have higher DHT and T levels, adrenal activity will be lower. T and DHT levels are symptoms of good thyroid and proper synthetis of steroids from the gonads. Adrenals kick in when thyroid/gonads are not doing their job. Adrenals are controlled by the pituitary, and the only primary purpose of the pituitary is to respond to perceived stress signaled by the hypothalamus and CRH release.

### Source 7 — #21: Coronavirus, Hair Loss, Finasteride, DHEA, DHT, and Question Catch-Up with Georgi Dinkov

Georgi Dinkov · Interview · Mar 27, 2020 · https://open.spotify.com/episode/2tym7r7CIbtrzBp8EMoX7S

> **Georgi Dinkov:** Also, PCOS is actually now at this point fairly well known to be driven by estrogen. So in the early stage, estrogen is what irritates the adrenals. And while they're still working well, we'll be pumping out a lot of DHEA. But with age, that has been shown to eventually DHEA production declines and you're stuck with only the estrogen. And that's really when all the really bad problems with PCOS start. So surprisingly, you know, or unsurprisingly, there are some older studies that show that aromatase inhibitors can actually stop PCOS in its tracks. But most doctors, they shy away from that because estrogen is stopped, is such a beneficial female hormone, nobody wants to inhibit it. So the, you know, if the situation becomes really bad, I think high dose of progesterone may help. I have clients, female clients who've said that high doses of aspirin have helped. And I also have clients which have said that cyproheptadine actually managed to fully stop their PCOS and in many cases reverse some of the fibroid cystic effects that they had. And I was initially surprised by that, but recently I saw studies showing that cyproheptadine has a remarkably strong inhibiting effect on estrogen receptor alpha. So it is a very viable and potent anti-estrogenic drug as well. So if progesterone or aspirin or vitamin E are not working for you for whatever reason, or the situation is really dire, you may want to consider cyproheptadine as well.

### Source 8 — Autonomic systems

Ray Peat · Article · 2006 · https://raypeat.com/articles/other/autonomic-systems.shtml

> One injection of estrogen can induce a large increase in the number of sympathetic nerves in the ovaries. At menopause, a similar “invasion” of sympathetic nerves occurs. The polycystic ovary (which is even more common after menopause than before, and some studies have found the condition in 20% of premenopausal women) responds to estrogen by producing nerve growth factor(s), and growing a large number of new sympathetic nerves.
>
> Although the hyperestrogenism associated with the polycystic ovary syndrome has many harmful effects, the invasion of the ovary by adrenergic nerves apparently protects it from the development of cancer.
>
> Parasympathetic nerves, pituitary hormones and mast cells activate the ovaries. The number of mast cells in the ovaries is increased by the pituitary hormones (including the thyroid stimulating hormone), and by estrogen (Jaiswal and Krishna, 1996). Estrogen is the most potent of these hormones in causing the cells to release histamine.
>
> The overgrowth of the sympathetic nerves in the polycystic ovary causes the number and activity of mast cells to decrease, possibly as a protective adaptation against excessive stimulation from the many pro-inflammatory factors.
>
> The mast cells are needed for the follicles to rupture, so their suppression prevents ovulation.
>
> The nervous system is closely involved in controlling the growth of tissues, and it has been argued (R.E. Kavetsky reviewed the subject in his book, emphasizing the role of depression in development of cancer) that cancer results from reduced activity of the sympathetic nerves, or unopposed action of the parasympathetic system.
>
> That stress has a role in cancer is acknowledged by the scientific establishment, but the nervous system’s direct involvement in the regulation of cellular metabolism, cell division, and other processes that are central to the cancerous state is either flatly denied or simply ignored.
>
> Although mast cells have been known to be a common component of tumors for many years, it is only recently that antihistamines and other antiinflammatory drugs have been recognized as valuable therapies in cancer.

### Source 9 — Polycystic Ovarian Syndrome (PCOS), Or: How You Lost Your Oxidative Machinery

Danny Roddy · Article · Nov 26, 2012

> Fulfilling its role as an anti-estrogen, progesterone destroys proteins that bind estrogen inside the cell dumping it into the blood for the liver to detoxify. A deficiency of progesterone can cause the cellular accumulation of estrogen ("deficiency" in the blood), which is seen in stress, sickness, and aging.
>
> # 3: The Role of The Pituitary Hormones In PCOS
>
> When diagnosing PCOS a physician will often look for elevated testosterone, decreased serum levels of estrogen, and an inverted ratio of the pituitary gonadotrophins, luteinizing hormone (LH) and follicle stimulating hormone (FSH).
>
> Despite their names, both LH and FSH have estrogen-like actions, and like all pituitary hormones, are increased in stress. It's important to note that the pituitary is activated by a perceived energy deficiency (low thyroid).
>
> Prolactin, another pituitary hormone, has been referred to as the "mothering hormone." Bromocriptine, a drug that inhibits prolactin (apparently by acting on serotonin), reduces PCOS symptoms. Similar to estrogen, prolactin decreases the cell's ability to consume oxygen and produce oxidative energy. Additionally, it has been found to inhibit the ovaries' production of progesterone.
>
> Estrogen, Cell Division & Your Oxidative Machinery
>
> An excess of estrogen and a deficiency of progesterone represents a much bigger problem than a simple "hormone imbalance."
>
> The type of energy we produce sends a strong message to our cells whether to divide and grow, or differentiate and support the functional systems of the organism.
>
> During stress, reproduction, or tissue repair, estrogen stimulates the cell's glycolytic pathway, but inhibits mitochondrial respiration, creating an anaerobic (no oxygen) environment that promotes simple cell division.
>
> In order to achieve greater mobility, the dividing cell rids itself of its bulky oxidative machinery (partly or wholly) to produce energy through glycolysis (lactic acid instead of carbon dioxide).
>
> If oxygen deprivation is chronic (prolonged stress), the cell may be unable to shift back to its oxidative state, even if oxygen is reintroduced.

### Source 10 — Danny Roddy - Why Sugar Is Healthy, Stress, Hormones & Reversing Baldness With Diet

Danny Roddy · Interview · Oct 29, 2012 · https://www.youtube.com/watch?v=2ELOooPT2As

> **Justin:** right and so because your work takes into account the thyroid gland and the hormones would this also help women too with their hair loss because i would imagine it's all hormone related isn't it
>
> **Danny Roddy:** Yeah, totally. It's PCOS or polycystic ovarian syndrome is in a couple of different papers I've read. It's referred to as like the male or the same hormonal environment as those with male pattern baldness or androgenic alopecia. And interesting thing is like women can get quote male pattern baldness. They can bald in a certain shape, just like a male can. So it's like, it's like, This idea of male and like male problems like hair loss or female being separate that's in the right hormonal environment, you can literally have the same thing happen to either sex. So yeah, I think it's especially important for women. I think, I don't know who writes me more. It's probably 50-50, but I get tons of emails from women saying they're experiencing the type of hair loss that males experience.
>
> **Justin:** Wow, that's crazy. So it's not just DHT, especially for men. And the DHT, from what I understand, in people, unlike you, I'm losing my hair. So I'm sure there's some sort of genetic predisposition there, I guess. So DHT, is it something like in my hair, would the DHT just be kind of congregated around the hair follicles? Or what kind of happens with the DHT?

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