CoMorbidities, Diabetes, PCOS

Autistic Cooccurring Trait: Polycystic Ovaries

The autistic community has a high prevalence of Polycystic Ovaries. There are studies that correlate the high testosterone causing autism but that does not make sense. There is no concrete scientific data backing that up.

According to Molecular Psychiatry, autistic people with uteruses are 1.78 times more likely to have PCO than neurotypical peers.  Polycystic Ovaries (PCO) is a hormonal difference that is common with female bodied people of reproductive age. Uterus owners with PCO have irregular menstrual cycles or prolonged periods or excess male hormones. The ovaries could develop multiple collections of fluid and fail to release the egg. 

  • There is no known cause of PCO. Early diagnosis and treatment paired with weight loss may reduce the risk of long term complications like type 2 diabetes and heart disease. 

Symptoms

  • Irregular periods- infrequent, irregular or prolonged menstrual cycles are the most common sign of PCO. This can be cycles that do not happen every month, they may be light then heavy, etc.
  • Excess male hormones- Elevated male hormones can result in physical signs such as hirsutism (excess facial and body hair) and sever acne and male pattern baldness
  • Mood changes
  • enlarged ovaries or have many cysts
  • weight gain
  • acne or oily skin
  • Male pattern baldness or thinning hair
  • skin tags
  • dark or thick skin patches on back of neck, in the armpits or under the breasts

Risk Factors

  • Excess insulin- Insulin is a hormone produced by the pancreas that helps cells process glucose. Glucose is the main energy source of the body. If the cells are resistent to insulin, the blood sugar levels will rise and the pancreas will produce more insulin. Excess insulin causes more male hormone production.
  • low grade inflammation- This term is used when white blood cells production of substances to fight infection. People with PCO have a type of low grade inflammation that stimulates polycystic ovaries to produce male hormones which can lead to vascular and heart problems.
  • Heredity- There is a genetic factor to PCO
  • Excess androgen- The ovaries produce abnormally high levels of male hormones.
  • Ovarian Cysts

Complications

  • Infertility
  • Gestational Diabetes
  • Miscarriage, stillbirth or premature birth
  • Non alcoholic steatohepatitis – sever liver inflammation caused by fat accumulation of the liver (fatty liver)
  • Metabolic syndrome – a cluster of conditions including high blood pressure, high blood sugar and abdnomal cholesterol or triglyceride levels that increase risk of cardiovascular disease
  • Type 2 diabetes or prediabetes
  • Depression, anxiety and eating disorders
  • Abnormal uterine bleeding
  • Endometrial cancer
  • Weight gain

Diagnosis

There is no specific test for PCO. The OBGN will take a medical history. This will include mentrual periods and weight changes.

After this, the doctor may perform:

  • A pelvic exam- the doctor visually and manually inspects reproductive tract for masses, growth and other abnormalities.
  • Blood tests- the blood is taken for analysis to measure hormone levels. This can also rule out other conditions that mimic PCO.
  • Ultrasound- the doctor will look at the appearance of the ovaries and thickness of the uterine lining.

Diagnostic Criteria

There are three diagnostic criteria and the patient must meet two.

  • clinical hyperandrogegism or biochemical hyperandrogegism- high androgen (male hormone) levels . This includes male pattern hair growth, weight gain, hair loss, etc.
  • Oligiomenorrhea- irregular or absence of menstrual cycles
  • Polycystic ovaries on the ultrasound- must have visible thickening of the ovaries or cysts

Treatment:

  • Based on individual symptoms experienced
  • Lifestyle changes
  • Weight loss via a low calorie diet – a small reduction in weight can improve the condition
  • Moderate Excercise
  • Medication and supplements that reduce insulin resistance by lowering androgen levels.

IF YOU THINK YOU HAVE PCOS, PLEASE SEE A DOCTOR FOR EVALUATION

PCO is an Intersex Trait

Polycystic Ovaries happen when there is non polar bimodal development. Due to this PCO is an intersex trait

Why is PCO Intersex?

  1. During puberty and later, the pituitary gland produces androgens, testosterone for example, much higher than the expected range for a person who has the 46xx genotype. This by itself is enough to be classified as intersex
  2. This balance of sex hormones causes physiological changes in sex development. This changes are not always obvious. The ovaries are polycystic because the membrane of the ovary develops to be thicker like the membrane of the testes. Because of this thicker membrane, cycts form when the ovum cannot rupture through the membrane. This can cause some pain when it ruptures through. This again, makes the person intersex.
  3. Higher levels of male sex hormones cause secondary sexual development to change. This includes oil skin, cystic acne, facial hair, greater body hair distribution, “masculine” fat distribution, a deeper voice and/or developed erectile tissue in the external genitalia. This, again, makes the person intersex.

You are intersex even if you take medication to mitigate symptoms. Medication isn’t mandatory but it can mitigate other health conditions that are associated with PCOS.

People with PCO are More Likely to Have Gender Dysphoria

It is true that people who have PCOS are more likely to experience gender dysphoria. In 2005, there was a cohort study done in a gynecological clinic in Poland. They surveyed 89 people aged 17-42 who had PCO.

They were split into two groups. The first group was ages 30 and younger. The second group was age 31 and older. There were 45 people who did not have PCO used as the control group.

They used a general health questionnaire, Ferriman- Gallwey score and psychological gender inventory to access masculinity and femininity through self reported possession of socially desirable, stereotypical personality traits (masculine, feminine, androgynous, undifferentiated). It was supplemented by questions concerning social status (education, profession) and gynecological history. All questionnaires were anonymous and independently answered during clinic visits.

The influence of PCO and concomitant hirsutism on true gender was the main symptom tested. This study resulted in people having PCO with hirsutism are less likely to identify as feminine and more likely to identify as nonbinary or transgender.

The study team concluded that people who have PCO, depending on age and severity of symptoms, do not identify as female. Duration and severity of PCO can negatively effect self image. This is because they do not identify as female.

PCO While Trans

Many trans masculine people take testosterone therapy. Testosterone therapy can treat the ovarian pain about the same as anti androgens. Testosterone therapy has the effect of thickening the membrane of the ovary even further.

This makes it impossible for the ovum to rupture the membrane. Testosterone will also reduce the rate at which the ovum will mature. This should eliminate the formation of new cysts.

Most people who take testosterone should see the halt of their menstrual cycle after a period of time. There might be occasional spotting.

When undergoing hormone replacement therapy, you need to be under the care of a licensed endocrinologist.

Sources:

https://pubmed.ncbi.nlm.nih.gov/22443151/

https://primarycarenotebook.com/simplepage.cfm?ID=x20120518100458251876

https://www.nature.com/articles/s41380-019-0398-0

https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439#:~:text=Polycystic%20ovary%20syndrome%20(PCOS)%20is,fail%20to%20regularly%20release%20eggs.

https://www.webmd.com/women/what-is-pcos#1

https://www.healthline.com/health/polycystic-ovary-disease#what-is-pcos

https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos

https://www.sciencedaily.com/releases/2018/08/180801084039.htm

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