Research
Androgen Excess and Anxiety in PCOS
Explore the connection between androgen excess and anxiety in women with PCOS, highlighting treatment options and the importance of mental health.
August 7, 2025
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Explore the connection between androgen excess and anxiety in women with PCOS, highlighting treatment options and the importance of mental health.
Polycystic Ovary Syndrome (PCOS) affects up to 10% of women of reproductive age and is often linked to increased androgen levels. While physical symptoms like irregular periods and acne are well-known, the connection between excess androgens and anxiety is less discussed but equally important.
Ignoring the emotional effects of PCOS can delay proper treatment. Addressing both hormonal imbalances and mental health challenges is key to improving overall well-being.
Treatment often combines lifestyle changes, hormonal therapies, and mental health support like therapy or mindfulness practices. Early screening for anxiety using validated tools can help identify and address symptoms effectively.
Read on to understand how androgen excess affects emotions, why anxiety is so common in PCOS, and what treatment options are available.
Recent studies have shed light on how elevated androgen levels can influence emotional well-being, particularly anxiety, in women with PCOS. Through comparative prevalence rates and biochemical data, researchers have confirmed a strong link between higher androgen levels and increased anxiety.
A systematic review and meta-analysis revealed that 43% of women with PCOS reported anxiety symptoms, compared to just 10% in healthy individuals. Women with PCOS face nearly three times the odds of experiencing anxiety, with an odds ratio of 2.76. For example, a 2025 study conducted in Saudi Arabia's Jazan region found anxiety rates of 32.61% in women with PCOS, compared to 22.33% in a control group. Similarly, research from China reported anxiety prevalence as high as 76.7% among women with PCOS, highlighting the heightened risk. Across clinical studies, 42% of women with PCOS consistently report clinically significant anxiety symptoms, compared to just 8.5% of healthy women.
The relationship between androgen levels and mental health is further supported by studies examining free testosterone. Research has shown a significant correlation between serum free testosterone levels and mental health outcomes in adolescent girls with PCOS. One study found that free testosterone levels were positively associated with both depression and anxiety scores:
| Measure | Testosterone Correlation | Statistical Significance |
|---|---|---|
| Depression (BDI Score) | R = 0.417 | P = 0.006 |
| State Anxiety (STAI-S Score) | R = 0.472 | P = 0.001 |
| Trait Anxiety (STAI-T Score) | R = 0.402 | P = 0.007 |
| Psychosocial Quality of Life | R = –0.461 | P = 0.002 |
These findings suggest that higher free testosterone levels are linked to increased depression and anxiety, as well as reduced cognitive performance and heightened perceived stress.
Adding to this, studies on adolescents with PCOS show that 28.5% experience moderate-to-severe depressive symptoms, with many also reporting higher levels of anxiety. The Androgen Excess-Polycystic Ovary Syndrome Society recognized these challenges and, in 2018, called for a stronger research focus on mental health in PCOS. Some studies also point to stress-coping mechanisms and personality traits, such as ego-resilience, as contributing factors. Women with PCOS often show higher levels of anxiety and depression and lower ego-resiliency compared to their healthy counterparts.
These findings highlight the pressing need for deeper exploration into how androgen excess contributes to anxiety in PCOS, paving the way for better understanding and management of these mental health challenges.
Androgen excess in PCOS disrupts brain chemistry, receptor activity, and metabolism. These disruptions combine to heighten anxiety and guide treatment considerations.
Elevated androgen levels interfere with key inhibitory neurotransmitters like serotonin, dopamine, GABA, and acetylcholine - chemicals vital for maintaining emotional stability. Research by Balikci et al. revealed that women with PCOS often have higher levels of DHEA-S and total testosterone, which are linked to increased anxiety, depression, and anger. This is thought to occur through a GABA-antagonistic effect. At the same time, a rise in excitatory neurotransmitters, such as glutamate, can further amplify feelings of anxiety. These chemical imbalances in the brain set the stage for more complex receptor-level interactions.
The amygdala, a region of the brain responsible for processing fear and anxiety, is rich in androgen receptors. These receptors play a direct role in anxiety-related behaviors. Animal studies demonstrate that testosterone activity in the amygdala can increase anxiety, but blocking these receptors with drugs like flutamide reverses this effect. Chronic exposure to DHT (dihydrotestosterone) during puberty has been shown to down-regulate androgen receptors in the hypothalamus, leading to persistent anxiety-like behaviors. Additionally, maternal androgen excess may predispose offspring to anxiety disorders. These receptor-level changes are further influenced by metabolic factors, creating a complex web of interactions contributing to anxiety in PCOS.
The combination of hyperandrogenism and insulin resistance in PCOS not only leads to visible symptoms like hirsutism, acne, and weight gain but also takes a toll on self-esteem. Chronic low-grade inflammation exacerbates both insulin resistance and androgen excess. This metabolic imbalance is widespread among women with PCOS, with obesity affecting 50–80%, impaired glucose tolerance present in 30–35%, and over 50% developing type 2 diabetes by age 40. These metabolic shifts also disrupt the HPA axis, contributing to imbalances in androgen and cortisol levels. On top of this, altered amino acid metabolism can interfere with neurotransmitter production, further fueling anxiety. These interconnected metabolic and psychological challenges highlight the far-reaching impact of PCOS.
It’s worth noting that over 60% of women with PCOS are diagnosed with at least one psychiatric disorder. Understanding these intertwined mechanisms is crucial for creating holistic treatment plans that address both hormonal and mental health concerns.
Breaking this cycle is possible, as endocrinologist Dr. Ula Abed-Alwahab emphasizes:
"The good news is that many lifestyle changes can pull you out of the metabolic chaos of PCOS. It can also decrease your chances of developing other related conditions such as diabetes, heart disease, hypertension, sleep apnea, anxiety, depression and infertility."
Managing anxiety linked to PCOS requires a careful blend of medical evaluation, targeted treatments, and collaborative care. Addressing both the hormonal and psychological aspects of PCOS is key to effective treatment, building on the hormonal and neurochemical insights discussed earlier.
Screening for anxiety is crucial since women with PCOS are significantly more likely to experience these symptoms - up to three to eight times more often than others. Studies reveal that women with PCOS face five times higher odds of experiencing anxiety symptoms and nearly six times higher odds of moderate to severe anxiety compared to their peers.
Healthcare professionals should use validated tools to identify anxiety and depression in PCOS patients. Commonly used questionnaires include the Beck Anxiety Inventory, the Hospital Anxiety and Depression Scale (HADS), and the State-Trait Anxiety Inventory. Research highlights that 34% of women with PCOS had elevated HADS anxiety scores, which significantly impacted their quality of life.
A comprehensive evaluation should include a detailed gynecological history, focusing on the onset and regularity of menstrual cycles over the past six months. Tracking menstrual patterns can provide insights into the relationship between hormonal fluctuations and psychiatric symptoms. Additionally, screening for coexisting conditions like eating disorders and sleep disturbances is essential, as these often accompany anxiety in PCOS.
The Polycystic Ovary Syndrome Questionnaire (PCOSQ) is another valuable tool. This 26-item assessment evaluates the emotional impact of symptoms such as hirsutism, weight concerns, infertility, and menstrual irregularities, helping to pinpoint how these issues affect mental health and overall quality of life. Insights from these screenings guide the selection of appropriate treatments.
Effective treatment for anxiety in PCOS must address both the hormonal imbalances and psychological challenges associated with the condition. Since androgen excess can disrupt neurotransmitter balance, therapies often combine lifestyle changes, hormonal treatments, and psychological support.
Lifestyle adjustments are a cornerstone of treatment. Diet and regular exercise not only help manage PCOS symptoms but also improve mental health. Studies show that exercise-induced weight loss leads to better outcomes in menstrual regularity and ovulation compared to dietary changes alone.
Hormonal therapies are another key component. Combined oral contraceptives (COCs) can regulate cycles, reduce hirsutism, and improve acne, though they should be prescribed cautiously for women with metabolic syndrome or severe insulin resistance. Metformin, often used alongside COCs, is particularly effective for improving insulin sensitivity and menstrual regularity in women with overweight or obesity.
Psychological interventions also play a significant role. Cognitive-behavioral therapy (CBT) has been shown to enhance quality of life, boost self-esteem, and alleviate depressive symptoms while equipping women with effective coping strategies. Mindfulness meditation is another helpful tool, reducing stress and promoting psychological well-being.
Multidisciplinary approaches that combine CBT, lifestyle changes, and hormonal therapies often yield the best results, addressing the many factors contributing to anxiety in PCOS. Research consistently shows that integrating different treatment methods is more effective than relying on a single approach.
For example, a study by Cooney et al. found that women undergoing CBT combined with lifestyle modifications lost more than twice as much weight per week and reported greater improvements in quality of life compared to those using lifestyle interventions alone. Another study demonstrated that a one-year program incorporating CBT, diet, and exercise significantly improved self-esteem and reduced depressive symptoms compared to standard care.
When hormonal treatments reduce imbalances, anxiety often decreases as well. Similarly, addressing anxiety through therapy and lifestyle changes can make hormonal symptoms easier to manage. This creates a positive feedback loop that enhances the overall effectiveness of treatment.
Additionally, combining exercise with group counseling has been shown to support weight loss while fostering social connections. Behavioral strategies that build self-efficacy empower women to take control of their condition, promoting long-term success in managing PCOS.
High androgen levels in PCOS don't just affect physical health - they also have a profound impact on mental well-being. Studies show a strong link between elevated serum free testosterone and increased rates of anxiety and depression, with individuals with PCOS experiencing these conditions 3–4 times more often than the general population.
To tackle this effectively, PCOS care needs to address both hormonal imbalances and mental health challenges. This means combining hormonal treatments with lifestyle adjustments like balanced nutrition and regular physical activity. While supplements may offer additional support, they should always be used under personalized healthcare guidance.
Mental health care plays a pivotal role here. Anxiety and depression, if left untreated, can make it harder for individuals to stick to necessary lifestyle changes or medical treatments. A multidisciplinary approach - bringing together OB/GYNs, endocrinologists, dietitians, and mental health professionals - can provide the comprehensive care needed to address all aspects of PCOS.
As discussed, treating PCOS effectively requires looking at both the physical and emotional sides of the condition. Including mental health support as a core part of treatment ensures women with PCOS receive the well-rounded care they need to improve not just their physical health, but their overall quality of life. By understanding and addressing this complex connection, healthcare providers can offer more personalized and impactful solutions.
Research indicates that androgen excess in women with PCOS is closely tied to higher levels of anxiety and depression. Elevated androgen levels can throw off hormonal balance, potentially affecting how the brain regulates mood. On top of that, physical symptoms like acne, hair thinning, or excessive hair growth (hirsutism) caused by high androgen levels can take a toll on self-esteem and social interactions, often leading to emotional challenges.
There's also evidence suggesting that maternal androgen excess during pregnancy might play a role in shaping anxiety-like behaviors in children, further underscoring the link between androgens and mental health. Women with PCOS are encouraged to address both their physical and emotional health, as a well-rounded approach to managing symptoms can make a big difference in their overall well-being.
Managing anxiety for women dealing with PCOS often requires a mix of lifestyle adjustments, emotional support, and sometimes medical intervention.
Lifestyle changes play a key role. Incorporating regular exercise, maintaining a balanced diet, and practicing mindfulness techniques - like deep breathing or meditation - can significantly ease stress and boost overall health.
On the psychological front, therapies such as cognitive-behavioral therapy (CBT) or group counseling have proven effective in addressing anxiety and enhancing mental well-being. For more intense cases, healthcare providers may recommend medications like antidepressants or anti-anxiety drugs. Collaborating with your doctor is crucial to determine the approach that works best for you.
For trustworthy resources and expert advice on PCOS and its symptoms, check out PCOSHelp.
Managing hormonal imbalances and mental health is crucial for individuals with PCOS. Hormonal shifts, like elevated androgen levels, are often tied to anxiety, depression, and mood swings. These mental health struggles can, in turn, intensify physical symptoms such as fatigue and weight gain, creating a challenging cycle that affects overall well-being.
Tackling both areas together can lead to more effective symptom control, a better quality of life, and improved long-term health. Focusing on both physical and emotional aspects ensures a more complete approach to managing the complexities of PCOS.
