Mark Stewart and Travis Johnson, MS 是美国一直活跃在PCSO领域的人士，作为生物化学家Travis总是从概念性的角度为我解答很多关于PCOS的问题，专业性比较强。经过他们俩的同意，我开辟了一个新的板块，就是Travis Mark 系列解答。作为进阶版，感兴趣的姐妹可以深入挖掘挖掘。
Here’s the explanation of the phenomenon of estrogen dominance, and how unraveling it can cause acne and weight gain:
Estrogen Dominance:
The dismantling of an estrogen dominance scenario can have some unexpected consequences. Travis and I have written about this before:
Many women with PCOS have what is called estrogen dominance, which is a high estrogen to progesterone ratio. This is usually the result of elevated estrogen, a scarcity of progesterone, or both.
All sex hormones bind to SHBG (sex hormone binding globulin), so a very high estrogen can make bioavailable testosterone (testosterone not bound to SHBG) high just by competing for the binding sites*. And it is bioavailable testosterone that really determines whether someone will have symptoms of high androgens (acne, alopecia, hirsutism, etc.).
In clinical trials, DCI was shown to increase SHBG overall. Combining that effect with DCI’s tendency to help normalize estrogen levels, the additional clinical observation that free testosterone was cut in half made a lot of sense.
However, not all of these changes are necessarily going to happen at the same rate in every woman. And, in fact, estrogen drives synthesis of SHBG, so dropping estrogen can also lead to a decrease in SHBG, the upshot of which is that free T can increase.
If that change happens earlier or faster than the decrease in total testosterone, the woman could develop worsened or renewed symptoms of high free T. This should be transient as the woman’s hormone profile moves more toward normal.
*The binding sites concept is hard for many people. Think of the SHBG binding site as spaces in a parking garage. There are a finite number of parking spaces, and the more extra estrogen that is out cruising for a spot, the longer it will take the testosterone to find a spot. And the T don’t just drive around the garage, they vandalize the building as they look for a space—turning hair growth on or off, for instance.
We normally are addressing the free testosterone and resulting acne when this question comes up, but weight gain is also possible as a result of the same re-balancing act.
We normally are addressing the free testosterone and resulting acne when this question comes up, but weight gain is also possible as a result of the same re-balancing act.
以下是对雌激素主导现象的解释，以及它如何导致痤疮和体重增加
雌激素主导地位:
雌性激素主导可能会带来一些意想不到的后果。崔维斯和我之前写过:
很多患有PCOS的女性都有所谓的雌激素主导，这是一种高雌激素和孕酮的比例失调。这通常是雌激素升高的结果，或者是孕酮的缺乏，或者两者都有。
所有的性激素都与SHBG(性激素结合)结合在一起，所以非常高的雌激素可以使生物可利用的睾酮(睾酮不受SHBG的限制)高，仅仅通过竞争这些SHBG结合点就实现了。它是一种生物可利用的睾酮，它决定了某人是否会有高雄激素的症状(痤疮，脱发，多毛症，等等)。
在临床试验中，DCI被显示增加了SHBG。将这种效果与DCI的趋势相结合，有助于使雌激素水平正常化，临床观察表明，游离睾酮被减少一半。
然而，并不是所有的这些变化都必然发生在每个女人身上。事实上，雌激素会促进SHBG的合成，所以减少雌激素也会导致SHBG的减少，结果是，游离睾酮可以增加。
如果这一变化发生的时间比睾酮下降更早或者更快，那么女性可能会出现更严重的或重新出现的高游离睾酮的症状。不过这应该是暂时的，因为女性的荷尔蒙曲线会向正常的方向移动。
对于许多人来说，理解概念是很困难的。把SHBG的结合想象成一个停车场的空间。停车位的数量是有限的，而停车的雌性激素越多，没的停车的雄性激素就会越高。睾酮不仅仅是在车库里四处走动，他们还在破坏建筑，比如他们影响毛发长长落落。
当这个问题出现的时候，我们通常关注的睾酮和粉刺，但是对于同样的失衡，体重增加也是一种可能性。
关于我们是否缺乏雌激素，可以参考我之前的文章（我们真的雌激素低吗？）。