An intrauterine device (IUD) is a small, T-shaped form of contraception placed directly inside the uterus to prevent pregnancy. These devices are widely used due to their high efficacy and long-term convenience. A common question is whether an IUD can disrupt the body’s hormonal balance and lead to elevated testosterone levels. A rise in biologically active testosterone, or androgen excess, can cause noticeable side effects for users. The answer depends entirely on the type of IUD used.
Hormonal Versus Non-Hormonal IUDs
Intrauterine devices fall into two distinct categories based on their mechanism of action. The non-hormonal option is the copper IUD, which is wrapped in copper that acts as a spermicide, preventing fertilization without releasing systemic hormones. Since the copper IUD does not introduce synthetic hormones, it has no biological pathway to affect the body’s natural testosterone levels.
The second category is the hormonal IUD, which releases a synthetic progestin hormone called Levonorgestrel (LNG) directly into the uterine cavity. This progestin primarily works by thickening the cervical mucus and thinning the uterine lining to prevent sperm from reaching an egg. Although Levonorgestrel is localized, a small amount enters the bloodstream and can interact with the endocrine system. Therefore, discussions about IUDs causing high testosterone focus exclusively on the hormonal, Levonorgestrel-releasing models.
Progestin’s Interaction with Testosterone
The Levonorgestrel released by hormonal IUDs can theoretically lead to an increase in free testosterone. Testosterone circulates in the bloodstream in two main forms: bound and free. The majority is bound to Sex Hormone Binding Globulin (SHBG), which renders the testosterone inactive.
Levonorgestrel can suppress the liver’s production of SHBG. When less SHBG is present, less testosterone is bound, resulting in a higher concentration of free testosterone. This free fraction is the biologically active form of the hormone that binds to androgen receptors and causes symptoms. Levonorgestrel also exhibits mild androgenic activity, meaning it can sometimes stimulate androgen receptors directly.
Hormonal IUDs release Levonorgestrel at a much lower dose and more locally than other hormonal contraceptives. Therefore, the systemic suppression of SHBG is significantly less pronounced compared to high-dose oral progestins. However, even a minimal change in SHBG can raise free testosterone levels enough for a sensitive individual to experience noticeable side effects.
Evaluating Clinical Data and Symptoms
While the mechanism for increased free testosterone exists, clinical data suggests that significant androgen excess in hormonal IUD users is uncommon. The low systemic dose of Levonorgestrel means that most users do not experience a clinically significant rise in free testosterone. In studies comparing the hormonal IUD to other contraceptives, the IUD’s impact on SHBG and free testosterone is often described as minimal or intermediate.
For the small percentage of individuals sensitive to this hormonal shift, the symptoms are consistent with hyperandrogenism. These outcomes include adult-onset acne and hirsutism (growth of coarse, dark hair in a male pattern, such as on the chin or chest). Another potential symptom is androgenic alopecia, or thinning of the hair on the scalp. These symptoms result from the increased activity of free testosterone on the skin and hair follicles.
Guidance on Diagnosis and Management
If a user of a hormonal IUD suspects they are experiencing symptoms of high testosterone, the first step is to consult a healthcare provider for an accurate diagnosis. Self-diagnosis can be misleading, as other conditions, such as Polycystic Ovary Syndrome (PCOS), can present with similar symptoms.
The most reliable way to confirm a hormonal issue is through specific blood tests. These tests should measure total testosterone and Sex Hormone Binding Globulin (SHBG) to accurately calculate the level of free testosterone. If the findings correlate with clinical symptoms, management options can be discussed.
Management Options
For those with persistent androgenic side effects, the most definitive treatment involves removal of the IUD. Symptoms often resolve after the device is removed. A user may also switch to a non-hormonal method like the copper IUD or an alternative hormonal contraceptive known to have less androgenic activity.