An intrauterine device (IUD) is a small, T-shaped form of long-acting reversible contraception known for its high effectiveness. These devices are placed directly into the uterus to prevent pregnancy for several years at a time. A common concern among users is whether the IUD can disrupt the body’s natural endocrine balance, specifically leading to elevated testosterone levels. Understanding the potential for changes in androgen activity depends entirely on the specific type of device used.
The Two Types of IUDs and Their Hormonal Impact
IUDs are categorized into two types based on their composition and function: copper and hormonal. The copper IUD, often sold under the brand name ParaGard, is a non-hormonal option that prevents pregnancy primarily by generating a localized inflammatory reaction in the uterus, which is toxic to sperm. Because this device does not release synthetic hormones into the bloodstream, it has no systemic impact on the body’s androgen levels and does not significantly alter testosterone or Sex Hormone Binding Globulin (SHBG) concentrations.
In contrast, hormonal IUDs, such as Mirena, Kyleena, Liletta, and Skyla, release a synthetic progestin called levonorgestrel (LNG). These devices prevent pregnancy by thickening cervical mucus, thinning the uterine lining, and in some cases, partially inhibiting ovulation. While the hormone is delivered locally into the uterus, a small amount is absorbed into the systemic circulation, which is where the potential for androgen-related effects arises. Therefore, only the levonorgestrel-releasing IUDs have the potential to influence a person’s circulating testosterone.
How Hormonal IUDs Affect Androgen Levels
The progestin levonorgestrel can indirectly influence testosterone activity, even without significantly increasing the total amount produced. Testosterone circulates in the blood in two forms: bound and unbound, or “free.” Most testosterone is bound tightly to Sex Hormone Binding Globulin (SHBG), a protein. This bound testosterone is inactive and cannot interact with cell receptors to exert its effects.
Levonorgestrel suppresses the production of SHBG. When SHBG levels drop, less testosterone is bound, and a greater proportion of the total testosterone becomes “free” or biologically active. This increase in the free, active form of the hormone is the mechanism that can cause symptoms of hyperandrogenism, even if total testosterone remains within the normal range. Furthermore, levonorgestrel possesses intrinsic androgenic activity, meaning it can directly stimulate androgen receptors similar to testosterone, contributing to side effects.
Recognizing Symptoms of Increased Androgen Activity
The physical manifestation of increased free testosterone activity is known as hyperandrogenism. These symptoms can be subtle and develop gradually over months or even years of IUD use, making them challenging to link directly to the contraceptive device. While the physical changes are the most apparent, some people also report changes in mood, including increased irritability or aggression, and a potential increase in libido.
Common Symptoms of Hyperandrogenism
- Hirsutism: Excessive growth of dark, coarse hair in male-pattern areas (e.g., upper lip, chin, chest, or back).
- Persistent or severe acne: Caused by androgens stimulating the sebaceous glands to produce excess oil.
- Androgenic alopecia: Thinning hair on the scalp, particularly near the temples or crown.
- Oily skin.
Next Steps: Diagnosis and Clinical Management
If a person suspects their hormonal IUD is causing symptoms related to increased androgen activity, the initial step is to consult a healthcare provider. The provider will typically begin by assessing clinical symptoms and performing a physical examination, often using a standardized scale to measure hair growth severity. To confirm the hormonal imbalance, specific blood tests will be ordered, focusing on measuring Free Testosterone and SHBG levels. Evaluating the ratio of these two components provides a clearer picture of bioavailable androgen activity than measuring total testosterone alone.
Based on the severity of symptoms and test results, several management options may be discussed. For those with mild symptoms, the provider may recommend waiting, as the body sometimes adjusts to the hormone and side effects can lessen over time. If symptoms are bothersome, options include switching to a combined oral contraceptive (which increases SHBG and reduces free testosterone), removing the IUD for a non-hormonal alternative, or prescribing anti-androgen medications like spironolactone to manage symptoms while the IUD remains in place.