Estrogen Dominance and DCI

This question of worsened symptoms comes up now and again, and I still struggle to answer because it is a difficult concept. But I've been working on and explanation and thought I should share this answer:

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 level can make the "free" testosterone level (testosterone that is already not bound to SHBG) high just by competing for the binding sites*. And it is the level of free testosterone that causes the well-known symptoms of high androgens (acne, alopecia, amenorrhea, hirsutism, etc.).  
*The binding sites concept is hard for many people. Think of the SHBG binding sites 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 for the free testosterone to find a spot. And the T don't just drive around the garage, they damage the building as they look for a space—turning hair growth on or off, for instance.   
In clinical trials, DCI was shown to increase SHBG overall. Combining that effect with DCI's tendency to help normalize estrogen levels, the clinical observation that free testosterone was cut in half made a lot of sense.  
However, these changes are not going to happen at the same rate. In fact, estrogen drives synthesis of SHBG, so decreasing estrogen could also lead to a decrease in SHBG, the upshot of which is that free T may increase. 
If that change happens faster than the decrease in "total" testosterone, the woman could develop worsened or renewed symptoms of high (free) testosterone. Worsened acne is the most common effect at this stage, although weight gain is possible as well. These effects would be transient; as the woman's hormone profile moves more toward normal, those symptoms should disappear along with the rest of the signs and symptoms of PCOS. 
It is hard to explain this complicated bit of biochemistry, and it is a hard sell—many women have quit DCI therapy as a result of the worsened symptoms, even though those symptoms were actually a very good sign that DCI is working as they had hoped.

About This Blog

We are envisioning this blog as a way to archive all of the questions and answers from our old site. We'll be posting on a fairly regular basis, after combing through the thousands of questions and answers that were posted over the last six years.

Of course, you can ask your own question by writing, or ask for clarification on any point by using the comments on this blog.

We ask that you keep your comments on topic and respectful. All comments will be moderated.

We hope you find what you are looking for. And we sincerely hope that you find a solution for your PCOS.

Comparison With Myo-Inositol

What are you vegetable capsules made of? Are they rice or millet base by chance? 
Also, based on your video, I have a few questions concerning the consumption of inositol powder verses Chiral Balance dci supplements.  I recently purchased and tried regular inositol powder, which to my understanding from your video is regular myo-inositol.  I experienced a few symptoms of high testosterone such as losing small hairs that had been forced into teleogen phase.  This always happens with a larger quantity of short hairs lost when I consume sugar, and my blood sugar becomes unbalanced. On days when my blood sugar is balanced, I lose mostly long hairs (as my hair is about 12 inches long).  Also, i experienced a great deal of brain fog (also related to excess testosterone for me) after consuming the regular myo-inositol.  The brain fog cleared after about 6 hours of taking the myo-inositol, and I actually felt high in energy and was able to think clearly.  Is this possibly a situation where my body is producing too much testosterone while the myo-inositol is by itself (unbalanced), and then it takes about 5-6 hours for the myo-inositol to be converted into dci by my body and that's when I start feeling good and balanced and having energy?  So in fact, my body is just very slow, and inefficient at this process of converting myo-inositol to dci?  
I'd like to know your opinion, since you have done more research than myself on this process.  And I am obviously just making darting guesses at what is happening to my body when I take myo-inositol.  I am interested to know though, because if what I have described is close to the truth, then taking dci will...quickly elevate me to a balanced blood sugar level.  And primarily, my question is, will it give me the same increased testosterone as regular myo-inositol?  I realize that in your video you describe that it doesn't, and that it only helps to burn and store sugar.  However, would dci ever convert back to myo-inositol and cause the resulting high testosterone in that manner?
I would love to know your opinion, and informed answer.  I have suffered with pcos since I was 14 (I am now 25) and have been forced on the path of avandia, metformin, and birth control pills to regulate my ovaries, menstrual cycle, acne, hair loss, and excess hair growth.  I am not currently on any medication and have since restored balance to my body through a grain-free, sugar-free, exercise-full lifestyle and I feel that your product will be the tool I need to advance my health to the level that I felt when I was on avandia, minus the horrendous side-effects.

Many thanks for your time, 

Hi Nadine—
Our capsules are made from pullulan*, a polysaccharide similar to starch. Pullulan itself is made from starch by a close relative of yeast. They are a vegan/vegetarian friendly and are both kosher and halal. 
Your question about myo-inositol is very interesting. This is something I've speculated about before. We know that an epimerase (a specialized enzyme) is responsible for converting myo-inositol to D-chiro-inositol (DCI). From animal studies, we know that it is possible for the enzyme to be absent or non-functional and still have a viable organism, but one which is insulin resistant. DCI's role in insulin metabolism, coupled with this fact and others led Larner et al. to propose the model detailed in the video.
DCI's absence however, could also be caused by a slow functioning version of the enzyme, which would possibly produce the effects you described. So, in short, your theory has some merit and is certainly a possibility. Yes, the epimerase would also be converting DCI back to myo-inositol, but that process would be just as slow and would, more importantly, come to equilibrium. It is an excess of myo-insotiol that drives DCI production and vice-versa. If the model you proposed is what is taking place in your body, then taking DCI would most likely correct the issue, and it would not increase testosterone production. 
It is important to note: any information you read on is for informational purposes only. Chiral Balance always recommends seeking medical advice only from your doctor.

 *Our capsules are no longer made of pullulan, but are still a 100% vegetable material— hypromellose.

Since this answer was posted, the understanding of the interconversion of DCI and myo-inositol hasn't really progressed. That is a disappointment, but is understandable once you understand how little demand there is for inositols. Several large pharmaceutical companies have tried and failed to gain a significant foothold in the PCOS/inositol market, some by making unsubstantiated claims and/or overselling the promises of inositol therapy. Chiral Balance soldiers on, happy to serve the PCOS community by providing thoughtfully-designed nutritional therapies. Our business is based on solid research and realistic expectations.

DCI Test?

I am obese and have PCOS. How do I know if I have DCI deficiency? Is it assumed that I do since I have been diagnosed with PCOS? I read the only way to test for DCI is through a muscle biopsy. Is it possible to overload the body with DCI? I know I'm being skeptical. I have read the studies and the outcomes seem to good to be true. I guess I just can't believe My doctors have never told me about this supplement. Thank you for the information! 

Hi Theresa—
PCOS is a complicated syndrome which likely has numerous causes and aggravating factors. There is not a commercial test for DCI levels, although a urinalysis is possible and may become commercially available at some point in the future. 
Since DCI is water soluble and a natural human metabolite, it would take an extreme amount of Chiral Balance DCI to cause any adverse affects, the worst of which would probably be diarrhea and resulting dehydration. This is not a concern if taken as directed. 
The studies were peer-reviewed and published in highly respected journals so there is no cause for concern about their validity. That said, skepticism is healthy, and it is important to note that the reported results are the average of several women, some of whom responded very positively and some of whom may not have responded at all. In fact, given the many facets and factors of PCOS, it is unlikely that DCI will work for everyone equally well. However, we provide a money back guarantee* on any customer's first order to accommodate that fact. 
And, don't be surprised that your doctors never told you about Chiral Balance DCI. The average woman with PCOS will see six doctors before getting a correct diagnosis, and then she will almost invariably be prescribed metformin and/or oral contraceptives. A nutritional approach like Chiral Balance DCI is easy to overlook.

*We don't like to call it a guarantee anymore. It is important to understand that not every woman with PCOS will see benefit from DCI therapy. Not every woman develops PCOS as a result of insulin resistance; not all women develop insulin resistance as a result of DCI deficiency. That's why we don't call it a guarantee. Instead, we would like you to know that you can try DCI risk-free for up to 60 days. If DCI doesn't help you, let us know and we will refund your purchase. We want you to find the solution for your PCOS!

One thing that has not changed since this was written: it is still difficult for PCOS women to find the help that they need. Awareness is rising, but PCOS is still overlooked all too often. And many doctors still do not do enough to help women with PCOS. It is imperative that you advocate for yourself—learn as much as you can about PCOS and your situation in particular. Find a doctor that listens to you and treats you well. It will make all the difference.

Thyroid Medication

I take compounded thyroid every morning 1/2 hour before intake of food. I just received my first bottle of D-Chiro and the instructions seem to be the same in the morning same time before food intake. What is the conflict if any for absorption of my thyroid medication - if taken at same time as the D-chiro-inositol? Please advise.


Hi Annie— 
It is not known whether or not D-chiro-inositol affects the absorption of thyroid medications. For that reason, Chiral Balance recommends taking our DCI later in the day*, either before your mid-day meal or last meal of the day, at the same time each day. Thank you for your question and we will be adding a more thorough discussion of DCI and thyroid medications to the knowledge base as soon as possible.

*Since this was written, we've modified our recommendation for when to take DCI if you are taking thyroid medication: follow the recommendation for when it is okay to eat food. That is, if you must wait 90 minutes before eating food, then wait 90 minutes to take your DCI. 


I can't say enough about your product.

We tried to conceive for almost 3 years, but we had difficulty due to my irregular (almost nonexistent) cycles.

I am not overweight, so my first doctor told me I could not have PCOS. I did my own research and found a new doctor! I fortunately found your product, and I noticed an immediate difference in my body. I found out I was pregnant within several months.

We now have a beautiful 1 1/2 year old daughter.

I can't thank you enough.


This obviously wasn't a question, but it brings up a very good point about doctors. If you're not getting the care you need and deserve, find a new doctor!

Like so many women with PCOS, Angie was seeing a doctor who didn't understand her condition. The doctor didn't know that not every woman with PCOS is overweight. This and other misunderstandings are common, even in the medical community. That is why it is vital that you find a doctor that understands this condition and has the skills to treat it. You deserve it!

Is DCI Made in China?

I placed an order to try this DCI for 1 month to check it out, but am concerned this D-chiro-inositol is from China or somewhere that I do not trust - please advise. 

Hi Annie—

Chiral Balance DCI is manufactured in South Korea*, in compliance with the country's strict FDA regulations. South Korea doesn't suffer from the lack of oversight and regulation that may have allowed Chinese manufactures to put dangerous products on the market. Chiral Balance DCI is imported to the United States, at which point it undergoes additional testing for pesticides, heavy metals, pathogens, and more chemicals to confirm that it meets United States FDA standards Chiral Balance D-chiro-inositol is put into capsules and bottles at a cGMP facility in Florida. Chiral Balance DCI has been safely used by thousands of customers since 2005.

*Since that answer was written six years ago, we have begun contracting with Euronutra to manufacture our DCI. Euronutra is located in Malaga, Spain, and is subject to rigorous testing and licensure under the laws of Spain and the EU. Furthermore, Euronutra is an FDA-inspected facility.