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For doctorsIs “the keto crotch” true?
, medical content by Dr. Michael D. Fox, MD
in Keto, PCOS / Fertility, Q&A 
Is the “foul-smelling” vagina on the keto diet true? Can you have post-menopausal bleedings on keto? What diet do you recommend if one has high testosterone levels? And, can keto improve testosterone and libido in men?
Get the answers to these questions in this week’s Q&A with fertility specialist Dr. Fox:
Changes in pH
I just read an article that says keto will change your body’s pH in a negative way causing a foul-smelling vagina. Is this true and how can we avoid it?
Pamela
Dr. Fox:
In all the time I have been getting patients to start this diet, I have never had a patient complain of this problem. If anything, the vaginal environment will be greatly improved resulting in a more normal mix of bacteria and fewer problems.
Read more about the infamous “Keto crotch” here.
Post menopausal bleeding
While losing weight on keto, I’ve been having light post-menopausal bleeding. I’ve had all the invasive tests that have ruled out a serious cause such as cancer. Last regular period was 9 years ago. I’m 60 years old now. Will this balance out as I get the rest of the weight off? I’ve lost 35 pounds but still have 35-40 pounds to lose.
Thank you, Dr. Fox,
Patty
Dr. Fox:
Bleeding is not something that we see in the postmenopausal period as a result of the nutrition change. You are the second with a similar complaint. I can’t think of any obvious physiologic reason the diet would cause this. It is possible that ketosis extends fertility into the later age groups – we just have not seen this effect. I will keep my eye out for this issue. It is possible that ketosis could restore some of the egg stem cells and you are experiencing this in some way. Sorry I couldn’t be of more help to you now.
High testosteron
Hello Dr,
I would like to know which diet you recommend me as I’m trying to get pregnant. I have high testosterone and I have a lot of acne – do you recommend a low-carb diet or keto diet?
Thank you,
Wendy
Dr. Fox:
Low carb is the same as ketogenic or has a little more carbohydrates preventing ketosis. I am a strong supporter that nature wants all of us to be ketogenic. It seems to generate the best pregnancy rate in my experience.
Can keto improve testosterone and libido in men? Also, does it lower or block estrogen in men?
I got married but I had libido problems with wify, so I have done a blood analysis and it turns out that I have high estrogen and low testosterone. Also, I have had these symptoms since I was a teenager and I am now 31. This affected the quality of sperms and the quality of life by always having a constant depression.
Is it possible to gain back my sex life and become a father?
Mutazbllah
Dr. Fox:
Metabolic improvement through ketogenic nutrition most certainly can improve those symptoms and will gradually pick up the testosterone and therefore the sexual function will follow. It may be a slow process. Increases in fat from insulin resistance increases the conversion of testosterone to estrogen in the fat cells. Estrogen is a potent inhibitor of FSH and LH the testicular stimulation hormones. This results in low testosteron. The problem of increased estrogen due to fat is further worsened by low testosterone – a vicious cycle. It is important to seek some level of testosterone replacement early on. This aids weight (fat) loss and decreases estrogen levels. Be patient and at some point, the testosterone replacement might be stopped and normal levels return. Best of luck!
More questions and answers
Questions and answers about low carb
Read all earlier questions and answers to Dr. Fox – and ask your own! – here:
Ask Dr. Fox about nutrition, low carb and fertility – for members (free trial available)
Within a short time of starting keto I began to have spotting--I was toward the end of peri-menopause but not in full menopausal yet--I was still occasionally having periods. The spotting was not unusual for me at that point. But within a short while, it became heavy bleeding like my periods, and then it became very heavy bleeding to the point where I would sometimes stand up and feel a gush of blood completely soak the overnight pads I wore for heavy bleeding. I talked to my doctor who brushed it off as "just menopause" but it continued for 8 weeks. Finally, in desparation, I consulted Dr. Google and learned that flax is a phytoestrogen that sometimes causes female bleeding. I stopped the flax muffins, and within 48 hours the bleeding stopped after 8 weeks. At that point I felt washed out and was having daily headaches. I had to talk my doctor into doing some blood tests and found I was pretty anemic (no surprise to me). I'm pretty sure the flax was to blame, and--needless to say--he's not my doctor anymore.
Phytoestrogens are in soy and a lot of other seeds like hemp and chia, too. So if you added anything like this to your diet, that may be the culprit.
I see that I’m not alone in having this issue and I hope we will eventually get some answers.
I am very intrigued by this new information. I have been on keto since August 2018, and have lost 50 pounds and thankfully my migraines as well. I am 53, and entering menopause and started having issues as well. I have fibroids and have recently been diagnosed with endometriosis as well. But started spotting a month ago while on the medication my dr gave me. I also have been religiously eating keto cereal, full of all of the seeds Jan mentioned! I may have to adjust the recipe. Until then I’m going to back off on it and see if it helps. I have also heard raspberry tea can help these issues as well. Thanks!
I have been having post menopausal spotting too - for about 6 weeks, then last week, a full on bleed like a period. I'm 62 and haven't had a period for 10 - 15 years. I've been eating low-carb for about 9 months. Spotting isn't that unusual for me, but haven't had any for a couple of years and have never experienced bleeding. I am midst gynaecological investigations ATM. I have always eaten chia seeds, but only recently started eating hemp seeds in granola that I make. I rarely eat the granola more than once a week, surely that wouldn't be enough to cause problems? Hoping I can get this problem resolved without having to stop eating this way.
You may also wish to make sure you are not eating anything with soy as it can affect hormone levels.