Objective: Functional androgenization (FA) can be divided into five groups corresponding to the predominant organ pathology as recently shown by our group: functional cutaneous androgenization (FCA, skin) and FA syndrome (FAS) I (ovary, lean individual), II (adrenal gland), III (ovary, fat tissue, pancreas, and hyperinsulinemia), and IV (residual FA dysfunctions). Group-specific clusters are based on primary variables such as LH, testosterone, DHEAS, sex hormone-binding globulin (SHBG), body mass index (BMI), glucose, insulin, and enlarged polyfollicular ovaries. Because anti-Mü llerian hormone (AMH) positively correlates with the antral follicle count, its relevance as an additional primary variable for classifying FA was investigated. Design: In this study, 178 patients with FA were consecutively enrolled and classified into the five FA groups as described earlier and 30 women with regular menstrual cycles served as control. Methods: Primary variables and serum AMH were analyzed in the early follicular phase. Results: FA patients showed significantly elevated AMH levels (11.1G6.7 ng/ml) versus control (3.0G2.0 ng/ml; P!.0001). AMH was significantly increased in groups FAS I (15.6G5.8 ng/ml) and FAS III (11.6G6.6 ng/ml) compared with groups FCA (7.0G3.8 ng/ml), FAS II (5.05G3.0 ng/ml), and FAS IV (6.9G4.6 ng/ml) and correlated positively (P!.0001) with LH (rZ0.538) and testosterone (rZ0.368). In regression and multivariate analyses, AMH was not dependent on SHBG, DHEAS, BMI, glucose, or insulin. In receiver operating characteristic analysis, 9.21 ng/ml AMH showed 90% specificity with 71.2% sensitivity for the diagnosis of the two ovarian FA groups, FAS I and III. Conclusion: AMH confirms the novel stratification system and constitutes a useful primary variable in the algorithm of FA classification.
