Prevalence and impact of hyperandrogenemia in 1,218 women with polycystic ovary syndrome

Abstract

Hyperandrogenemia modifies phenotypic characteristics of women with polycystic ovary syndrome (PCOS). The aim of the present study is to evaluate (a) the prevalence of hyperandrogenemia in PCOS women (Rotterdam criteria) and (b) the impact of either the degree or the type of hyperandrogenemia on phenotype. Anthropometric, clinical, hormonal, metabolic and ultrasound characteristics of 1,218 women with PCOS were analyzed in this cross-sectional study. The prevalence of hyperandrogenemia was 58.8 %. Women with hyperandrogenemia had higher luteinizing hormone (LH), follicle-stimulating hormone (FSH), free androgen index, lower sex-hormone-binding globulin (SHBG) and fasting glucose levels compared to women with normal androgens (p < 0.001 for all comparisons; p = 0.001 for fasting glucose). Regarding the presence of isolated hyperandrogenemia, the group with only elevated testosterone levels was termed GT and an analogous categorization was made for dehydroepiandrosterone sulfate (GD) and androstenedione (Δ4) (GΔ4), respectively. GT, GD and GΔ4 comprised the 17.2, 7.6 and 4.1 % of total cohort, respectively. These groups differed significantly between them in LH, LH/FSH ratio, and SHBG (p < 0.001). Hyperandrogenemia is found in almost 60 % of women with PCOS (Rotterdam criteria), and it affects hormonal characteristics of these women such as LH and SHBG values. Regarding the impact of isolated hyperandrogenemia on PCOS characteristics, it appears that Δ4 and testosterone elevations are associated with increased LH levels.

Androgens and ovarian function: translation from basic discovery research to clinical impact

“…Androgen excess is a key trait in the majority (~60%) of women with PCOS, and the most frequent common feature, as hyperandrogenism is a diagnostic criteria in three out of the four PCOS phenotypes (A-D) endorsed by the 2018 international evidence-based guidelines (Livadas et al 2014, Teede et al 2018. Interestingly, the presence of elevated androgen levels observed in congenital adrenal hyperplasia patients (Lucis et al 1966, Hague et al 1990 and female-to-male transsexuals treated with testosterone (Futterweit & Deligdisch 1986, Spinder et al 1989, De Roo et al 2017 are reported to cause the appearance of polycystic ovarian morphology (PCOM), similar to that observed in women with PCOS, with enlarged ovaries that exhibit multiple cysts and theca interstitial hyperplasia.…”

Role of androgens in normal and pathological ovarian function

“…Unity has still not been reached on the diagnostic criteria for PCOS, with recent recommendations that metabolic disorders be added when defining the PCOS phenotype (Conway et al 2014). Nevertheless, the most consistent feature of PCOS is hyperandrogenism, affecting at least 60% of women with PCOS (Abbott et al 2005, Livadas et al 2014, highlighting the importance of androgenic actions in the disorder.…”

Low testosterone levels are associated with endothelial dysfunction in oophorectomized early postmenopausal women

“…The hyperandrogenism seen in PCOS, rather constituted by testosterone (39), was shown to be linked to increased advanced glycation end-products (AGEs), capable of generating reactive oxygen species and translocation of kappa B nuclear factor, which triggers inflammation, immune response and apoptosis (40). Diamanti-Kandarakis et al (41), in a cross-sectional study with 106 healthy postmenopausal women, found that those with testosterone levels in the highest quartile (53-160 ng/dl) had significantly higher serum AGEs levels compared to the three quartiles comprising testosterone levels between 2 and 53 ng/dl, even after adjustments for insulin and HOMA-IR.…”