Opposing effects of dehydroepiandrosterone sulfate and free testosterone on metabolic phenotype in women with polycystic ovary syndrome

In studying the association of adrenal and ovarian androgens with metabolic parameters in women with polycystic ovary syndrome, distinguishing between adrenal and ovarian hyperandrogenism is important to evaluate metabolic risk.

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Elisabeth Lerchbaum, M.D., Verena Schwetz, M.D., Albrecht Giuliani, M.D., Thomas R. Pieber, M.D., Barbara Obermayer-Pietsch, M.D.

Vol 98, Issue 5, Pages 1318-1325.e1



To study the association of adrenal and ovarian androgen levels with metabolic parameters in a large cohort of PCOS women.


Cross-sectional study.


Outpatient clinic of an academic hospital.


Six hundred twenty-two women with PCOS.



Main outcome measures:

Analysis of the association of endocrine dehydroepiandrosterone sulfate (DHEAS) and free testosterone (FT) parameters with metabolic measurements.


In multivariate adjusted logistic regression analyses, OR for insulin resistance was significantly higher (4.42 (2.26-8.67)) for PCOS women with elevated FT levels compared to women with normal DHEAS and FT levels (reference group). We found no significant differences when PCOS women with elevated DHEAS or a combined elevation of DHEAS and FT levels were compared to the reference group (p>0.05). PCOS women with high DHEAS/FT-ratios had a more beneficial metabolic profile compared to women with low DHEAS/FT-ratios. In multivariate adjusted binary logistic regression analyses, we found a significantly lower risk for insulin resistance in PCOS women in the highest DHEAS/FT-ratio quartile compared to PCOS women in the lowest quartile (OR 0.35 (0.14-0.89)).


Our results suggest that the distinction between adrenal and ovarian hyperandrogenism is important when evaluating metabolic risk in PCOS.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.