11-Oxygenated Androgens in Pcos: Impact of Pcos Phenotypes and First-Line Interventions
Abstract
CONTEXT
Androgen excess in polycystic ovary syndrome (PCOS)/polyendocrine metabolic ovarian syndrome (PMOS) is classically attributed to ovarian steroids, yet adrenal-derived 11-oxygenated androgens are potent contributors whose regulation and treatment responsiveness in PMOS remains poorly characterized.
OBJECTIVE
To quantify classic and 11-oxygenated androgens across PMOS phenotypes versus controls and to evaluate their responses to oral contraceptive pills (OCPs), metformin, or lifestyle modification (LSM).
DESIGN
Secondary analysis of residual serum samples from three trials: OWL-PCOS (16-week OCP vs LSM), COMET-PCOS (24-week OCP vs metformin), and AMIGOS (controls).
SETTING
Two academic medical centers.
PATIENTS OR OTHER PARTICIPANTS
276 with Rotterdam-defined PMOS and 97 controls.
INTERVENTION(S)
Low dose OCPs (4-6 months), metformin (2000mg/day for 6 months), or LSM (4 months).
MAIN OUTCOME MEASURE(S)
Serum concentrations of 11β-hydroxytestosterone (11-OHT), 11-ketotestosterone (11-KT), 11-ketoandrostenedione (11-KA4), and 11β-hydroxyandrostenedione (11-OHA4) measured by LC-MS/MS, and total testosterone (TT), at baseline and end of study.
RESULTS
Adjusting for age and BMI, women with PCOS/PMOS had higher median 11-OHT (11.0 vs 7.8 ng/dL; P = 0.01) and 11-KT (31.9 vs 25.6 ng/dL; P = 0.03) than controls. Elevations were phenotype-specific: biochemical hyperandrogenism showed broad increases, whereas clinical hyperandrogenism with normal TT found no significant…
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