The relationships of sex hormone-binding globulin, total testosterone, androstenedione and free testosterone with metabolic and reproductive features of polycystic ovary syndrome

Pomme I H G Simons; Olivier Valkenburg; Judith A P Bons; Coen D A Stehouwer; Martijn C G J Brouwers

doi:10.1002/edm2.267

The relationships of sex hormone-binding globulin, total testosterone, androstenedione and free testosterone with metabolic and reproductive features of polycystic ovary syndrome

Endocrinol Diabetes Metab. 2021 May 24;4(3):e00267. doi: 10.1002/edm2.267. eCollection 2021 Jul.

Authors

Pomme I H G Simons^{1

2

3}, Olivier Valkenburg⁴, Judith A P Bons⁵, Coen D A Stehouwer^{2

3

6}, Martijn C G J Brouwers^{1

3}

Affiliations

¹ Division of Endocrinology and Metabolic Diseases Department of Internal Medicine Maastricht University Medical Centre Maastricht The Netherlands.
² Laboratory for Metabolism and Vascular Medicine Maastricht University Maastricht The Netherlands.
³ CARIM School for Cardiovascular Diseases Maastricht University Maastricht The Netherlands.
⁴ Department of Reproductive Medicine Maastricht University Medical Centre Maastricht The Netherlands.
⁵ Central Diagnostic Laboratory Maastricht University Medical Centre Maastricht The Netherlands.
⁶ Division of General Internal Medicine Department of Internal Medicine Maastricht University Medical Centre Maastricht The Netherlands.

Abstract

Objective: A recent Mendelian randomization study has suggested a causal role for sex hormone-binding globulin (SHBG), total testosterone and free testosterone in the pathogenesis of polycystic ovary syndrome (PCOS). The aim of this study was to assess the relationships of SHBG, androstenedione, total and free testosterone with the individual metabolic and reproductive features of PCOS.

Design: Cross-sectional data in PCOS patients (n=96) prospectively collected in a secondary/tertiary clinic for menstrual cycle disorders.

Methods: Multivariable regression analyses were conducted to study the associations between SHBG, androstenedione, total and free testosterone with metabolic (BMI, waist circumference, systolic and diastolic blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides and homeostatic model assessment for insulin resistance [HOMA2-IR]) and reproductive features (menstrual cycle length, antral follicle count, anti-Müllerian hormone, luteinizing hormone, follicle-stimulating hormone and Ferriman-Gallwey score) of PCOS.

Results: Serum SHBG and free testosterone, but not total testosterone or androstenedione, were significantly associated with BMI, waist circumference, serum triglycerides, HDL cholesterol, LDL cholesterol and HOMA2-IR. The strength of the associations with serum lipids was reduced after adjustment for BMI, but not for HOMA2-IR. Total testosterone was significantly associated with antral follicle count. SHBG, total testosterone and androstenedione were significantly associated with serum AMH. Only the strength of the association for SHBG was reduced after adjustment for BMI.

Conclusions: Serum SHBG is associated with primarily metabolic features, whereas total testosterone and androstenedione are associated with reproductive features of PCOS. These results suggest a differential underlying pathophysiology for the metabolic and reproductive features of PCOS.

Keywords: androgens; metabolic syndrome; polycystic ovary syndrome; sex hormone‐binding globulin.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Androstenedione*
Cross-Sectional Studies
Female
Humans
Polycystic Ovary Syndrome* / complications
Polycystic Ovary Syndrome* / pathology
Sex Hormone-Binding Globulin / analysis
Sex Hormone-Binding Globulin / metabolism
Testosterone

Substances

Sex Hormone-Binding Globulin
Testosterone
Androstenedione