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Reproductive Endocrinology

SAT-194 - What Proportion of Women with Elevated Androgen Levels in Medically Unbiased Populations Have PCOS?

Saturday, June 13, 2026
9:30 AM - 4:30 PM CT
Location: ENDOExpo; Poster Floor
Disclosure(s):
Stephanie Mohammed, Ph.D: No financial relationships to disclose
Ricardo Azziz, MD, MBA, MPH: Core Acess Surgical Technologies: Consultant (); May Health: Consultant (); Postera: Consultant (); Quest Diagnostics: Grant Recipient (); Quest Foundation: Grant Recipient (); Tellurian Global, LLC (dba SPH Consulting Group): Owner/Co-Owner Founder/Co-Founder ()


Background: Androgens are an important independent predictor of cardiometabolic (CM) risk in men – the lower the androgens, the higher the CM risk. However, the association of androgens to CM risk in women is less well understood and is likely discordant with that observed in men. Much of what we know about elevated androgens and CM risk in women stems from the study of a common endocrinopathy, polycystic ovary syndrome (PCOS). PCOS is associated with clinical and/or biochemical androgen excess (AE), functional and/or morphologic ovarian dysfunction, and increased CM risk. However, likely not all women with higher androgen levels in the general population have PCOS. In this study, we aimed to determine the proportion of women with PCOS among women with elevated androgens in representative medically unbiased populations.

Methods: The data for this study were obtained from the PCOS Epidemiology & Phenotype (PEP) studies in Nigeria, Trinidad, and the US. In Nigeria and Trinidad, total testosterone (TT) was measured by liquid chromatography–tandem mass spectrometry (LC-MS/MS); in Nigeria, PCOS was defined by the Rotterdam 2003 criteria and in Trinidad by the NIH 1990 criteria (Phenotypes A & B of Rotterdam 2003, i.e., “classic PCOS”). In the US (Alabama) cohort, TT was measured after steroid extraction and Sephadex column chromatography using an in-house RIA, and PCOS was defined by the NIH 1990 criteria. Free testosterone (FT) was measured by equilibrium dialysis following LC-MS/MS in the Nigeria and Trinidad cohorts. Higher androgen levels (i.e., AE) were defined as values in the upper quartile of the population’s distribution.


Results: Substantial overlap in androgen levels was observed between women with and without PCOS in all three populations. In Alabama, only 30.4% of women with TT levels in the upper quartile met criteria for PCOS. In Nigeria, 55.5% of women with TT levels in the upper quartile had PCOS, while in Trinidad, 65.0% of women with TT in the upper quartile had PCOS. Assessing FT indicated similar patterns: in Nigeria, 61.9% of women with FT levels in the upper quartile had PCOS, and in Trinidad, 67.2% had PCOS.

Conclusion: Across three diverse populations, between 30% and 70% of women with TT or FT in the upper quartile of the population do not have PCOS. These data indicate that higher androgen levels are highly prevalent in women, independent of whether they have PCOS, and may play an important role in the CM risk of this population.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*

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