Vol 70, No 4 (2019)
Original paper
Published online: 2019-07-09

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The value of the free androgen index depends on the phenotype of polycystic ovary syndrome — a single-centre experience

Katarzyna Ożga1, Magdalena Krzyczkowska- Sendrakowska1, Alicja Hubalewska- Dydejczyk2, Aleksandra Gilis-Januszewska2, Maciej Ratajczak3, Magdalena Ratajczak4, Zlata Chaykivska5, Robert Jach1
Pubmed: 30938834
Endokrynol Pol 2019;70(4):330-335.


Introduction: The free androgen index (FAI) values differ among patients with polycystic ovarian syndrome; however, the differences are not fully understood or known. The aim of the study was to evaluate FAI in women with polycystic ovary syndrome (PCOS) in regard to the phenotype of the PCOS and insulin resistance status.

Material and methods: Anthropometric, hormonal, and biochemical parameters were assessed in 312 recruited women with PCOS. The FAI values were calculated in the reproductive and metabolic phenotypes of PCOS in groups of insulin resistance status based on the homeostasis model assessment-insulin resistance (HOMA-IR) > 2.0 or fasting insulin (FI) > 10 mmol/L. To test the relationship between individual variables, Spearman’s correlation analysis, the Kolmogorov-Smirnov test, and Student’s t-test were used.

Results: The correlation between FAI values and HOMA-IR and FI was 0.42 and 0.47, respectively, in PCOS patients. A two fold higher FAI value was observed in metabolic PCOS phenotype when compared to the reproductive one (8.51 ± 5.56 vs. 4.40 ± 2.45 for HOMA-IR and 8.73 ± 6.09 vs. 4.31 ± 3.39 for FI, respectively; p < 0.05).
Conclusions: PCOS patients are not a homogenous group in terms of FAI value. Patients with metabolic PCOS phenotype are characterised by two-fold higher FAI values compared with reproductive PCOS phenotype. Further studies on the metabolic and androgenic status of different types of PCOS phenotypes should be carried out. 

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  1. Milewicz A, Kudła M, Spaczyński R, et al. Stanowisko Polskiego Towarzystwa Endokrynologicznego, Polskiego Towarzystwa Ginekologów i Położników oraz Polskiego Towarzystwa Endokrynologii Ginekologicznej w sprawie diagnostyki i leczenia zespołu policystycznych jajników. Endokrynologia Polska. 2018; 69(4).
  2. Azziz R, Carmina E, Dewailly D, et al. Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009; 91(2): 456–488.
  3. Lujan M, Chizen D, Pierson R. Diagnostic Criteria for Polycystic Ovary Syndrome: Pitfalls and Controversies. J Obstet Gynaecol Can. 2008; 30(8): 671–679.
  4. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012; 33(6): 981–1030.
  5. Wild RA, Umstot ES, Andersen RN, et al. Androgen parameters and their correlation with body weight in one hundred thirty-eight women thought to have hyperandrogenism. Am J Obstet Gynecol. 1983; 146(6): 602–606.
  6. Cunliffe WJ, Gould DJ. Prevalence of facial acne vulgaris in late adolescence and in adults. Br Med J. 1979; 1(6171): 1109–1110.
  7. Ehrmann DA, Liljenquist DR, Kasza K, et al. PCOS/Troglitazone Study Group, PCOS/Troglitazone Study Group. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999; 22(1): 141–146.
  8. Tomé MA, Botana MA, Cadarso-Suárez C, et al. Prevalence of metabolic syndrome in Galicia (NW Spain) on four alternative definitions and association with insulin resistance. J Endocrinol Invest. 2009; 32(6): 505–511.
  9. Hedblad B, Nilsson P, Janzon L, et al. Relation between insulin resistance and carotid intima-media thickness and stenosis in non-diabetic subjects. Results from a cross-sectional study in Malmö, Sweden. Diabet Med. 2000; 17(4): 299–307.
  10. Goodman NF, Cobin RH, Futterweit W, et al. American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE), Androgen Excess and PCOS Society (AES). American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome — part 1. Endocr Pract. 2015; 21(11): 1291–1300.
  11. Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab. 1999; 84(10): 3666–3672.
  12. Azziz R, Sanchez LA, Knochenhauer ES, et al. Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab. 2004; 89(2): 453–462.
  13. Hautanen A. Synthesis and regulation of sex hormone-binding globulin in obesity. Int J Obes Relat Metab Disord. 2000; 24 Suppl 2: S64–S70.
  14. Morin-Papunen LC, Vauhkonen I, Koivunen RM, et al. Insulin sensitivity, insulin secretion, and metabolic and hormonal parameters in healthy women and women with polycystic ovarian syndrome. Hum Reprod. 2000; 15(6): 1266–1274.
  15. Szurkowska M, Szafraniec K, Gilis-Januszewska A, et al. [Insulin resistance indices in population-based study and their predictive value in defining metabolic syndrome]. Przegl Epidemiol. 2005; 59(3): 743–751.
  16. Ascaso JF, Pardo S, Real JT, et al. Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism. Diabetes Care. 2003; 26(12): 3320–3325.
  17. Olszanecka-Glinianowicz M, Banaś M, Zahorska-Markiewicz B. [Insulin resistance and serum concentrations of ovarian and adrenal androgen in obese women without additional disease and with policystic ovary syndrome]. Endokrynol Pol. 2005; 56(6): 921–926.
  18. Chen X, Yang D, Li L, et al. Abnormal glucose tolerance in Chinese women with polycystic ovary syndrome. Hum Reprod. 2006; 21(8): 2027–2032.
  19. Lee H, Oh JY, Sung YA, et al. The prevalence and risk factors for glucose intolerance in young Korean women with polycystic ovary syndrome. Endocrine. 2009; 36(2): 326–332.
  20. Weerakiet S, Srisombut C, Bunnag P, et al. Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in Asian women with polycystic ovary syndrome. Int J Gynaecol Obstet. 2001; 75(2): 177–184.
  21. Lenarcik A, Bidzińska-Speichert B, Tworowska-Bardzińska U, et al. Hormonal abnormalities in first-degree relatives of women with polycystic ovary syndrome (PCOS). Endokrynol Pol. 2011; 62(2): 129–133.
  22. Ganie MA, Dhingra A, Nisar S, et al. Oral glucose tolerance test significantly impacts the prevalence of abnormal glucose tolerance among Indian women with polycystic ovary syndrome: lessons from a large database of two tertiary care centers on the Indian subcontinent. Fertil Steril. 2016; 105(1): 194–201.e1.
  23. O'Reilly MW, Taylor AE, Crabtree NJ, et al. Hyperandrogenemia predicts metabolic phenotype in polycystic ovary syndrome: the utility of serum androstenedione. J Clin Endocrinol Metab. 2014; 99(3): 1027–1036.
  24. Albu A, Radian S, Fica S, et al. Biochemical hyperandrogenism is associated with metabolic syndrome independently of adiposity and insulin resistance in Romanian polycystic ovary syndrome patients. Endocrine. 2015; 48(2): 696–704.
  25. Kissebah AH, Vydelingum N, Murray R, et al. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab. 1982; 54(2): 254–260.
  26. Burghen GA, Givens JR, Kitabchi AE. Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease. J Clin Endocrinol Metab. 1980; 50(1): 113–116.
  27. Dickerson EH, Cho LW, Maguiness SD, et al. Insulin resistance and free androgen index correlate with the outcome of controlled ovarian hyperstimulation in non-PCOS women undergoing IVF. Hum Reprod. 2010; 25(2): 504–509.
  28. Fukui M, Kitagawa Y, Ose H, et al. Role of Endogenous Androgen Against Insulin Resistance and Athero-sclerosis in Men with Type 2 Diabetes. Curr Diabetes Rev. 2007; 3(1): 25–31.
  29. Nadaraja RND, Sthaneshwar P, Razali N. Establishing the cut off values of androgen markers in the assessment of polycystic ovarian syndrome. Malays J Pathol. 2018; 40(1): 33–39.
  30. Zhou Z, Ni R, Hong Yu, et al. Defining hyperandrogenaemia according to the free androgen index in Chinese women: a cross-sectional study. Clin Endocrinol (Oxf). 2012; 77(3): 446–452.
  31. Maredia H, Lambert-Messerlian GM, Palomaki GE, et al. Cut-off levels for hyperandrogenemia among Samoan women: An improved methodology for deriving normative data in an obese population. Clin Biochem. 2016; 49(10-11): 782–786.
  32. Hahn S, Kuehnel W, Tan S, et al. Diagnostic value of calculated testosterone indices in the assessment of polycystic ovary syndrome. Clin Chem Lab Med. 2007; 45(2): 202–207.
  33. Brand JS, van der Tweel I, Grobbee DE, et al. Testosterone, sex hormone-binding globulin and the metabolic syndrome: a systematic review and meta-analysis of observational studies. Int J Epidemiol. 2011; 40(1): 189–207.
  34. Apridonidze T, Essah PA, Iuorno MJ. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005; 90(4): 1929–1935.
  35. Albu A, Radian S, Fica S, et al. Biochemical hyperandrogenism is associated with metabolic syndrome independently of adiposity and insulin resistance in Romanian polycystic ovary syndrome patients. Endocrine. 2015; 48(2): 696–704.
  36. DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol. 1979; 237(3): E214–E223.