Hyperandrogenemia Association with Acne and Hirsutism Severity in Croatian Women with Polycystic Ovary Syndrome

Clinical trait associated with androgen, acne and hirsutism, are important diagnostic features of polycystic ovary syndrome (PCOS). As androgens are necessary for the development of cutaneous signs of PCOS, patients with severe forms of clinical hyperandrogenism are expected to present with higher levels of plasma androgens. This relationship has not been well established and studies examining the relationship have produced inconsistent results. The aim of this study was to analyze the correlation between the severity of clinical traits caused by androgen, acne and hirsutism, with plasma levels of androgens in Croatian women diagnosed with PCOS. A hundred and forty-five women in the reproductive age with isolated acne (N=61) or isolated hirsutism (N=84), oligo/amenorrhea and polycystic morphology of the ovaries were enrolled in the study. Acne grade, hirsutism grade, BMI and WHR were recorded. Hormonal profiles were measured, and an assessment of insulin resistance was performed. There were were no significant associations between acne severity and BMI, WHR and examined hormonal and insulin resistance parameters. There was a significant correlation between SHBG and FT levels and the severity of hirsutism (ρ=-0.611, P<0.001; ρ=0.337, P=0.002). No significant association was found between the hirsutism grade and other hormonal and metabolic parameters examined. In conclusion, acne severity in PCOS patients is not linearly associated with serum androgen levels, therefore, their levels should not be used to determine the dose of anti-androgen therapy. The observed negative correlation between serum SHBG levels and the degree of hirsutism suggests that hormonal contraception, which elevates SHBG, should be used as the primary therapy in hirsute PCOS patients.