PCOS may not be just a reproductive disorder in

women. It is rather a metabolic disorder (with

reproductive dysfunction) that can be seen in

both men and women.

The two reproductive characteristics of PCOS seen solely in women include oligo-ovulatory (scanty ovulation) or anovulatory (no ovulation) which is necessary for the diagnosis along with hyperandrogenism (high male hormones) and polycystic ovaries in spite of the name PCOS, not all sufferers have polycystic ovaries and it is not necessary for the diagnosis.

Other characteristics, such as metabolic abnormalities, and cardiovascular problems, can all be found in both genders, especially in men who are relatives of women with PCOS. As discussed, the genetic basis of PCOS has been found in the close male relatives of women with PCOS. The insulin signal transduction defect resulting in insulin resistance and hyperinsulinemia which drives androgen production in both sexes.

There are a few published articles regarding PCOS phenotype in men. The findings suggest that male relatives of women with PCOS display premature male baldness as well as hirsutism (One study by Dusková et al. concluded that in a population of men experiencing premature hair loss, close to 30% of men displayed hormonal resemblances to women with PCOS (low SHBG, gonadotropin abnormalities) in addition to an increased occurrence of insulin resistance.

30

It is possible that this 30% represents the male equivalent of PCOS, which corresponds to the prevalence of PCOS in women.

Once the relationship between the male and female phenotype is better understood, it may be beneficial for male relatives of women with PCOS to be examined. Early detection of symptoms can help us further characterize risks and treatment options.

Polycystic Ovary

Syndrome (PCOS)

Polycystic ovary syndrome (PCOS), also referred to as Stein-Leventhal syndrome, is one of the most common endocrinopathies. It is characterized by hyperandrogenism, hyperinsulinemia, central obesity, polycystic ovaries, and anovulation. However, some of these manifestations, including the polycystic ovaries, are neither specific for the disorder, nor found in all affected individuals. PCOS appears to be due to one or more primary defects in the upstream gonadotropin/androgen and/or insulin pathway, with the polycystic ovaries being one of many downstream manifestations. Yet, the pathophysiology of PCOS is not completely elucidated. Since the primary defect underlying PCOS may be an upstream endocrine and/or metabolic disturbance, rather than a defect in the ovaries themselves, we hypothesize that this aberration can also arise in men and that the absence of polycystic ovaries in men with other stigmata of the disorder should not eliminate the diagnosis. Our hypothesis is supported by the observation that a genetic susceptibility to PCOS exists, and that PCOS-type manifestations are not limited to women. Indeed, male relatives may suffer from insulin resistance, obesity, diabetes mellitus, and cardiovascular disease. Therefore, recognition of this syndrome in men is important, since pharmacologic treatments identified for women with PCOS may alleviate metabolic problems related to insulin resistance and its sequelae in men with a similar underlying defect. We suggest that first-degree relatives of patients with PCOS should be examined not only for phenotypic features characteristic of PCOS but also for biochemical evidence of hyperinsulinemia and hyperandrogenism. In addition to examining these individuals for obesity, the women should be evaluated for hirsutism and the men should be screened for early-onset male-pattern alopecia and excess hairiness. Serologic evaluation should included the ratio of fasting levels of glucose to insulin, a glucose tolerance test, the free testosterone level and the sex hormone-binding globulin level. Finally, both male and female first-degree relatives of patients with PCOS should be tested for the underlying molecular defect(s) of this condition, once it is identified. As new treatments for PCOS emerge, e.g. insulin-sensitizing drugs, it will be important to determine if these treatments have beneficial effects on the metabolic symptoms and complications in all afflicted patients, regardless of gender.

Author: Division of Cancer Medicine, University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States