Hyperandrogenism in Women with Polycystic Ovarian Syndrome: Pathophysiology and Controversies

Polycystic ovary syndrome (PCOS) is an essential differential diagnosis of hyperandrogenism to consider in women, with most women presenting with irregular menses, infertility, and hirsutism. The diagnosis is challenging because it is a heterogenous disorder with significant variations in its associated features. Classic PCOS (hyperandrogenism plus ovulatory dysfunction) affects about 10% of reproductive-age women. Hyperandrogenism (clinical, biochemical, or both) is a hallmark of the syndrome. Approximately 60–76% of PCOS women are hirsute and hyperandrogenemia is observed in 75–90% of these women. Androgen assays are not always reliable at the lower levels detected in women with PCOS. This article will attempt to review the pathophysiology and controversies of hyperandrogenism in PCOS women, its clinical and biochemical presentations, and management.