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Both RCTs and pre-post studies providing data for direct extraction or calculation of mean (SD) changes in the investigated outcomes, published until March 1, 2025, were considered. Protocols included \u201cVery Low\u201d and \u201cLow\u201d Calories KD, and modified KD regimens. The primary outcome was the effect of the KD on total testosterone (TT), Free T (FT) and Sex Hormone Binding Globulin (SHBG) compared to baseline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The KD was found to be associated with a statistically significant reduction in TT (n\u2009=\u2009290, Mean Difference [MD] -0.35, CI -0.46; -0.24) and a significant increase in SHBG levels (n\u2009=\u2009144, MD 19.50, CI 6.90; 32.11), independently of study design. When considering only RCTs (4 studies), the KD showed a moderate, statistically significant benefit on TT levels compared to the control intervention, with a high heterogeneity (n\u2009=\u2009115 vs. 117, SMD -0.284, CI -0.543, -0.035; p\u2009=\u20090.031). Neither the duration of the KD protocol, the change in BMI, the change in fasting insulin levels nor the change in LH\/FSH ratio were able to significantly affect the change in TT levels observed over time. In addition, the KD associated with a significant reduction in LH levels (n\u2009=\u2009275, MD -3.48, CI -4.71; -2.26) and in the LH\/FSH ratio (n\u2009=\u2009275, MD -0.99, CI -1.44; -0.54).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our meta-analysis indicates a reduced biochemical hyperandrogenism\u2014particularly a reduction in TT\u2014and a reduction in the LH\/FSH ratio among women with PCOS following a KD. Our findings also suggest a specific effect of ketosis on ovarian function acting alongside metabolic improvements, but a direct causal link cannot be definitively established. Owing to the low quality and heterogeneous nature of the available studies, larger, high-quality RCTs are essential to consolidate this evidence and determine clinical efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40618-026-02924-1","type":"journal-article","created":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T06:53:17Z","timestamp":1781333597000},"page":"3185-3202","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ketogenic diet as a therapeutic intervention for biochemical hyperandrogenism in PCOS women with obesity or overweight: a meta-analytic study"],"prefix":"10.1007","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1472-6051","authenticated-orcid":false,"given":"Elisa","family":"Maseroli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Alfaroli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Cirillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena Anna","family":"Ravelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Lambrinoudaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Focardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianni","family":"Virgili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Vignozzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,13]]},"reference":[{"issue":"4","key":"2924_CR1","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1016\/j.fertnstert.2023.07.025","volume":"120","author":"HJ Teede","year":"2023","unstructured":"Teede HJ, Tay CT, Laven J, Dokras A, Moran LJ, Piltonen TT, Costello MF, Boivin J, Redman ML, Boyle AJ, Norman RJ, Mousa A, Joham AE, International PCOS Network (2023) Recommendations from the 2023 International Evidence-based Guideline for the assessment and management of Polycystic Ovary Syndrome. 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EM declares: speaker honoraria for Therascience, Theramex Italia, New Penta, Eli Lilly. LV declares to have received funding from the following companies for scientific research, advisory board attendance, and speaker honoraria: Therascience, Theramex, Bayer-Schering Pharma, Intercept Pharmaceutics, Lipocine Incorporated, Bruno Pharmaceutics, Penta, Ibsa Farmaceutici Italia, Galecto Inc., and Freya Pharma Solutions. LV is president of SIAMS (Italian Society of Andrology and Sexual Medicine) and ISSWSH (International Society for the Study of Women\u2019s Sexual Health).","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}