{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:20:35Z","timestamp":1791951635440,"version":"4.3.4"},"reference-count":96,"publisher":"Oxford University Press (OUP)","issue":"2","content-domain":{"domain":["rep.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6,23]]},"abstract":"<jats:sec>\n                    <jats:title>In brief<\/jats:title>\n                    <jats:p>Polycystic ovary syndrome (PCOS) is a complex endocrine disorder characterised by androgen excess, which drives not only reproductive dysfunction but also significant metabolic disturbances. This review outlines the mechanistic role of classical and 11-oxygenated androgens in tissue-specific metabolic dysfunction and their progression to the metabolic manifestations seen in women with PCOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>\n                      Polycystic ovary syndrome (PCOS) is a complex endocrine disorder characterised by androgen excess, reproductive dysfunction and metabolic disturbances. Beyond its reproductive implications, hyperandrogenism plays a central role in the pathogenesis of metabolic dysfunction, contributing to insulin resistance, type 2 diabetes mellitus (T2DM), metabolic-associated steatotic liver disease (MASLD) and cardiovascular disease (CVD). While classical androgens have long been implicated, increasing evidence highlights the role of peripheral androgen metabolism, particularly 11-oxygenated androgens, in driving metabolic dysregulation. Androgen excess promotes tissue-specific changes, leading to increased visceral adiposity, impaired adipocyte function, increased skeletal muscle insulin resistance and hepatic lipid accumulation and fibrosis. These metabolic perturbations are further compounded by the bidirectional relationship between insulin resistance and androgen excess, establishing a self-perpetuating cycle of metabolic dysfunction. Epidemiological and\n                      <jats:italic>in vivo<\/jats:italic>\n                      studies support a causal link between hyperandrogenism and T2DM, independent of obesity, underscoring its role as a key metabolic driver in PCOS. While the long-term cardiovascular implications of PCOS remain debated, emerging evidence suggests an increased risk of CVD, particularly in hyperandrogenic phenotypes. This review examines the mechanistic interplay between androgen excess and metabolic dysfunction in PCOS, integrating translational insights into the clinical manifestations of the metabolic disturbances increasingly recognised in PCOS.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/rep-25-0102","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T09:25:15Z","timestamp":1750670715000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-11","source":"Crossref","is-referenced-by-count":18,"title":["POLYCYSTIC OVARY SYNDROME: ORIGINS AND IMPLICATIONS: Polycystic ovary syndrome: the impact of androgen excess on metabolic health"],"prefix":"10.1093","volume":"170","author":[{"given":"Leanne","family":"Cussen","sequence":"first","affiliation":[{"name":"Androgens in Health & Disease Research Group, Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland"},{"name":"Department of Endocrinology, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"McDonnell","sequence":"additional","affiliation":[{"name":"Androgens in Health & Disease Research Group, Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland"},{"name":"Department of Endocrinology, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Miller","sequence":"additional","affiliation":[{"name":"Androgens in Health & Disease Research Group, Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland"},{"name":"Department of Endocrinology, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"McIlroy","sequence":"additional","affiliation":[{"name":"Androgens in Health & Disease Research Group, Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland"},{"name":"Endocrine Oncology Research Group, Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9108-9105","authenticated-orcid":true,"given":"Michael W","family":"O\u2019Reilly","sequence":"additional","affiliation":[{"name":"Androgens in Health & Disease Research Group, Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland"},{"name":"Department of Endocrinology, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"bib1","series-title":"Clin Endocrinol","first-page":"426","article-title":"Visceral adiposity index (VAI) is related to the severity of anovulation and other clinical features in women with polycystic ovary syndrome","volume":"81","author":"Androulakis II","year":"2014","unstructured":"Androulakis II\n, \nKandaraki E\n, \nChristakou C\n, et al.\n 2014 Visceral adiposity index (VAI) is related to the severity of anovulation and other clinical features in women with polycystic ovary syndrome. Clin Endocrinol 81 426\u2013431. (https:\/\/doi.org\/10.1111\/cen.12447)"},{"key":"bib2","series-title":"J Gastroenterol Hepatol","first-page":"980","article-title":"Adverse metabolic phenotype of adolescent girls with non-alcoholic fatty liver disease plus polycystic ovary syndrome compared with other girls and boys","volume":"31","author":"Ayonrinde OT","year":"2016","unstructured":"Ayonrinde OT\n, \nAdams LA\n, \nDoherty DA\n, et al.\n 2016 Adverse metabolic phenotype of adolescent girls with non-alcoholic fatty liver disease plus polycystic ovary syndrome compared with other girls and boys. J Gastroenterol Hepatol 31 980\u2013987. (https:\/\/doi.org\/10.1111\/jgh.13241)"},{"key":"bib3","series-title":"Clin Endocrinol","first-page":"137","article-title":"Obesity and polycystic ovary syndrome","volume":"65","author":"Barber TM","year":"2006","unstructured":"Barber TM\n, \nMcCarthy MI\n, \nWass JA\n, et al.\n 2006 Obesity and polycystic ovary syndrome. Clin Endocrinol 65 137\u2013145. (https:\/\/doi.org\/10.1111\/j.1365-2265.2006.02587.x)"},{"key":"bib4","series-title":"Clin Endocrinol","first-page":"513","article-title":"Metabolic characteristics of women with polycystic ovaries and oligo-amenorrhoea but normal androgen levels: implications for the management of polycystic ovary syndrome","volume":"66","author":"Barber TM","year":"2007","unstructured":"Barber TM\n, \nWass JA\n, \nMcCarthy MI\n, et al.\n 2007 Metabolic characteristics of women with polycystic ovaries and oligo-amenorrhoea but normal androgen levels: implications for the management of polycystic ovary syndrome. Clin Endocrinol 66 513\u2013517. (https:\/\/doi.org\/10.1111\/j.1365-2265.2007.02764.x)"},{"key":"bib5","series-title":"Fertil Steril","first-page":"e93","article-title":"Skeletal muscle phenotype and receptor gene expression in polycystic ovary syndrome","volume":"102","author":"Berger JJ","year":"2014","unstructured":"Berger JJ\n, \nBamman MM\n, \nGower BA\n, et al.\n 2014 Skeletal muscle phenotype and receptor gene expression in polycystic ovary syndrome. Fertil Steril 102 e93. (https:\/\/doi.org\/10.1016\/j.fertnstert.2014.07.316)"},{"key":"bib6","series-title":"J Clin Endocrinol Metab","first-page":"e3369","article-title":"Women with polycystic ovary syndrome have an increased risk of major cardiovascular events: a population study","volume":"106","author":"Berni TR","year":"2021","unstructured":"Berni TR\n, \nMorgan CL\n & \nRees DA\n\n 2021 Women with polycystic ovary syndrome have an increased risk of major cardiovascular events: a population study. J Clin Endocrinol Metab 106 e3369\u2013e3380. (https:\/\/doi.org\/10.1210\/clinem\/dgab392)"},{"key":"bib7","series-title":"J Clin Endocrinol Metab","first-page":"113","article-title":"Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease","volume":"50","author":"Burghen GA","year":"1980","unstructured":"Burghen GA\n, \nGivens JR\n & \nKitabchi AE\n\n 1980 Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease. J Clin Endocrinol Metab 50 113\u2013116. (https:\/\/doi.org\/10.1210\/jcem-50-1-113)"},{"key":"bib8","series-title":"Int J Obes","first-page":"1341","article-title":"High-free androgen index is associated with increased risk of non-alcoholic fatty liver disease in women with polycystic ovary syndrome, independent of obesity and insulin resistance","volume":"41","author":"Cai J","year":"2017","unstructured":"Cai J\n, \nWu CH\n, \nZhang Y\n, et al.\n 2017 High-free androgen index is associated with increased risk of non-alcoholic fatty liver disease in women with polycystic ovary syndrome, independent of obesity and insulin resistance. Int J Obes 41 1341\u20131347. (https:\/\/doi.org\/10.1038\/ijo.2017.116)"},{"key":"bib9","series-title":"Obstet Gynecol","first-page":"263","article-title":"A 20-year follow-up of young women with polycystic ovary syndrome","volume":"119","author":"Carmina E","year":"2012","unstructured":"Carmina E\n, \nCampagna AM\n & \nLobo RA\n\n 2012 A 20-year follow-up of young women with polycystic ovary syndrome. Obstet Gynecol 119 263\u2013269. (https:\/\/doi.org\/10.1097\/AOG.0b013e31823f7135)"},{"key":"bib10","series-title":"Hum Reprod","first-page":"2619","article-title":"Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic\u2013hyperinsulinaemic clamp studies","volume":"31","author":"Cassar S","year":"2016","unstructured":"Cassar S\n, \nMisso ML\n, \nHopkins WG\n, et al.\n 2016 Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic\u2013hyperinsulinaemic clamp studies. Hum Reprod 31 2619\u20132631. (https:\/\/doi.org\/10.1093\/humrep\/dew243)"},{"key":"bib11","series-title":"J Hepatol","first-page":"412","article-title":"Nonalcoholic fatty liver disease in women with polycystic ovary syndrome","volume":"47","author":"Cerda C","year":"2007","unstructured":"Cerda C\n, \nPerez-Ayuso RM\n, \nRiquelme A\n, et al.\n 2007 Nonalcoholic fatty liver disease in women with polycystic ovary syndrome. J Hepatol 47 412\u2013417. (https:\/\/doi.org\/10.1016\/j.jhep.2007.04.012)"},{"key":"bib12","series-title":"Am J Respir Crit Care Med","first-page":"530","article-title":"Effect of testosterone administration on upper airway collapsibility during sleep","volume":"149","author":"Cistulli PA","year":"1994","unstructured":"Cistulli PA\n, \nGrunstein RR\n & \nSullivan CE\n\n 1994 Effect of testosterone administration on upper airway collapsibility during sleep. Am J Respir Crit Care Med 149 530\u2013532. (https:\/\/doi.org\/10.1164\/ajrccm.149.2.8306057)"},{"key":"bib13","series-title":"Am J Physiol Endocrinol Metab","first-page":"E1047","article-title":"Insulin resistance in the skeletal muscle of women with PCOS involves intrinsic and acquired defects in insulin signaling","volume":"288","author":"Corbould A","year":"2005","unstructured":"Corbould A\n, \nKim YB\n, \nYoungren JF\n, et al.\n 2005 Insulin resistance in the skeletal muscle of women with PCOS involves intrinsic and acquired defects in insulin signaling. Am J Physiol Endocrinol Metab 288 E1047\u2013E1054. (https:\/\/doi.org\/10.1152\/ajpendo.00361.2004)"},{"key":"bib14","series-title":"Obesity","first-page":"2399","article-title":"Hepatic steatosis is common in adolescents with obesity and PCOS and relates to de novo lipogenesis but not insulin resistance","volume":"24","author":"Cree-Green M","year":"2016","unstructured":"Cree-Green M\n, \nBergman BC\n, \nCoe GV\n, et al.\n 2016 Hepatic steatosis is common in adolescents with obesity and PCOS and relates to de novo lipogenesis but not insulin resistance. Obesity 24 2399\u20132406. (https:\/\/doi.org\/10.1002\/oby.21651)"},{"key":"bib15","series-title":"J Endocr Soc","first-page":"931","article-title":"Insulin resistance, hyperinsulinemia, and mitochondria dysfunction in nonobese girls with polycystic ovarian syndrome","volume":"1","author":"Cree-Green M","year":"2017","unstructured":"Cree-Green M\n, \nRahat H\n, \nNewcomer BR\n, et al.\n 2017 Insulin resistance, hyperinsulinemia, and mitochondria dysfunction in nonobese girls with polycystic ovarian syndrome. J Endocr Soc 1 931\u2013944. (https:\/\/doi.org\/10.1210\/js.2017-00192)"},{"key":"bib16","series-title":"J Steroid Biochem Mol Biol","article-title":"Long-term androgen excess induces insulin resistance and non-alcoholic fatty liver disease in PCOS-like rats","volume":"208","author":"Cui P","year":"2021","unstructured":"Cui P\n, \nHu W\n, \nMa T\n, et al.\n 2021 Long-term androgen excess induces insulin resistance and non-alcoholic fatty liver disease in PCOS-like rats. J Steroid Biochem Mol Biol 208 105829. (https:\/\/doi.org\/10.1016\/j.jsbmb.2021.105829)"},{"key":"bib17","series-title":"Endocr Rev","first-page":"981","article-title":"Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications","volume":"33","author":"Diamanti-Kandarakis E","year":"2012","unstructured":"Diamanti-Kandarakis E\n & \nDunaif A\n\n 2012 Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev 33 981\u20131030. (https:\/\/doi.org\/10.1210\/er.2011-1034)"},{"key":"bib18","series-title":"Diabetes","first-page":"1257","article-title":"Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome","volume":"41","author":"Dunaif A","year":"1992","unstructured":"Dunaif A\n, \nSegal KR\n, \nShelley DR\n, et al.\n 1992 Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome. Diabetes 41 1257\u20131266. (https:\/\/doi.org\/10.2337\/diab.41.10.1257)"},{"key":"bib19","series-title":"Eur J Endocrinol","first-page":"555","article-title":"Association of polycystic ovary syndrome with cardiovascular disease among female hospitalizations in the United States","volume":"188","author":"Dwivedi AK","year":"2023","unstructured":"Dwivedi AK\n, \nVishwakarma D\n, \nDubey P\n, et al.\n 2023 Association of polycystic ovary syndrome with cardiovascular disease among female hospitalizations in the United States. Eur J Endocrinol 188 555\u2013563. (https:\/\/doi.org\/10.1093\/ejendo\/lvad067)"},{"key":"bib20","series-title":"Int J Obes","first-page":"157","article-title":"Body fat topography in women with androgen excess","volume":"12","author":"Evans DJ","year":"1988","unstructured":"Evans DJ\n, \nBarth JH\n & \nBurke CW\n\n 1988 Body fat topography in women with androgen excess. Int J Obes 12 157\u2013162. (https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3384560)"},{"key":"bib21","series-title":"Nat Sci Sleep","first-page":"45","article-title":"Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies","volume":"10","author":"Fernandez RC","year":"2018","unstructured":"Fernandez RC\n, \nMoore VM\n, \nVan Ryswyk EM\n, et al.\n 2018 Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nat Sci Sleep 10 45\u201364. (https:\/\/doi.org\/10.2147\/NSS.S127475)"},{"key":"bib22","series-title":"Acta Obstet Gynecol Scand","first-page":"320","article-title":"Higher menopausal age but no differences in parity in women with polycystic ovary syndrome compared with controls","volume":"98","author":"Forslund M","year":"2019","unstructured":"Forslund M\n, \nLandin-Wilhelmsen K\n, \nSchmidt J\n, et al.\n 2019 Higher menopausal age but no differences in parity in women with polycystic ovary syndrome compared with controls. Acta Obstet Gynecol Scand 98 320\u2013326. (https:\/\/doi.org\/10.1111\/aogs.13489)"},{"key":"bib23","series-title":"J Clin Endocrinol Metab","first-page":"1158","article-title":"Hypersecretion of androstenedione by isolated thecal cells from polycystic ovaries","volume":"79","author":"Gilling-Smith C","year":"1994","unstructured":"Gilling-Smith C\n, \nWillis DS\n, \nBeard RW\n, et al.\n 1994 Hypersecretion of androstenedione by isolated thecal cells from polycystic ovaries. J Clin Endocrinol Metab 79 1158\u20131165. (https:\/\/doi.org\/10.1210\/jcem.79.4.7962289)"},{"key":"bib24","series-title":"Clin Endocrinol","first-page":"93","article-title":"Evidence for a primary abnormality of thecal cell steroidogenesis in the polycystic ovary syndrome","volume":"47","author":"Gilling-Smith C","year":"1997","unstructured":"Gilling-Smith C\n, \nStory H\n, \nRogers V\n, et al.\n 1997 Evidence for a primary abnormality of thecal cell steroidogenesis in the polycystic ovary syndrome. Clin Endocrinol 47 93\u201399. (https:\/\/doi.org\/10.1046\/j.1365-2265.1997.2321049.x)"},{"key":"bib25","series-title":"Cardiovasc Diabetol","first-page":"37","article-title":"Cardiovascular disease in a nationwide population of Danish women with polycystic ovary syndrome","volume":"17","author":"Glintborg D","year":"2018","unstructured":"Glintborg D\n, \nRubin KH\n, \nNybo M\n, et al.\n 2018 Cardiovascular disease in a nationwide population of Danish women with polycystic ovary syndrome. Cardiovasc Diabetol 17 37. (https:\/\/doi.org\/10.1186\/s12933-018-0680-5)"},{"key":"bib26","series-title":"Endocr Connect","first-page":"437","article-title":"Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature","volume":"6","author":"Helvaci N","year":"2017","unstructured":"Helvaci N\n, \nKarabulut E\n, \nDemir AU\n, et al.\n 2017 Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature. Endocr Connect 6 437\u2013445. (https:\/\/doi.org\/10.1530\/EC-17-0129)"},{"key":"bib27","series-title":"Sci Rep","article-title":"Non-alcoholic fatty liver disease is associated with hyperandrogenism in women with polycystic ovary syndrome","volume":"13","author":"Hong SH","year":"2023","unstructured":"Hong SH\n, \nSung YA\n, \nHong YS\n, et al.\n 2023 Non-alcoholic fatty liver disease is associated with hyperandrogenism in women with polycystic ovary syndrome. Sci Rep 13 13397. (https:\/\/doi.org\/10.1038\/s41598-023-39428-4)"},{"key":"bib28","series-title":"Diabetes","first-page":"1113","article-title":"Association of increased intramyocellular lipid content with insulin resistance in lean nondiabetic offspring of type 2 diabetic subjects","volume":"48","author":"Jacob S","year":"1999","unstructured":"Jacob S\n, \nMachann J\n, \nRett K\n, et al.\n 1999 Association of increased intramyocellular lipid content with insulin resistance in lean nondiabetic offspring of type 2 diabetic subjects. Diabetes 48 1113\u20131119. (https:\/\/doi.org\/10.2337\/diabetes.48.5.1113)"},{"key":"bib29","series-title":"J Clin Endocrinol Metab","first-page":"2414","article-title":"5alpha-reductase activity in women with polycystic ovary syndrome","volume":"84","author":"Jakimiuk AJ","year":"1999","unstructured":"Jakimiuk AJ\n, \nWeitsman SR\n & \nMagoffin DA\n\n 1999 5alpha-reductase activity in women with polycystic ovary syndrome. J Clin Endocrinol Metab 84 2414\u20132418. (https:\/\/doi.org\/10.1210\/jcem.84.7.5863)"},{"key":"bib30","series-title":"Sleep","first-page":"zsy085","article-title":"The association between obstructive sleep apnea and metabolic abnormalities in women with polycystic ovary syndrome: a systematic review and meta-analysis","volume":"41","author":"Kahal H","year":"2018","unstructured":"Kahal H\n, \nKyrou I\n, \nUthman O\n, et al\n. 2018 The association between obstructive sleep apnea and metabolic abnormalities in women with polycystic ovary syndrome: a systematic review and meta-analysis. Sleep 41 zsy085. (https:\/\/doi.org\/10.1093\/sleep\/zsy085)"},{"key":"bib31","series-title":"Hum Reprod Update","first-page":"455","article-title":"Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression","volume":"24","author":"Kakoly NS","year":"2018","unstructured":"Kakoly NS\n, \nKhomami MB\n, \nJoham AE\n, et al.\n 2018 Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression. Hum Reprod Update 24 455\u2013467. (https:\/\/doi.org\/10.1093\/humupd\/dmy007)"},{"key":"bib32","series-title":"Ther Adv Endocrinol Metab","article-title":"Implicating androgen excess in propagating metabolic disease in polycystic ovary syndrome","volume":"11","author":"Kempegowda P","year":"2020","unstructured":"Kempegowda P\n, \nMelson E\n, \nManolopoulos KN\n, et al.\n 2020 Implicating androgen excess in propagating metabolic disease in polycystic ovary syndrome. Ther Adv Endocrinol Metab 11 2042018820934319. (https:\/\/doi.org\/10.1177\/2042018820934319)"},{"key":"bib33","series-title":"Horm Res Paediatr","first-page":"242","article-title":"Carotid intima-media thickness is associated with increased androgens in adolescents and young adults with classical congenital adrenal hyperplasia","volume":"85","author":"Kim MS","year":"2016","unstructured":"Kim MS\n, \nDao-Tran A\n, \nDavidowitz E\n, et al.\n 2016 Carotid intima-media thickness is associated with increased androgens in adolescents and young adults with classical congenital adrenal hyperplasia. Horm Res Paediatr 85 242\u2013249. (https:\/\/doi.org\/10.1159\/000444169)"},{"key":"bib34","series-title":"Aliment Pharmacol Ther","first-page":"1403","article-title":"Polycystic ovary syndrome with hyperandrogenism as a risk factor for non-obese non-alcoholic fatty liver disease","volume":"45","author":"Kim JJ","year":"2017","unstructured":"Kim JJ\n, \nKim D\n, \nYim JY\n, et al.\n 2017 Polycystic ovary syndrome with hyperandrogenism as a risk factor for non-obese non-alcoholic fatty liver disease. Aliment Pharmacol Ther 45 1403\u20131412. (https:\/\/doi.org\/10.1111\/apt.14058)"},{"key":"bib35","series-title":"Acta Obstet Gynecol Scand","first-page":"728","article-title":"Women with polycystic ovary syndrome are burdened with multimorbidity and medication use independent of body mass index at late fertile age: a population-based cohort study","volume":"101","author":"Kujanpaa L","year":"2022","unstructured":"Kujanpaa L\n, \nArffman RK\n, \nPesonen P\n, et al.\n 2022 Women with polycystic ovary syndrome are burdened with multimorbidity and medication use independent of body mass index at late fertile age: a population-based cohort study. Acta Obstet Gynecol Scand 101 728\u2013736. (https:\/\/doi.org\/10.1111\/aogs.14382)"},{"key":"bib36","series-title":"Eur J Endocrinol","first-page":"409","article-title":"Polycystic ovary syndrome presents as a multimorbid condition by age 50: birth cohort linkage to national register data","volume":"190","author":"Kujanpaa L","year":"2024","unstructured":"Kujanpaa L\n, \nArffman RK\n, \nPesonen P\n, et al.\n 2024 Polycystic ovary syndrome presents as a multimorbid condition by age 50: birth cohort linkage to national register data. Eur J Endocrinol 190 409\u2013420. (https:\/\/doi.org\/10.1093\/ejendo\/lvae057)"},{"key":"bib37","series-title":"PLoS Med","article-title":"Polycystic ovary syndrome, androgen excess, and the risk of nonalcoholic fatty liver disease in women: a longitudinal study based on a United Kingdom primary care database","volume":"15","author":"Kumarendran B","year":"2018","unstructured":"Kumarendran B\n, \nO\u2019Reilly MW\n, \nManolopoulos KN\n, et al.\n 2018 Polycystic ovary syndrome, androgen excess, and the risk of nonalcoholic fatty liver disease in women: a longitudinal study based on a United Kingdom primary care database. PLoS Med 15 e1002542. (https:\/\/doi.org\/10.1371\/journal.pmed.1002542)"},{"key":"bib38","series-title":"Eur J Endocrinol","first-page":"265","article-title":"Increased risk of obstructive sleep apnoea in women with polycystic ovary syndrome: a population-based cohort study","volume":"180","author":"Kumarendran B","year":"2019","unstructured":"Kumarendran B\n, \nSumilo D\n, \nO'Reilly MW\n, et al.\n 2019 Increased risk of obstructive sleep apnoea in women with polycystic ovary syndrome: a population-based cohort study. Eur J Endocrinol 180 265\u2013272. (https:\/\/doi.org\/10.1530\/EJE-18-0693)"},{"key":"bib39","series-title":"J Steroid Biochem Mol Biol","first-page":"131","article-title":"Intracrinology in action: importance of extragonadal sex steroid biosynthesis and inactivation in peripheral tissues in both women and men","volume":"145","author":"Labrie F","year":"2015","unstructured":"Labrie F\n\n 2015 Intracrinology in action: importance of extragonadal sex steroid biosynthesis and inactivation in peripheral tissues in both women and men. J Steroid Biochem Mol Biol 145 131\u2013132. (https:\/\/doi.org\/10.1016\/j.jsbmb.2014.09.012)"},{"key":"bib40","series-title":"J Clin Endocrinol Metab","first-page":"3242","article-title":"Changes in glucose tolerance over time in women with polycystic ovary syndrome: a controlled study","volume":"90","author":"Legro RS","year":"2005","unstructured":"Legro RS\n, \nGnatuk CL\n, \nKunselman AR\n, et al.\n 2005 Changes in glucose tolerance over time in women with polycystic ovary syndrome: a controlled study. J Clin Endocrinol Metab 90 3242. (https:\/\/doi.org\/10.1210\/jc.2004-1843)"},{"key":"bib41","series-title":"Obes Rev","first-page":"339","article-title":"Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression","volume":"20","author":"Lim SS","year":"2019","unstructured":"Lim SS\n, \nKakoly NS\n, \nTan JWJ\n, et al.\n 2019 Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Obes Rev 20 339\u2013352. (https:\/\/doi.org\/10.1111\/obr.12762)"},{"key":"bib98","series-title":"PLoS One","first-page":"e11302","article-title":"Androgen Excess Produces Systemic Oxidative Stress and Predisposes to \u03b2-Cell Failure in Female Mice","volume":"5","author":"Liu S","year":"2010","unstructured":"Liu S\n, \nNavarro G\n & \nMauvais-Jarvis F\n\n 2010 Androgen Excess Produces Systemic Oxidative Stress and Predisposes to \u03b2-Cell Failure in Female Mice. PLoS One 5 e11302. (https:\/\/doi.org\/10.1371\/journal.pone.0011302)"},{"key":"bib42","series-title":"Fertil Steril","first-page":"S9","article-title":"Ovarian enzyme activities in women with polycystic ovary syndrome","volume":"86","author":"Magoffin DA","year":"2006","unstructured":"Magoffin DA\n\n 2006 Ovarian enzyme activities in women with polycystic ovary syndrome. Fertil Steril 86 (Supplement 1) S9\u2013S11. (https:\/\/doi.org\/10.1016\/j.fertnstert.2006.03.015)"},{"key":"bib43","series-title":"J Clin Endocrinol Metab","first-page":"1622","article-title":"High androgens in postmenopausal women and the risk for atherosclerosis and cardiovascular disease: the rotterdam study","volume":"103","author":"Meun C","year":"2018","unstructured":"Meun C\n, \nFranco OH\n, \nDhana K\n, et al.\n 2018 High androgens in postmenopausal women and the risk for atherosclerosis and cardiovascular disease: the rotterdam study. J Clin Endocrinol Metab 103 1622\u20131630. (https:\/\/doi.org\/10.1210\/jc.2017-02421)"},{"key":"bib44","series-title":"Clin Endocrinol","first-page":"150","article-title":"The cardiovascular risk profile of middle-aged women with polycystic ovary syndrome","volume":"92","author":"Meun C","year":"2020","unstructured":"Meun C\n, \nGunning MN\n, \nLouwers YV\n, et al.\n 2020 The cardiovascular risk profile of middle-aged women with polycystic ovary syndrome. Clin Endocrinol 92 150\u2013158. (https:\/\/doi.org\/10.1111\/cen.14117)"},{"key":"bib45","series-title":"Hum Reprod Update","first-page":"741","article-title":"PCOS during the menopausal transition and after menopause: a systematic review and meta-analysis","volume":"29","author":"Millan-de-Meer M","year":"2023","unstructured":"Millan-de-Meer M\n, \nLuque-Ramirez M\n, \nNattero-Chavez L\n, et al.\n 2023 PCOS during the menopausal transition and after menopause: a systematic review and meta-analysis. Hum Reprod Update 29 741\u2013772. (https:\/\/doi.org\/10.1093\/humupd\/dmad015)"},{"key":"bib46","series-title":"Climacteric","first-page":"29","article-title":"Prediction of age at menopause in women with polycystic ovary syndrome","volume":"21","author":"Minooee S","year":"2018","unstructured":"Minooee S\n, \nRamezani Tehrani F\n, \nRahmati M\n, et al.\n 2018 Prediction of age at menopause in women with polycystic ovary syndrome. Climacteric 21 29\u201334. (https:\/\/doi.org\/10.1080\/13697137.2017.1392501)"},{"key":"bib47","series-title":"J Clin Endocrinol Metab","first-page":"E628","article-title":"Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome","volume":"98","author":"Moghetti P","year":"2013","unstructured":"Moghetti P\n, \nTosi F\n, \nBonin C\n, et al.\n 2013 Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome. J Clin Endocrinol Metab 98 E628\u2013E637. (https:\/\/doi.org\/10.1210\/jc.2012-3908)"},{"key":"bib48","series-title":"Hum Reprod Update","first-page":"477","article-title":"Metabolic features of the reproductive phenotypes of polycystic ovary syndrome","volume":"15","author":"Moran L","year":"2009","unstructured":"Moran L\n & \nTeede H\n\n 2009 Metabolic features of the reproductive phenotypes of polycystic ovary syndrome. Hum Reprod Update 15 477\u2013488. (https:\/\/doi.org\/10.1093\/humupd\/dmp008)"},{"key":"bib49","series-title":"JCI Insight","article-title":"Androgen excess in pancreatic beta cells and neurons predisposes female mice to type 2 diabetes","volume":"3","author":"Navarro G","year":"2018","unstructured":"Navarro G\n, \nAllard C\n, \nMorford JJ\n, et al.\n 2018 Androgen excess in pancreatic beta cells and neurons predisposes female mice to type 2 diabetes. JCI Insight 3 e98607. (https:\/\/doi.org\/10.1172\/jci.insight.98607)"},{"key":"bib50","series-title":"J Clin Endocrinol Metab","first-page":"4465","article-title":"Transcriptional and epigenetic changes influencing skeletal muscle metabolisxm in women with polycystic ovary syndrome","volume":"103","author":"Nilsson E","year":"2018","unstructured":"Nilsson E\n, \nBenrick A\n, \nKokosar M\n, et al.\n 2018 Transcriptional and epigenetic changes influencing skeletal muscle metabolisxm in women with polycystic ovary syndrome. J Clin Endocrinol Metab 103 4465\u20134477. (https:\/\/doi.org\/10.1210\/jc.2018-00935)"},{"key":"bib51","series-title":"Lancet","first-page":"685","article-title":"Polycystic ovary syndrome","volume":"370","author":"Norman RJ","year":"2007","unstructured":"Norman RJ\n, \nDewailly D\n, \nLegro RS\n, et al.\n 2007 Polycystic ovary syndrome. Lancet 370 685\u2013697. (https:\/\/doi.org\/10.1016\/S0140-6736(07)61345-2)"},{"key":"bib52","series-title":"J Clin Endocrinol Metab","first-page":"1027","article-title":"Hyperandrogenemia predicts metabolic phenotype in polycystic ovary syndrome: the utility of serum androstenedione","volume":"99","author":"O'Reilly MW","year":"2014","unstructured":"O'Reilly MW\n, \nTaylor AE\n, \nCrabtree NJ\n, et al.\n 2014 Hyperandrogenemia predicts metabolic phenotype in polycystic ovary syndrome: the utility of serum androstenedione. J Clin Endocrinol Metab 99 1027\u20131036. (https:\/\/doi.org\/10.1210\/jc.2013-3399)"},{"key":"bib53","series-title":"Lancet","first-page":"S16","article-title":"Effect of insulin on AKR1C3 expression in female adipose tissue: in-vivo and in-vitro study of adipose androgen generation in polycystic ovary syndrome","volume":"385","author":"O'Reilly M","year":"2015","unstructured":"O'Reilly M\n, \nGathercole L\n, \nCapper F\n, et al.\n 2015 Effect of insulin on AKR1C3 expression in female adipose tissue: in-vivo and in-vitro study of adipose androgen generation in polycystic ovary syndrome. Lancet 385 (Supplement 1) S16. (https:\/\/doi.org\/10.1016\/S0140-6736(15)60331-2)"},{"key":"bib54","series-title":"J Clin Endocrinol Metab","first-page":"840","article-title":"11-oxygenated C19 steroids are the predominant androgens in polycystic ovary syndrome","volume":"102","author":"O'Reilly MW","year":"2017a","unstructured":"O'Reilly MW\n, \nKempegowda P\n, \nJenkinson C\n, et al.\n 2017a 11-oxygenated C19 steroids are the predominant androgens in polycystic ovary syndrome. J Clin Endocrinol Metab 102 840\u2013848. (https:\/\/doi.org\/10.1210\/jc.2016-3285)"},{"key":"bib55","series-title":"J Clin Endocrinol Metab","first-page":"3327","article-title":"AKR1C3-mediated adipose androgen generation drives lipotoxicity in women with polycystic ovary syndrome","volume":"102","author":"O'Reilly MW","year":"2017b","unstructured":"O'Reilly MW\n, \nKempegowda P\n, \nWalsh M\n, et al.\n 2017b AKR1C3-mediated adipose androgen generation drives lipotoxicity in women with polycystic ovary syndrome. J Clin Endocrinol Metab 102 3327\u20133339. (https:\/\/doi.org\/10.1210\/jc.2017-00947)"},{"key":"bib57","series-title":"Clin Endocrinol","first-page":"145","article-title":"Serum testosterone, sex hormone-binding globulin and sex-specific risk of incident type 2 diabetes in a retrospective primary care cohort","volume":"90","author":"O\u2019Reilly MW","year":"2019","unstructured":"O\u2019Reilly MW\n, \nGlisic M\n & \nKumarendran B\n\n 2019 Serum testosterone, sex hormone-binding globulin and sex-specific risk of incident type 2 diabetes in a retrospective primary care cohort. Clin Endocrinol 90 145\u2013154. (https:\/\/doi.org\/10.1111\/cen.13862)"},{"key":"bib58","series-title":"J Clin Endocrinol Metab","first-page":"739","article-title":"Weight gain and dyslipidemia in early adulthood associate with polycystic ovary syndrome: prospective cohort study","volume":"101","author":"Ollila MM","year":"2016","unstructured":"Ollila MM\n, \nPiltonen T\n, \nPuukka K\n, et al.\n 2016 Weight gain and dyslipidemia in early adulthood associate with polycystic ovary syndrome: prospective cohort study. J Clin Endocrinol Metab 101 739\u2013747. (https:\/\/doi.org\/10.1210\/jc.2015-3543)"},{"key":"bib59","series-title":"J Clin Endocrinol Metab","first-page":"1221","article-title":"Self-reported polycystic ovary syndrome is associated with hypertension: a Northern Finland Birth Cohort 1966 Study","volume":"104","author":"Ollila ME","year":"2019","unstructured":"Ollila ME\n, \nKaikkonen K\n, \nJarvelin MR\n, et al.\n 2019 Self-reported polycystic ovary syndrome is associated with hypertension: a Northern Finland Birth Cohort 1966 Study. J Clin Endocrinol Metab 104 1221\u20131231. (https:\/\/doi.org\/10.1210\/jc.2018-00570)"},{"key":"bib60","series-title":"Int J Environ Res Public Health","first-page":"1336","article-title":"Polycystic ovary syndrome: an evolutionary adaptation to lifestyle and the environment","volume":"19","author":"Parker J","year":"2022","unstructured":"Parker J\n, \nO\u2019Brien C\n, \nHawrelak J\n, et al.\n 2022 Polycystic ovary syndrome: an evolutionary adaptation to lifestyle and the environment. Int J Environ Res Public Health 19 1336. (https:\/\/doi.org\/10.3390\/ijerph19031336)"},{"key":"bib61","series-title":"Fertil Steril","first-page":"862","article-title":"Higher risk of type 2 diabetes in women with hyperandrogenic polycystic ovary syndrome","volume":"116","author":"Persson S","year":"2021","unstructured":"Persson S\n, \nElenis E\n, \nTurkmen S\n, et al.\n 2021 Higher risk of type 2 diabetes in women with hyperandrogenic polycystic ovary syndrome. Fertil Steril 116 862\u2013871. (https:\/\/doi.org\/10.1016\/j.fertnstert.2021.04.018)"},{"key":"bib62","series-title":"PLoS One","article-title":"Insulin resistance and hyperandrogenism drive steatosis and fibrosis risk in young females with PCOS","volume":"12","author":"Petta S","year":"2017","unstructured":"Petta S\n, \nCiresi A\n, \nBianco J\n, et al.\n 2017 Insulin resistance and hyperandrogenism drive steatosis and fibrosis risk in young females with PCOS. PLoS One 12 e0186136. (https:\/\/doi.org\/10.1371\/journal.pone.0186136)"},{"key":"bib63","series-title":"Fertil Steril","first-page":"788","article-title":"Normo- and hyperandrogenic women with polycystic ovary syndrome exhibit an adverse metabolic profile through life","volume":"107","author":"Pinola P","year":"2017","unstructured":"Pinola P\n, \nPuukka K\n, \nPiltonen TT\n, et al.\n 2017 Normo- and hyperandrogenic women with polycystic ovary syndrome exhibit an adverse metabolic profile through life. Fertil Steril 107 788\u2013795.e2. (https:\/\/doi.org\/10.1016\/j.fertnstert.2016.12.017)"},{"key":"bib64","series-title":"J Clin Med","first-page":"698","article-title":"Possible effect of polycystic ovary syndrome (PCOS) on cardiovascular disease (CVD): an update","volume":"13","author":"Profili NI","year":"2024","unstructured":"Profili NI\n, \nCastelli R\n, \nGidaro A\n, et al.\n 2024 Possible effect of polycystic ovary syndrome (PCOS) on cardiovascular disease (CVD): an update. J Clin Med 13 698. (https:\/\/doi.org\/10.3390\/jcm13030698)"},{"key":"bib65","series-title":"J Endocr Soc","article-title":"Endogenous testosterone levels are associated with risk of type 2 diabetes in women without established comorbidity","volume":"4","author":"Rasmussen JJ","year":"2020","unstructured":"Rasmussen JJ\n, \nSelmer C\n, \nFr\u00f8ssing S\n, et al.\n 2020 Endogenous testosterone levels are associated with risk of type 2 diabetes in women without established comorbidity. J Endocr Soc 4 bvaa050. (https:\/\/doi.org\/10.1210\/jendso\/bvaa050)"},{"key":"bib66","series-title":"Endocrine","first-page":"630","article-title":"Long-term cardiometabolic morbidity in young adults with classic 21-hydroxylase deficiency congenital adrenal hyperplasia","volume":"80","author":"Righi B","year":"2023","unstructured":"Righi B\n, \nAli SR\n, \nBryce J\n, et al.\n 2023 Long-term cardiometabolic morbidity in young adults with classic 21-hydroxylase deficiency congenital adrenal hyperplasia. Endocrine 80 630\u2013638. (https:\/\/doi.org\/10.1007\/s12020-023-03330-w)"},{"key":"bib67","series-title":"J Endocr Soc","first-page":"1087","article-title":"Persistent poor metabolic profile in postmenopausal women with ovarian hyperandrogenism after testosterone level normalization","volume":"3","author":"Rocha T","year":"2019","unstructured":"Rocha T\n, \nCrespo RP\n, \nYance VVR\n, et al.\n 2019 Persistent poor metabolic profile in postmenopausal women with ovarian hyperandrogenism after testosterone level normalization. J Endocr Soc 3 1087\u20131096. (https:\/\/doi.org\/10.1210\/js.2018-00405)"},{"key":"bib68","series-title":"J Clin Endocrinol Metab","first-page":"3848","article-title":"Development and risk factors of type 2 diabetes in a nationwide population of women with polycystic ovary syndrome","volume":"102","author":"Rubin KH","year":"2017","unstructured":"Rubin KH\n, \nGlintborg D\n, \nNybo M\n, et al.\n 2017 Development and risk factors of type 2 diabetes in a nationwide population of women with polycystic ovary syndrome. J Clin Endocrinol Metab 102 3848\u20133857. (https:\/\/doi.org\/10.1210\/jc.2017-01354)"},{"key":"bib69","series-title":"Nat Med","first-page":"252","article-title":"Using human genetics to understand the disease impacts of testosterone in men and women","volume":"26","author":"Ruth KS","year":"2020","unstructured":"Ruth KS\n, \nDay FR\n, \nTyrrell J\n, et al.\n 2020 Using human genetics to understand the disease impacts of testosterone in men and women. Nat Med 26 252\u2013258. (https:\/\/doi.org\/10.1038\/s41591-020-0751-5)"},{"key":"bib70","series-title":"Clin Med Insights Reprod Health","article-title":"Pathogenesis and consequences of disordered sleep in PCOS","volume":"13","author":"Sam S","year":"2019","unstructured":"Sam S\n & \nEhrmann DA\n\n 2019 Pathogenesis and consequences of disordered sleep in PCOS. Clin Med Insights Reprod Health 13 1179558119871269. (https:\/\/doi.org\/10.1177\/1179558119871269)"},{"key":"bib71","series-title":"Sci Rep","first-page":"563","article-title":"Elevated circulating adiponectin levels do not prevent anxiety-like behavior in a PCOS-like mouse model","volume":"14","author":"Samad M","year":"2024","unstructured":"Samad M\n, \nEk J\n, \nBorchers S\n, et al.\n 2024 Elevated circulating adiponectin levels do not prevent anxiety-like behavior in a PCOS-like mouse model. Sci Rep 14 563. (https:\/\/doi.org\/10.1038\/s41598-023-50503-8)"},{"key":"bib72","series-title":"J Steroid Biochem Mol Biol","article-title":"Human steroid biosynthesis, metabolism and excretion are differentially reflected by serum and urine steroid metabolomes: a comprehensive review","volume":"194","author":"Schiffer L","year":"2019","unstructured":"Schiffer L\n, \nBarnard L\n, \nBaranowski ES\n, et al.\n 2019 Human steroid biosynthesis, metabolism and excretion are differentially reflected by serum and urine steroid metabolomes: a comprehensive review. J Steroid Biochem Mol Biol 194 105439. (https:\/\/doi.org\/10.1016\/j.jsbmb.2019.105439)"},{"key":"bib73","series-title":"J Clin Endocrinol Metab","first-page":"3794","article-title":"Cardiovascular disease and risk factors in PCOS women of postmenopausal age: a 21-year controlled follow-up study","volume":"96","author":"Schmidt J","year":"2011","unstructured":"Schmidt J\n, \nLandin-Wilhelmsen K\n, \nBrannstrom M\n, et al.\n 2011 Cardiovascular disease and risk factors in PCOS women of postmenopausal age: a 21-year controlled follow-up study. J Clin Endocrinol Metab 96 3794\u20133803. (https:\/\/doi.org\/10.1210\/jc.2011-1677)"},{"key":"bib74","series-title":"ELife","article-title":"Proteomic analysis shows decreased type I fibers and ectopic fat accumulation in skeletal muscle from women with PCOS","volume":"12","author":"Stener-Victorin E","year":"2024","unstructured":"Stener-Victorin E\n, \nEriksson G\n, \nMohan Shrestha M\n, et al.\n 2024 Proteomic analysis shows decreased type I fibers and ectopic fat accumulation in skeletal muscle from women with PCOS. ELife 12 RP87592. (https:\/\/doi.org\/10.7554\/eLife.87592)"},{"key":"bib75","series-title":"J Clin Endocrinol Metab","first-page":"5372","article-title":"Molecular mechanisms of insulin resistance in polycystic ovary syndrome: unraveling the conundrum in skeletal muscle?","volume":"104","author":"Stepto NK","year":"2019","unstructured":"Stepto NK\n, \nMoreno-Asso A\n, \nMcIlvenna LC\n, et al.\n 2019 Molecular mechanisms of insulin resistance in polycystic ovary syndrome: unraveling the conundrum in skeletal muscle? J Clin Endocrinol Metab 104 5372\u20135381. (https:\/\/doi.org\/10.1210\/jc.2019-00167)"},{"key":"bib76","series-title":"Lancet","first-page":"431","article-title":"5 \u03b1-Reductase activity in polycystic ovary syndrome","volume":"335","author":"Stewart PM","year":"1990","unstructured":"Stewart PM\n, \nEdwards CRW\n & \nShackleton CHL\n\n 1990 5 \u03b1-Reductase activity in polycystic ovary syndrome. Lancet 335 431\u2013433. (https:\/\/doi.org\/10.1016\/0140-6736(90)90664-q)"},{"key":"bib77","series-title":"Eur J Endocrinol","first-page":"R98","article-title":"The clinical and biochemical significance of 11-oxygenated androgens in human health and disease","volume":"188","author":"Storbeck K-H","year":"2023","unstructured":"Storbeck K-H\n & \nO\u2019Reilly MW\n\n 2023 The clinical and biochemical significance of 11-oxygenated androgens in human health and disease. Eur J Endocrinol 188 R98\u2013R109. (https:\/\/doi.org\/10.1093\/ejendo\/lvad047)"},{"key":"bib78","series-title":"Hum Reprod","first-page":"2113","article-title":"Obesity, body composition and metabolic disturbances in polycystic ovary syndrome","volume":"23","author":"Svendsen PF","year":"2008","unstructured":"Svendsen PF\n, \nNilas L\n, \nNorgaard K\n, et al.\n 2008 Obesity, body composition and metabolic disturbances in polycystic ovary syndrome. Hum Reprod 23 2113\u20132121. (https:\/\/doi.org\/10.1093\/humrep\/den211)"},{"key":"bib79","series-title":"J Steroid Biochem Mol Biol","first-page":"132","article-title":"11\u03b2-Hydroxyandrostenedione, the product of androstenedione metabolism in the adrenal, is metabolized in LNCaP cells by 5\u03b1-reductase yielding 11\u03b2-hydroxy-5\u03b1-androstanedione","volume":"138","author":"Swart AC","year":"2013","unstructured":"Swart AC\n, \nSchloms L\n & \nStorbeck KH\n\n 2013 11\u03b2-Hydroxyandrostenedione, the product of androstenedione metabolism in the adrenal, is metabolized in LNCaP cells by 5\u03b1-reductase yielding 11\u03b2-hydroxy-5\u03b1-androstanedione. J Steroid Biochem Mol Biol 138 132\u2013142. (https:\/\/doi.org\/10.1016\/j.jsbmb.2013.04.010)"},{"key":"bib80","series-title":"Statpearls [Internet]","article-title":"Metabolic syndrome","author":"Swarup S","year":"2025","unstructured":"Swarup S\n, \nAhmed I\n, \nGrigorova Y\n, et al\n. 2025 Metabolic syndrome. In Statpearls [Internet]. Treasure Island (FL), USA: StatPearls Publishing. (https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29083742)"},{"key":"bib81","series-title":"J Clin Endocrinol Metab","first-page":"4097","article-title":"Cardiovascular and metabolic outcomes in congenital adrenal hyperplasia: a systematic review and meta-analysis","volume":"103","author":"Tamhane S","year":"2018","unstructured":"Tamhane S\n, \nRodriguez-Gutierrez R\n, \nIqbal AM\n, et al.\n 2018 Cardiovascular and metabolic outcomes in congenital adrenal hyperplasia: a systematic review and meta-analysis. J Clin Endocrinol Metab 103 4097\u20134103. (https:\/\/doi.org\/10.1210\/jc.2018-01862)"},{"key":"bib82","series-title":"Sleep Med Clin","first-page":"37","article-title":"Polycystic ovary syndrome and obstructive sleep apnea","volume":"3","author":"Tasali E","year":"2008","unstructured":"Tasali E\n, \nVan Cauter E\n & \nEhrmann DA\n\n 2008 Polycystic ovary syndrome and obstructive sleep apnea. Sleep Med Clin 3 37\u201346. (https:\/\/doi.org\/10.1016\/j.jsmc.2007.11.001)"},{"key":"bib83","series-title":"J Endocr Soc","article-title":"11-oxyandrogens in adolescents with polycystic ovary syndrome","volume":"6","author":"Taylor AE","year":"2022","unstructured":"Taylor AE\n, \nWare MA\n, \nBreslow E\n, et al.\n 2022 11-oxyandrogens in adolescents with polycystic ovary syndrome. J Endocr Soc 6 bvac037. (https:\/\/doi.org\/10.1210\/jendso\/bvac037)"},{"key":"bib84","series-title":"Gynecol Endocrinol","first-page":"276","article-title":"Measures of body adiposity and visceral adiposity index as predictors of metabolic syndrome among Thai women with PCOS","volume":"32","author":"Techatraisak K","year":"2016","unstructured":"Techatraisak K\n, \nWongmeerit K\n, \nDangrat C\n, et al.\n 2016 Measures of body adiposity and visceral adiposity index as predictors of metabolic syndrome among Thai women with PCOS. Gynecol Endocrinol 32 276\u2013280. (https:\/\/doi.org\/10.3109\/09513590.2015.1112785)"},{"key":"bib85","series-title":"Fertil Steril","first-page":"767","article-title":"Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome","volume":"120","author":"Teede HJ","year":"2023","unstructured":"Teede HJ\n, \nTay CT\n, \nLaven J\n, et al.\n 2023 Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril 120 767\u2013793. (https:\/\/doi.org\/10.1016\/j.fertnstert.2023.07.025)"},{"key":"bib86","series-title":"J Clin Endocrinol Metab","article-title":"Impaired 11\u03b2-Hydroxysteroid dehydrogenase type 2 activity in kidney disease disrupts 11-oxygenated androgen biosynthesis","volume":"110","author":"Tomkins M","year":"2024","unstructured":"Tomkins M\n, \nMcDonnell T\n, \nCussen L\n, et al.\n 2024 Impaired 11\u03b2-Hydroxysteroid dehydrogenase type 2 activity in kidney disease disrupts 11-oxygenated androgen biosynthesis. J Clin Endocrinol Metab 110 dgae714. (https:\/\/doi.org\/10.1210\/clinem\/dgae714)"},{"key":"bib87","series-title":"Hum Reprod","first-page":"2515","article-title":"Insulin resistance in a large cohort of women with polycystic ovary syndrome: a comparison between euglycaemic-hyperinsulinaemic clamp and surrogate indexes","volume":"32","author":"Tosi F","year":"2017","unstructured":"Tosi F\n, \nBonora E\n & \nMoghetti P\n\n 2017 Insulin resistance in a large cohort of women with polycystic ovary syndrome: a comparison between euglycaemic-hyperinsulinaemic clamp and surrogate indexes. Hum Reprod 32 2515\u20132521. (https:\/\/doi.org\/10.1093\/humrep\/dex308)"},{"key":"bib88","series-title":"J Clin Endocrinol Metab","first-page":"e2047","article-title":"Clinical value of serum levels of 11-oxygenated metabolites of testosterone in women with polycystic ovary syndrome","volume":"107","author":"Tosi F","year":"2022","unstructured":"Tosi F\n, \nVillani M\n, \nGarofalo S\n, et al.\n 2022 Clinical value of serum levels of 11-oxygenated metabolites of testosterone in women with polycystic ovary syndrome. J Clin Endocrinol Metab 107 e2047\u2013e2055. (https:\/\/doi.org\/10.1210\/clinem\/dgab920)"},{"key":"bib89","series-title":"Eur J Endocrinol","first-page":"433","article-title":"Association of hyperandrogenaemia with hypertension and cardiovascular events in pre-menopausal women: a prospective population-based cohort study","volume":"191","author":"Tuorila K","year":"2024","unstructured":"Tuorila K\n, \nOllila MM\n, \nHurskainen E\n, et al.\n 2024 Association of hyperandrogenaemia with hypertension and cardiovascular events in pre-menopausal women: a prospective population-based cohort study. Eur J Endocrinol 191 433\u2013443. (https:\/\/doi.org\/10.1093\/ejendo\/lvae124)"},{"key":"bib90","series-title":"Int J Clin Pract","first-page":"4579831","article-title":"Role of oxidative stress in Obese and nonobese PCOS patients","volume":"2022","author":"Uckan K","year":"2022","unstructured":"Uckan K\n, \nDemir H\n, \nTuran K\n, et al.\n 2022 Role of oxidative stress in Obese and nonobese PCOS patients. Int J Clin Pract 2022 4579831. (https:\/\/doi.org\/10.1155\/2022\/4579831)"},{"key":"bib91","series-title":"Eur J Endocrinol","first-page":"739","article-title":"Increased prevalence of polycystic ovary syndrome in premenopausal women with nonalcoholic fatty liver disease","volume":"173","author":"Vassilatou E","year":"2015","unstructured":"Vassilatou E\n, \nVassiliadi DA\n, \nSalambasis K\n, et al.\n 2015 Increased prevalence of polycystic ovary syndrome in premenopausal women with nonalcoholic fatty liver disease. Eur J Endocrinol 173 739\u2013747. (https:\/\/doi.org\/10.1530\/EJE-15-0567)"},{"key":"bib92","series-title":"J Clin Endocrinol Metab","first-page":"2626","article-title":"Excess 11-oxygenated androgens in women with severe insulin resistance are mediated by adrenal insulin receptor signaling","volume":"107","author":"Walzer D","year":"2022","unstructured":"Walzer D\n, \nTurcu AF\n, \nJha S\n, et al.\n 2022 Excess 11-oxygenated androgens in women with severe insulin resistance are mediated by adrenal insulin receptor signaling. J Clin Endocrinol Metab 107 2626\u20132635. (https:\/\/doi.org\/10.1210\/clinem\/dgac365)"},{"key":"bib93","series-title":"J Appl Physiol","first-page":"1452","article-title":"Influence of testosterone on ventilation and chemosensitivity in male subjects","volume":"59","author":"White DP","year":"1985","unstructured":"White DP\n, \nSchneider BK\n, \nSanten RJ\n, et al.\n 1985 Influence of testosterone on ventilation and chemosensitivity in male subjects. J Appl Physiol 59 1452\u20131457. (https:\/\/doi.org\/10.1152\/jappl.1985.59.5.1452)"},{"key":"bib94","series-title":"Reprod Health","first-page":"77","article-title":"A potential link between polycystic ovary syndrome and non-alcoholic fatty liver disease: an update meta-analysis","volume":"15","author":"Wu J","year":"2018","unstructured":"Wu J\n, \nYao XY\n, \nShi RX\n, et al.\n 2018 A potential link between polycystic ovary syndrome and non-alcoholic fatty liver disease: an update meta-analysis. Reprod Health 15 77. (https:\/\/doi.org\/10.1186\/s12978-018-0519-2)"},{"key":"bib95","series-title":"J Ovarian Res","first-page":"9","article-title":"Insulin resistance in polycystic ovary syndrome across various tissues: an updated review of pathogenesis, evaluation, and treatment","volume":"16","author":"Zhao H","year":"2023","unstructured":"Zhao H\n, \nZhang J\n, \nCheng X\n, et al.\n 2023 Insulin resistance in polycystic ovary syndrome across various tissues: an updated review of pathogenesis, evaluation, and treatment. J Ovarian Res 16 9. (https:\/\/doi.org\/10.1186\/s13048-022-01091-0)"},{"key":"bib97","series-title":"Diabetes","first-page":"627","article-title":"Polycystic ovary syndrome and risk of type 2 diabetes, coronary heart disease, and stroke","volume":"70","author":"Zhu T","year":"2021","unstructured":"Zhu T\n, \nCui J\n & \nGoodarzi MO\n\n 2021 Polycystic ovary syndrome and risk of type 2 diabetes, coronary heart disease, and stroke. Diabetes 70 627\u2013637. (https:\/\/doi.org\/10.2337\/db20-0800)"}],"container-title":["Reproduction"],"original-title":[],"link":[{"URL":"https:\/\/rep.bioscientifica.com\/view\/journals\/rep\/170\/2\/REP-25-0102.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/rep.bioscientifica.com\/downloadpdf\/journals\/rep\/170\/2\/REP-25-0102.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/rep.bioscientifica.com\/downloadpdf\/journals\/rep\/170\/2\/REP-25-0102.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T23:03:33Z","timestamp":1767567813000},"score":1,"resource":{"primary":{"URL":"https:\/\/rep.bioscientifica.com\/view\/journals\/rep\/170\/2\/REP-25-0102.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,23]]},"references-count":96,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.1530\/rep-25-0102","relation":{},"ISSN":["1470-1626","1741-7899"],"issn-type":[{"value":"1470-1626","type":"print"},{"value":"1741-7899","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,23]]}}}