Presentations of Hyperandrogenic Phenotypes in Taiwanese Women
Presentations of Hyperandrogenic Phenotypes in Taiwanese Women
STUDY QUESTION: Which of the four abnormally elevated androgen groups (total testosterone
 [TT], androstenedione [A4], free androgen index [FAI], or dehydroepiandrosterone-sulfate
 [DHEA-S]) present with an unfavorable metabolic and hormonal profile, appear to be more
 insulin-resistant and pose additional cardiovascular risk? SUMMARY ANSWER: Subjects with
 excess free androgen index tend to be obese and face the highest metabolic syndrome risk,
 adipocytokine alterations, insulin resistance (IR) and cardiovascular risk. The excess TT
 group presents with a marginal IR risk, while the excess A4 group has the highest
 antimüllerian hormone (AMH), and may counterbalance obesity; this group and the excess DHEA-S
 group have a favorable association with IR.
STUDY DESIGN, SIZE, DURATION:A retrospective study in 160 Taiwanese women with HA and 165
 women without HA, with medical records reviewed from 2009 up to 2012. The hyperandrogenic
 women were classified into four groups (TT, A4, FAI, and DHEA-S) according to independent
 abnormally elevated androgen measures each above its cut-off value, and the groups were
 compared with each other and with controls.

 PARTICIPANTS/MATERIALS, SETTING, METHODS: This study was performed in the Reproductive
 Endocrinology Clinic at Wan Fang Medical Center in Taipei, Taiwan. Anthropometric, metabolic,
 endocrine, and IR components as well as lipid accumulation product (LAP) index were compared
 between the groups. IR was assessed with the following markers: fasting glucose and insulin
 levels, oral glucose tolerance test, glucose-to-insulin ratio and homeostasis model
 assessment of IR index (HOMA-IR).
Inclusion Criteria:

 -  Hyperandrogenic women who were classified into four groups:

 -  Total testosterone (TT),

 -  Androstenedione (A4),

 -  Free androgen index (FAI),

 -  and Dehydroepiandrosterone sulphate(DHEA-S).

 -  According to abnormally elevated androgen measures each above its cut-off value, and
 non hyperandrogenic women (who had all androgens below their cut-off values)

 Exclusion Criteria:

 -  None of the women studied had

 -  Hypogonadotropic hypogondism,

 -  Hyperprolactinemia,

 -  Congenital adrenal hyperplasia,

 -  Premature ovarian failure,

 -  Androgen-secreting tumors,

 -  Cushing's syndrome,

 -  or any other endocrine or systemic disease that may affect the reproductive
 function,

 -  or any disorders of the uterus (e.g. Asherman's syndrome and Mullerian genesis)
 and chromosomal anomalies (e.g. Turner's syndrome).

 -  In addition, we excluded females who had

 -  Experienced menarche less than three years preceding the study start,

 -  or who had day 3 FSH > 15 mIU/ml, as well as women with insufficient
 clinical/biochemical records,

 -  and women with ovarian cysts or tumors in an ultrasonographic examination.