Men without ovaries can get "polycystic ovary syndrome"?

*It is only for medical professionals to read for reference.
It is said that polycystic ovary syndrome is a female disease, but how come recent studies say that men can also get "polycystic ovary syndrome"? 01 Is polycystic ovary syndrome a "female disease"? Polycystic ovary syndrome (PCOS), as the name implies, is a disease related to the function of the female ovaries.

In traditional concepts, PCOS is one of the most common endocrine disorders in women, and it is seen in 10% of women of childbearing age.

It is characterized by irregular menstruation, normal metabolic disorders, and elevated testosterone levels.

 Most women with PCOS have androgenic manifestations, such as hirsutism, acne, and androgenic alopecia.

A large number of studies have also proved that the fertility function of women suffering from PCOS will be affected [1], therefore, PCOS is often considered to be an exclusive disease for women.

 02 Men also have polycystic ovary syndrome? At the 2021 American Endocrine Society Annual Meeting (ENDO), a new genetic study showed that men can show the characteristics of PCOS [2].

 Figure 1: ENDO 2021-genetic evidence suggests that men can also have PCOS-like symptoms.
The study included genetic data from 176,360 men in the UK and found that men with high PCOS genetic risk scores have an increased risk of obesity, diabetes, cardiovascular disease, and baldness.

 The emergence of this epoch-making research in the field of PCOS is not groundless.

In recent years, successive studies have found that men may also be related to the "female disease" of PCOS.

 In 2016, a cross-sectional study investigated the differences in reproductive hormone levels among male relatives of women with PCOS [3].

Figure 2: Screenshot of the results of the cross-sectional study in 2016.
The subjects of this study were male relatives of women with PCOS—63 fathers and 66 brothers.

The study measured the early morning fasting blood reproductive hormone levels in the test population.

 The results showed that compared with the control group, male relatives of PCOS women had significantly higher levels of anti-Müllerian hormone (AMH), luteinizing hormone (LH), and follicle stimulating hormone (FSH), but estradiol (E2) ), estrone (E1), testosterone (T) and inhibin B levels were not significantly different.

 Figure 3: The main results of the 2016 cross-sectional study.
This study of male relatives of women with PCOS suggests that there may also be PCOS susceptibility genes in men, which changes the state of testicular function and gonadotropin secretion under neuroendocrine regulation.

 Combined with the team’s previous research, the 11p14.
1 chromosomal locus in the FSH B polypeptide gene (FSH B) region is likely to be one of the susceptibility genes for male PCOS [4].

 A study in 2020 focused on men with PCOS-like symptoms [5], aiming to explore the definition of the disease in men with PCOS.

 Figure 4: A screenshot of the research results in 2020 with men with PCOS-like symptoms as the research object.
The results found that people who meet ≥1 of the following conditions are characterized by increased levels of dehydroepiandrosterone sulfate (DHEAS) and gonads Steroid production is reduced, and the risk of developing gonadal dysfunction is greater.

1.
Early-onset androgenic alopecia (AGA) 2.
BMI>25kg/m23, insulin resistance (IR) 4.
Sex hormone binding globulin (SHBG) <25nmol/L This standard can be used to define male PCOS.

03Opening a new door for PCOS research.
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PCOS in the traditional sense is named based on ovarian dysfunction, but men do not have ovaries.

 It is also because men can still show PCOS-like symptoms without ovaries, suggesting that the main cause of PCOS may have nothing to do with ovaries.

 We can reasonably guess that, in some cases, the reproductive dysfunction of PCOS may be caused by a biological mechanism shared by men and women.

 This discovery has given us a further understanding of the disease mechanism of PCOS, and perhaps the definition of PCOS can shift from symptom manifestations to pathogenic mechanisms in the future.

 Future research on the genetic risk factors of PCOS may help us better understand the disease mechanism and potential treatment targets of PCOS.

 References: [1]MILLS G, BADEGHIESH A, SUARTHANA E, et al.
Polycystic ovary syndrome as an independent risk factor for gestational diabetes and hypertensive disorders of pregnancy: a population-based study on 9.
1 million pregnancies [J].
Hum Reprod , 2020, 35(7): 1666-74.
[2] -men-can-develop-pcos-like-condition Genetic evidence suggests men can develop PCOS-like condition[3]Torchen LC, Kumar A, Kalra B, Savjani G, Sisk R, Legro RS, et al.
Increased antimüllerian hormone levels and other reproductive endocrine changes in adult male relatives of women with polycystic ovary syndrome.
Fertil Steril.
2016;106(1):50-5.
[4]Hayes MG, Urbanek M, Ehrmann DA, Armstrong LL, Lee JY, Sisk R , et al.
Genome-wide association of polycystic ovary syndrome implicates alterations in gonadotropin secretion in European ancestry populations.
Nat Commun.
2015;6:7502.
[5]Cannarella R, Condorelli RA, Dall'Oglio F, La Vignera S, Mongioì LM, Micali G , et al.
Increased DHEAS and Decreased Total Testosterone Serum Levels in a Subset of Men with Early-Onset Androgenetic Alopecia: Does a Male PCOS-Equivalent Exist? Int J Endocrinol.
2020;2020:1942126.