High salivary testosterone to androstenedione (T/A4) ratio and adverse metabolic phenotypes in women with PCOS

Abstract

Background

Polycystic ovary syndrome (PCOS) is characterized by a combination of hormonal and metabolic disturbances, such as insulin resistance, glucose intolerance, anovulation and hyperandrogenism. Clinical phenotypes of PCOS show different patterns of steroid hormones that have been investigated to some extent. This study aimed to establish a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the quantification of salivary testosterone and androstenedione, and to describe the salivary testosterone to androstenedione (T/A4) ratio as a new tool for the assessment of hyperandrogenism and metabolic health.

Material and Methods

Saliva and serum samples of 274 PCOS patients and 51 healthy women were used for the quantification of steroid hormones. A comprehensive clinical and metabolic assessment was performed. Salivary testosterone and androstenedione were measured via LC-MS/MS. The salivary T/A4 ratio was calculated and correlated with hormones and metabolic parameters.

Results

Salivary testosterone (p<0.001), androstenedione (p<0.001) and the salivary T/A4 ratio (p<0.001) were significantly higher in PCOS patients compared to healthy women. In PCOS patients, a high salivary T/A4 ratio was associated with an adverse metabolic phenotype, i.e. glucose intolerance (p=0.019), insulin resistance (p<0.001), metabolic syndrome (p<0.001), obesity (p<0.001) and oligo-/anovulation (p=0.001). Significant correlations of the salivary T/A4 ratio with adverse metabolic parameters were found.

Conclusion

Quantification of salivary androgens provides an attractive alternative to serum analysis and helps in characterising metabolic health in women with PCOS. Our data show a strong link between a high salivary T/A4 ratio and an adverse metabolic phenotype in PCOS patients.

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