PCOS equivalent in men
| Educator
13th Apr, 2021Quick read

Male PCOS

 

The concept of a male equivalent of polycystic ovary syndrome (PCOS) was first described more than 20 years ago (1). Male equivalent PCOS mainly affects men whose female relatives suffer from PCOS and is predominantly caused by genes responsible for the susceptibility of this syndrome in women (2,3). Similar hormonal, metabolic, and clinical alterations occurring in PCOS women have also been reported in their male relatives, suggesting an association between the male and female forms of the syndrome (2,4).

Affecting up to 10% of women, PCOS is characterised by ovulatory dysfunction and hyperandrogenism commonly associated with insulin resistance, obesity, and elevation in cardiovascular risk factors. Familial clustering implies an important genetic component.

Although similar clinical characteristics of PCOS observed in women have been found in male subjects affected by the male equivalent syndrome, the precise mechanism of the hormonal and metabolic backgrounds in these patients has not been yet established.

 

Diagnostic criteria

Male equivalent PCOS may be defined as an endocrine syndrome with a metabolic background that occurs in male members of a family with a PCOS history. It is characterised by the clinical signs of androgenism, complete hair loss, and the same hormonal pattern seen in PCOS, except for testosterone levels that seem to be in the subnormal range (2).

Early-onset (< 35 years of age) androgenetic alopecia  (AGA), characterised by hair recession, pronounced hypertrichosis , insulin resistance and biochemical and hormonal abnormalities, is an important diagnostic indication (2).

Diagnostic criteria include a family history positive for PCOS and/or the presence of the following clinical signs (3,5):

  • Hyperandrogenism (early-onset AGA, acne or hypertrichosis )
  • PCOS-like hormonal pattern (increased DHEAS , AMH , 17α-OH-progesterone, FAI , decreased FSH )
  • Metabolic abnormalities (insulin-resistance, low SHBG  levels, hyperglycaemia, hyperinsulinemia)
  • A trend toward higher BMI values.

High BMI and obesity cannot be defined as typical elements of male equivalent PCOS but when presented, they may contribute to the development of the hormonal, metabolic, and clinical scenario (2).

The hormonal/metabolic profile of the syndrome is still controversial (2). A recent case-control study analysing the hormonal pattern of 57 young men (19 - 30 years) with early-onset AGA, found hormonal parameters similar to the ones of female PCOS when compared to age-matched controls (6).

Also, similar to what happens in women with PCOS, an increased function of adrenal glands has been shown to occur in men with early-onset AGA (7). A higher prevalence of hypertriglyceridemia and hypertension has been reported in siblings with PCOS; more specifically, they seem to occur frequently in brothers of women with PCOS (8,9,10).

 

Health complications

Early-onset AGA is associated with metabolic abnormalities (e.g., insulin resistance, hyperinsulinemia), endothelial dysfunction, hypertension, cardiovascular disease, benign prostate hyperplasia, prostate inflammation and prostate cancer (3).

Evidence indicates that men with moderate to severe AGA have poorer semen quality than patients affected by moderate to mild AGA (11) indicating that male fertility may be affected.

In women, hyperinsulinemia enhances testosterone production by the ovarian theca cells leading to hyperandrogenism. In males, hyperinsulinemia negatively impacts Leydig cell steroidogenesis, resulting in decreased testosterone levels, which in turn increases the susceptibility of developing type 2 diabetes mellitus and cardiovascular disease, common features in men with early-onset AGA (3,12,13).

 

Conclusion

While it is still to be confirmed whether a PCOS equivalent is present in males, there is sufficient evidence to consider enquiring about a family history of PCOS in males with early-onset AGA, obesity or other evidence of metabolic abnormalities (2).

Patients with the early-onset AGA should be screened for metabolic parameters to eventually adopt pharmacological and nutritional strategies to reduce the risk of developing type 2 diabetes mellitus and cardiovascular diseases (2,4).

Early diagnosis of the syndrome is necessary to permit patients to adopt healthy lifestyle interventions to prevent the risk of metabolic and cardiovascular events.

References
1Legro RS. Is there a male phenotype in polycystic ovary syndrome families? J Pediatr Endocrinol Metab. 2000;13 Suppl 5:1307–9.
2Di Guardo F, Ciotta L, Monteleone M, Palumbo M. Male Equivalent Polycystic Ovarian Syndrome: Hormonal, Metabolic and Clinical Aspects. Int J Fertil Steril. 2020;14(2):79–83.
3Cannarella R, Condorelli RA, Mongioì LM, La Vignera S, Calogero AE. Does a male polycystic ovarian syndrome equivalent exist? J Endocrinol Invest. 2018 Jan;41(1):49–57.
4Di Guardo F, Cerana MC, D’urso G, Genovese F, Palumbo M. Male PCOS equivalent and nutritional restriction: Are we stepping forward? Med Hypotheses. 2019 May;126:1–3.
5Cannarella R, La Vignera S, Condorelli RA, Calogero AE. Glycolipid and Hormonal Profiles in Young Men with Early-Onset Androgenetic Alopecia: A meta-analysis. Scientific Reports. 2017 Aug 10;7(1):7801.
6Sanke S, Chander R, Jain A, Garg T, Yadav P. A Comparison of the Hormonal Profile of Early Androgenetic Alopecia in Men With the Phenotypic Equivalent of Polycystic Ovarian Syndrome in Women. JAMA Dermatol. 2016 Sep 1;152(9):986–91.
7Stárka L, Cermáková I, Dusková M, Hill M, Dolezal M, Polácek V. Hormonal profile of men with premature balding. Exp Clin Endocrinol Diabetes. 2004 Jan;112(1):24–8.
8Hirsso P, Laakso M, Matilainen V, Hiltunen L, Rajala U, Jokelainen J, et al. Association of insulin resistance linked diseases and hair loss in elderly men. Finnish population-based study. Cent Eur J Public Health. 2006 Jun;14(2):78–81.
9Norman RJ, Masters S, Hague W. Hyperinsulinemia is common in family members of women with polycystic ovary syndrome. Fertil Steril. 1996 Dec;66(6):942–7.
10Kaushal R, Parchure N, Bano G, Kaski J-C, Nussey SS. Insulin resistance and endothelial dysfunction in the brothers of Indian subcontinent Asian women with polycystic ovaries. Clin Endocrinol (Oxf). 2004 Mar;60(3):322–8.
11Güngör ES, Güngör Ş, Zebitay AG. Assessment of semen quality in patients with androgenetic alopecia in an infertility clinic. Dermatologica Sinica. 2016 Mar 1;34(1):10–3.
12Corona G, Monami M, Rastrelli G, Aversa A, Tishova Y, Saad F, et al. Testosterone and metabolic syndrome: a meta-analysis study. J Sex Med. 2011 Jan;8(1):272–83.
13Corona G, Rastrelli G, Di Pasquale G, Sforza A, Mannucci E, Maggi M. Endogenous Testosterone Levels and Cardiovascular Risk: Meta-Analysis of Observational Studies. J Sex Med. 2018 Sep;15(9):1260–71.