# Evaluation of dihydrotestosterone levels and total testosterone to dihydrotestosterone ratio with clinical symptoms and metabolic parameters in patients with polycystic ovary syndrome

## TL;DR

This study explores how dihydrotestosterone levels and the testosterone-to-DHT ratio relate to symptoms and metabolic health in women with polycystic ovary syndrome.

## Contribution

The study introduces the TT/DHT ratio as a potential biomarker for metabolic severity in PCOS patients.

## Key findings

- The TT/DHT ratio was significantly lower in patients with regular menstruation compared to those with irregular cycles.
- DHT levels showed a moderate positive correlation with BMI, and the TT/DHT ratio correlated with fasting blood sugar.
- Patients with insulin resistance had a significantly higher TT/DHT ratio than those without.

## Abstract

Polycystic ovary syndrome (PCOS) is a clinically heterogeneous endocrine disorder with lifelong health risks. Androgen excess, particularly testosterone, plays a key role in the pathophysiology of PCOS. Dihydrotestosterone (DHT) is an active metabolite derived from testosterone, and the total testosterone (TT) to DHT ratio is known as a potential marker of androgen metabolism, which can be used for evaluation of metabolic phenotype. This exploratory study aims to evaluate the association between DHT levels and TT/DHT ratio with the metabolic parameters and clinical features of PCOS patients.

This cross-sectional study was conducted on 30 patients diagnosed with PCOS based on the Rotterdam 2003 criteria. Clinical, metabolic, and biochemical parameters were assessed. The association between DHT levels, TT/DHT ratio, and clinical as well as metabolic features was analyzed using ANOVA, Spearman correlation, and independent sample t-tests, with a significance threshold of p < 0.05.

The TT/DHT ratio was significantly lower in patients with regular menstruation compared to those with oligomenorrhea and amenorrhea (p < 0.05). A moderate positive correlation was found between DHT levels and BMI (r = 0.487, p < 0.05), while fasting blood sugar (FBS) was significantly correlated with the TT/DHT ratio (r = 0.376, p < 0.05). Patients with insulin resistance had a significantly higher TT/DHT ratio compared to those without insulin resistance (p < 0.05), whereas DHT levels did not differ significantly between these groups.

The TT/DHT ratio could be a useful biomarker to identify PCOS patients with more severe metabolic issues.

The online version contains supplementary material available at 10.1186/s12902-025-02070-4.