Overview
Introduction : Androgens play a vital role in the female reproductive system, influencing ovarian follicular development, oocyte quality, and ovarian responsiveness to controlled ovarian stimulation. The main circulating androgens include dehydroepiandrosterone sulfate (DHEA-S), dehydroepiandrosterone (DHEA), androstenedione (AD), testosterone (T), and dihydrotestosterone (DHT). Studies have shown that androgens promote early follicular growth by regulating follicle-stimulating hormone (FSH) receptor expression and the intrafollicular microenvironment; however, excessive levels may interfere with follicular maturation and ovulation, leading to ovarian dysfunction. Total testosterone (TT) represents the sum of bound and free circulating testosterone. The majority of circulating testosterone is tightly bound to sex hormone-binding globulin (SHBG) or loosely bound to albumin (ALB), α-globulins, and corticosteroid-binding globulin, with only 1-4% existing as free testosterone (FT). Only free testosterone can enter cells and exert biological effects. Because SHBG concentrations are readily influenced by sex, age, body weight, metabolic syndrome, SHBG gene polymorphisms, and certain medications, whereas FT is unaffected by SHBG, FT is considered an ideal marker for assessing bioactive testosterone status. Free testosterone, as the most biologically active androgen form, is closely correlated with ovarian response, particularly in patients with polycystic ovary syndrome (PCOS).
Mass spectrometry （LC-MS/MS）is widely recognized as a highly accurate method for determining androgen profiles. However, due to various factors such as cost, large-scale studies using mass spectrometry to measure androgen profiles have not yet been conducted, and there is even a lack of research on the diagnostic performance of mass spectrometry-derived androgen profiles for polycystic ovary syndrome (PCOS).
The aim of this study is to evaluate the diagnostic performance (AUC, sensitivity, and specificity) of LC-MS/MS-measured androgen profiles in a multicenter real-world cohort for PCOS diagnosis. We will compare the diagnostic value of DHEA-S, DHEA, AD, T, DHT, and FT, and develop a multi-marker combined diagnostic model using machine learning to optimize the diagnostic efficacy for PCOS.
The primary research question is: Can LC-MS/MS-measured androgen profiles improve the diagnostic accuracy for PCOS?
By recruiting an appropriate number of participants and measuring the above serum biomarkers, we will statistically analyze the diagnostic performance of LC-MS/MS-determined androgen profiles, especially free testosterone (FT), in PCOS.
Eligibility
Inclusion Criteria:
PCOS group:Women who meet the Rotterdam diagnostic criteria (at least two of the following three features after excluding other endocrine disorders: oligo-ovulation/anovulation, clinical and/or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound).
Control group: Age-matched healthy women or women attending the clinic for routine gynecological check-ups who have regular menstrual cycles and show no clinical or biochemical signs of hyperandrogenism, and no polycystic ovarian morphology on ultrasound.
Exclusion Criteria:
Ovarian resistance syndrome, complete androgen insensitivity syndrome, functional hypothalamic amenorrhea, adrenocortical hyperplasia, and other similar conditions; Use of medications that affect hormone secretion within 3 months prior to enrollment; Thyroid dysfunction, hyperprolactinemia, and other endocrine disorders.-
