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The Association of Obesity and Hyperandrogenemia during the Pubertal Transition in Girls: Obesity as a Potential Factor in the Genesis of Postpubertal Hyperandrogenism

The Center for Research in Reproduction and Division of Endocrinology (C.R.M., K.A.P., S.C., C.A.E., J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22908; Division of Reproductive Endocrinology and Infertility (R.Y., R.J.C.), Department of Reproductive Medicine, University of California, San Diego, California 92103; and Division of Endocrinology (C.M.F.), Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan 48109

Address all correspondence and requests for reprints to: Christopher R. McCartney, Center for Research in Reproduction, Box 800391, University of Virginia Health System, Charlottesville, Virginia 22908. E-mail: cm2hq{at}virginia.edu.

Context: Adolescent hyperandrogenemia is considered a forerunner of adult polycystic ovary syndrome, but its etiology remains uncertain.

Objective: Our objective was to explore the hypothesis that peripubertal obesity is associated with hyperandrogenemia.

Design and Setting: We performed a cross-sectional analysis of data obtained at General Clinical Research Centers.

Subjects: Subjects were 41 obese [body mass index (BMI) for age, 95%] and 35 normal-weight (BMI for age, <95%) peripubertal girls.

Intervention: We used pooled blood samples (0500–0700 h; n = 64) while fasting or single morning (fasting) samples (n = 12).

Main Outcome Measures: We assessed adiposity and androgen concentrations.

Results: BMI correlated with total testosterone (T) (r_s = 0.59), SHBG (r_s = –0.69), and free T (r_s = 0.69); free T was three times as great in obese girls compared with normal-weight girls (P < 0.0001 for all). BMI correlated with insulin (r_s = 0.52); both insulin and LH correlated with free T (r_s = 0.45 and 0.44, respectively; P < 0.001 for all). When analyzing early pubertal girls (pubertal stages 1–3; n = 36) alone, BMI correlated with total T (r_s = 0.65), SHBG (r_s = –0.74), and free T (r_s = 0.75); free T was five times as great in obese early-pubertal girls (P < 0.001 for all). BMI correlated with insulin (r_s = 0.65), and insulin correlated with free T (r_s = 0.63, P < 0.01 for both). BMI correlated with free T while simultaneously adjusting for age, pubertal stage, insulin, LH, and dehydroepiandrosterone sulfate.

Conclusion: Peripubertal obesity is associated with marked hyperandrogenemia, which is especially pronounced in early puberty.

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