Obesity Is Associated With Hyperandrogenemia in a Nationally Representative Sample of US Girls Aged 6 to 18 Years

Studies have associated obesity with peripubertal hyperandrogenemia. However, these studies were performed in academic centers and could have been influenced by selection bias.

To investigate if free testosterone levels are elevated in peripubertal girls with obesity.

We analyzed data from the National Health and Nutrition Examination Survey 2013-2016 databases.

1299 girls aged 6-18 years residing in the United States.

Mean free testosterone concentration (calculated from total testosterone and SHBG).

Among girls aged 6 to 9 years, mean (95% confidence interval) free testosterone was 0.33 pg/mL (0.28-0.38) in healthy-weight girls vs 0.86 pg/mL (0.67-1.05) in girls with obesity. Among girls aged 10 to 14 years, free testosterone was 2.29 pg/mL (2.05-2.53) in healthy-weight girls vs 4.10 pg/mL (3.60-4.60) in girls with obesity. Among girls aged 15 to 18 years, free testosterone was 3.33 pg/mL (2.96-3.70) in healthy-weight girls and 5.64 pg/mL (4.93-6.36) in girls with obesity. Girls with obesity in all age groups had higher free testosterone levels compared to healthy-weight girls. In each age group, the 95% confidence intervals for free testosterone did not overlap between healthy weight vs obesity subgroups. A multiple regression model accounted for 42% of the variance in free testosterone (R2 = 0.42), and both weight and age categories were independent predictors of free testosterone (P < .0001 for each).

In a nationally representative sample of US girls, obesity is associated with elevated free testosterone, suggesting an important relationship between obesity and peripubertal hyperandrogenemia.