Adolescent PCOS and metabolic health: An analysis of fat, muscle, and hormones

This study aimed to evaluate anthropometric, metabolic, hormonal, and body composition characteristics in adolescents with polycystic ovary syndrome (PCOS) compared to healthy controls, with further analyses by metabolic syndrome (MetS) status and body mass index (BMI) categories.

A total of 69 adolescents with PCOS and 63 age-matched healthy controls were included. Participants underwent assessments of anthropometric measures, metabolic and hormonal profiles, and body composition via bioelectrical impedance analysis. Subgroup analyses were performed according to BMI (<30 and ≥ 30 kg/m²) and MetS status.

There were no significant differences in age, BMI, or waist circumference between groups. However, adolescents with PCOS had significantly higher systolic and diastolic blood pressure (p = 0.013 and p = 0.022), and elevated androgen levels including total testosterone (p < 0.001), free androgen index (p < 0.001), and DHEA-SO₄ (p < 0.001), with lower SHBG levels (p = 0.007). Metabolic parameters such as fasting glucose, triglycerides, and HDL cholesterol showed no significant differences.Body composition measures-including fat mass, muscle mass indices, and trunk fat mass-were comparable between PCOS and control groups. Subgroup analysis revealed that lean adolescents with PCOS exhibited higher androgen levels and increased skeletal muscle indices compared to lean controls. In contrast, obese adolescents with PCOS showed a significantly higher prevalence of MetS compared to non-obese counterparts (p = 0.002). Correlation analyses showed that waist circumference strongly correlated with fat mass, percent body fat, and inversely with SHBG and HDL-C in both groups. FAI was positively associated with adiposity measures and negatively with SHBG. In the PCOS group, HDL-C was more consistently and negatively associated with adiposity and hormonal markers, indicating early lipid metabolism disturbances.

Adolescents with PCOS exhibit early cardiovascular and hormonal alterations, particularly elevated blood pressure and androgen excess, even in the absence of major body composition changes. Obesity further amplifies metabolic risk, as evidenced by the higher MetS prevalence among obese PCOS adolescents. Comprehensive metabolic and hormonal evaluation, beyond anthropometric measures, is essential for early detection and management of cardiometabolic risks in adolescents with PCOS.