Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline

    Ricardo Azziz, Enrico Carmina, Didier Dewailly, Evanthia Diamanti-Kandarakis, Héctor F. Escobar-Morreale, Walter Futterweit, Onno E. Janssen, Richard S. Legro, Robert J. Norman, Ann E. Taylor, Selma F. Witchel
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    TLDR Polycystic Ovary Syndrome should be seen mainly as a condition of excess male hormones, with a focus on this in its definition.
    The Androgen Excess Society Task Force on PCOS recommended that Polycystic Ovary Syndrome should be primarily considered a disorder of androgen excess, and that the definition of PCOS should emphasize hyperandrogenism as a central feature. They proposed modifications to the 1990 NIH criteria for PCOS, informed by discussions from the 2003 Rotterdam conference. The task force identified nine different PCOS phenotypes based on various combinations of ovulatory dysfunction, hirsutism, hyperandrogenemia, and polycystic ovaries. They found strong evidence of increased metabolic dysfunction risk in women with phenotypes showing hirsutism and/or hyperandrogenemia. The recommendations were based on a systematic review of literature, prioritizing studies with over 100 subjects, and a consensus process with international experts. The task force noted that the definition of PCOS might change with new research and that women with PCOS symptoms should be treated even if they do not meet the full diagnostic criteria.
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