Hirsutism can occur in the presence of normal or near normal levels of serum
testosterone, unbound
testosterone (uT), dehydroepiandrostene
sulfate,
androstenedione, and
dihydrotestosterone. However, we have found that serum androstanediol
glucuronide (
3 alpha-diol G) is markedly increased in idiopathic
hirsutism and it serves as an excellent marker of peripheral
androgen metabolism and action. In the present work, we studied 12 hirsute (H) and 12 nonhirsute (NH) patients with
polycystic ovary syndrome (PCO) and 13 age and weight matched controls in order to determine if differences in sex
steroid levels or peripheral tissue
androgen events were associated with
hirsutism. Serum unbound
estradiol levels and LH-FSH ratios were similar in both groups of women with PCO, and both were significantly higher than levels in controls (P less than 0.05). Whereas serum
testosterone, uT, and
androstenedione were elevated in both H-PCO and NH-PCO patients compared to controls, the levels in these two groups were similar. Serum dehydroepiandrostene
sulfate was higher in PCO patients compared to controls, but H-PCO patients had slightly higher levels than NH-PCO patients. Serum
delta 5-androstenediol was also slightly higher in H-PCO compared to NH-PCO patients.
Dihydrotestosterone was normal and unconjugated; 3 alpha-diol was higher than normal in both groups of patients with PCO, although H-PCO patients had higher levels than NH-PCO patients. Compared to these relatively minor changes between the PCO patient groups, serum
3 alpha-diol G was markedly elevated in H-PCO patients (approximately 10-fold), yet normal in NH-PCO patients (P less than 0.01). The ratios of serum
3 alpha-diol G-uT were similar in NH-PCO patients and controls, but were elevated in H-PCO patients (P less than 0.01). These data indicate that: 1) women with PCO have increased circulating
androgen levels regardless of the presence or absence of
hirsutism; and 2) the presence of
hirsutism is not only a function of circulating
androgen levels, but may also be determined by events in peripheral tissues.