Department of Medical Surgical Specialties, University of Catania, Via Tindaro 2, 95124 Catania, Italy.
Department of Internal Medicine, The University of Connecticut, 263 Farmington Ave, Farmington, CT 06030, United States.
Med Hypotheses. 2019 May;126:1-3. doi: 10.1016/j.mehy.2019.03.003. Epub 2019 Mar 5.
Polycystic ovarian syndrome (PCOS) is an endocrine disorder characterized by alteration of menses, polycystic ovaries, clinical and or biochemical signs of hyper-androgenism in the context of metabolic abnormalities such as obesity and insulin resistance that play a fundamental role in pathogenesis of the disease as well as in development of long-term complications including cardiovascular disease (CVD) and type II diabetes mellitus (DM II). Latest evidence supports the hypothesis of a genetic component in the aetiology of PCOS that seems to be inherited through an oligo-genic mechanism and cluster in families. Recent studies identified the existence of a male PCOS correspondent syndrome in which the genes responsible for PCOS susceptibility in women may be inherited by male relatives of women with PCOS. The same hormonal, clinical and metabolic alterations of women with PCOS have been found in their male relatives suggesting a relation between the syndrome in its male equivalent. Considering clinical manifestations of male PCOS equivalent, the early onset andro-genetic alopecia (AGA) is considered a clinical marker of insulin resistance, supported by the findings of a case-control study that reported an increased prevalence of hyperinsulinemia and insulin-resistance-associated disorders such as dyslipidaemia, hypertension and obesity, in men with early onset of alopecia (<35), compared with age-matched controls. Moreover, AGA and insulin resistance show higher levels of active androgens, highlighting that low SHBG levels occur in both the diseases and that the two conditions may concur to a worsening of the disease. With regards to the existence of a male PCOS equivalent syndrome, in particular with refer to its phenotypic hallmark of early onset AGA, our hypothesis supposes a beneficial effect of diet restriction used for PCOS as therapy for male patients affected by PCOS equivalent syndrome. Several observational studies and some randomized trials reported that modest reductions of body weight decrease the risk of development of many diseases, including diabetes and cardiovascular disease and contributes to increase insulin sensitivity in PCOS women. Weight reduction may be adopted for men affected by PCOS equivalent syndrome in order to reduce both levels of circulating androgens, insulin resistance and related-complications such as CVD and DM II.
多囊卵巢综合征（PCOS）是一种内分泌紊乱疾病，其特征为月经不规律、多囊卵巢、临床和/或生化高雄激素血症，同时伴有代谢异常，如肥胖和胰岛素抵抗，这些异常在疾病发病机制以及长期并发症的发展中发挥着重要作用，包括心血管疾病（CVD）和 2 型糖尿病（DM II）。最新证据支持 PCOS 发病机制中的遗传因素假说，该假说似乎通过寡基因机制遗传，并在家族中聚集。最近的研究发现了男性 PCOS 对应综合征的存在，女性 PCOS 易感性相关的基因可能会遗传给女性 PCOS 男性亲属。女性 PCOS 患者的激素、临床和代谢改变也存在于其男性亲属中，这表明男性 PCOS 对应综合征之间存在关联。考虑到男性 PCOS 对应综合征的临床表现，早发性雄激素性脱发（AGA）被认为是胰岛素抵抗的临床标志物，这一观点得到了一项病例对照研究的支持，该研究报告称，早发性脱发（<35 岁）男性中，高胰岛素血症和与胰岛素抵抗相关的疾病（如血脂异常、高血压和肥胖）的患病率增加，与年龄匹配的对照组相比。此外，AGA 和胰岛素抵抗表现出更高水平的活性雄激素，这表明这两种疾病都会出现低 SHBG 水平，并且这两种情况可能会相互加重疾病。关于男性 PCOS 对应综合征的存在，特别是关于其早发性 AGA 的表型特征，我们的假设假设了限制饮食对 PCOS 患者的有益效果，也将这种治疗方法用于治疗患有 PCOS 对应综合征的男性患者。几项观察性研究和一些随机试验报告称，适度减轻体重可以降低许多疾病（包括糖尿病和心血管疾病）的发病风险，并有助于提高 PCOS 女性的胰岛素敏感性。患有 PCOS 对应综合征的男性可以通过减轻体重来降低循环雄激素、胰岛素抵抗和相关并发症（如 CVD 和 DM II）的水平。
