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Angelica Lindén Hirschberg

Emerging evidence indicates that testosterone, which can increase muscle mass and strength, stimulates erythropoiesis, promotes competitive behaviour, and enhances the physical performance of women. Indeed, the levels of testosterone within the normal female range are related to muscle mass and athletic performance in female athletes. Furthermore, among these athletes, the prevalence of hyperandrogenic conditions, including both polycystic ovary syndrome and rare differences/disorders of sex development (DSD), which may greatly increase testosterone production, are elevated. Thus, if the androgen receptors of an individual with XY DSD are functional, her muscle mass will develop like that of a man. These findings have led to the proposal that essential hyperandrogenism is beneficial for athletic performance and plays a role in the choice by women to compete in athletic activities. Moreover, a recent randomized controlled trial demonstrated a significant increase in the lean mass and aerobic performance by young exercising women when their testosterone levels were enhanced moderately. Circulating testosterone is considered the strongest factor to explain the male advantage in sport performance, ranging between 10 and 20%. It appears to be unfair to allow female athletes with endogenous testosterone levels in the male range (i.e. 10–20 times higher than normal) to compete against those with normal female androgen levels. In 2012, this consideration led international organizations to establish eligibility regulations for the female classification in order to ensure fair and meaningful competition, but the regulations are controversial and have been challenged in court.

Open access

Jan Roar Mellembakken, Azita Mahmoudan, Lars Mørkrid, Inger Sundström-Poromaa, Laure Morin-Papunen, Juha S. Tapanainen, Terhi Piltonen, Angelica Linden Hirschberg, Elisabeth Stener-Victorin, Eszter Vanky, Pernille Ravn, Richard Christian Jensen, Marianne Skovsager Andersen, and Dorte Glintborg

Abstract

Objective: Obesity is considered to be the strongest predictive factor for cardio-metabolic risk in women with polycystic ovary syndrome (PCOS). The aim of the study was to compare blood pressure (BP) in normal weight women with PCOS and controls matched for age and BMI?

Methods: From a Nordic cross-sectional base of 2,615 individuals of Nordic ethnicity, we studied a sub cohort of 793 normal weight women with BMI<25 kg/m2 (512 women with PCOS according to Rotterdam criteria and 281 age and BMI-matched controls). Participants underwent measurements of BP and body composition (BMI, waist-hip ratio), lipid status, and fasting BG. Data were presented as median (quartiles).

Results: The median age for women with PCOS were 28 (25; 32) years, and median BMI was 22.2 (20.7; 23.4) kg/m2. Systolic BP was 118 (109; 128) mmHg in women with PCOS compared to 110 (105; 120) mmHg in controls, and diastolic BP was 74 (67; 81) vs. 70 (64; 75) mmHg, both p<0.001. The prevalence of women with BP ≥140/90 mmHg was 11.1% (57/512) in women with PCOS vs. 1.8% (5/281) in controls, p<0.001. In women ≥ 35 years the prevalence of BP ≥140/90 mmHg was comparable in women with PCOS and controls (12.7% vs. 9.8%, p=0.6). Using multiple regression analyses, the strongest association with BP was found for waist circumference, fasting BG and total cholesterol in women with PCOS.

Conclusions: Normal weight women with PCOS have higher BP than controls. BP and metabolic screening are relevant also in young normal weight women with PCOS.