The Association of Obesity and Hyperandrogenemia during the Pubertal Transition in Girls: Obesity as a Potential Factor in the Genesis of Postpubertal Hyperandrogenism

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Abstract
Context: Adolescent hyperandrogenemia is considered a forerunner of adult polycystic ovary syndrome, but its etiology remains uncertain. Objective: Our objective was to explore the hypothesis that peripubertal obesity is associated with hyperandrogenemia. Design and Setting: We performed a cross-sectional analysis of data obtained at General Clinical Research Centers. Subjects: Subjects were 41 obese [body mass index (BMI) for age, ≥95%] and 35 normal-weight (BMI for age, <95%) peripubertal girls. Intervention: We used pooled blood samples (∼0500–0700 h; n = 64) while fasting or single morning (fasting) samples (n = 12). Main Outcome Measures: We assessed adiposity and androgen concentrations. Results: BMI correlated with total testosterone (T) (rs = 0.59), SHBG (rs = −0.69), and free T (rs = 0.69); free T was three times as great in obese girls compared with normal-weight girls (P < 0.0001 for all). BMI correlated with insulin (rs = 0.52); both insulin and LH correlated with free T (rs = 0.45 and 0.44, respectively; P < 0.001 for all). When analyzing early pubertal girls (pubertal stages 1–3; n = 36) alone, BMI correlated with total T (rs = 0.65), SHBG (rs = −0.74), and free T (rs = 0.75); free T was five times as great in obese early-pubertal girls (P < 0.001 for all). BMI correlated with insulin (rs = 0.65), and insulin correlated with free T (rs = 0.63, P < 0.01 for both). BMI correlated with free T while simultaneously adjusting for age, pubertal stage, insulin, LH, and dehydroepiandrosterone sulfate. Conclusion: Peripubertal obesity is associated with marked hyperandrogenemia, which is especially pronounced in early puberty.