We now suspect that many of the drivers behind PCOS are heritable components – a genetic vulnerability passed from parents, possibly one but often both. This growing understanding has identified a phenomenon referred to as ‘PCOS families’ i.e. a family in which at least one female has confirmed PCOS.
Being a primary biological relative of someone with PCOS, it would seem, suggests a shared risk, even if you are a son, or brother or father.
So beyond the very high rates of undiagnosed PCOS in sisters of someone already diagnosed, there is much talk now about a male PCOS phenotype equivalent.
The evidence for this in male relatives comes from numerous small epidemiological studies and so far has revealed the following possible trends:
- Increased BMI (from early infancy in sons of PCOS mothers & as adults for other relatives), insulin resistance (both independent & dependent on BMI) & increased blood clotting
- Elevated CRP
- Increased Anti-Mullerian Hormone (AMH) in prepubertal sons of PCOS mothers producing increased Sertolli cells & activity
- Elevated Luteinising Hormone (LH)
- Suboptimal SHBG and therefore elevated Free Androgen Index (FAI)
- Possible association with premature (<30 yrs) androgenic balding in males
To date, no clear impact has been identified on male fertility and it would seem that their absolute testosterone values do not differ, but without a doubt these men carry risk factors for diabetes, CVD and relative androgenic excess. We’ve yet to understand the specific mechanism/s behind this genetic vulnerability (most people’s money seems to be on a predisposition to weight gain as the most underpinning cause) & I think the bigger story about the full hormonal consequence is still to emerge but for now we should be ensuring that we ask every male patient who seeks treatment, “Do you come from a PCOS family?” Next time I’ll talk about some interesting research on new research on CRP as a marker…it’s a new year & for all of us working in integrated health there’s so much to get excited about already! 🙂
Want to read more on PCOS families? Here are some places to start: