J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website https://www.jofem.org

Original Article

Volume 11, Number 1, February 2021, pages 14-21

Luteinizing Hormone to Follicle-Stimulating Hormone Ratio Significantly Correlates With Androgen Level and Manifestations Are More Frequent With Hyperandrogenemia in Women With Polycystic Ovary Syndrome

Figure 1. Serum total testosterone (mean ± SD) in altered LH-FSH ratio with different cut-offs. SD: standard deviation; LH: luteinizing hormone; FSH: follicle-stimulating hormone.

Figure 2. Serum total testosterone level (mean ± SD) according to the quartiles of LH-FSH ratio. SD: standard deviation; LH: luteinizing hormone; FSH: follicle-stimulating hormone.

Figure 3. Serum LH-FSH ratio according to quartiles of serum total testosterone. LH: luteinizing hormone; FSH: follicle-stimulating hormone.

Figure 4. Correlation of serum total testosterone with LH-FSH ratio. LH: luteinizing hormone; FSH: follicle-stimulating hormone.

**Table 1.** Characteristics of the Study Population (N = 550)
Variables	Total (N = 550)	LH-FSH ratio (cut-off > 1.0)	P	Androgenemia (cut-off > 46 ng/dL)	P
Within parentheses are percentages over column total of respective variable. Chi-square test was done. PCOS: polycystic ovary syndrome; mF-G: modified Ferriman-Gallwey; BMI: body mass index; WC: waist circumference; BP: blood pressure; TT: total testosterone; LH: luteinizing hormone; FSH: follicle-stimulating hormone.
Personal history
Menstrual abnormality	454 (82.5)	325 (83.5)	129 (80.1)	0.387	207 (88.5)	247 (78.2)	0.002
Subfertility	124 (22.5)	85 (21.9)	39 (24.2)	0.575	58 (24.8)	66 (20.9)	0.303
Menstrual regulation or abortion	57 (10.4)	35 (9.0)	22 (13.7)	0.123	25 (10.7)	32 (10.1)	0.888
Family history
PCOS	112 (20.4)	79 (20.3)	33 (20.5)	1.000	57 (24.4)	55 (17.4)	0.045
Subfertility	127 (23.1)	91 (23.4)	36 (22.4)	0.825	59 (25.2)	68 (21.5)	0.357
Diabetes mellitus	339 (61.6)	233 (59.9)	106 (65.8)	0.211	158 (67.5)	181 (57.3)	0.017
Obesity	305 (55.5)	214 (55.0)	91 (56.5)	0.778	145 (62.0)	160 (50.6)	0.009
Physical findings
Hirsutism (mF-G score ≥ 8)	453 (82.4)	323 (83.0)	130 (80.7)	0.540	214 (91.5)	239 (75.6)	< 0.001
Obesity (BMI ≥ 25 kg/m²)	369 (67.1)	256 (65.8)	113 (70.2)	0.370	156 (66.7)	213 (67.4)	0.927
Central obesity (WC ≥ 80 cm)	425 (77.3)	305 (78.4)	120 (74.5)	0.371	184 (78.6)	241 (76.3)	0.538
Hypertension (BP ≥ 140/90 mm Hg)	51 (9.3)	34 (8.7)	17 (10.6)	0.520	25 (10.7)	26 (8.2)	0.373
Investigations
Hyperandrogenemia (TT > 46 ng/dL)	234 (42.6)	170 (43.7)	64 (39.8)	0.448	-	-	-
Altered LH-FSH ratio (> 1.0)	389 (70.7)	-	-	-	170 (72.6)	219 (69.3)	0.448
Polycystic ovarian morphology	462 (84.0)	323 (83.0)	139 (86.3)	0.373	198 (84.6)	264 (83.5)	0.814

Table 1. Characteristics of the Study Population (N = 550)

Variables

Total (N = 550)

LH-FSH ratio (cut-off > 1.0)

Androgenemia (cut-off > 46 ng/dL)

Altered (n = 389, 70.73%)

Normal (n = 161, 29.27%)

High (n = 234, 42.55%)

Normal (n = 316, 57.45%)

Within parentheses are percentages over column total of respective variable. Chi-square test was done. PCOS: polycystic ovary syndrome; mF-G: modified Ferriman-Gallwey; BMI: body mass index; WC: waist circumference; BP: blood pressure; TT: total testosterone; LH: luteinizing hormone; FSH: follicle-stimulating hormone.

Personal history

Menstrual abnormality

454 (82.5)

325 (83.5)

129 (80.1)

0.387

207 (88.5)

247 (78.2)

0.002

Subfertility

124 (22.5)

85 (21.9)

39 (24.2)

0.575

58 (24.8)

66 (20.9)

0.303

Menstrual regulation or abortion

57 (10.4)

35 (9.0)

22 (13.7)

0.123

25 (10.7)

32 (10.1)

0.888

Family history

PCOS

112 (20.4)

79 (20.3)

33 (20.5)

1.000

57 (24.4)

55 (17.4)

0.045

Subfertility

127 (23.1)

91 (23.4)

36 (22.4)

0.825

59 (25.2)

68 (21.5)

0.357

Diabetes mellitus

339 (61.6)

233 (59.9)

106 (65.8)

0.211

158 (67.5)

181 (57.3)

0.017

Obesity

305 (55.5)

214 (55.0)

91 (56.5)

0.778

145 (62.0)

160 (50.6)

0.009

Physical findings

Hirsutism (mF-G score ≥ 8)

453 (82.4)

323 (83.0)

130 (80.7)

0.540

214 (91.5)

239 (75.6)

< 0.001

Obesity (BMI ≥ 25 kg/m²)

369 (67.1)

256 (65.8)

113 (70.2)

0.370

156 (66.7)

213 (67.4)

0.927

Central obesity (WC ≥ 80 cm)

425 (77.3)

305 (78.4)

120 (74.5)

0.371

184 (78.6)

241 (76.3)

0.538

Hypertension (BP ≥ 140/90 mm Hg)

51 (9.3)

34 (8.7)

17 (10.6)

0.520

25 (10.7)

26 (8.2)

0.373

Investigations

Hyperandrogenemia (TT > 46 ng/dL)

234 (42.6)

170 (43.7)

64 (39.8)

0.448

Altered LH-FSH ratio (> 1.0)

389 (70.7)

170 (72.6)

219 (69.3)

0.448

Polycystic ovarian morphology

462 (84.0)

323 (83.0)

139 (86.3)

0.373

198 (84.6)

264 (83.5)

0.814

**Table 2.** Characteristics of the Study Population (N = 550)
Variables	Total (N = 550)	LH-FSH ratio (cut-off > 1.0)	P	Androgenemia (cut-off > 46 ng/dL)	P
Data are expressed as mean ± SD or median (interquartile range) as appropriate. Independent samples t-test or *Mann-Whitney U test was done. SD: standard deviation; LH: luteinizing hormone; FSH: follicle-stimulating hormone.
Age (years)	23.14 ± 4.80	22.77 ± 4.77	24.01 ± 4.79	0.006	23.19 ± 4.58	23.09 ± 4.97	0.81
Body mass index (kg/m²)	27.64 ± 5.34	27.54 ± 5.35	27.87 ± 5.34	0.507	27.58 ± 5.29	27.68 ± 5.39	0.82
Waist circumference (cm)	87.52 ± 11.77	87.36 ± 11.57	87.92 ± 12.25	0.615	87.81 ± 11.59	87.32 ± 11.91	0.63
Systolic blood pressure (mm Hg)	111.37 ± 13.22	111.20 ± 13.06	111.77 ± 13.65	0.648	112.72 ± 13.16	110.37 ± 13.21	0.039
Diastolic blood pressure (mm Hg)	75.20 ± 9.42	75.17 ± 9.28	75.28 ± 9.76	0.895	76.50 ± 8.90	74.23 ± 9.68	0.005
Serum total testosterone (ng/dL)	49.45 ± 29.81	51.47 ± 29.92	44.56 ± 29.07	0.013	-	-	-
Serum LH-FSH ratio	1.49 (0.89 - 2.35)	-	-	-	1.70 (0.96 - 2.39)	1.42 (0.87 - 2.27)	0.118*

Table 2. Characteristics of the Study Population (N = 550)

Variables

Total (N = 550)

LH-FSH ratio (cut-off > 1.0)

Androgenemia (cut-off > 46 ng/dL)

Altered (n = 389)

Normal (n = 161)

High (n = 234)

Normal (n = 316)

Data are expressed as mean ± SD or median (interquartile range) as appropriate. Independent samples t-test or *Mann-Whitney U test was done. SD: standard deviation; LH: luteinizing hormone; FSH: follicle-stimulating hormone.

Age (years)

23.14 ± 4.80

22.77 ± 4.77

24.01 ± 4.79

0.006

23.19 ± 4.58

23.09 ± 4.97

0.81

Body mass index (kg/m²)

27.64 ± 5.34

27.54 ± 5.35

27.87 ± 5.34

0.507

27.58 ± 5.29

27.68 ± 5.39

0.82

Waist circumference (cm)

87.52 ± 11.77

87.36 ± 11.57

87.92 ± 12.25

0.615

87.81 ± 11.59

87.32 ± 11.91

0.63

Systolic blood pressure (mm Hg)

111.37 ± 13.22

111.20 ± 13.06

111.77 ± 13.65

0.648

112.72 ± 13.16

110.37 ± 13.21

0.039

Diastolic blood pressure (mm Hg)

75.20 ± 9.42

75.17 ± 9.28

75.28 ± 9.76

0.895

76.50 ± 8.90

74.23 ± 9.68

0.005

Serum total testosterone (ng/dL)

49.45 ± 29.81

51.47 ± 29.92

44.56 ± 29.07

0.013

Serum LH-FSH ratio

1.49 (0.89 - 2.35)

1.70 (0.96 - 2.39)

1.42 (0.87 - 2.27)

0.118*

**Table 3.** Multivariable Logistic Regression Analysis for Altered LH-FSH Ratio (Cut-Off > 1.0) and Hyperandrogenemia (Cut-Off > 46 ng/dL) in the Study Population
Covariates	Altered LH-FSH ratio	P	Hyperandrogenemia	P
Binary logistic regression analysis was done. OR: odds ratio; CI: confidence interval; LH: luteinizing hormone; FSH: follicle-stimulating hormone.
Age, years	-0.053	0.948 (0.911 - 0.986)	0.008	0.002	1.002 (0.965 - 1.040)	0.921
Body mass index, kg/m²	-0.013	0.987 (0.924 - 1.054)	0.696	-0.038	0.962 (0.905 - 1.023)	0.218
Waist circumference, cm	0.007	1.007 (0.976 - 1.038)	0.671	0.011	1.011 (0.983 - 1.041)	0.434
Systolic blood pressure, mm Hg	-0.004	0.996 (0.977 -1.015)	0.682	0.003	1.003 (0.985 - 1.021)	0.774
Diastolic blood pressure, mm Hg	0.002	1.002 (0.975 - 1.030)	0.883	0.027	1.028 (1.002 - 1.054)	0.036
Serum total testosterone, ng/dL	0.082	1.086 (1.016 - 1.160)	0.016	-	-	-
Serum LH-FSH ratio	-	-	-	0.137	1.147 (1.025 - 1.284)	0.017

Table 3. Multivariable Logistic Regression Analysis for Altered LH-FSH Ratio (Cut-Off > 1.0) and Hyperandrogenemia (Cut-Off > 46 ng/dL) in the Study Population

Covariates

Altered LH-FSH ratio

Hyperandrogenemia

OR (95% CI)

Binary logistic regression analysis was done. OR: odds ratio; CI: confidence interval; LH: luteinizing hormone; FSH: follicle-stimulating hormone.

Age, years

-0.053

0.948 (0.911 - 0.986)

0.008

0.002

1.002 (0.965 - 1.040)

0.921

Body mass index, kg/m²

-0.013

0.987 (0.924 - 1.054)

0.696

-0.038

0.962 (0.905 - 1.023)

0.218

Waist circumference, cm

0.007

1.007 (0.976 - 1.038)

0.671

0.011

1.011 (0.983 - 1.041)

0.434

Systolic blood pressure, mm Hg

-0.004

0.996 (0.977 -1.015)

0.682

0.003

1.003 (0.985 - 1.021)

0.774

Diastolic blood pressure, mm Hg

0.002

1.002 (0.975 - 1.030)

0.883

0.027

1.028 (1.002 - 1.054)

0.036

Serum total testosterone, ng/dL

0.082

1.086 (1.016 - 1.160)

0.016

Serum LH-FSH ratio

0.137

1.147 (1.025 - 1.284)

0.017