(118) The Impact of Treatment Choice on Serum Androgen Levels in Adolescents with PCOS

Background: Combined hormonal contraceptives (CHC) are a first line recommended treatment for polycystic ovary syndrome (PCOS) due to their protective effect on the endometrium and potential benefits from decreased hyperandrogenemia. Some patients, however, may not be good candidates for CHC because of estrogen contraindications or desire for higher contraceptive efficacy. Metformin and progestin-only hormonal contraceptives (PHC) are alternative treatments. Metformin may offer greater benefits to patients with higher metabolic risk, while PHC provide endometrial protection and contraceptive benefits. The impact of medication choice on hyperandrogenemia has not been well studied. The objective of this study was to assess changes in serum testosterone measurements in adolescents with PCOS on CHC, metformin or PHC.

Methods: A retrospective cohort study of post-menarchal females < 21 years of age with a diagnosis of PCOS was conducted. Diagnosis of PCOS required oligo-anovulation and clinical and/or biochemical evidence of hyperandrogenism. Patients were excluded if they were on medication within 3 months prior to initial androgen testing, were not started on CHC, metformin or PHC monotherapy, and did not have follow up laboratory studies after medication initiation. Descriptive statistics included medians (interquartile range, IQR) for continuous variables and counts (percentages) for categorical variables.

Results: Among the 47 individuals meeting eligibility criteria, median age at PCOS diagnosis was 15.2 (IQR 13.9, 16.6). 55% were white and 32% African American. 15% reported Hispanic or Latino ethnicity. 63% of individuals were publicly insured. Mean serum total testosterone at baseline was 61.5 ng/dL and 50.3 ng/dL after treatment initiation. CHC, metformin and PHC monotherapy all resulted in decreased serum androgen levels (Table).

Conclusions: In addition to lifestyle modifications, first line treatment for PCOS often is CHC for management of clinical hyperandrogenism and irregular cycles. While sample sizes are small, patients taking metformin and PHC experienced decreases in serum androgens like those on CHC. Further study will increase sample size per group and explore combination therapy in addition to monotherapy.