Role of hyperandrogenism on disordered eating behaviors in adolescents with PCOS and interplay with insulin resistance

Nazan Kaymaz; Özlem Kara; Hande Şirin; Tolga Kasap; Mehmet Erdem Uzun

doi:10.1515/jpem-2025-0151

Article

Role of hyperandrogenism on disordered eating behaviors in adolescents with PCOS and interplay with insulin resistance

Nazan Kaymaz , Özlem Kara , Hande Şirin , Tolga Kasap and Mehmet Erdem Uzun

Published/Copyright: November 11, 2025

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 39 Issue 1

Abstract

Objectives

This study examines the roles of hyperandrogenism (HA) and insulin resistance (IR) in eating behaviors among adolescents with polycystic ovary syndrome (PCOS).

Methods

Fifty adolescents with PCOS (mean age 16.04 ± 1.46 years, BMI 27.55 ± 6.34) were assessed. IR was evaluated using HOMA-IR, and eating behaviors were measured with the Eating Attitudes Test (EAT) and the Eating Disorders Examination Questionnaire (EDE-Q).

Results

IR was present in 46 % of participants, with obesity affecting 71 % of those with IR. While EAT scores showed no significant association with BMI, HA, or IR, the IR group had higher EDE-Q Total scores (p=0.05), particularly in Shape Concern (SC, p=0.003) and Weight Concern (WC, p=0.03). HA primarily influenced WC (p=0.04). BMI correlated more strongly with WC (r=0.579, p<0.001) than IR. ROC analysis indicated BMI>27.5 (AUC=0.967) and HOMA-IR>3.1 (AUC=0.961) as strong predictors of disordered eating.

Conclusions

BMI and HOMA-IR are more reliable than HA for identifying disordered eating behaviors in PCOS adolescents. The EDE-Q is recommended for effective screening, emphasizing the need to monitor BMI and HOMA-IR in this population.

Keywords: polycystic ovary syndrome; insulin resistance; hyperandrogenism; disordered eating behaviors; adolescent

Corresponding author: Tolga Kasap, Asst. Prof., Department of Pediatrics, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye, E-mail: tolga.kasap@hotmail.com

Research ethics: The study received approval from the local Ethics Committee of Bursa Yüksek İhtisas Training and Research Hospital Clinical Research Ethics Committee (number:2011-KAEK-25 2023/01-11).
Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Use of Large Language Models, AI and Machine Learning Tools: None declared.
Conflict of interest: The authors state no conflict of interest.
Research funding: None declared.
Data availability: Not applicable.

References

1. World Health Organization. Polycystic ovary syndrome [Internet]. Geneva: WHO; 2023 [cited 2025 Apr 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome.Search in Google Scholar

2. Bozdag, G, Mumusoglu, S, Zengin, D, Karabulut, E, Yildiz, BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2016;31:2841–55. https://doi.org/10.1093/humrep/dew218.Search in Google Scholar PubMed

3. Lentscher, JA, Decherney, AH. Clinical presentation and diagnosis of polycystic ovarian syndrome. Clin Obstet Gynecol 2021;64:3–11. https://doi.org/10.1097/grf.0000000000000563.Search in Google Scholar

4. Brutocao, C, Zaiem, F, Alsawas, M, Morrow, AS, Murad, MH, Javed, A. Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine 2018;62:318–25. https://doi.org/10.1007/s12020-018-1692-3.Search in Google Scholar PubMed

5. Salvador, J, Gutierrez, G, Llavero, M, Gargallo, J, Escalada, J, López, J. Endocrine disorders and psychiatric manifestations. In: Portincasa, P, Frühbeck, G, Nathoe, HM, editors. Endocrinology and systemic diseases. Cham: Springer; 2019.10.1007/978-3-319-66362-3_12-1Search in Google Scholar

6. Cesta, CE, Månsson, M, Palm, C, Lichtenstein, P, Iliadou, AN, Landén, M. Polycystic ovary syndrome and psychiatric disorders: co-morbidity and heritability in a nationwide Swedish cohort. Psychoneuroendocrinology 2016;73:196–203. https://doi.org/10.1016/j.psyneuen.2016.08.005.Search in Google Scholar PubMed

7. Karjula, S, Arffman, RK, Morin-Papunen, L, Franks, S, Järvelin, MR, Tapanainen, JS, et al.. A population-based follow-up study shows high psychosis risk in women with PCOS. Arch Womens Ment Health 2022;25:301–11. https://doi.org/10.1007/s00737-021-01195-4.Search in Google Scholar PubMed PubMed Central

8. Podfigurna-Stopa, A, Luisi, S, Regini, C, Katulski, K, Centini, G, Meczekalski, B, et al.. Mood disorders and quality of life in polycystic ovary syndrome. Gynecol Endocrinol 2015;31:431–4. https://doi.org/10.3109/09513590.2015.1009437.Search in Google Scholar PubMed

9. Karjula, S, Morin-Papunen, L, Auvinen, J, Ruokonen, A, Puukka, K, Franks, S, et al.. Psychological distress is more prevalent in fertile age and premenopausal women with PCOS symptoms: 15-year follow-up. J Clin Endocrinol Metab 2017;102:1861–9. https://doi.org/10.1210/jc.2016-3863.Search in Google Scholar PubMed PubMed Central

10. Wang, G, Liu, X, Lei, J. Association between body-image satisfaction and anxiety, depressive symptoms among women with PCOS: the mediating role of emotion regulation strategies. J Psychol 2024;158:200–14. https://doi.org/10.1080/00223980.2023.2283472.Search in Google Scholar PubMed

11. Alur-Gupta, S, Chemerinski, A, Liu, C, Lipson, J, Allison, K, Sammel, MD, et al.. Body-image distress is increased in women with polycystic ovary syndrome and mediates depression and anxiety. Fertil Steril 2019;112:930–8. https://doi.org/10.1016/j.fertnstert.2019.06.018.Search in Google Scholar PubMed PubMed Central

12. Tay, CT, Teede, HJ, Hill, B, Loxton, D, Joham, AE. Increased prevalence of eating disorders, low self-esteem, and psychological distress in women with polycystic ovary syndrome: a community-based cohort study. Fertil Steril 2019;112:353–61. https://doi.org/10.1016/j.fertnstert.2019.03.027.Search in Google Scholar PubMed

13. Lalonde-Bester, S, Malik, M, Masoumi, R, Ng, K, Sidhu, S, Ghosh, M, et al.. Prevalence and etiology of eating disorders in polycystic ovary syndrome: a scoping review. Adv Nutr 2024;15:100193. https://doi.org/10.1016/j.advnut.2024.100193.Search in Google Scholar PubMed PubMed Central

14. Greenwood, EA, Pasch, LA, Cedars, MI, Huddleston, HG. Obesity and depression are risk factors for future eating disorder-related attitudes and behaviors in women with polycystic ovary syndrome. Fertil Steril 2020;113:1039–49. https://doi.org/10.1016/j.fertnstert.2020.01.016.Search in Google Scholar PubMed

15. Naessén, S, Carlström, K, Garoff, L, Glant, R, Hirschberg, AL. Polycystic ovary syndrome in bulimic women – an evaluation based on the new diagnostic criteria. Gynecol Endocrinol 2006;22:388–94. https://doi.org/10.1080/09513590600847421.Search in Google Scholar PubMed

16. Hollinrake, E, Abreu, A, Maifeld, M, Van Voorhis, BJ, Dokras, A. Increased risk of depressive disorders in women with polycystic ovary syndrome. Fertil Steril 2007;87:1369–76. https://doi.org/10.1016/j.fertnstert.2006.11.039.Search in Google Scholar PubMed

17. Saei Ghare Naz, M, Ozgoli, G, Mousavi, M, Ramezani Tehrani, F. Polycystic ovary syndrome and body image concerns during adolescence. J Pediatr Nurs 2023;72:e1–9. https://doi.org/10.1016/j.pedn.2023.05.009.Search in Google Scholar PubMed

18. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. Geneva: World Health Organization; 2000 (WHO technical report series; no. 894).Search in Google Scholar

19. Centers for Disease Control and Prevention. Z-score data files [Internet]. Hyattsville (MD). National Center for Health Statistics; 2009 [updated 2009 Aug 4; cited 2025 Apr 14]. Available from: http://www.cdc.gov/growthcharts/zscore.htm.Search in Google Scholar

20. Matthews, DR, Hosker, JP, Rudenski, AS, Naylor, BA, Treacher, DF, Turner, RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–9. https://doi.org/10.1007/bf00280883.Search in Google Scholar

21. Ferriman, D, Gallwey, JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab 1961;21:1440–7. https://doi.org/10.1210/jcem-21-11-1440.Search in Google Scholar PubMed

22. Asunción, M, Calvo, RM, San Millán, JL, Sancho, J, Avila, S, Escobar-Morreale, HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 2000;85:2434–8. https://doi.org/10.1210/jc.85.7.2434.Search in Google Scholar

23. Garner, DM, Garfinkel, PE. The Eating Attitudes Test: an index of the symptoms of anorexia nervosa. Psychol Med 1979;9:273–9. https://doi.org/10.1017/s0033291700030762.Search in Google Scholar PubMed

24. Savasir, I, Erol, N. Eating attitudes Test: Anorexia Nervosa Symptom Index [Turkish]. Turk Psikol Derg 1989;7:19–25.Search in Google Scholar

25. Fairburn, CG, Beglin, SJ. Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 1994;16:363–70. https://doi.org/10.1002/1098-108x(199412)16:4<363::aid-eat2260160405>3.0.co;2-#.10.1002/1098-108X(199412)16:4<363::AID-EAT2260160405>3.0.CO;2-#Search in Google Scholar

26. Yucel, B, Polat, A, Ikiz, T, Dusgor, BP, Elif Yavuz, A, Sertel Berk, O. The Turkish version of the eating disorder examination questionnaire: reliability and validity in adolescents. Eur Eat Disord Rev 2011;19:509–11. https://doi.org/10.1002/erv.1104.Search in Google Scholar

27. Sharma, ST, Nestler, JE. Prevention of diabetes and cardiovascular disease in women with PCOS: treatment with insulin sensitizers. Best Pract Res Clin Endocrinol Metabol 2006;20:245–60. https://doi.org/10.1016/j.beem.2006.02.003.Search in Google Scholar

28. Stefanaki, K, Karagiannakis, DS, Raftopoulou, M, Psaltopoulou, T, Paschou, SA, Ilias, I. Obesity and hyperandrogenism are implicated with anxiety, depression and food cravings in women with polycystic ovary syndrome. Endocrine 2023;82:201–8. https://doi.org/10.1007/s12020-023-03436-1.Search in Google Scholar

29. Ozturk, A, Mazicioglu, MM, Hatipoglu, N, Budak, N, Keskin, G, Yazlak, Z, et al.. Reference body mass index curves for Turkish children 6 to 18 years of age. J Pediatr Endocrinol Metab 2008;21:827–36. https://doi.org/10.1515/jpem.2008.21.9.827.Search in Google Scholar

30. Eyupoglu, ND, Aksun, S, Ozturk, M, Yildiz, BO. Impact of social isolation during COVID-19 pandemic on health behaviors and weight management in women with polycystic ovary syndrome. Eat Weight Disord 2022;27:2407–13. https://doi.org/10.1007/s40519-022-01369-8.Search in Google Scholar

31. Nestler, JE. Sex hormone-binding globulin: a marker for hyperinsulinemia and/or insulin resistance? J Clin Endocrinol Metab 1993;76:273–4. https://doi.org/10.1210/jcem.76.2.8432767.Search in Google Scholar

32. Morford, JJ, Wu, S, Mauvais-Jarvis, F. The impact of androgen actions in neurons on metabolic health and disease. Mol Cell Endocrinol 2018;465:92–102. https://doi.org/10.1016/j.mce.2017.09.001.Search in Google Scholar

33. Herriot, AM, Whitcroft, S, Jeanes, Y. An retrospective audit of patients with polycystic ovary syndrome: the effects of a reduced glycaemic load diet. J Hum Nutr Diet 2008;21:337–45. https://doi.org/10.1111/j.1365-277x.2008.00890.x.Search in Google Scholar

34. Rojas, J, Chávez, M, Olivar, L, Rojas, M, Morillo, J, Mejías, J, et al.. Polycystic ovary syndrome, insulin resistance, and obesity: navigating the pathophysiologic labyrinth. Int J Reprod Med 2014;2014:719050. https://doi.org/10.1155/2014/719050.Search in Google Scholar

35. Sundblad, C, Landén, M, Eriksson, T, Bergman, L, Eriksson, E. Effects of the androgen antagonist flutamide and the serotonin reuptake inhibitor citalopram in bulimia nervosa: a placebo-controlled pilot study. J Clin Psychopharmacol 2005;25:85–8. https://doi.org/10.1097/01.jcp.0000150222.31007.a9.Search in Google Scholar PubMed

36. Bergman, L, Eriksson, E. Marked symptom reduction in two women with bulimia nervosa treated with the testosterone receptor antagonist flutamide. Acta Psychiatr Scand 1996;94:137–9. https://doi.org/10.1111/j.1600-0447.1996.tb09838.x.Search in Google Scholar PubMed

37. Naessén, S, Carlström, K, Byström, B, Pierre, Y, Hirschberg, AL. Effects of an antiandrogenic oral contraceptive on appetite and eating behavior in bulimic women. Psychoneuroendocrinology 2007;32:548–54. https://doi.org/10.1016/j.psyneuen.2007.03.008.Search in Google Scholar PubMed

Received: 2025-03-18

Accepted: 2025-10-22

Published Online: 2025-11-11

Published in Print: 2026-01-23

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Articles in the same Issue

https://doi.org/10.1515/jpem-2025-0151

Keywords for this article

polycystic ovary syndrome; insulin resistance; hyperandrogenism; disordered eating behaviors; adolescent