Impact of androgens on cardiovascular risk in women with polycystic ovary syndrome and transgender men

Cardiovascular disease is the leading cause of morbidity and mortality throughout much of the world. Androgen excess polycystic ovary syndrome (AE-PCOS) is a common female endocrinopathy and a leading cause of infertility. In AE-PCOS, the vascular system is exposed to chronically high androgens levels, increasing risk of endothelial dysfunction, mild hypertension, and metabolic dysfunction. Another condition in which the female vascular system is exposed to chronically high androgens is during gender-affirming hormone therapy (GAHT) in transgender men. Like AE-PCOS, GAHT is associated with endothelial dysfunction, mild hypertension, and dyslipidemia. However, little is known about the long-term consequences of these changes and potential mechanisms involved; thus, few interventions to mitigate these phenomena have been proposed. Our studies suggest that hyperandrogenemia is a primary driver for changes in vascular function in AE-PCOS and transgender men, although more research is required to confirm this hypothesis and mechanisms involved in these effects.