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Licensed Unlicensed Requires Authentication Published by De Gruyter October 5, 2022

Gender diversity in adolescents with polycystic ovary syndrome

  • Cintya L. Schweisberger , Laurie Hornberger , Romina Barral , Charles Burke , Emily Paprocki , Ashley Sherman , Heidi Vanden Brink and Tania S. Burgert EMAIL logo



The objective of our study was to describe the prevalence of gender diverse (GD) youth  among adolescents with polycystic ovary syndrome (PCOS).


We conducted a retrospective chart review on patients who met NIH criteria for PCOS in our Multidisciplinary Adolescent PCOS Program (MAPP). We compared those with PCOS to MAPP patients who did not meet PCOS criteria as well as to non-PCOS patients from the Adolescent Specialty Clinic (ASC). Variables analyzed included gender identity, androgen levels, hirsutism scores, and mood disorders. We used chi-square, Fisher’s exact, t-tests, and Wilcoxon rank sum tests to compare groups.  Gender identities self-reported as male, fluid/both or nonbinary  were pooled into the GD category.


Within the MAPP, 7.6% (n=12) of PCOS youth self-identified as GD compared to 1.8% (n=3) of non PCOS youth (p=0.01, chi-square). When compared to non-PCOS GD adolescents from ASC (4.4%; n=3), the difference to PCOS youth was no longer significant (p=0.56). Among MAPP patients, gender diversity was associated with higher hirsutism scores (p<0.01), but not higher androgen levels. In PCOS, depression/anxiety was higher in GD vs cisgender youth (100% vs. 37.6%, p<0.01 and 77.8% vs. 35.8%, p=0.03 respectively).


Gender diversity was observed more commonly in those meeting PCOS criteria. PCOS GD youth were more hirsute and reported more depression/anxiety. Routine screening for differences in gender identity in comprehensive adolescent PCOS programs could benefit these patients, as alternate treatment approaches may be desired to support a transmasculine identity.

Corresponding author: Tania S. Burgert, MD, Division of Endocrinology, Children’s Mercy Hospital and Clinics, 3101 Broadway Blvd, Kansas City, MO 64111, USA, E-mail:

Funding source: Canadian Institutes of Health Research

Award Identifier / Grant number: 171268

  1. Research funding: This study was funded by Canadian Institutes of Health Research (No. 171268).

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: This study was a secondary analysis of data collection with waived consent.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review.


1. Naz, MSG, Tehrani, FR, Majd, HA, Ahmadi, F, Ozgoli, G, Fakari, FR, et al.. The prevalence of polycystic ovary syndrome in adolescents: a systematic review and meta-analysis. Int J Reprod Biomed 2019;17:533–42.Search in Google Scholar

2. Teede, HJ, Misso, ML, Costello, MF, Dokras, A, Laven, J, Moran, L, et al.. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod 2018;33:1602–18.10.1093/humrep/dey256Search in Google Scholar PubMed PubMed Central

3. Carreau, AM, Pyle, L, Garcia-Reyes, Y, Rahat, H, Vigers, T, Jensen, T, et al.. Clinical prediction score of nonalcoholic fatty liver disease in adolescent girls with polycystic ovary syndrome (PCOS-HS index). Clin Endocrinol 2019;91:544–52. in Google Scholar PubMed PubMed Central

4. Kerchner, A, Lester, W, Stuart, SP, Dokras, A. Risk of depression and other mental health disorders in women with polycystic ovary syndrome: a longitudinal study. Fertil Steril 2009;91:207–12. in Google Scholar PubMed

5. Coban, OG, Tulaci, OD, Adanir, AS, Onder, A. Psychiatric disorders, self-esteem, and quality of life in adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol 2019;32:600–4. in Google Scholar PubMed

6. Emeksiz, HC, Bideci, A, Nalbantoglu, B, Nalbantoglu, A, Celik, C, Yulaf, Y, et al.. Anxiety and depression states of adolescents with polycystic ovary syndrome. Turk J Med Sci 2018;48:531–6.Search in Google Scholar

7. Witchel, SF, Oberfield, SE, Pena, AS. Polycystic ovary syndrome: pathophysiology, presentation, and treatment with emphasis on adolescent girls. J Endocr Soc 2019;3:1545–73. in Google Scholar PubMed PubMed Central

8. Eisenberg, ME, Gower, AL, McMorris, BJ, Rider, GN, Shea, G, Coleman, E. Risk and protective factors in the lives of transgender/gender nonconforming adolescents. J Adolesc Health 2017;61:521–6. in Google Scholar PubMed PubMed Central

9. Baba, T, Endo, T, Ikeda, K, Shimizu, A, Honnma, H, Ikeda, H, et al.. Distinctive features of female-to-male transsexualism and prevalence of gender identity disorder in Japan. J Sex Med 2011;8:1686–93. in Google Scholar PubMed

10. Balen, AH, Schachter, ME, Montgomery, D, Reid, RW, Jacobs, HS. Polycystic ovaries are a common finding in untreated female to male transsexuals. Clin Endocrinol 1993;38:325–9. in Google Scholar PubMed

11. Mueller, A, Gooren, LJ, Naton-Schotz, S, Cupisti, S, Beckmann, MW, Dittrich, R. Prevalence of polycystic ovary syndrome and hyperandrogenemia in female-to-male transsexuals. J Clin Endocrinol Metab 2008;93:1408–11. in Google Scholar PubMed

12. Liu, M, Murthi, S, Poretsky, L. Polycystic ovary syndrome and gender identity. Yale J Biol Med 2020;93:529–37.Search in Google Scholar

13. Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf 2009;42:377–81. in Google Scholar PubMed PubMed Central

14. Harris, PA, Taylor, R, Minor, BL, Elliott, V, Fernandez, M, O’Neal, L, et al.. The REDCap consortium: building an international community of software platform partners. J Biomed Inf 2019;95:103208. in Google Scholar PubMed PubMed Central

15. Olson, J, Schrager, SM, Belzer, M, Simons, LK, Clark, LF. Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. J Adolesc Health 2015;57:374–80. in Google Scholar PubMed PubMed Central

16. 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. in Google Scholar PubMed

17. Teede, H, Deeks, A, Moran, L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med 2010;8:41. in Google Scholar PubMed PubMed Central

18. Spritzer, PM, Barone, CR, Oliveira, FB. Hirsutism in polycystic ovary syndrome: pathophysiology and management. Curr Pharmaceut Des 2016;22:5603–13. in Google Scholar PubMed

19. Afifi, L, Saeed, L, Pasch, LA, Huddleston, HG, Cedars, MI, Zane, LT, et al.. Association of ethnicity, Fitzpatrick skin type, and hirsutism: a retrospective cross-sectional study of women with polycystic ovarian syndrome. Int J Womens Dermatol 2017;3:37–43. in Google Scholar PubMed PubMed Central

20. Babu, R, Shah, U. Gender identity disorder (GID) in adolescents and adults with differences of sex development (DSD): a systematic review and meta-analysis. J Pediatr Urol 2021;17:39–47. in Google Scholar PubMed

21. Dessens, AB, Slijper, FM, Drop, SL. Gender dysphoria and gender change in chromosomal females with congenital adrenal hyperplasia. Arch Sex Behav 2005;34:389–97. in Google Scholar PubMed

22. Sir-Petermann, T, Codner, E, Perez, V, Echiburu, B, Maliqueo, M, Ladron de Guevara, A, et al.. Metabolic and reproductive features before and during puberty in daughters of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2009;94:1923–30. in Google Scholar PubMed PubMed Central

23. Toomey, RB, Syvertsen, AK, Shramko, M. Transgender adolescent suicide behavior. Pediatrics 2018;142:e20174218. in Google Scholar PubMed PubMed Central

24. Pena, AS, Witchel, SF, Hoeger, KM, Oberfield, SE, Vogiatzi, MG, Misso, M, et al.. Adolescent polycystic ovary syndrome according to the international evidence-based guideline. BMC Med 2020;18:72. in Google Scholar PubMed PubMed Central

25. Lizneva, D, Suturina, L, Walker, W, Brakta, S, Gavrilova-Jordan, L, Azziz, R. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril 2016;106:6–15. in Google Scholar PubMed

Received: 2022-05-07
Accepted: 2022-09-05
Published Online: 2022-10-05
Published in Print: 2022-11-25

© 2022 Walter de Gruyter GmbH, Berlin/Boston

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