5α-reductase activity in women with polycystic ovary syndrome: a systematic review and meta-analysis

Background: 5 alpha-reductase activity might be important during the development of polycystic ovary syndrome (PCOS). However, the changes of 5 alpha-reductase activity in PCOS subjects and the relationship between 5 alpha-reductase activity and body mass index (BMI), insulin resistance (IR) remain largely unknown. Methods: We performed a meta-analysis to examine 5 alpha-reductase activity in women with PCOS; exploratory subgroup analyses were also performed. Results: Five articles (with 356 cases and 236 controls) reporting 5 alpha-reductase activity in patients with PCOS were selected for the meta-analysis. We observed significantly higher ratios of 5 alpha THF/THF (5 alpha-reduced tetrahydrocortisol to 5 beta-reduced tetrahydrocortisol) and An/Et (androsteroneto/etiocholanolone) levels, which were used to assess 5a-reductase activity, among the patients with PCOS, [standardized mean differences (SMD) =0.43, 95% confidence intervals (95% CI) = 0.25-0.61, P < 0.00001; SMD = 0.86, 95% CI = 0.29-1.44, P = 0.003]. We observed significant heterogeneity between studies for An/Et (I-2 = 89% and P < 0.00001). According to the group analysis, women with PCOS exhibited increased 5 alpha-reductase activity which was significantly associated with homeostasis model assessment of insulin resistance (HOMA-IR) regardless of obesity. Conclusions: 5 alpha-reductase activity was enhanced in women with PCOS. Increased 5 alpha-reductase activity in patients with PCOS was related to IR.