Polycystic ovarian disease (PCOD) is associated with elevated serum LH and (sub)normal FSH levels, while serum androgen levels are often elevated. To clarify the role of androgens in this abnormal pattern of gonadotropin secretion, LH secretion was studied in 1) 9 eugonadal female to male transsexual subjects before and during long term (6 months) testosterone (T) administration (250 mg/2 weeks, im), and 2) in a woman with an androgen-secreting ovarian tumor both before and after surgical removal of the tumor. Finally, we studied the effects of high serum androgen levels on ovarian histology in 3) 26 transsexual subjects after long term (9–36 months) T administration (250 mg/2 weeks, im) to assess whether T-induced ovarian abnormalities are similar to those that occur in women with PCOD.

Long term T treatment in the nine female to male transsexual subjects resulted in increases in the mean serum T level from 1.7 ± 0.8 (±sd) to 40.8 ± 31.9 nmol/L (P < 0.01), the mean serum dihydrotestosterone level from 0.6 ± 0.2 to 3.3 ± 1.5 nmol/L (P < 0.02), and the mean serum free T level from 9.5 ± 5.2 to 149 ± 46 pmol/L (P < 0.02). Mean serum estrone and estradiol levels were similar before and during T treatment. The mean serum LH level decreased from 6.3 ± 2.0 to 2.9 ± 1.1 U/L (P < 0.01), and the mean FSH levels decreased from 6.6 ± 2.0 to 3.7 ± 2.2 U/L (P < 0.02). Pulsatile LH secretion before and during T treatment was studied in five subjects. Neither the mean nadir LH interval nor the LH pulse amplitude changed significantly in these five subjects. The serum T level in the woman with the androgen-secreting ovarian tumor was 9.6 nmol/L, and it declined to normal after removal of the tumor. Her mean serum LH and FSH levels, the mean nadir LH interval, and LH pulse amplitude were in the normal range before and after removal of the tumor.

Studies of ovarian histopathology in 26 transsexual subjects after long term androgen treatment revealed multiple cystic follicles in 18 subjects (69.2%), diffuse ovarian stromal hyperplasia in 21 subjects (80.8%), collagenization of the tunica albuginea in 25 subjects (96.2%), and luteinization of stromal cells in 7 subjects (26.9%). Findings consistent with criteria for the pathological diagnosis of polycystic ovaries, that is 3 of the 4 findings listed above, were present in 18 of the 26 subjects (69.2%).

We conclude that high serum T levels in eugonadal women lower serum LH levels, suggesting that elevated androgen levels are not the prime stimulus for elevated serum LH levels in women with PCOD. However, high serum T levels may induce PCOD-like histopathological changes in the ovary.