The Effect of Hyperandrogenism on Risk for PTSD in Women

Background: Polycystic ovary syndrome (PCOS) and hirsutism, two disorders characterized by elevated androgen hormone levels, have been associated with a wide range of psychiatric disorders. PCOS and hirsutism have been linked to higher rates of depression, bipolar disorder, personality disorders, and anxiety disorders. A few prior studies have noted an association of post-traumatic stress disorder (PTSD) with PCOS, but have not controlled for psychiatric and medical comorbidities that could contribute to the development of PTSD. Additionally, the impact of hirsutism on development of PTSD has not been studied.

Methods: Cross-sectional analysis of a cohort study of female patients at Veterans Health Administration primary care clinic. PCOS, hirsutism, and psychiatric diagnoses were obtained from encounter records. Regression analyses were performed to examine the association of PCOS and hirsutism with PTSD, focused on prevalence across racial/ethnic groups and by distinct age groups to examine patterns across the lifespan.

Results: Among women with PCOS (n=2,748) or hirsutism (n=1,553) compared to women without these disorders (n=102,054), risk of PTSD was increased by 39% (46% vs. 33%) in women with PCOS and 48% (49% vs. 33%) in women with hirsutism. In an analysis controlling for medical/psychiatric comorbidities, the association between hyperandrogenic disorders and PTSD remained significant (PCOS: OR 1.26, CI 1.2-1.4; Hirsutism: OR 1.34, CI 1.2-1.5).

Discussion: PCOS and hirsutism are both associated with an increased risk of PTSD. Consistent with prior studies, the increased psychiatric morbidity conferred by PCOS/hirsutism was not limited to PTSD. Women with PCOS/hirsutism also had higher rates of depression, substance use disorders, OCD, schizophrenia, and bipolar disorder. Although we did not have access to androgen levels, several observations from this study suggest that androgen plays a direct role in the comorbidity of PCOS and hirsutism with PTSD and psychiatric disorders.

Future prospective studies using serum measures of androgen levels are needed to confirm the role of androgen as a direct mediator in the association of PTSD with PCOS/hirsutism. There is a need for novel approaches to PTSD treatment. There are high rates of non-response to existing psychotherapy and medication treatment. If confirmed, these results suggest correction of hyperandrogenism as a potential treatment approach for women with comorbid hyperandrogenism and PTSD.

Conclusion: This study demonstrated an increased risk of PTSD among hyperandrogenic disorders PCOS and hirsutism, which persisted after controlling for medical/psychiatric comorbidities. It remains to be determined whether correction of hyperandrogenism could facilitate recovery from PTSD. Because hyperandrogenism is more common among women with PTSD, screening for hyperandrogenism should be considered in this population.

References:

Cohen BE, Maguen S, Bertenthal D, Shi Y, Jacoby V, Seal KH. Reproductive and other health outcomes in Iraq/Afghanistan women veterans using VA health care: association with mental health diagnoses. Womens Health Issues. 2012;22:e461-471.

Dennett CC, Simon J. The role of PCOS in reproductive and metabolic health: overview/approaches for treatment. Diabetes Spectr. 2015;28:116-120.

Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T, Norman RJ. Recommendations from the international evidence-based guideline for the assessment and management of PCOS. Hum Reprod. 2018;33:1602-1618.