Evaluating the Diagnostic Accuracy of Androgen Measurement in Polycystic Ovary Syndrome: A Systematic Review and Diagnostic Meta-Analysis to Inform Evidence-Based Guidelines

The systematic review and diagnostic meta-analysis by Asmamaw Demis Bizuneh and colleagues evaluated the diagnostic accuracy of androgen measurements in diagnosing polycystic ovary syndrome (PCOS) across 18 studies with 2,857 participants. The study found that total testosterone (TT) and calculated free testosterone (cFT) are the most accurate first-line tests for assessing biochemical hyperandrogenism in PCOS, with high pooled sensitivity and specificity. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was recommended for its superior accuracy over direct immunoassay methods. The findings informed the 2023 International PCOS Guidelines, emphasizing TT and FT as primary tests, while androstenedione (A4) and dehydroepiandrosterone sulfate (DHEAS) could be considered if TT or cFT are not elevated. The study highlights the need for standardized guidelines and further research on optimal cut-off values across diverse populations.