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Ovarian Function and Disorders · Journal article
BMC Women S Health · August 15, 2026
Encouraging direction, but not yet definitive.
In women with hirsutism (excluding those with severe obesity), the LH/FSH ratio and ALT/AST ratio independently discriminate PCOS from idiopathic hirsutism, with a two-marker model achieving moderate diagnostic accuracy (AUC 0.728). The authors propose these inexpensive, routinely available ratios as practical adjuncts for clinical differentiation, though prospective validation is explicitly required.
Retrospective cross-sectional study. Women presenting with hirsutism; BMI ≤40 kg/m². 206 had PCOS diagnosis, 69 had idiopathic hirsutism diagnosis (diagnostic criteria not specified in abstract).. Intervention: None; observational comparison of two groups.. Compared with: Idiopathic hirsutism (IH) versus polycystic ovary syndrome (PCOS).. n = 275. Not stated in source text..
LH/FSH ratio independently associated with PCOS (OR 2.86; 95% CI 1.589–5.135) ALT/AST ratio independently associated with PCOS (OR 2.70; 95% CI 1.057–6.892) Total testosterone was significantly higher in PCOS but did not remain independent in multivariable model
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Clinicians evaluating women with hirsutism may use LH/FSH and ALT/AST ratios as inexpensive, widely available adjuncts to differentiate PCOS from idiopathic hirsutism, though these markers have moderate discriminatory power (AUC 0.728) and the authors emphasize the need for prospective validation before routine clinical implementation.
A sound cross-sectional study identifying two routine biomarkers (LH/FSH and ALT/AST ratios) that independently discriminate PCOS from idiopathic hirsutism with moderate discriminatory power (AUC 0.728), but requiring prospective validation before clinical adoption.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians evaluating women with hirsutism may use LH/FSH and ALT/AST ratios as inexpensive, widely available adjuncts to differentiate PCOS from idiopathic hirsutism, though these markers have moderate discriminatory power (AUC 0.728) and the authors emphasize the need for prospective validation before routine clinical implementation.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Hirsutism is a common endocrine complaint most frequently associated with polycystic ovary syndrome (PCOS), but it may also occur in idiopathic hirsutism (IH). Because the two conditions differ in long-term metabolic risk and management, distinguishing them is clinically important, yet reliable, routinely available discriminators remain incompletely defined. Rather than re-describing established differences, this study aimed to determine whether routine hormonal and biochemical parameters can help discriminate PCOS from IH in women presenting with hirsutism, independent of the confounding effect of severe obesity. In this retrospective cross-sectional study, 275 women with hirsutism (69 with IH and 206 with PCOS) were evaluated. To minimize the confounding effect of severe obesity, women with a body mass index (BMI) > 40 kg/m² were excluded. Clinical, biochemical, and hormonal parameters were compared between groups, and multivariable logistic regression was performed to identify parameters independently associated with PCOS. Compared with women with IH, women with PCOS had significantly higher triglycerides, alanine aminotransferase (ALT), aspartate aminotransferase (AST), the ALT/AST ratio, thyroid-stimulating hormone (TSH), luteinizing hormone (LH), the LH to follicle-stimulating hormone (FSH) ratio, and total testosterone. In contrast, BMI, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and lipid parameters other than triglycerides did not differ significantly between groups. In multivariable logistic regression, only the LH/FSH ratio (odds ratio [OR] 2.86; 95% confidence interval [CI] 1.589–5.135) and the ALT/AST ratio (OR 2.70; 95% CI 1.057–6.892) remained independently associated with PCOS, whereas total testosterone did not. A model combining these routinely available markers discriminated PCOS from IH with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.728 (95% CI 0.661–0.794), exceeding that of any single marker, with good calibration (Hosmer–Lemeshow p = 0.361). After minimizing the confounding effect of severe obesity, women with PCOS and IH showed comparable classic metabolic indices (fasting insulin, HOMA-IR, and lipids), but differed in hormonal profile and in two routinely available laboratory ratios — LH/FSH and ALT/AST — that were independently associated with PCOS. These inexpensive, widely available ratios may serve as a practical adjunct for distinguishing PCOS-related hirsutism from idiopathic hirsutism, pending prospective validation.
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