A major shift is underway in women’s endocrine health that is changing how the medical community approaches Polycystic Ovary Syndrome (PCOS) and its link to cardiovascular risk. Recent findings published in the European Journal of Endocrinology, titled “Hyperandrogenaemia, Polycystic Ovary Syndrome, and Physical Fitness in Women—a Northern Finland Birth Cohort Study,” stem from a large population-based study of 5,889 women, whose hormone profiles and lifestyle habits were tracked at ages 31 and 46 years. Central to the study is the paradoxical finding that women with higher androgen levels, especially testosterone, demonstrated greater muscular power — measured by grip strength — but had impaired heart–lung function. This impairment led to a decreased capacity for sustained physical activity, revealing a disconnect between visible strength and underlying aerobic fitness.
Historically, PCOS has been tied to cardiovascular risk factors like obesity and insulin resistance. However, the study clarifies that not every woman with PCOS has high androgen levels (hyperandrogenaemia, HA), and conversely, not all women with HA have PCOS. By analyzing a diverse group, researchers were able to pinpoint that it’s the elevated androgen levels — not just the PCOS diagnosis — that independently raise long-term cardiovascular risk. The study found that PCOS alone did not account for differences in fitness; rather, hormone levels, specifically HA, were the critical factor.
As research continues to shed light on the complex connections between hormones, physical fitness, and heart health, clinicians must evolve their recommendations to safeguard patients against this hidden but serious threat.
One of the most compelling results involved the Free Androgen Index, a marker of bioavailable testosterone. Women in the highest quartile of this index were significantly more likely to fail a standardized step-test from exhaustion. This is a key insight because low cardiorespiratory fitness (CRF) is a stronger predictor of overall and cardiovascular mortality than other common risk factors like smoking, high blood pressure, or type 2 diabetes.
While this study points to HA as a main culprit compromising heart health, it only measured serum testosterone — other androgens might also play a role. Future studies to look at these as well as other hormones such as estrogen, insulin, and cortisol, should be considered, the authors write.
The clinical implications are immediate and significant. The research supports a movement toward more tailored exercise recommendations for women with HA and PCOS. Whereas existing guidelines focus largely on weight management, the new evidence suggests greater emphasis should be placed on boosting heart endurance and aerobic capacity. Women with high androgen levels may seem physically fit or active, yet they harbor an invisible risk that general exercise advice may not sufficiently address. Healthcare professionals are urged to look beyond surface-level strength and consider interventions, such as brisk walking, swimming, and cycling, that target and improve cardiorespiratory fitness. Standard advice to simply “exercise more” is inadequate — programs must specifically aim to build aerobic stamina to counteract the increased cardiovascular risk linked to hyperandrogenaemia. As research continues to shed light on the complex connections between hormones, physical fitness, and heart health, clinicians must evolve their recommendations to safeguard patients against this hidden but serious threat.
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