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Androgens are hormones everyone produces, and in PMOS they are often either present at higher levels or acting more strongly on the tissues that respond to them. Symptoms vary widely between people with similar hormone levels because sensitivity to androgens differs from person to person, which is why blood results and visible symptoms do not always line up.
Key takeaways
- Androgens are hormones everyone produces. In polyendocrine metabolic ovarian syndrome (PMOS, formerly PCOS), they are often present at higher levels or acting more strongly.
- Hyperandrogenism is one of the three features used in diagnosis and can be identified either from symptoms or from a blood test.
- Two people with similar hormone levels can have very different symptoms, because tissue sensitivity to androgens varies between individuals.
- This is why a blood test in the reference range does not necessarily contradict what you are seeing.
- Symptoms appear in skin and hair because those tissues are where androgen-sensitive structures are.
What are androgens?
Hormones that everyone produces, in different amounts.
Testosterone is the best known, but the group includes several others. In people with ovaries they are made in the ovaries and the adrenal glands, and they do necessary work: they contribute to bone density, muscle, hair growth and libido.1
The issue in PMOS is not their presence. It is the amount, and how strongly the tissues that respond to them are responding.
What does ”hyperandrogenism” mean?
Higher androgen levels or effects than expected. It is one of the three features used to diagnose PMOS.
Diagnosis in adults requires two of three: clinical or biochemical hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology on ultrasound or elevated anti-Müllerian hormone, after other causes are excluded (DOI: 10.1210/clinem/dgad463).2
| Clinical | Biochemical |
|---|---|
| What is visible | Blood test |
Note that the criterion is clinical or biochemical. It can be established from what is visible (the clinical route) or from a blood test measuring androgen levels. Both count. A clinician does not need both.
Why does the ovary produce more?
Because two signals push in the same direction.
Ovarian androgens are made by theca cells. Luteinizing hormone stimulates them, and insulin acts alongside luteinizing hormone to increase their output. The two work together rather than separately.1 This is the link between the metabolic side of the condition and the visible symptoms.
There is a second mechanism worth knowing about. Much of the testosterone circulating in blood is bound to a protein called sex hormone-binding globulin, and bound testosterone is not biologically active. Higher insulin reduces how much of that protein the liver produces,1 so a larger proportion of whatever testosterone is present becomes active, without the total necessarily rising.
That second mechanism explains a common and confusing situation: a blood test showing total testosterone in the reference range while symptoms of androgen excess are clearly present.
Why do symptoms differ so much between people?
Because hormone levels are only half of it. The other half is how strongly tissues respond.
Androgens act by binding to receptors in tissues. How sensitive those tissues are varies between individuals, so the same circulating level can produce noticeably different effects in two different people.1
Practically, this means:
- Two people with similar blood results can have very different visible symptoms
- Someone with symptoms and in-range bloodwork is not imagining it
- Someone with raised levels and few symptoms is not being under-treated by omission
| Blood test | Your tissues |
|---|---|
| What is circulating | What they do with it |
A blood test measures what is circulating. It does not measure what your tissues do with it. Both matter, and only one of them is easy to measure.
Why skin and hair?
Because that is where the androgen-sensitive structures are.
Hair follicles and the sebaceous glands in skin carry androgen receptors, so they are among the first places an increase in androgen activity becomes visible.1 Hair growth in areas where it is androgen-dependent, changes in scalp hair, and changes in skin oil production all reflect the same underlying signal reaching tissues that are built to respond to it.
Where and how strongly this shows up differs between people, and is also influenced by genetic background and family patterns of hair growth. Assessment of this is something clinicians do with standardized methods rather than by impression.2
What this means for talking to a clinician
Two things are worth raising directly.
- If your bloodwork came back in range but you are seeing symptoms, say so. The diagnostic criterion is clinical or biochemical,2 and tissue sensitivity varies. An in-range result does not close the question on its own.
- If symptoms are affecting your daily life or how you feel about yourself, that is a medical reason to raise them, not a cosmetic aside. The guideline recognizes psychological features as part of the picture of this condition.2
Treatment options exist and vary considerably between individuals. What is appropriate depends on your full clinical picture, what else is going on, and what matters to you, which is a conversation for a clinician who knows all three.
What this means for tracking with Premom
Nothing in this article is visible in a tracking app. Androgen levels are measured in blood, and whether a symptom counts as clinical hyperandrogenism is a clinical judgment made in person. What cycle records contribute is one strand of a different criterion (ovulatory dysfunction) in a form that is easier to bring to an appointment than to recall.
Premom is an ovulation tracking application. It is not intended to diagnose, treat, cure, or prevent any disease, including PMOS. The information provided is for educational purposes and should not replace consultation with a healthcare provider.
When to talk to a clinician
The information here is general and is not a basis for self-diagnosis. Speak with a clinician if:
- You have symptoms of androgen excess that have not been assessed
- Your bloodwork was in range but your symptoms have not changed
- Symptoms are affecting your mood, confidence or daily life
- Symptoms appeared suddenly or have worsened quickly, which is worth prompt assessment
Frequently asked questions
Androgens act by binding to receptors in tissues, and how strongly tissues respond differs between people. A blood test measures what is circulating, not what your tissues do with it. The diagnostic criterion is clinical or biochemical (DOI: 10.1210/clinem/dgad463), so an in-range result does not close the question.
Testosterone is the best known of the group, but there are several. Everyone produces them, in the ovaries and adrenal glands, and they contribute to bone density, muscle, hair growth and libido.
Not necessarily. Hyperandrogenism can be established clinically, from what is visible, or biochemically, from a blood test. Both routes count and a clinician does not need both.
That depends on a great deal that is specific to you, and it is not something an article can answer. It is a medical reason to raise the subject with a clinician rather than a cosmetic aside.
Because hair follicles and the sebaceous glands in skin carry androgen receptors, so they are among the first places an increase in androgen activity becomes visible.
About PMOS
Polycystic ovary syndrome was renamed polyendocrine metabolic ovarian syndrome (PMOS) by international consensus published in The Lancet on 12 May 2026.3 A three-year transition runs to 2028, and both names remain in clinical use. Diagnostic criteria did not change, and an existing PCOS diagnosis remains valid.
Reported prevalence varies with the criteria applied; the 2023 International Evidence-Based Guideline reports 10–13% (DOI: 10.1210/clinem/dgad463).2
References
- Strauss JF III, Barbieri RL, eds. Yen & Jaffe’s Reproductive Endocrinology: Physiology, Pathophysiology, and Clinical Management. 8th ed. Elsevier; 2019. ISBN 978-0-323-47912-7.
- Teede HJ, et al. Recommendations from the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447–2469. DOI 10.1210/clinem/dgad463 · PMID 37580314.
- Teede HJ, et al. The Lancet, 12 May 2026. DOI 10.1016/S0140-6736(26)00717-8 · PMID 42119588.
