Testosterone and androstenedione are positively associated with anti-Müllerian hormone in premenopausal women

Objective

To document associations between anti-müllerian hormone (AMH) and circulating androgens in non-healthcare-seeking premenopausal women.

Design

Community-based, cross-sectional study.

Setting

Eastern states of Australia.

Participants

Women aged 18-39 years not using systemic hormones, not pregnant or breast feeding within 3 months, and not postmenopausal.

Measurements

AMH, measured by the Beckman Access 2, 2 site immunometric assay from fresh samples, and testosterone, androstenedione, dehydroepiandrosterone (DHEA) and 11-oxygenated C19 steroids, measured by liquid chromatography-tandem mass spectrometry.

Results

Data were available for 794 women, median age of 33 years (range 18-39). 76.1% were of European ancestry and 48.2% were parous. Serum AMH was positively associated with testosterone (r=0.29, p<0.001), androstenedione (r=0.39, p<0.001) and DHEA (r=0.10, p=0.005) but not 11-ketoandrostenedione or 11-ketotestosterone. When adjusted for age and body mass index, using quantile regression, independent positive associations remained between AMH and testosterone (β coefficient 21.16, 95%CI 15.50 to 28.79; p<0.001) and androstenedione (β coefficient 5.69, 95%CI 4.16 to 7.91; p<0.001). The serum concentration of testosterone was greater at the top AMH quintile than other quintiles (0.56nmol/L (range 0.21 to 1.90) vs 0.36nmol/L (range 0.13 to 0.87), p=0.001).

Conclusions

The positive associations between serum testosterone and androstenedione and AMH in premenopausal women indicate that serum concentrations of these androgens reflect follicular maturation. As the highest AMH concentrations are most likely to be seen in women with multifollicular ovaries, it is to be expected that women with multifollicular ovaries would have higher serum testosterone. Therefore, the combination of PCOM and hyperandrogenemia as independent characteristics of PCOS requires review.