Baseline Androgen Status Predicts Free Androgen Index (FAI) Response to a 12-Month Nutritional Intervention in Exercising Women with Menstrual Disturbances
Research Poster Health & Life Sciences 2025 Graduate ExhibitionPresentation by Keiona Khen
Exhibition Number 94
Abstract
Functional hypothalamic oligo/amenorrhea (FHOA) is linked to chronic energy deficiency characterized by low triiodothyronine, insulin, leptin, and metabolic rates. However, some exercising women with oligomenorrhea exhibit hyperandrogenemia, marked by elevated androgens and higher body mass index, body fat percentage, insulin, leptin, Free Androgen Index (FAI), and LH/FSH ratios. These differences suggest distinct etiologies requiring tailored treatments. If hyperandrogenemia contributes to oligomenorrhea, weight gain through nutritional intervention could exacerbate ovarian dysfunction by further elevating FAI. This study tested whether baseline FAI predicted changes in FAI over a 12-month nutritional intervention. Methods: Twenty-three exercising women with oligo/amenorrhea were randomized to increase caloric intake for 12 months. Daily urinary estrone-1-glucuronide, pregnanediol glucuronide, and LH were assayed to assess menstrual status. Serum total testosterone (total T) and sex hormone-binding globulin (SHBG) were repeatedly measured to calculate FAI ([total T/SHBG]*100). Generalized linear mixed models were used to analyze changes in FAI over time. Results: Mean FAI values were: Baseline (4.98±0.6), Week 21 (5.37±0.54), Week 33 (6.16±0.82), and Post (4.8±0.56). Significant effects were observed for FAI_BL (p<.001), Time (p=0.028), and FAI_BL × time (p=0.014). Higher FAI_BL was associated with higher FAI across all time points (=0.67, p<0.001), with stronger effects at FAI_WK21 and FAI_Post. Conclusion: BL_FAI significantly predicted changes in FAI throughout the intervention, with higher BL_FAI associated with consistently elevated FAI across all time points. Time-dependent fluctuations suggest that androgen exposure during nutritional interventions may vary based on BL_FAI. These findings highlight the need for careful nutritional monitoring and further research to optimize intervention strategies.
Importance
Menstrual disturbances in exercising women have traditionally been attributed to functional hypothalamic oligo/amenorrhea (FHOA), a condition caused by chronic energy deficiency. However, a subset of these women also exhibit hyperandrogenemia, characterized by elevated male sex hormones and a distinct metabolic and endocrine profile. Treatment strategies differ significantly—while energy-deficiency-driven menstrual disturbances typically improve with increased caloric intake, weight loss is often prescribed for hyperandrogenemia-driven cases. This study investigates whether baseline androgen levels predict androgen responses to a 12-month nutritional intervention, assessing whether refeeding worsens hyperandrogenemia. These findings provide insight into individualized approaches for managing menstrual dysfunction and improving our understanding of the overlap between FHOA and hyperandrogenemia to optimize reproductive and metabolic health in exercising women.