The RolE oF Androgen Excess in MUscle Energy MetaboLism in Women With PolyCystic Ovary Syndrome (REFUEL PCOS) Study 2

Polycystic ovary syndrome (PCOS) affects 10% of all women, and it usually co-exists with high levels of sex hormones called androgens, such as testosterone. Women with PCOS are at increased risk of metabolic complications such as diabetes, non-alcoholic fatty liver disease, high blood pressure and heart disease. However, very little is understood about how androgen excess may drive the metabolic complications observed in women with PCOS.Skeletal muscle is an important site of energy metabolism; increasingly, it is suspected that skeletal muscle energy balance is adversely impacted by androgens, thereby driving metabolic complications. To take this theory forward, we want to investigate the effects of androgens on muscle energy metabolism. We will perform detailed metabolic testing (including blood tests and muscle biopsies) in women with PCOS before and after taking tablets that block the action of testosterone for 28 days. In addition, we will be using a gold standard technique to see how women with PCOS metabolise fat and other nutrients by measuring markers in blood and breath samples after a breakfast test meal. This clinical research will increase our understanding of the complex relationships between hormonal abnormalities and metabolic disease in women with PCOS.

Inclusion Criteria:Women with a confirmed diagnosis of polycystic ovary syndrome with androgen excess on clinical or biochemical groundsBMI 20-40kg/m2Age range 18-40 yearsAbility to provide informed consentNegative pregnancy test at screeningEffective method of contraception (will sign a pregnancy waiver)Exclusion Criteria:A confirmed diagnosis of diabetesCurrent or recent (<3 months) use of weight loss medicationsCurrent or recent use of oral contraceptive pill or hormone replacement therapy (within last 3-months)Blood haemoglobin <11.0g/dLHistory of alcoholism or a greater than recommended alcohol intake (recommendations > 21 units on average per week for men and > 14 units on average per week for women)Haemorrhagic disordersTreatment with anticoagulant agentsOther co-morbidities that in the view of the investigators may affect data collectionAny medical condition in the opinion of the investigator that might impact upon safety or validity of the resultsPregnancy or breastfeeding at the time of planned recruitmentA diagnosis of PCOS according to Rotterdam criteria where the patient does not have clinical or biochemical evidence of androgen excessHistory of significant renal (eGFR<30) or hepatic impairment (AST or ALT >two-fold above ULN; pre-existing bilirubinaemia >1.2 ULN)Any other significant disease or disorder that, in the opinion of the Investigator, may either put the participant at risk because of participation in the study, or may influence the result of the study, or the participant's ability to participate in the study.Participants who have participated in another research study involving an investigational medicinal product in the 12 weeks preceding the planned recruitmentGlucocorticoid use via any route within the last three monthsCurrent intake of drugs known to impact upon steroid or metabolic function or intake of such drugs during the six months preceding the planned recruitmentUse of oral or transdermal hormonal contraception in the three months preceding the planned recruitmentUse of contraceptive implants in the twelve months preceding the planned recruitment