From male PCOS to male endocrine-metabolic syndrome: a gender-neutral hypothesis

Abstract

The proposed renaming of polycystic ovary syndrome (PCOS) as polyendocrine metabolic ovarian syndrome (PMOS) is an important step toward recognizing the systemic endocrine-metabolic nature of a condition historically misrepresented by ovarian cystic morphology. However, the persistence of the word ovarian remains conceptually limiting and reinforces the perception of a female-exclusive disorder. Published reports have provocatively proposed a male PCOS equivalent, particularly in male relatives of women with PCOS. We posit that those observations may be better conceptualized as male Endocrine-Metabolic Syndrome (male EMS), rather than male PCOS, hoping to offer a more coherent depiction of this clinical condition. In this perspective, male EMS is thus proposed as a sex-specific expression of shared endocrine-metabolic alteration characterized by insulin resistance, compensatory hyperinsulinemia, altered sex hormone-binding globulin dynamics, adrenal androgen dysregulation, early-onset androgenetic alopecia, acne or seborrhea, hypertrichosis, cardiometabolic vulnerability, and possible testicular or reproductive abnormalities. Unlike classical metabolic syndrome, male EMS would include endocrine-androgenic and dermatological features and may emerge earlier in life, particularly in individuals with a family history of female PCOS/PMOS/EMS. The present hypothesis remains to be validated prospectively, and male EMS should be considered a conceptual, research-oriented construct, not yet a defined clinical diagnosis. Nevertheless, such framework may help generate testable hypotheses and stimulate early identification of endocrine and cardiometabolic risk in men.