Individuals with Hispanic/Latino ethnicity may experience the most severe form of PCOS with the highest risk of developing insulin resistance.[1],[2]

In this article we explore the link between PCOS and having Hispanic/Latino ethnicity.

Individuals with Hispanic/Latino ethnicity span a diverse mix of genetic and cultural backgrounds from Cuba, Mexico, Puerto Rico, Spain, South/Central America and other areas of the world.[3]

Individuals with Hispanic/Latino ethnicity have been shown to manifest PCOS symptoms differently than other groups, including higher prevalence of:[4]

• Hirsutism, the growth of excessive male-pattern hair in women after puberty;[5]

• Acne, a skin condition where hair follicles become plugged with oil and dead skin cells;[6]

• Insulin resistance, where cells in the muscles, fat and liver don’t respond well to insulin and cannot take up glucose from the blood;[7]

• Abnormal free androgen index (FAI), a measure of androgens based on a blood test;[8] 

• Abnormal homeostasis model assessment (HOMA), an assessment of plasma glucose and insulin concentrations;[9]

• Hyperglycemia, a condition in which the level of glucose in the blood is higher than normal;[10]

• Lower sex hormone binding globulin (SHBG), a protein that helps controls the amount of “free” sex hormones such as androgens that are active in the body by binding to those hormones in the blood;[11] and

• Postpartum depression (PPD) and anhedonia, a lack of interest, enjoyment or pleasure from life’s experiences.[12]

These elevated symptoms were independent of body mass index (BMI) with lean individuals also showing these differences.[13] 

These symptoms are also independent of where an individual lives.  Studies have shown that this more severe expression of PCOS is seen in Hispanic/Latino individuals living within Argentina, Brazil, Chile and Ecuador[14] as well as the US.[15]

The underlying cause of PCOS is a result of a complex interaction of genetic, epigenetic and environmental factors.[16]  Genetic factors relate to how individual or groups of genes are implicated in health and disease.[17]  Epigenetic factors relate to how genes are expressed or function, in response to the environmental factors within the womb or later in life.[18]  Environmental factors include lifestyle, diet, stress / trauma and exposure to endocrine-disruptors,[19] natural or man-made chemicals that may mimic, block or interfere with the body’s hormones.[20]

Whilst PCOS is associated with a number of specific genetic variations, genetic factors are believed to be largely common across different ethnic groups.  Only <10% of PCOS hereditability has been found to be due to genetic factors.[21]

Disparities in the expression of the disease are therefore believed to be largely driven by social determinants of health (SDOH), “the conditions in the environment of where people are born, live, learn, work, play, worship and age”.[22] 

There is a vast array of variables included within SDOH and limited research to date.  Underlying factors are likely to include dietary makeup, accessibility and affordability of fresh fruit and vegetables which can vary by socioeconomic status, cultural norms and geographic location.[23]

The factors are also likely to include a rich mix of cultural and social factors, including multi-generational effects.  For example, one study found that individuals with the highest risk of PCOS (in general) were those with a higher personal education level but whose parents had a low parental education level.[24]

Reviewed by Keila Turino Miranda, an expert on PCOS and cardiovascular outcomes in transgender men

Sources

[1] https://www.fertstert.org/article/S0015-0282(23)00069-9/fulltext

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5420474/

[3] https://www.fertstert.org/article/S0015-0282(23)00069-9/fulltext

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5420474/

[5] https://www.ncbi.nlm.nih.gov/books/NBK470417/

[6] https://www.mayoclinic.org/diseases-conditions/acne/symptoms-causes/syc-20368047

[7] https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance

[8] https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=free_androgen_index

[9] https://www.sciencedirect.com/topics/medicine-and-dentistry/homeostatic-model-assessment

[10] https://www.yalemedicine.org/conditions/hyperglycemia-symptoms-causes-treatments

[11] https://medlineplus.gov/lab-tests/shbg-blood-test/

[12] https://my.clevelandclinic.org/health/symptoms/25155-anhedonia

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5420474/

[14] https://www.mdpi.com/2077-0383/13/8/2376

[15] https://www.fertstert.org/article/S0015-0282(23)00069-9/fulltext

[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883751/

[17] https://www.cdc.gov/genomics/about/basics.htm

[18] https://www.cdc.gov/genomics/disease/epigenetics.htm

[19] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9864804/

[20] https://www.niehs.nih.gov/health/topics/agents/endocrine

[21] https://www.fertstert.org/article/S0015-0282(23)00069-9/fulltext

[22] https://health.gov/healthypeople/priority-areas/social-determinants-health

[23] https://www.fertstert.org/article/S0015-0282(23)00069-9/fulltext

[24] https://www.fertstert.org/article/S0015-0282(23)00069-9/fulltext