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. 2024 Apr 8;14:8229. doi: 10.1038/s41598-024-58064-0

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© The Author(s) 2024

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Proposed mechanism or pathophysiology of increased LH/FSH ratio in lean PCOS patients. Dynorphin from KNDy neurons increases the activity of GnRH neurons, increasing GnRH frequency, increasing LH secretion, and increasing the LH/FSH ratio. AMH produced by the ovaries affects GnRH neurons and increases the LH/FSH ratio. HOMA-IR will increase FAI, while FAI will increase AMH. Dot line: pathophysiology of increased LH/FSH ratio in lean PCOS patients. Red arrow: significant relationships found in this study. Black arrow: significant relationships found in other studies.