Exercise linked to lower testosterone in adults with PCOS

Overall, exercise interventions were associated with a small but statistically significant reduction in testosterone (effect size g = −0.34; 95% CI [−0.61 to −0.07]). Aerobic exercise showed a notably stronger effect than other modalities (g = −0.51 across 14 studies), suggesting that cardiovascular training may be particularly effective for this outcome. Subgroup analysis also revealed that participants with baseline BMI in the overweight range (25–29.9) and those aged 26–30 years showed the largest hormone shifts. The researchers assessed methodological quality using the PEDro scale and graded certainty of evidence via GRADE, and verified robustness through sensitivity analyses. Publication bias was examined using Egger's test and corrected using trim-and-fill methods where needed.

The testosterone reduction was consistent across the studies (heterogeneity assessed via Cochran's Q), with leave-one-out sensitivity checks confirming the finding was not driven by any single trial. Notably, aerobic exercise (g = −0.51) outperformed the pooled effect, while resistance training and combined modalities showed weaker signals—this suggests cardiovascular intensity or duration may matter more than strength work alone for hormonal balance in PCOS. The effect was strongest in the BMI 25–29.9 subgroup (g = −0.49) and the 26–30 age band (g = −0.49), hinting that metabolic factors and age-related hormone sensitivity may modify the response. The meta-analysis included high-quality RCTs, but individual trial durations, exercise prescriptions (frequency, intensity, duration), and adherence measurement varied—future work should standardize dosing protocols to clarify optimal exercise 'prescriptions' for this population. Baseline testosterone levels and degree of insulin resistance were not uniformly reported, which limits ability to predict who will respond most.