Most PCOS information starts with the same sentence, something like "if you're a woman trying to get pregnant, here's what you need to know." For a large number of people with PCOS, that sentence works fine. For plenty of others, it's the first sign that the information in front of them wasn't written with them in mind.

PCOS is diagnosed by looking at ovaries, hormone levels and metabolic markers, not by looking at a person's gender identity or who they're dating. Trans men, non-binary people and intersex people can have PCOS. Some are diagnosed before they start any hormone therapy. Some are diagnosed after, when a clinician works out which symptoms come from testosterone therapy and which were already there.

Language isn't a side issue in any of this. It's often the thing that decides whether a patient feels comfortable enough to ask a follow-up question, whether they get diagnosed at all, and whether they come back for the next appointment. This article looks at where PCOS language usually defaults to a narrow picture of who has this condition, what the research on testosterone therapy and PCOS-like symptoms actually says, and what more inclusive practice looks like, for clinicians, content creators and anyone writing about PCOS online.

We're writing this as a supplement brand that talks about PCOS every day, which means we've been part of this problem too. More on that further down.

Who Gets PCOS, and Why Does the Framing Around It Matter?

Short answer: PCOS affects anyone with ovaries, including trans men, non-binary people and intersex people, not only cisgender women.

PCOS (polycystic ovary syndrome) is diagnosed using the Rotterdam criteria, the framework most UK clinicians work from. A diagnosis generally needs two out of three of: irregular or absent ovulation, signs of excess androgens (on a blood test or physically, such as acne or extra hair growth), and polycystic-appearing ovaries on an ultrasound.^[1]

Look at that list again. None of it mentions gender identity, sexuality or relationship status. It's about ovaries, hormones and how they're behaving. Which means anyone born with ovaries can have PCOS: cisgender women, trans men, non-binary people assigned female at birth, and some intersex people with ovarian tissue.

Some trans men are diagnosed with PCOS long before they start testosterone therapy, during investigation of irregular periods, acne or fertility questions, the same route a lot of cisgender women take. Others are diagnosed later, when a clinician is untangling what's caused by hormone therapy and what was there beforehand (more on that below).

Framing matters because when every leaflet, form and GP conversation defaults to "she/her" and "your husband," a patient who isn't a straight cisgender woman has to do extra translation work just to work out if the information even applies to them. At worst, they get the message that they don't fully belong in this conversation. That can delay diagnosis, delay treatment-seeking, and add distress to a condition that's already confusing enough. Your diagnosis is a starting point, not a verdict, and that should be true whoever you are.

Where Do Intersex People Fit Into This?

Intersex is an umbrella term for natural variations in sex characteristics, such as chromosomes, hormones or anatomy, that don't fit typical binary definitions of male or female bodies. Some intersex people have ovaries or ovarian tissue and can develop a PCOS-like presentation; others have anatomy where the Rotterdam criteria don't straightforwardly apply at all. Intersex people are frequently assigned a sex at birth, sometimes alongside early medical intervention, without their own input, which makes the "ask, don't assume" approach covered later in this article especially important for this group. It's also worth being honest that PCOS research specifically on intersex populations is thinner than the research on transmasculine populations covered below, and content written for this audience should say so rather than paper over the gap.

Why Does Most PCOS Content Assume You're Trying to Get Pregnant With a Man?

Short answer: PCOS research and content historically centred fertility in heterosexual, cisgender women, so that became the default voice, even though it doesn't fit everyone with PCOS.

PCOS research has long focused heavily on fertility outcomes, partly because irregular ovulation was one of the earliest and most visible things clinicians noticed, and partly because that's where funding and public interest concentrated. Content creators and brands, us included, tend to write for the audience they assume is largest, which historically has been framed as cisgender, straight women planning families. That assumption became the default voice of PCOS content, even for readers it doesn't describe.

The result is that readers who aren't trying to conceive, aren't partnered with a man, or aren't women at all, either have to mentally translate the content as they read it, or feel invisible in it. For someone questioning their gender, recently out, or simply not on a "trying to conceive" path, reading "when you and your husband are ready to start trying" over and over can be genuinely wearing, on top of everything else a PCOS diagnosis already brings.

None of this is an argument for dropping fertility content. Fertility matters to plenty of people with PCOS, whatever their gender. It's an argument for not treating it as the only story worth telling.

Where Does Exclusionary Language Actually Show Up in PCOS Care?

It rarely shows up as anything dramatic. It's usually small, repeated defaults that add up.

In the Clinic Room

• A clinician defaulting to "she/her" without asking, even when a patient's name, notes or presentation suggest otherwise.
• Fertility questions phrased in a way that assumes a patient is trying to conceive, and specifically trying to conceive with a male partner.
• Hirsutism, weight or acne treatment being framed as helping a patient "look more like a woman" or "more feminine," language that assumes every patient wants a more typically feminine presentation, when for a trans man or non-binary patient the goal might be the opposite, or might not sit on a masculine/feminine axis at all.
• Hair removal or fertility preservation being discussed as a given, before anyone has asked the patient what they actually want.

On Forms and Intake Paperwork

• Title fields limited to Mrs, Miss or Ms, with no option that fits.
• A single "relationship status: married/single" field with nothing in between.
• No space to record a name or pronoun that differs from what's on an NHS record or insurance card, so it never makes it into the notes the next clinician reads.
• Fertility intake questions written as though a male partner is a given ("does your partner have any fertility issues," with no acknowledgement he might not exist).

In Blogs, Leaflets and Social Content

• Headlines like "PCOS and your fertility: what every woman needs to know," as though PCOS is a women's-only condition by definition.
• Treatment outcomes described purely in terms of becoming more conventionally feminine (softer skin, less hair, a "more feminine" cycle), rather than in terms of what's actually changing physiologically (lower androgen levels, more predictable ovulation, skin that's easier to manage).

Why These Small Defaults Add Up

None of these examples are, on their own, catastrophic. A single form with three title options isn't going to derail someone's care. But PCOS management is rarely a single appointment; it's blood tests, follow-ups, medication reviews, and often years of contact with the same clinic. When the same assumption repeats at every one of those touchpoints, from the first two-line intake form to a five-year follow-up, it stops being small. It becomes part of the reason a patient stops going, stops asking questions, or quietly withholds information a clinician actually needs to treat them properly.

Does Testosterone Therapy Cause PCOS-Like Symptoms?

Short answer: Testosterone therapy is expected to produce some effects that overlap with PCOS symptoms, and separate research suggests PCOS itself may already be more common in transmasculine people before they start hormone therapy, though the evidence is still developing.

This is a genuinely complicated, under-discussed area, and it deserves a straight answer rather than a vague one.

Masculinising hormone therapy, meaning testosterone prescribed for trans men and some non-binary people, is designed to produce certain physical changes: acne, increased body and facial hair, a deepening voice, and over time, periods stopping.^[2] Several of those overlap with the physical signs used to help diagnose PCOS. That overlap is an expected, wanted effect of gender-affirming treatment, not evidence of a new PCOS diagnosis on its own.

Separately from that expected overlap, a small but growing body of research has looked at how common PCOS itself is in transmasculine people, particularly before anyone has started hormone therapy at all. A 2023 study of 112 treatment-naive transgender adults assigned female at birth, published in the journal Endocrine, found PCOS in 38.4% of participants using Rotterdam criteria, and almost 80% had at least one feature of PCOS (irregular ovulation, signs of high androgens, or polycystic-appearing ovaries). Both figures are notably higher than the 8 to 13% typically quoted for the general population.^[3] A separate study of 105 adolescent and young transmasculine patients presenting for gender-affirming care found PCOS in 23.8% of that group, again higher than expected background rates, with the researchers recommending PCOS screening and counselling on long-term health implications become a standard part of care for this group.^[4]

Researchers don't yet agree on why this overlap exists, and it's worth being honest about that rather than pretending the science is settled. Explanations discussed in the literature include shared biology around insulin resistance and androgen levels, and referral bias (transmasculine patients already having their androgen levels closely monitored, which means existing PCOS is more likely to be picked up). This is an active, evolving research area, not a closed case. It should never be read as suggesting that gender identity is caused by, or is a symptom of, PCOS or hormone levels. That link isn't supported by this research and isn't what these studies are asking.

What this does mean in practice: for someone starting testosterone therapy who already has a PCOS diagnosis, or who is found to have PCOS features during pre-therapy screening, the useful questions are usually about baseline health markers such as cholesterol, blood pressure and insulin sensitivity, and how PCOS and hormone therapy overlap in ongoing monitoring. That's part of why NHS gender identity clinics run baseline bloods, including a lipid profile and glucose, before starting testosterone, not despite a PCOS history but partly because of how often these risk factors overlap.^[2] WPATH's Standards of Care, Version 8, frames hormone therapy as something planned individually with each patient around their own goals and health picture, rather than a fixed protocol applied the same way to everyone, which is the same principle good PCOS care should run on regardless of a patient's gender.^[5]

For patients diagnosed with PCOS only after starting testosterone therapy, working out what's actually driving a particular symptom, whether that's the therapy doing exactly what it's meant to do, an unrelated PCOS process, or something else entirely such as thyroid function, usually takes a longer conversation, and sometimes a referral back to an endocrinologist alongside the gender service. That's not a sign anything has gone wrong. It's what untangling overlapping hormonal systems looks like in practice, and it's worth expecting rather than being alarmed by.

What Does Inclusive PCOS Care Actually Look Like?

Short answer: Asking rather than assuming pronouns, relationship structure and treatment goals, and describing outcomes by symptom rather than by gendered narrative.

None of this requires guessing better. It requires assuming less and asking more: a patient's pronouns, their name, their relationship structure, and what "improvement" would actually mean to them specifically, rather than what it's assumed to mean for a typical patient.

Practical Language Swaps

• Instead of "This will help you feel more feminine," try "This may help with testosterone-related symptoms like acne and excess hair growth."
• Instead of "When you and your husband decide to try for a baby...," try "If and when fertility is something you're thinking about, here's what's worth knowing."
• Instead of "Every woman with PCOS should...," try "Anyone with PCOS, whatever their gender, may find it helpful to..."
• Instead of defaulting to "she/her," ask once, "What pronouns should I use for you?", note the answer, and use it consistently.
• Instead of a single Mrs/Miss/Ms field, offer a free-text title and name field, or drop the title field altogether.

For Clinicians and Practices

• Add a free-text pronoun and name field to intake forms, and make sure it actually reaches every clinician who opens the notes, not just the person who took it down.
• Ask about relationship structure and fertility goals as an open question, such as "is fertility something you want to talk about today?", rather than a statement that assumes the answer.
• When discussing how testosterone therapy interacts with PCOS management, say plainly where the evidence is still developing, instead of presenting a confident answer that doesn't yet exist.
• If a misgendering mistake happens, correct it briefly and move on, rather than over-apologising in a way that puts the patient in the position of managing the clinician's discomfort.

For Content Creators and Brands

• Default to "people with PCOS" or "anyone with PCOS" alongside "women," rather than "women" on its own, in general content.
• Use symptom-based headlines, such as "managing acne and excess hair with PCOS," instead of gender-based ones, where the content itself doesn't specifically require a gendered frame.
• Review fertility content for language that assumes a male partner, and rewrite it around the actual goal (conceiving, or preserving fertility) rather than the assumed relationship.
• Expect to get this wrong sometimes, and give readers an easy way to flag it, rather than assuming that feedback will never come.

Why This Benefits Everyone, Not Just LGBTQIA+ Patients

Symptom-based, assumption-free language is simply more accurate for every patient, not only queer or trans ones. A cisgender woman who has no interest in having children doesn't need fertility-first framing either. A patient who isn't interested in smoother skin or fewer symptoms being framed as being about looking "more womanly" just wants clear information about what a treatment does and why. Precise language makes for better clinical communication, on its own merits, and it tends to read as more trustworthy too, because it isn't guessing at things it can't actually know about the person reading it.

What Is MyOva Doing About This?

We write about PCOS often, and for a long time our own content defaulted to "she/her" and fertility-with-a-male-partner framing too, mostly out of habit rather than any conscious decision. We're working on making our own content and product information less assumption-heavy: reviewing how we describe symptoms, updating intake language, and trying to talk about outcomes in terms of hormones and symptoms rather than gendered ideals. We don't always get it right, and we're not finished, but we'd rather say that plainly than pretend it's already sorted.

MyOva's supplements are formulated for anyone with PCOS, regardless of gender identity; you can read more about the condition itself on our page on what PCOS actually is.

Frequently Asked Questions

Can trans men get PCOS?
Yes. PCOS is diagnosed by ovarian function, hormone levels and metabolic markers, not gender identity, and trans men can be diagnosed with PCOS either before or after starting testosterone therapy.

Does testosterone therapy cause PCOS-like symptoms?
Masculinising testosterone therapy is expected to produce some effects that overlap with PCOS symptoms, such as acne, increased body hair and periods stopping, but that's a known, wanted effect of treatment rather than a new PCOS diagnosis. Separately, research suggests PCOS itself may be more common in transmasculine people even before hormone therapy starts, though researchers are still working out why.

Why does most PCOS content assume you're trying to get pregnant with a man?
PCOS research and content historically centred fertility in cisgender, heterosexual women, so that became the default framing, even though plenty of people with PCOS don't fit that description.

How can I ask my GP to use language that fits me?
You can simply state your name and pronouns at the start of an appointment and ask for them to be used and noted on your record. Many UK GP practices and all NHS gender identity clinics now expect and support this; if a clinician gets it wrong, a brief, calm correction such as "actually, I use he/him" is usually enough.

Is being non-binary or genderqueer relevant to getting a PCOS diagnosis?
No, diagnosis is based on ovulation, androgen levels and ovarian appearance, not gender identity. It's still worth telling your clinician your pronouns and relevant history, so the conversation and any hormone therapy planning fits your actual situation.

Where can I find PCOS information that isn't written only for straight cisgender women?
It's limited but growing. Look for content from gender identity clinics, trans health organisations and PCOS charities that explicitly include trans and non-binary experiences, and don't be afraid to ask your own clinician directly rather than relying on a generic leaflet.

Conclusion

Good PCOS care doesn't need anyone to guess less about who a patient is. It needs less assuming and more asking. Whether that's a form with a free-text pronoun field, a GP who checks in before saying "when you get pregnant," or a supplement brand rewriting a decade of "she/her" copy, the goal is the same: information and care that fits the person actually in front of you, not a template of who that person is expected to be. Your diagnosis is a starting point, not a verdict, and that's true whoever you are.

Further Reading

• What Is PCOS? A Plain-English Guide

References

1. NHS. Polycystic ovary syndrome: Diagnosis. nhs.uk/conditions/polycystic-ovary-syndrome-pcos/diagnosis/
2. North Central and East London NHS Gender Service. Masculinising hormone treatment. ncth.nhs.uk/masculinising-hormone-treatment/
3. Study of 112 treatment-naive transgender adults assigned female at birth. The prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome in treatment-naive transgender people assigned female at birth. Endocrine, 2023. link.springer.com/article/10.1007/s12020-023-03648-5
4. Prevalence of Polycystic Ovarian Syndrome in Young and Adolescent Transmasculine Patients Presenting for Gender-Affirming Care. Journal of Pediatric and Adolescent Gynecology. sciencedirect.com/science/article/abs/pii/S1083318823004023
5. Coleman E, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 2022. pmc.ncbi.nlm.nih.gov/articles/PMC9553112/

This article is for general information only and does not replace advice from your GP, endocrinologist or gender identity clinic. Food supplements should not be used as a substitute for a varied and balanced diet. If you're taking hormone therapy or any medication, check with your prescribing clinician before starting a new supplement.

References