Hidradenitis suppurativa (HS) and polycystic ovary syndrome (PCOS) are meaningfully connected. Women with HS are roughly twice as likely to have PCOS compared to women without HS, with about 9% of HS patients carrying a PCOS diagnosis. The two conditions share overlapping hormonal drivers, particularly excess androgen activity and insulin resistance, which helps explain why they so frequently appear together.
How Strong Is the Link?
A large population-based analysis in the United States found that patients with HS were 2.14 times more likely to have PCOS than patients without HS. A separate study focusing on underrepresented groups confirmed the pattern, finding that 8.8% of female HS patients had PCOS compared to 4.3% of women without HS. After adjusting for other factors, HS patients still had 1.34 to 2.17 times the odds of also having PCOS.
These aren’t small or borderline associations. Multiple studies using different populations and methods consistently find the same thing: if you have one of these conditions, your chances of having the other are significantly elevated.
The Androgen Connection
The strongest biological thread tying HS and PCOS together is androgen activity. Androgens are hormones often called “male hormones,” though everyone produces them. In PCOS, the ovaries produce abnormally high levels of androgens due to a chain reaction: insulin resistance leads to excess insulin, which signals the ovaries to ramp up androgen production. This causes many of the hallmark PCOS symptoms like irregular periods, acne, and excess hair growth.
HS skin tells a parallel story. Skin affected by HS shows roughly double the androgen receptor activity compared to healthy skin (54% versus 26%). The tunnels that form under the skin in more advanced HS have even higher concentrations of these receptors in both men and women. In one study, 88% of patients with the follicular type of HS, the most common form, had significantly elevated testosterone levels. Essentially, the hair follicles in HS-prone areas are hyper-responsive to androgens, which contributes to the plugging and inflammation that starts the disease process.
This shared hormonal driver is why some researchers describe an “androgen-mediated HS phenotype,” a subset of HS patients whose disease is fundamentally fueled by the same hormonal imbalance seen in PCOS.
Insulin Resistance and Chronic Inflammation
Beyond androgens, HS and PCOS share a deeper metabolic foundation. Both conditions are marked by insulin resistance, where the body’s cells stop responding efficiently to insulin and the pancreas compensates by producing more. That excess insulin doesn’t just raise blood sugar risk. It directly increases androgen production and fuels a state of low-grade, body-wide inflammation that researchers call “meta-inflammation.”
This chronic inflammatory state promotes the development of related problems like type 2 diabetes and cardiovascular risk factors, which show up at higher rates in both HS and PCOS populations. Obesity is common in both conditions and makes insulin resistance worse, creating a feedback loop: more insulin resistance leads to more androgens and more inflammation, which can worsen both HS flares and PCOS symptoms. Research suggests that insulin resistance and obesity common in PCOS may directly exacerbate the development of HS.
What This Means for Treatment
Because these conditions share hormonal and metabolic roots, some treatments can address both at once. The most studied is spironolactone, a medication that blocks androgen activity. It’s commonly prescribed for PCOS symptoms like acne and excess hair growth, and it’s also used for HS. The typical dose is 50 to 100 mg daily.
Results for HS specifically are mixed, though. One retrospective study found that only 20% of women with HS improved on spironolactone, while a different study reported 85% of patients responding well, with most reaching remission within three to four months. The discrepancy likely reflects the fact that not all HS is androgen-driven. Patients with milder, earlier-stage disease tend to respond better, and those who have already failed multiple other treatments are less likely to benefit. If your HS is part of the androgen-mediated subtype, and especially if you also have PCOS, anti-androgen therapy has a stronger rationale.
Diet and Lifestyle Factors That Affect Both
Because insulin resistance sits at the intersection of both conditions, dietary choices that reduce insulin spikes can be relevant for managing both HS and PCOS. Foods with a high glycemic index, including sweets, white bread, pastries, and potato chips, can trigger surges in insulin that increase androgen receptor activity and worsen HS severity. Dairy products containing casein and whey raise levels of insulin and a growth factor called IGF-1, which also amplifies androgen signaling.
In one study, HS patients had significantly lower adherence to a Mediterranean-style diet and consumed higher glycemic foods compared to controls. Higher intake of olive oil and nuts, along with minimal consumption of commercial pastries, showed the strongest association with reduced disease severity. A low-glycemic diet, rich in vegetables, whole grains, lean proteins, and healthy fats, has been proposed as beneficial for HS specifically because it reduces the insulin spikes that activate androgen receptors in hair follicles.
Maintaining a healthy body weight matters too. Excess weight worsens insulin resistance, which feeds the hormonal cycle driving both conditions. Even modest weight loss can improve insulin sensitivity and reduce the inflammatory burden that connects HS and PCOS.
Should You Be Screened for PCOS?
If you have HS and also notice irregular periods, excess facial or body hair, stubborn acne, or difficulty losing weight, these are signs of androgen excess that warrant a conversation with your doctor about PCOS. Some researchers have recommended that dermatologists screen HS patients for PCOS when signs of excess androgen are present.
That said, routine screening for every HS patient isn’t currently supported. A 2025 study found that having a PCOS diagnosis didn’t predict worse HS severity, which tempers the urgency of blanket screening. The practical takeaway: if you have HS with no hormonal symptoms, PCOS testing may not change your care. But if you recognize overlapping symptoms, getting evaluated for PCOS could open the door to treatments that target the shared root cause rather than just managing each condition separately.