Finally, during the course of our data collection and analysis period, other groups looked at bile acids, FGF-19 and FGF-21 levels in PCOS patients with varying recruitment criteria and conditions.28,33,34 FGF-19 levels have been published as decreased or unchanged in patients with PCOS.27 As our recruitment population was from an underserved rural area with high levels of diabetes and obesity, it is possible that distribution patterns of bile acids are affected heterogeneously depending on environmental queues. This evidence concerns the gene FGF19 and obesity due to melanocortin 4 receptor deficiency.