If the energy balance remains chronically positive, the underpinning drive of ectopic adiposity will also remain, and the endocrine-metabolic responses to this drive (insulin resistance, low adiponectin, and SHBG) will persist, and potentially result in a full-blown phenotype of adolescent polycystic ovary syndrome (PCOS) including luteinizing hormone (LH) hypersecretion which in turn, can drive ovarian androgen excess and oligo-anovulation [16]. Here, PLOD1 is linked to polycystic ovary syndrome.