Studies have shown that PCOS patients commonly exhibit hyperandrogenism, and elevated testosterone levels can alter gut microbiota structure by regulating bile acid signaling pathways (such as FXR, CYP7A1, etc.), leading to a reduction in the abundance of metabolically protective microbiota such as Akkermansia (Duan et al., 2024). This evidence concerns the gene NR1H4 and polycystic ovary syndrome.