This study investigates the neuroendocrine mechanisms underlying the elevated LH/FSH ratio in lean patients with polycystic ovary syndrome (PCOS). The research, conducted at Dr. Cipto Mangunkusumo Kencana Hospital and the IMERI UI HRIFF cluster, involved 110 lean PCOS patients. The study measured various hormones and metabolic parameters, including LH, FSH, kisspeptin, dynorphin, and anti-Müllerian hormone (AMH), to understand their relationships with the LH/FSH ratio. Key findings include: - A significant negative correlation between dynorphin and kisspeptin levels. - No significant correlation between NKB and kisspeptin levels. - A positive correlation between testosterone and kisspeptin levels. - A significant positive correlation between AMH levels and the LH/FSH ratio. - No significant association between insulin levels or HOMA-IR and the LH/FSH ratio. - A positive correlation between HOMA-IR and leptin levels, and a negative correlation with adiponectin levels. - A positive correlation between HOMA-IR and free androgen index (FAI), and between FAI and AMH. Path analysis confirmed these relationships, showing that AMH acted as an intermediary variable between HOMA-IR and FAI, influencing the LH/FSH ratio. The study suggests that targeting dynorphin and AMH may be potential therapeutic strategies for managing lean PCOS patients. Further research is needed to explore the therapeutic potential of these targets.This study investigates the neuroendocrine mechanisms underlying the elevated LH/FSH ratio in lean patients with polycystic ovary syndrome (PCOS). The research, conducted at Dr. Cipto Mangunkusumo Kencana Hospital and the IMERI UI HRIFF cluster, involved 110 lean PCOS patients. The study measured various hormones and metabolic parameters, including LH, FSH, kisspeptin, dynorphin, and anti-Müllerian hormone (AMH), to understand their relationships with the LH/FSH ratio. Key findings include: - A significant negative correlation between dynorphin and kisspeptin levels. - No significant correlation between NKB and kisspeptin levels. - A positive correlation between testosterone and kisspeptin levels. - A significant positive correlation between AMH levels and the LH/FSH ratio. - No significant association between insulin levels or HOMA-IR and the LH/FSH ratio. - A positive correlation between HOMA-IR and leptin levels, and a negative correlation with adiponectin levels. - A positive correlation between HOMA-IR and free androgen index (FAI), and between FAI and AMH. Path analysis confirmed these relationships, showing that AMH acted as an intermediary variable between HOMA-IR and FAI, influencing the LH/FSH ratio. The study suggests that targeting dynorphin and AMH may be potential therapeutic strategies for managing lean PCOS patients. Further research is needed to explore the therapeutic potential of these targets.