Background <p>Idiopathic intracranial hypertension (IIH) and polycystic ovary syndrome (PCOS) share several clinical features, including obesity and hyperandrogenism. Although previous studies have suggested an association between these conditions, the relationship between IIH and specific PCOS phenotypes remains incompletely characterized. </p> Aims <p>This study aimed to characterize androgen profiles and evaluate the prevalence and phenotypic distribution of PCOS in women with IIH.</p> Methods <p>In this cross-sectional study, 26 women with IIH and 21 age-matched overweight or obese controls were evaluated. PCOS diagnosis and phenotypic classification were determined according to the Rotterdam criteria. Serum androgen concentrations, clinical and biochemical features of hyperandrogenism were assessed, and body fat distribution patterns were also analyzed.</p> Results <p>Women with IIH demonstrated higher androgen concentrations, including free testosterone and dehydroepiandrosterone sulfate (DHEAS), compared with controls. Among women with IIH, free testosterone levels tended to be higher in those with concomitant PCOS (<i>p</i> = 0.09). Although the overall PCOS prevalence did not differ significantly between groups (38.4% vs 25%, <i>p</i> = 0.29), hyperandrogenic PCOS phenotypes (A-C) were observed exclusively in women with IIH, whereas all PCOS cases in the control group were classified as phenotype D. Among women with PCOS, hyperandrogenism and ovulatory dysfunction were significantly more frequent in the IIH group than in the control group (<i>p</i> = 0.006 and <i>p</i> = 0.005, respectively).</p> Conclusions <p>Women with IIH exhibit increased a higher prevalence of hyperandrogenism and a predominance of hyperandrogenic PCOS phenotypes. These findings support the hypothesis that androgen-related mechanisms may contribute to IIH pathophysiology beyond the effects of obesity alone, highlighting a potential endocrine component linking IIH and PCOS.</p>