Background <p>Polycystic ovary syndrome (PCOS) is a clinically heterogeneous endocrine disorder with lifelong health risks. Androgen excess, particularly testosterone, plays a key role in the pathophysiology of PCOS. Dihydrotestosterone (DHT) is an active metabolite derived from testosterone, and the total testosterone (TT) to DHT ratio is known as a potential marker of androgen metabolism, which can be used for evaluation of metabolic phenotype. This exploratory study aims to evaluate the association between DHT levels and TT/DHT ratio with the metabolic parameters and clinical features of PCOS patients.</p> Methods <p>This cross-sectional study was conducted on 30 patients diagnosed with PCOS based on the Rotterdam 2003 criteria. Clinical, metabolic, and biochemical parameters were assessed. The association between DHT levels, TT/DHT ratio, and clinical as well as metabolic features was analyzed using ANOVA, Spearman correlation, and independent sample t-tests, with a significance threshold of <i>p</i> &lt; 0.05.</p> Results <p>The TT/DHT ratio was significantly lower in patients with regular menstruation compared to those with oligomenorrhea and amenorrhea (<i>p</i> &lt; 0.05). A moderate positive correlation was found between DHT levels and BMI (<i>r</i> = 0.487, <i>p</i> &lt; 0.05), while fasting blood sugar (FBS) was significantly correlated with the TT/DHT ratio (<i>r</i> = 0.376, <i>p</i> &lt; 0.05). Patients with insulin resistance had a significantly higher TT/DHT ratio compared to those without insulin resistance (<i>p</i> &lt; 0.05), whereas DHT levels did not differ significantly between these groups.</p> Conclusion <p>The TT/DHT ratio could be a useful biomarker to identify PCOS patients with more severe metabolic issues.</p>