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Hyperinsulinemia with insulin resistance (universal)
Can have problems w/ GnRH pulsatile effect
Effects of hyperinsulinemia
Leads to increase & enhancement of LH-stimulated ovarian androgen production (more testosterone). It also decreases serum SHBG. Treatment with metformin, diazoxide or troglitazide results in fall of free testosterone.
Diet & exercise
Metformin - (usually used w/ obese pts. who might get diabetes) won't eliminate androgens (can decrease them) but can help regulate periods & increase fertility. Add clomiphene to help fertility & stimulate ovulation.
Spironolactone - to help with fertility, hirsutism & androgens
Birth control - helps w/ hirsutism in pts who don't want to get pregnant