Metformin Reduces Testosterone Levels in Teens With PCOS

Short-term metformin treatment lowers testosterone concentrations, increases the likelihood of menses, and improves HDL cholesterol levels in adolescent girls with polycystic ovarian syndrome (PCOS).

Insulin resistance and hyperinsulinemia are believed to promote the excess androgen production in PCOS. Insulin-sensitizing agents have been shown to improve the clinical status of women with PCOS, Dr. Tracey Bridger and her associates note in the March issue of the Archives of Pediatric and Adolescent Medicine. However, there have been no controlled trials of metformin in teenagers with PCOS.

Dr. Bridger, from Memorial University of Newfoundland in St. John’s, and her team evaluated 22 girls between 13 and 18 years old with hyperinsulinemia and PCOS. They all had chronic oligomenorrhea, evidence of hyperandrogenism, and elevated BMI (26.0 to 44.7). Half were randomly assigned to metformin, maximum dose 720 mg twice daily, or placebo.

After 12 weeks, total testosterone levels dropped significantly in the metformin group (mean -38.3 ng/dL versus -0.86 ng/dL). Ten girls in the metformin group and four in the placebo group achieved menses (relative risk 2.50). HDL cholesterol levels increased by 6.98 mg/dL in the metformin group, but decreased in the placebo group by 2.33 mg/dL.

Measures of insulin sensitivity increased in the active treatment group, but not significantly, and body weight was not affected by treatment.

Dr. Bridger’s group notes that longer term studies will be required to see if metformin improves overall health, uterine health and insulin sensitivity, or other symptoms associated with PCOS.
Arch Pediatr Adolesc Med 2006;160:241-246.

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