Testosterone-Secreting Tumor or Insulin Resistance? Metformin as a Diagnostic and Therapeutic Trial

August 2013 in “ Fertility and sterility ”

Cecilia T. Valdés, Celeste Nagy, Razvan T. Dadu

testosterone insulin resistance metformin ovarian hyperandrogenism hirsutism virilization androgen-secreting tumor T IR M

TLDR Metformin can help diagnose and treat high testosterone levels in women, often due to insulin resistance rather than a tumor.

The study presented two cases of women with presumed ovarian hyperandrogenism and used metformin (M) as a diagnostic (Dx) and therapeutic (Rx) trial to differentiate elevated testosterone (T) levels due to insulin resistance (IR) from those due to a T-secreting tumor. Case #1 involved a 32-year-old woman with infertility and marked hirsutism, who normalized her T levels and conceived after 3 months on M. Case #2 involved a 55-year-old diabetic woman with rapid virilization, who showed a significant drop in T levels after M treatment. The results suggested that a trial of M is a benign and effective Dx maneuver compared to invasive venous sampling and also serves as an Rx, indicating that IR is more likely than an androgen-secreting tumor in cases of ovarian T excess.

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