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Human Reproduction, Vol. 12, No. suppl_1, pp. 53-62, 1997
© 1997 European Society of Human Reproduction and Embryology

Insulin regulation of human ovarian androgens

John E. Nestler

Division of Endocrinology and Metabolism, Department of Internal Medicine, and Department of Obstetrics and Gynecology, Medical College of Virginia/Virginia Commonwealth University Richmond, VA 23298, USA

Hyperinsulinaemic insulin resistance is characteristic of many, if not all, women with poly cystic ovary syndrome (PCOS). We will review evidence suggesting that hyperinsulinaemia promotes hyperandrogenism in PCOS by two distinct and independent mechanisms: (i) by increasing circulating ovarian androgens; and (ii) by directly reducing serum sex hormonebinding globulin concentrations. The net result of these actions is to increase circulating free testosterone concentrations. It appears likely that an inherent (probably genetically determined) ovarian defect need be present in women with PCOS, which makes the ovary susceptible to insulin stimulation of androgen production. Limited evidence suggests that hyperinsulinaemia might also promote ovarian androgen production by influencing pituitary release gonadotrophins. This latter possibility, however, has not been critically evaluated. The clinical implication of these findings is that amelioration of hyperandrogenism in women with PCOS may be achieved by interventions which improve insulin sensitivity and reduce circulating insulin. Such measures might include, but are not limited to, weight loss, dietary modification, and insulin-sensitizing medications.

Key words: androgen/insulin/metabolism/ovary/steroid


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