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Hyperinsulinemia can drive the ovaries to produce excessive testosterone in some women and disrupt other key hormones—luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, and progesterone—perpetuating a self-reinforcing cycle of reproductive and metabolic dysfunction.[9][2][3] Reducing both fasting and postprandial insulin levels therefore improves PMOS across multiple domains

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Start with the lowest recommended dose, increase gradually, and monitor closely