Answer 3 Metformin. PCOS is associated with insulin resistance and hyperinsulinemia. Insulin augments LH, which in turn stimulates ovarian theca cells to increase the production of androgens. Metformin has been shown to improve insulin sensitivity and decrease testosterone levels in patients with PCOS. Clomiphene citrate only improves infertility and does not address the other manifestations of PCOS. The other answer choices (ie, spironolactone, flutamide, finasteride) target androgens but would not address the underlying cause of androgen overproduction, namely hyperinsulinemia. Spironolactone blocks androgen receptors, flutamide is a nonsteroidal antiandrogen that competitively inhibits target tissue androgen receptor sites, and finasteride is a 5α-reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone. Click here to return to the questions
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