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Metformin decreased testosterone in girls with PCOS
HDL cholesterol concentrations improved significantly in the group assigned metformin vs. placebo over 12 weeks.
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Using metformin for the treatment of PCOS in adolescent girls may have several positive benefits. A randomized placebo-controlled double-blind study of 22 adolescent girls found that there was a significant decline in mean serum testosterone with the use of metformin compared to placebo.
“Metformin, in conjunction with advice on healthy active living, lowers testosterone levels, increases the likelihood of menses and decreases LDL cholesterol in adolescent females with polycystic ovary syndrome,” Tracey Bridger, MD, FRCPC, an assistant professor at Memorial University of Newfoundland, St John’s, told Endocrine Today.
Participants were recruited from the Montreal Children’s Hospital between 1999 and 2002. All were at least 12 years old, had a history of menarche at least two years prior, had chronic oligomenorrhea and clinical or biochemical evidence of hyperandrogenism. The results were published in the Archives of Pediatric and Adolescent Medicine.
After a series of blood tests to determine testosterone, progesterone and lipid profiles, participants were randomly assigned to metformin or placebo. In addition, researchers counseled all participants about healthy eating and physical activity.
After 12 weeks, the girls returned for a second round of testing. Unused pills were collected to determine compliance. One girl did not complete the study.
Increased incidence of menses
Upon completion, the weight and BMI of participants had not significantly changed. Testosterone levels dropped significantly in the metformin group. The mean difference from baseline was –38.3 ng/dL for metformin vs. –0.86 ng/dL for placebo.
Ten of 11 girls in the metformin group had menses during the study compared with four of the 11 girls assigned placebo.
Glucose and insulin profiles did not change throughout the study regardless of the treatment. HDL cholesterol concentrations had improved significantly in the group assigned metformin vs. placebo: +6.98 mg/dL vs. –2.33 mg/dL, respectively.
“Based on our results, I would recommend metformin for the treatment of PCOS in adolescent females,” Bridger said. “I regularly use metformin in my clinical practice with great success. However, it is equally important to counsel the patient on the benefits of physical activity and eating well.”
Little data available
Sleman A. Khoury, MD, called the study “excellent” and said it is a needed addition to the scant literature available on the subject. “Many endocrinologists and pediatricians already use metformin in adolescent girls with the Dysmetabolic Syndrome encompassing PCOS but, so far, there has not been much in the literature to support its use,” said Khoury, a clinical associate professor at Wayne State University and a member of Endocrine Today’s Editorial Board.
He said that the controversy over the use of metformin in this population has little basis. There is not only little evidence to support its use but also little opposition to its use.
“One could argue that prescribing medication would deter from the primary emphasis on exercise and diet — which I call in my practice vitamins E and D — but the failure rate is too high using these modalities alone. Until another approach comes along and gets tested for safety and efficacy over time, especially in this age, metformin is the one,” he said. – by Leah Smith
For more information:
- Bridger T, MacDonald S, Baltzer F, Rodd C. Randomized placebo-controlled trial of metformin for adolescents with polycystic ovary syndrome. Arch Pediatr Adolesc Med. 2006;160:241-246.