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Attributed to the selective IR paradox, compensatory hyperinsulinemia can amplify hyperandrogenism via several mechanisms: (i) cross-activation of insulin and/or IGF-1 receptors, which enhances LH-mediated expression of key steroidogenic enzymes (e.g., CYP17A1) in ovarian theca cells and increases androgen synthesis

By following proper preparation and technique, most users can manage and reduce these reactions effectively