The effect of combination therapy with metformin and combined oral contraceptives (COC) versus COC alone on insulin sensitivity, hyperandrogenaemia, SHBG and lipids in PCOS patients. Effect of two oral contraceptives containing ethinylestradiol and gestodene or norgestimate upon androgen parameters and serum binding proteins. Effects of seven low-dose combined oral contraceptives on sex hormone binding globulin, corticosteroid binding globulin, total and free testosterone. Effect of low-dose oral contraceptives on androgenic markers and acne. A randomized cross-over study on various hormonal parameters of two triphasic oral contraceptives. Sex hormone binding globulin, cortisol binding globulin, thyroxine binding globulin, ceruloplasmin: changes in treatment with two oral contraceptives low in oestrogen. Effect of oral versus transdermal steroidal contraceptives on androgenic markers. Effect of low-dose oral contraceptive on gonadotropins, androgens, and sex hormone binding globulin in nonhirsute women. Changes in androgens during treatment with four low-dose contraceptives. Effect of four different oral contraceptives on various sex hormones and serum-binding globulins. Effects of oral contraceptive combinations containing levonorgestrel or desogestrel on serum proteins and androgen binding. Effects on blood lipid and androgen levels of two triphasic oral contraceptives. Combined oral contraceptive treatment of adolescent girls with polycystic ovary syndrome. Lipid profile. Comparative evaluation of the androgenicity of four low-dose, fixed-combination oral contraceptives. The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials. ANDROGENS AND SEXUAL BEHAVIOUR IN WOMEN USING ORAL CONTRACEPTIVES Does oral contraceptive-induced reduction in free testosterone adversely affect the sexuality or mood of women?
BACKGROUND Neither oral contraceptives ( COC ) nor metformin are an optimal modality for the long-term treatment of polycystic ovary syndrome ( PCOS ) . The aim of this study was to evaluate whether a combination of both is beneficial over COC monotherapy . METHODS Altogether , 30 women were included in the study and 28 finished the protocol . The patients were r and omly assigned to two groups treated with either COC ( COC group ) or COC and metformin ( 1500 mg/day ) ( METOC group ) for 6 months . Anthropometric parameters , and rogens , lipids , fasting insulin , glucose and sex hormone binding globulin ( SHBG ) concentrations were measured before and at the end of the sixth cycle of treatment . The insulin sensitivity index was evaluated using the euglycaemic clamp . RESULTS There were no significant changes in anthropometric parameters , fasting glucose or insulin sensitivity in either group . Total testosterone , free and rogen index , and rostenedione and dehydroepi and rosterone decreased and SHBG increased significantly in both groups . When comparing the effect of both treatments , only a more pronounced decrease in free and rogen index was found in the METOC group . CONCLUSIONS Adding metformin slightly modified the treatment effect of COC , causing a more significant decrease in the free and rogen index but having no additional positive impact on lipids , insulin sensitivity , SHBG or testosterone . The available data do not offer enough evidence to advocate the st and ard use of combined treatment in PCOS . Whether the combination might be beneficial for specific subgroups of patients is of further interest The effect of a triphasic oral contraceptive containing ethinylestradiol and gestodene ( EE/GSD ) on various serum hormonal parameters was compared with that of a monophasic formulation containing 35 micrograms ethinylestradiol and 250 micrograms norgestimate ( EE/NGM ) . Blood sample s were collected from 46 women on days 2 , 11 , and 21 of the preceding control cycle and of the third , sixth and twelfth treatment cycle . There was no significant difference in the influence on any hormonal parameter between both formulations . Both EE/GSD and EE/NGM caused a time-dependent suppression of serum dehydroepi and rosterone sulphate ( DHEA-S ) by 20 - 30 % ( p < 0.01 ) and a reduction of 5 alpha- and rostane-3 alpha , 17 beta-diol glucuronide by 50 - 60 % ( p < 0.01 ) during each treatment cycle , while and rostenedione levels were reduced by 25 % ( p < 0.01 ) . There was also a significant decrease in the levels of total testosterone by 30 - 35 % ( p < 0.01 ) and free testosterone by 60 % ( p < 0.01 ) , while sex hormone-binding globulin ( SHBG ) was increased by 200 - 240 % on days 11 and 21 ( p < 0.01 ) . During the pill-free interval the SHBG levels were reduced to a certain degree but remained elevated by 100 % as compared to the pretreatment values . The serum levels of corticosteroid-binding globulin ( CBG ) which is known to be influenced only by the estrogenic component of combination pills , increased significantly by 170 % ( p < 0.01 ) during each treatment cycle . During the pill-free interval of 7 days , the CBG levels decreased but were still elevated by 90 - 100 % as compared to the control cycle . Similarly , the serum levels of cortisol were significantly elevated by 110 - 140 % ( p < 0.01 ) during treatment with both preparations . The results demonstrate a profound suppression of and rogen levels and peripheral and rogen metabolism The effect of seven low-dose oral contraceptive preparations on sex hormone binding globulin ( SHBG ) , cortisol binding globulin ( CBG ) , total and absolute free testosterone were investigated in groups of 10 healthy volunteers . All preparations contained about the same amount of ethinylestradiol but they differed in type and /or dose of progestagen . The progestagens studied were : levonorgestrel ( LNG ; in mono- and triphasic preparations ) , norethisterone ( NET ; in monophasic preparation ) , desogestrel ( DSG ; in mono- and biphasic preparations ) and gestodene ( GSD ; in triphasic preparation ) , all 19-nortestosterone derivatives , and the anti- and rogen cyproterone acetate ( CPA ) in a monophasic preparation . Differences observed in SHBG level , which reflect the estrogen- and rogen balance , can be attributed to the intrinsic and rogenic ( or anti- and rogenic ) properties of the progestagens , and were in agreement with the results of published receptor binding studies , performed in vitro . Based on our results the following ranking ( high to low ) can be made with respect to the and rogenicity of the preparations : monophasic LNG greater than or equal to monophasic NET = triphasic LNG greater than or equal to triphasic GSD = biphasic DSG = monophasic DSG greater than monophasic CPA . An anti-estrogenic effect of the 19-nortestosterone derived progestagens can be excluded by the effect on CBG , a marker for estrogenic activity . All preparations containing a 19-nortestosterone derived progestagen , independent of their type and dose , induce a similar rise in CBG , whereas the preparation with cyproterone acetate induced an even higher CBG level . Irrespective of the effect on total testosterone , which varies between the preparations , the absolute free testosterone level decreased to a comparable degree for all preparations . ( ABSTRACT TRUNCATED AT 250 WORDS Oral contraceptives ( OC ) suppress excess and rogen production ; however , different progestins in combination with low-dose estrogens produce divergent effects on sex hormone-binding globulin ( SHBG ) and testosterone that may influence clinical outcomes . This multicenter , open-label , r and omized study compared biochemical and rogen profiles and clinical outcomes associated with two OC containing the same amounts of ethinyl estradiol ( EE , 20 micrograms ) but different progestins , levonorgestrel ( LNG , 100 micrograms ) , and norethindrone acetate ( NETA , 1000 micrograms ) . Fifty-eight healthy women ( 18 - 28 years old ) received three cycles of treatment with LNG/EE ( n = 30 ) or NETA/EE ( n = 28 ) . The results showed that LNG reduced and rogen levels in three compartments -- adrenal , ovarian , and peripheral . NETA reduced only adrenal and peripheral and rogens . Despite a 2.2-fold greater relative increase in SHBG with NETA than LNG , bioavailable testosterone ( T ) was reduced by the same amount with LNG and NETA . Both treatments improved acne and were well tolerated . Low-dose OC ( EE , 20 micrograms ) are effective in reducing circulating and rogens and acne lesions without causing weight gain . Although LNG and NETA affected secondary markers differently , both OC formulations produced an equivalent decrease in bioavailable The effect of two triphasic oral contraceptives ( Triquilar [ TRQ ] and Trisiston [ TRS ] ) containing ethinyl estradiol ( EE ) and levonorgestrel ( LNG ) on various hormonal parameters was investigated in 26 women during a cross-over study .  TRS consisted of 0.03 mg EE + 0.05 mg LNG ( six tablets ) , 0.04 mg EE + 0.075 mg LNG ( six tablets ) , and 0.03 mg EE + 0.15 mg LNG ( nine tablets ) , whereas TRQ was different in the second phase ( five tablets ) and third phase ( 10 tablets ) . Blood sample s were taken on days 6 , 11 , 21 , and 28 of the control and washout cycles and the third treatment cycle . Both formulations inhibited ovulation reliably and decreased the serum levels of gonadotropins , free testosterone , and dehydroepi and osterone sulfate in a time-dependent manner , whereas estradiol and testosterone were already suppressed on day 6 , indicating a direct suppressive effect on ovarian steroid synthesis . Prolactin , which rose sporadically in some women , was not significantly changed . In contrast , the levels of sex hormone binding globulin , corticosteroid binding globulin , and cortisol were significantly elevated by 100 % . During the hormone-free interval of 7 days , all parameters returned at least partly to baseline . There was no significant difference between the effects of both formulations . The results suggest the possibility of a direct inhibitory effect of contraceptive steroids on ovarian steroid synthesis It is generally assumed that the oral contraceptives cause the carrier proteins to change . Notoriously this effect is used to evaluate indirectly their estrogenicity/gestagenicity ratio . In order to assess the residual intrinsic and rogenic activity of two new 19-nor-derivative components , Desogestrel ( DG ) 150 micrograms and Gestodene ( GD ) 75 micrograms , both in association with Ethinylestradiol ( EE ) 30 micrograms , Sex Hormone Binding Globulin , Thyroxine Binding Globulin , Ceruloplasmin and Free And rogen Index ( FAI ) , were studied in 40 young normally cycling healthy volunteers , matched for body mass index and age . The participants were r and omly assigned to either EE-DG or EE-GD treatment . A marked significant increase in all the carrier proteins was found . Conversely , the values for FAI decreased significantly . The changes in the two groups were substantially of the same magnitude . These results are an indirect confirmation of the well-known negligible receptor binding affinity of the two progestogen in vitro , also supporting for these compounds the lack of relevant and rogenic effects OBJECTIVE The purpose of this study was to compare biochemical and rogen profiles in women treated with the contraceptive patch versus an oral contraceptive ( OC ) . STUDY DESIGN Twenty-four healthy women were r and omly assigned to receive 3 cycles of either the contraceptive patch ( ethinyl estradiol [ EE ] 20 microg/d and norelgestromin 150 microg/d ) or OC ( EE 35 mug and norgestimate 250 microg ) . Blood sample s were taken at baseline and end of treatment . Serum levels of sex hormone-binding globulin ( SHBG ) , total testosterone ( T ) , and rostenedione ( A ) , dehydroepi and rosterone sulfate ( DHEAS ) , dihydrotestosterone ( DHT ) , and 3alpha- and rostanediol glucuronide ( 3alpha-diol G ) were quantified by immunoassay methods ; free T was calculated . The paired t and Student t tests were used for statistical analysis . RESULTS Nineteen women completed the study ( patch , n = 10 ; OC , n = 9 ) . Despite a 1.6-fold relative increase in SHBG levels with the patch versus OC ( 449 % vs 274 % , P = .03 ) , free T decreased equally in both groups ( patch 60 % , P < .0001 ; OC 59 % , P < .0001 ) . DHEAS decreased by 26 % in the patch group ( P < .01 ) and 32 % in the OC group ( P < .001 ) . 3alpha-diol G was reduced by 52 % in the patch group ( P < .0001 ) and 51 % in the OC group ( P < .0001 ) . In addition , the OC was associated with significant decreases in A and DHT . CONCLUSION The contraceptive patch had an effect comparable to the OC on several key and rogenic markers . Given these biochemical findings , the contraceptive patch has significant potential as a therapeutic agent for disorders of and rogen excess The effectiveness of a low-dose oral contraceptive ( OC ) in suppressing plasma levels of gonadotropins , ovarian , and adrenal and rogens and stimulating sex hormone-binding globulin ( SHBG ) was evaluated prospect ively in nonhirsute women . Thirty-three women ingested 35 micrograms of ethinyl estradiol and 1 mg of norethindrone beginning within day 1 to 5 of the menstrual cycle . Baseline levels of luteinizing hormone , follicle-stimulating hormone , total testosterone ( T ) , and rostenedione ( A ) , dehydroepi and rosterone sulfate ( DHEAS ) , and SHBG were obtained before ingestion of the OC and repeated after 3 , 6 and , 9 months of OC use on day 1 to 5 of the OC " cycle " . A significant suppression of gonadotropin levels is seen in nonhirsute women .  Sex hormone binding globulin is consistently stimulated by the low-dose OC . A significant suppression of T and DHEAS is observed . No change was seen in levels of A. The demonstrated effects become evident at 3 months and are maintained at 6 and 9 months The aim of the present study was to compare changes in the endogenous and rogen environment in healthy women while on low-dose oral contraceptives ( OCs ) . One-hundred healthy women were r and omized to receive one of four OCs during six months : 21 tablets of Cilest , Femodeen , Marvelon , or Mercilon . During the luteal phase of the pretreatment cycle , body weight and blood pressure were recorded and the following parameters were measured : sex hormone-binding globulin ( SHBG ) , corticosteroid-binding globulin ( CBG ) , testosterone ( T ) , free testosterone ( FT ) , 5 alpha-dihydrotestosterone ( DHT ) , and rostenedione ( A ) , dehydroepi and rosterone-sulphate ( DHEA-S ) and 17 alpha-hydroxyprogesterone ( 170HP ) while also the free and rogen index ( FAI ) was calculated . Measurements were repeated during the 3rd week of pill intake in the 4th and the 6th pill month . There were no differences on body mass and blood pressure with the use of the four OCs . The mean serum DHEA-S decreased significantly in all groups though less in the Mercilon group when compared to Cilest and Marvelon ( approximately 20 % vs 45 % ) . Mean serum SHBG and CBG increased significantly in all four groups approximately 250 % and 100 % , respectively . In each group CBG also increased significantly but less in women taking Mercilon ( -75 % ) as compared to the others ( -100 % ) . Current low-dose OCs were found to have similar impact on the endogenous and rogen metabolism with significant decreases of serum testosterone , DHT , A , and DHEA-S. They may be equally beneficial in women with and rogen related syndromes such as acne and hirsutism In a double-blind , controlled , r and omized , four-arm , bicentric clinical study , the effect of four oral contraceptives ( OCs ) on various hormone parameters and serum-binding globulins was investigated . Four groups with 25 volunteers each ( 18 - 35 years of age ) were treated for six cycles with monophasic combinations containing 21 tablets with either 30 microg ethinylestradiol ( EE ) + 2 mg dienogest ( DNG ) ( 30EE/DNG ) , 20 microg EE + 2 mg DNG ( 20EE/DNG ) , 10 microg EE + 2 mg estradiol valerate ( EV ) + 2 mg DNG ( EE/EV/DNG ) or 20 microg EE + 100 microg levonorgestrel ( LNG ) ( EE/LNG ) . The study was completed by 91 subjects . Blood sample s were taken after at least 12 h of fasting on Day 21 - 26 of the preceding control cycle and on Day 18 - 21 of the first , third and sixth treatment cycle . The serum concentrations of free testosterone were significantly decreased by about 40 - 60 % in all four groups , while those of dehydroepi and rosterone sulfate ( DHEAS ) showed a time-dependent decrease during treatment . Except for EE/EV/DNG , which increased prolactin significantly during the third and sixth cycles , no change was observed with the EE-containing preparations . There was a significant increase in the levels of serum-binding globulins during treatment , which differed according to the composition of the OCs used . The rise in sex hormone-binding globulin ( SHBG ) was highest during intake of 30EE/DNG ( + 320 % ) and lowest with EE/LNG ( + 80 % ) , while the effect of 20EE/DNG and EE/EV/DNG was similar ( + 270 % ) . The thyroxine-binding globulin ( TBG ) levels increased significantly , by 50 - 60 % , during treatment with the DNG-containing formulations , while the effect of EE/LNG was less significant ( + 30 % ) . The rise in corticosteroid-binding globulin ( CBG ) , which occurred in all groups , was most pronounced in women treated with 30EE/DNG ( + 90 % ) and least with EE/EV/DNG ( + 55 % ) , indicating a strong influence of EE and no effect of the progestogen component . In all treatment groups , the frequency of intracyclic bleeding rose in the first treatment cycle and decreased thereafter . Cycle control was significantly better with 30EE/DNG or EE/LNG than with 20EE/DNG or EE/EV/DNG . There was no significant change in blood pressure , body mass index or pulse rate throughout the study . In conclusion , the DNG-containing OCs caused a higher rise in SHBG and TBG levels than the LNG-containing preparation . The effects on CBG suggest a lesser hepatic effect of 2 mg EV as compared to 20 or 30 microg EE . In contrast to EE , the use of estradiol in OCs appeared to increase prolactin release , while the cycle control was better with the OC containing 30 microg EE The effects of the oral contraceptive combinations 0.125 mg Org 2969 ( desogestrel ) ( 13-ethyl-11-methylene-18,19-dinor-17alpha-pregn-4-en-20-yn-17-ol ) + 0.05 mg ethinyloestradiol ( EE ) and 0.125 mg levonorgestrel + 0.05 mg EE on serum sex-hormone-binding globulin ( SHBG ) , ceruloplasmin , transcortin and ratio free testosterone over total testosterone ( percentage free testosterone ) and ratio free 5alpha-dihydrotestosterone over total 5alpha-dihydrotestosterone ( percentage free 5alpha-dihydrotestosterone ) were compared in healthy female volunteers . Treatment was r and omly distributed over the volunteers ; 11 women received  Org 2969 + EE  and 11 women received  levonorgestrel + EE . These combinations induced similar increases in transcortin levels ( 115 and 140 % ) and ceruloplasmin levels ( 115 and 123 % ) after 3 months of treatment . However , the combination Org 2969 + EE induced a substantial increase ( 213 % ) in SHBG capacity after 3 months of treatment , whereas a smaller increase ( 80 % ) was observed with levonorgestrel + EE . A return to pretreatment values was observed 2 months after termination of treatment for all parameters . The difference in the effects of both preparations oh SHBG was statistically significant and can be best explained by a difference in the and rogenicity of the progestogens . A good correlation was free testosterone and the reciprocal value of the percentage free 5 alpha-dihydrotestosterone . These results confirm that SHBG is the major regulator of the biologically active free and rogen fraction in women before , during and after combined oral contraceptive treatment At Hospital Saint-Louis in Paris France physicians compared data on 34 women using a levonorgestrel triphasic oral contraceptive ( OC ) with data on 32 women using a norgestimate triphasic OC  to examine the triphasic OCs effects on blood lipids and and rogen levels . They also compared post-OC blood lipids and and rogen levels with baseline blood lipids and and rogen levels . 47 % of all subjects smoked . After 6 cycles neither triphasic OC caused a significant difference in low density lipoprotein ( LDL ) cholesterol levels or in triglyceride levels . High density lipoprotein ( HDL ) levels in women using the norgestimate OC were significantly higher than in those using the levonorgestrel OC ( p = .001 ) . Accordingly the OCs had a significant effect on the LDL/HDL ratio . Levels of HDL subfractions ( HDL-2 and HDL-3 ) were also significantly higher in the norgestimate OC group than in the levonorgestrel OC group ( p < .01 ) . Women using the norgestimate OC had a significant increase in apolipoproteins A-1 and 1 - 2 after 6 cycles ( 12.7 % and 15.8 % respectively ; p = .001 and .0001 respectively ) . Neither triphasic OC affected a greater increase in sex hormone binding globulin ( SHBG ) levels than did the levonorgestrel OC ( 163 % vs. 72 % ; p = .0005 ) . It reduced the free testosterone level by 40 % . The levonorgestrel OC reduced it by 30 % but neither change was significant . Neither OC had an effect on body weight or blood pressure . These findings showed a trend toward lower and rogenicity with the norgestimate OC . The norgestimate OC may be beneficial since it was linked with significant increases in all HDL subfractions and SHBG The clinical signs and neuroendocrine features of adolescents with polycystic ovary syndrome ( PCOS ) resemble those found in adult women with PCOS . These adolescent patients are c and i date s for long-term treatment by one of the different therapeutic approaches that have been proposed . It is therefore essential that the treatment does not induce unfavorable metabolic effects . We investigated and compared the effects of cyproterone acetate ( CA ) and desogestrel ( D ) , as part of combined oral contraceptives ( COC ) , on lipid metabolism and hirsutism in adolescents with PCOS . Twenty-four girls with clinical signs of PCOS were recruited . They were all hyper and rogenic and euthyroid and had normal prolactin plasma levels . Non-classic congenital adrenal hyperplasia was ruled out by the ACTH stimulation test . Blood sample s were obtained for sex hormone binding globulin ( SHBG ) , total cholesterol ( TC ) , LDL cholesterol , HDL cholesterol , triglycerides ( TGs ) , apolipoproteins A-I , A-II , B , and lipoprotein ( a ) ( Lp(a ) ) measurements . After the initial examination , therapy was initiated in a r and omly selected order ( 12 and 12 patients were treated daily by 2 mg CA and 0.150 mg D , respectively , plus 0.035 and 0.030 mg ethinylestradiol , respectively ) . The degree of hirsutism and the lipid profile were reevaluated every 3 months after initiation of therapy for 1 year . Our data show that after 12 months of treatment with the D or CA COC , the Ferriman-Gallway hirsutism score decreased and TC and LDL-C increased . TGs and HDL-C were raised significantly in the CA COC group , whereas apolipoprotein A1 increased during D COC treatment . The atheromatic indices did not change . These data suggest that treatment of adolescent girls with PCOS is comparably effective with the two contraceptive formulations and that the desogestrel COC could be considered in the treatment of adolescent PCOS patients because it does not have side effects on lipid metabolism Changes in endogenous and rogen metabolism were compared in healthy women taking one of four low-dose modern oral contraceptives ( OCs ) . One hundred women were r and omized to ( 1 ) 35 micrograms ethinyl estradiol ( EE ) + 250 micrograms norgestimate ( Cilest ) ; ( 2 ) 20 micrograms EE + 150 micrograms desogestrel ( Mercilon ) ; ( 3 ) 30 micrograms EE + 150 micrograms desogestrel ( Marvelon ) ; or ( 4 ) 30 micrograms EE + 75 micrograms gestodene ( Femodene ) . During the luteal phase of the pretreatment cycle , body weight and blood pressure were recorded , and plasma levels of the following variables were recorded : sex-hormone-binding globulin ( SHBG ) , cortisol-binding globulin ( CBG ) , testosterone , free testosterone , dihydrotestosterone , and rostenedione , dihydroepi and rosterone sulfate ( DHEAS ) , and hydroxyprogesterone . The free and rogen index was also calculated . These variables were remeasured during the third week of OC intake and during the fourth and sixth cycles . There were no statistically significant differences in and rogenic variables among the four OCs . The DHEAS concentration decreased less with the 20 micrograms EE + desogestrel formulation compared with either 30 micrograms EE + desogesterel or norgestimate-containing formulations ( 20 % vs. 45 % ) . Concentrations of SHBG and CBG increased significantly in all four groups ( average 263 + /- 119 % and 94 + /- 26 % , respectively ) ; CBG increased less in women taking 20 micrograms EE + desogestrel ( about 75 % ) than in the other formulations ( about 100 % ) . The four modern , low-dose OCs tested had similar impacts on endogenous and rogen metabolism , yielding significant decreases in testosterone , dihydrotestosterone , and rostenedione , and DHEAS . All of these formulations may be beneficial in women with and rogen-related syndromes such as acne and hirsutism . Large studies are under way to establish which of the third-generation OCs is the least and rogenic . In vitro studies suggest that norgestimate has the least and rogenic profile CONTEXT Polycystic ovary syndrome ( PCOS ) presents in adolescence , and obesity is a common finding . The benefits and risks of alternate approaches to the management of PCOS in obese adolescent women are not clear . OBJECTIVE We investigated the effects of metformin , oral contraceptives ( OCs ) , and /or lifestyle modification in obese adolescent women with PCOS . DESIGN Two small , r and omized , placebo-controlled clinical trials were performed . PATIENTS AND PARTICIPANTS A total of 79 obese adolescent women with PCOS participated . INTERVENTIONS In the single treatment trial , subjects were r and omized to metformin , placebo , a lifestyle modification program , or OC . In the combined treatment trial , all subjects received lifestyle modification and OC and were r and omized to metformin or placebo . MAIN OUTCOME MEASURES Serum concentrations of and rogens and lipids were measured . RESULTS Lifestyle modification alone result ed in a 59 % reduction in free and rogen index with a 122 % increase in SHBG . OC result ed in a significant decrease in total testosterone ( 44 % ) and free and rogen index ( 86 % ) but also result ed in an increase in C-reactive protein ( 39.7 % ) and cholesterol ( 14 % ) . The combination of lifestyle modification , OC , and metformin result ed in a 55 % decrease in total testosterone , as compared to 33 % with combined treatment and placebo , a 4 % reduction in waist circumference , and a significant increase in HDL ( 46 % ) . CONCLUSIONS In these preliminary trials , both lifestyle modification and OCs significantly reduce and rogens and increase SHBG in obese adolescents with PCOS . Metformin , in combination with lifestyle modification and OC , reduces central adiposity , reduces total testosterone , and increases HDL , but does not enhance overall weight reduction Twenty women using oral contraceptives and complaining of impaired sexual function were compared with twenty women without sexual problems , matched for age and oral contraceptive . Whilst the sexual behaviour differed in the two groups , the plasma testosterone , and rostenedione , oestradiol and SHBG concentrations were very similar . The total and rogen levels were low in both groups . Plasma testosterone and oestradiol concentrations were correlated with measures of sexual interest in the no‐problem group , but not in the problem group . Administration of exogenous and rostenedione to women in the problem group , using a double blind cross‐over comparison with a placebo , failed to improve their sexual function except in one case . The majority of women showed a rise in and rogen and oestradiol between day 24 of one pill cycle and day 4 of the next . The possible behavioural indications of this pattern are discussed The aim of this study was to examine whether changes in plasma and rogen levels ( total testosterone ( T ) , free testosterone ( FT ) , and dehydro-epi and rosterone-sulfate ( DHEA-S ) ) induced by oral contraceptive ( OC ) use were related to changes in sexual interest or response or in mood . Sixty-one women provided blood sample s and were assessed , using interviews and st and ardized question naires , prior to starting , and after 3 months on OCs ( Ortho-Tricyclen , Ortho-Tricyclen-Lo , or Ortho-Cyclen , all containing the same progestagen , norgestimate ) . Significant decreases in T , FT , and DHEA-S were found after 3 months , although the extent of reduction was variable across women . There was some support for a relationship between the degree of reduction in total T and FT and the frequency of sexual thoughts after 3 months on OCs . However , some women had no loss of sexual interest in spite of substantial reduction in FT , and there was overall no evidence that reduction in FT affected enjoyment of sexual activity with a partner . The findings are consistent with the idea that some women may be more sensitive to changes in T than others . No relationship was found between negative mood , as assessed by the Beck Depression Inventory , and changes in T , FT , or
However , subgroup analyses for the estrogen dose and the progestin type in relation to changes in SHBG levels did show significant differences : COCs containing second generation progestins and /or the lower estrogen doses ( 20–25 µg EE ) were found to have less impact on SHBG concentrations .
The current literature review and meta- analysis demonstrates that COCs decrease circulating levels of total T and free T and increase SBHG concentrations .
Due to the SHBG increase , free T levels decrease twice as much as total T. The estrogen dose and progestin type of the COC do not influence the decline of total and free T , but both affect SHBG .
BACKGROUND Combined oral contraceptives ( COCs ) reduce levels of and rogen , especially testosterone ( T ) , by inhibiting ovarian and adrenal and rogen synthesis and by increasing levels of sex hormone-binding globulin ( SHBG ) .
Although this suppressive effect has been investigated by numerous studies over many years , to our knowledge no systematic review concerning this issue had been performed .