This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Polycystic Ovarian Syndrome, Subject name: Gynaecology & Obstetrics
All of the following our the diagnosis of PCOS except 
Select and explain. 
A. Elevated LH, B. Reversed estradiol : estrone ratio, C. Reduced SHBG level, D. Reduced serum insulin level
D: Reduced serum insulin level
Answer: D: Reduced serum insulin level 
Explanation: BIOCHEMICAL MARKERS OF PCOD LH level is elevated and/or ratio of LH:FSH is > 3:1 Reversed estradiol:estrone ratio- The estrone level is markedly elevated. SHBG level is reduced. Androstenedione level is elevated. Serum testosterone and DHEA may be marginally elevated. Raised serum insulin level (ratio of fasting glucose: fasting insulin is < 4.5)