Antiandrogens and insulin sensitizers in PCOS management

BACKGROUND: Polycystic ovary syndrome (PCOS) is an endocrine/metabolic condition. Hyperandrogenism and in-sulin-resistance with compensatory hyperinsulinemia are important features of PCOS. The aim of this paper is to review the rationale of antiandrogens and insulin-sensitizers use in PCOS management. EVIDENCE ACQUISITION: We include in our research the most relevant scientific literature about the impact of anti-androgens and insulin sensitizers in PCOS between 1976 and 2025. EVIDENCE SYNTHESIS: According to the most recent recommendations, antiandrogens can be a possible therapeutic option to reduce the impact of hyperandrogenism and treat hirsutism in PCOS patients after a period of 6 months of estroprogestins and/or cosmetic therapy without adequate results. Insulin-sensitizers can decrease the levels of insulin in subjects affected by hyperinsulinemia, improving metabolic and hormonal alterations observed in PCOS patients. CONCLUSIONS: Antiandrogens and insulin sensitizers represent fundamental pharmacological therapies for PCOS management.