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Increased androgenic activity in the PCOS pathogenesis. There is increased GnRH pulse frequency with preferential LH secretion at the pituitary level. LH stimulates testosterone synthesis at the level of theca cells in the ovary. Testosterone reduces the negative progesterone feedback on the GnRH pulse generator and amplifies insulin resistance in the adipocytes and skeletal muscle. Compensatory hyperinsulinaemia in synergy with LH amplifies the testosterone production in the ovary.
