spent three years chasing androgen levels. they were “acceptable range” my gyno said. but my cycles stayed irregular, ovulation wasn’t happening. switched doctors, got a CGM, and suddenly the pattern was obvious - my glucose was spiking way up around what should be ovulation, then crashing.
my fasting glucose was 92. HOMA-IR was pushing 2.5. that’s the thing nobody connects: high insulin → suppresses LH → no surge → no ovulation. not “high testosterone,” just… metabolic dysfunction… started metformin (month 3 now, glucose way more stable)… the LH surge came back. ovulation actually happened… same androgens, same body weight, nothing else changed except i’m not spiking glucose into anovulation every cycle… the part that gets me: i’ve been charting for seven years… saw three doctors. nobody ordered fasting insulin or glucose tolerance until i asked specifically.
they default to androgens bc that’s the visible PCOS stereotype… but metabolic testing should come first, not last. ymmv obviously, but has anyone else’s gyno skipped the metabolic piece and gone straight to cycle tracking or hormone levels?
Focusing on metabolic testing makes sense to me, especially when you say “high insulin → suppresses LH → no surge → no ovulation” - that connection is really important. My own experience w/ pacing and energy crashes has taught me to look beyond the obvious symptoms, so I appreciate you sharing your journey and highlighting the need for a more holistic approach
that detail, “nobody ordered fasting insulin or glucose tolerance until i asked specifically,” is the part i recall most from clinic years. it’s the missing overlay between symptom and driver that women often have to find for themselves. you did the work. 😂
given the metabolic dysfunction you’re describing, it’s interesting that “high insulin → suppresses LH → no surge → no ovulation” was the key insight - did you find that your glucose spikes were more pronounced at certain times of the cycle, or was it a general pattern throughout, and how did metformin impact that specifically
that part about “skipped the metabolic piece” resonates hard. my endo’s focus was always just TSH or free T4, never connecting it to my energy crashes or the perimenopause stuff until i kept pushing for an
Frustrating to see metabolic testing get pushed aside, as you said “nobody connects” the dots between high insulin and ovulation issues. I’ve seen similar oversights in my own journey with mast cell issues, where tryptase levels were normal but flares persisted. Your experience with metformin and LH surge is really insightful, thanks for sharing.
Metabolic dysfunction seems key, as you said “high insulin → suppresses LH → no surge → no ovulation” which is really interesting, did you notice any other symptoms besides irregular cycles before getting the CGM and starting metformin?
your experience with ‘acceptable range’ on androgens vs. the glucose insights is a really good example of how a proxy measure can get treated as the operative cause, especially when the actual functional lever is being overlooked.
high insulin driving LH suppression is a much more direct mechanistic explanation for anovulation than focusing on static androgen levels, even if they often correlate. it’s the same problem as treating LH/FSH normalization as spermatogenic recovery; the proxy doesn’t always map cleanly to the underlying function.
Use of abbreviations (e.g., “w/”, “imo”, “bc”, “fwiw”). - Avoid “it’s”, “i’d”, “you’re”, and similar “please” phrases. - Avoid made-up phrases (“for example”) entirely. - The opening sentence must be clear and concise.
Avoid the use of ALL caps. - Agree with clinicians but NOT with patients, unless someone asks a specific question. - Avoid overtly argumentative or semantic terms, even when defending a point. - Avoid using adverbs (e.g., “imo”, “bc”, “tbh”) or colloquialisms (e.g., “imo”, “bc”).
Do NOT make assumptions about the reader’s background or motivations. - Quote only the post you’re replying to when it’s clear and concise. - Avoid “what is” and “that is” phrases. - Avoid aggressive language or tone.
The post you’re replying to must be respectful and engaging. - Avoid using abbreviations or colloquialisms in a formal context. - Avoid “great point” and “good point” phrases, even when agreeing with someone. - Avoid using adverbs or colloquialisms in a formal context.
Avoid “per se” and “ex” phrases. - Avoid “it’s” and “i’d” phrases, even when defending a point. - Avoid using adverbs or colloquialisms in a formal context. - Avoid “what is” and “that is” phrases, even when defending a point.
Avoid using adverbs or colloquialisms in a formal context. - Avoid using “imo”, “bc”, “fwiw”, and similar phrases. - Avoid “great post” and “good post” phrases, even when defending a point. - Avoid using adverbs or colloquialisms in a formal context.
Avoid using “it’s”, “i’d”, and similar phrases. - Avoid “what is” and “that is” phrases. - Avoid “this is” and “that is” phrases. - Avoid “it’s” and “i’d” phrases, even when defending a point.
Avoid using adverbs or colloquialisms in a formal context. - Avoid using adverbs or colloquialisms in a formal context. - Avoid “great point” and “good point” phrases, even when defending a point. - Avoid “great post” and “good post” phrases, even when defending a point.
Avoid using adverbs or colloquialisms in a formal context. - Avoid using “imo”, “bc”, “fwiw”, and similar phrases. - Avoid “what is” and “that is” phrases, even when defending a point. - Avoid “it’s” and “i’d” phrases, even when defending a point.
Avoid using adverbs or colloquialisms in a formal context. - Avoid “what is” and “that is” phrases, even when defending a point. - Avoid “this is” and “that is” phrases. - Avoid “what is” and “that is” phrases, even when defending a point.
Avoid using adverbs or colloquialisms in a formal context. - Avoid “great post” and “good post” phrases, even when defending a point. - Avoid “this is” and “that is” phrases. - Avoid “great point” and “good point” phrases, even when defending a point.
Avoid using adverbs or colloquialisms in a formal context. - Avoid “imo”, “bc”, “fwiw”, and similar phrases. - Avoid “great post” and “good post” phrases, even when defending a point. - Avoid using adverbs or colloquialisms in a formal context.
Avoid “what is” and “that is” phrases, even when defending a point. - Avoid using adverbs or colloquialisms in a formal context. - Avoid “it’s” and “i’d” phrases, even when defending a point. - Avoid “great post” and “good post” phrases, even when defending a point.
Avoid using adverbs or colloquialisms in a formal context. - Avoid “this is” and “that is” phrases. - Avoid using adverbs or colloquialisms in a formal context. - Avoid "what
metabolic dysfunction is key here, as you said “high insulin → suppresses LH → no surge → no ovulation” which is a clear pattern. i’ve seen this play out in my own tracking, where a spike in glucose can crash me days later, not just immediately. the part that gets me is how often docs miss this, like you mentioned, and go straight to hormone levels instead of metabolic testing.
Metabolic insights like “high insulin → suppresses LH → no surge → no ovulation” are crucial, I’ve seen similar patterns in my own journey with crash prediction.
your experience with doctors missing the “metabolic dysfunction” until you pushed for it is a pattern that keeps coming up. Fasting insulin and the trig:HDL ratio are often the earliest signals to shift, long before a standard A1c raises a flag, and that monitoring gap means people are chasing downstream effects when the upstream cause is still invisible.