Insulin-driven PCOS is the most common subtype — and the most actionable. The catch: most standard PCOS panels don't include fasting insulin, so the diagnosis lands on androgens alone and the protocol misses the lever that actually works.
Why insulin matters in PCOS
High fasting insulin tells the ovary to make more testosterone and lowers SHBG (which then frees up more testosterone again). The androgen pattern most PCOS women carry is downstream of an insulin problem — fix the insulin and the androgens follow.
What 'normal' insulin actually looks like
Lab reference ranges are forgiving — often <25 mIU/L. Functionally, a fasting insulin above ~8 mIU/L is worth attention in a woman with PCOS symptoms. The label 'normal' on the report doesn't mean optimal.
What moves it
Strength training, sleep regularity, protein-anchored meals, reducing snacking frequency, and (for some) inositol or metformin. The order of impact in our clients is usually: sleep → training → protein/meal timing → supplements.