Evaluation of Insulin Resistance Markers in Polycystic Ovary Syndrome Patients Receiving Metformin, Finasteride or Both

Section: Research Paper
Issue
Vol. 47 No. 2 (2025): Volume 47 Issue 2
Published
Dec 29, 2025
Pages
157-163

Abstract

Background: Polycystic ovary syndrome (PCOS) is a widespread endocrine disorder affecting approximately 6–15% of women of reproductive age worldwide. It is characterized by hyperandrogenism, chronic anovulation, and polycystic ovarian morphology, and is often associated with metabolic disturbances, particularly insulin resistance (IR). IR is observed in 35%–80% of PCOS patients and plays a critical role in the pathogenesis of both reproductive and metabolic dysfunctions in this condition. Effective management of IR is essential to improve clinical outcomes in PCOS. Several markers have been developed to assess IR, including non-insulin-based indices such as the Triglyceride-Glucose (TyG) index, TyG index adjusted for Body Mass Index (TyG-BMI), and the triglyceride to HDL-cholesterol ratio (TG/HDL-c), in addition to insulin-based measures like the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Metformin, an insulin sensitizer, and finasteride, an antiandrogen, are utilized in the management of PCOS, either alone or in combination. Evaluating the effects of these therapies on IR markers is crucial for optimizing treatment strategies.


Objective: To compare the effects of metformin, finasteride, or their combination on insulin resistance markers in Iraqi women with PCOS.


Patients and method: This non randomized interventional study enrolled 150 female patients diagnosed with polycystic ovary syndrome (PCOS) according to the Rotterdam criteria (2003), with an age range of 18 to 39 years. The participants were assigned into three equal groups (n = 50). The metformin group received an initial oral dose of 500 mg once daily, which was escalated by 500 mg every 1 to 2 weeks with meals, up to a maximum dose of 2500 mg/day over a 3-month period. The finasteride group was administered 5 mg orally once daily for 3 months. The combination group received both agents at the aforementioned doses and durations. Baseline and post-treatment data were collected for age, body mass index (BMI), and insulin resistance markers for comparative evaluation.


Results: After treatment, all three modalities—metformin, finasteride, and their combination—significantly reduced mean HOMA-IR levels (p < 0.001), with metformin alone showing the greatest reduction. In addition, all treatments significantly decreased the triglyceride-glucose (TyG) index, TyG-BMI index, and TG/HDL ratio (p < 0.001), with the combination therapy demonstrating the most pronounced effect.


Conclusion: Metformin alone was more effective in reducing insulin resistance, as indicated by HOMA-IR. In contrast, the combination of metformin and finasteride produced greater improvements in insulin sensitivity, reflected by the TyG index, TyG-BMI index, and TG/HDL ratio, suggesting potential added value of the combination in managing insulin-related disturbances in women with PCOS.


 

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Authors

Iman Abdul-Kadhim Abdul-Jabbar

Department of Pharmacology and Therapeutics, College of Medicine, University of Al-Qadisiyah, Iraq

Asma Abdul Jaleel Swadi

Department of Pharmacology and Therapeutics, College of Medicine, University of Al-Qadisiyah, Iraq

Identifiers

https://doi.org/10.33899/acmm.v47i2.60180
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1.
Abdul-Jabbar IA-K, Swadi AAJ. Evaluation of Insulin Resistance Markers in Polycystic Ovary Syndrome Patients Receiving Metformin, Finasteride or Both. Ann. coll. Med. Mosul [Internet]. 2025 Dec. 29 [cited 2026 Jan. 1];47(2):157-63. Available from: https://mmed.uomosul.edu.iq/index.php/mmed/article/view/60180