How to manage elevated luteinizing hormone (LH) and testosterone levels in a patient with Polycystic Ovary Syndrome (PCOS) or Gaana Kamaya?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: June 22, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Guidelines

Management of elevated luteinizing hormone (LH) and testosterone levels in PCOS, also known as Gaana Kamaya, typically involves a combination of lifestyle modifications and medications, with the first-line treatment being weight loss through diet and exercise for overweight patients, as even modest weight reduction of 5-10% can improve hormone levels and restore ovulation 1.

Key Considerations

  • Weight loss is crucial for improving hormone levels and restoring ovulation in overweight patients with PCOS.
  • Combined hormonal contraceptives (CHCs) containing ethinyl estradiol with progestins like drospirenone or cyproterone acetate are effective at reducing LH and testosterone levels.
  • Metformin at doses of 1500-2000 mg daily can improve insulin sensitivity, which indirectly lowers testosterone levels.
  • Anti-androgens like spironolactone (50-200 mg daily) may be added for persistent symptoms of hyperandrogenism.

Lifestyle Modifications

  • Dietary modifications, such as a low-carbohydrate diet, can help improve insulin sensitivity and reduce androgen levels.
  • Regular exercise, such as aerobic and resistance training, can help improve insulin sensitivity and reduce androgen levels.

Medications

  • CHCs are effective at reducing LH and testosterone levels, and a typical regimen is a daily pill containing 20-35 mcg ethinyl estradiol for at least 6 months.
  • Metformin can improve insulin sensitivity, which indirectly lowers testosterone levels, and is usually started at 500 mg and gradually increased to 1500-2000 mg daily.
  • Anti-androgens like spironolactone may be added for persistent symptoms of hyperandrogenism, and work by suppressing gonadotropin release, increasing sex hormone binding globulin production, and reducing ovarian androgen production.

Monitoring and Follow-up

  • Regular monitoring of hormone levels every 3-6 months is recommended to assess treatment efficacy.
  • Therapy often needs to be continued long-term as symptoms typically recur when treatment is discontinued.

Additional Considerations

  • Eating disorders, such as binge eating disorder, are prevalent in women with PCOS, and effective treatment of obesity in PCOS women must address both physical and psychological factors 1.
  • The treatment of binge eating disorder involves a combination of pharmacotherapy, psychotherapy, and emerging therapies, and lisdexamfetamine is the first-line Food and Drug Administration–approved medication for the treatment of binge eating disorder.

From the Research

Management of Elevated Luteinizing Hormone and Testosterone Levels

To manage elevated luteinizing hormone (LH) and testosterone levels in patients with Polycystic Ovary Syndrome (PCOS) or Gaana Kamaya, several treatment options are available.

  • Medications:
    • Spironolactone, an antiandrogen, can be used as a single agent for long-term therapy of hirsute patients with PCOS or idiopathic hirsutism, as shown in a study published in 2000 2.
    • Metformin, an insulin sensitizer, can decrease total testosterone levels and improve clinical manifestations of hyperandrogenism in women with PCOS, as demonstrated in a study published in 2003 3.
  • Combined Therapies:
    • A combination of combined oral contraceptives (COC) and spironolactone can be more effective than metformin in reducing hirsutism, androgen excess, and menstrual dysfunction in women with PCOS, as shown in a study published in 2017 4.
    • Spironolactone and metformin can both be effective in managing PCOS, with spironolactone appearing better in treating hirsutism, menstrual cycle frequency, and hormonal derangements, as demonstrated in a study published in 2004 5.
  • Diagnostic Markers:
    • Anti-Müllerian hormone (AMH), LH to follicle-stimulating hormone (FSH) ratio, total testosterone (TT), and prolactin (PRL) levels can be used to predict PCOS among women, with AMH having the largest operating characteristic curve, as shown in a study published in 2023 6.

Treatment Considerations

When managing elevated LH and testosterone levels in patients with PCOS or Gaana Kamaya, it is essential to consider the individual patient's symptoms, medical history, and treatment goals.

  • Monitoring: Regular monitoring of hormonal levels, menstrual cycle, and clinical symptoms is crucial to assess the effectiveness of treatment and make adjustments as needed.
  • Lifestyle Modifications: Lifestyle modifications, such as weight loss, exercise, and dietary changes, can also be beneficial in managing PCOS symptoms and improving hormonal balance.

Hormonal Regulation

Regulating hormonal imbalances is critical in managing PCOS and Gaana Kamaya.

  • LH and FSH: LH and FSH play a crucial role in regulating menstrual cycle and ovulation. Abnormalities in LH and FSH levels can contribute to PCOS symptoms.
  • Testosterone: Elevated testosterone levels can contribute to hirsutism, acne, and other PCOS symptoms. Reducing testosterone levels can help alleviate these symptoms.

By considering these factors and treatment options, healthcare providers can develop effective management plans for patients with PCOS or Gaana Kamaya and elevated LH and testosterone levels.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Effects of metformin therapy on hyperandrogenism in women with polycystic ovarian syndrome.

Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 2003

Related Questions

What is the appropriate dosing of Spironolactone for a 15-year-old patient with Polycystic Ovary Syndrome (PCOS)?
What is the typical dosing regimen for spironolactone (spirololactone) in the treatment of Polycystic Ovary Syndrome (PCOS)?
What is the treatment for hyperandrogenism (dangerously high levels of testosterone)?
Does spironolactone interfere with the evaluation for Polycystic Ovary Syndrome (PCOS)?
What is the role of spironolactone (aldosterone antagonist) in the treatment of Polycystic Ovary Syndrome (PCOS)?
What is the management of obstructive renal (kidney) failure with hematoma evacuation and metabolic acidosis with hyperkalemia?
What is the next appropriate intervention for a 2-month-old formula-fed infant with uncomplicated gastroesophageal reflux?
What is the approach to managing gynecomastia in a male patient with hypergonadism (high testosterone) and elevated Luteinizing Hormone (LH) levels?
What pulmonary function test results can I expect in a patient with emphysema, particularly in terms of Forced Expiratory Volume (FEV1) to Forced Vital Capacity (FVC) ratio, Residual Volume (RV), and Total Lung Capacity (TLC)?
What acid-base disturbances occur in postobstructive renal failure recovery?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question