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Collectively, AMH is a dual regulator of follicle growth and hypothalamic GnRH secretion, thus creating a vicious cycle ( Figure 3 3 Insulin resistance Hyperandrogenism promotes the accumulation of subcutaneous fat and the development of insulin resistance by suppressing lipolysis and promoting lipogenesis of adipocytes ( 4 Hyperandrogenism Patients with PCOS may experience a variety of distressing symptoms caused by excess male sex hormones, such as hirsutism (increased facial or body hair), androgenetic alopecia, and acne