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Hyperinsulinemia is also associated with ovarian and adrenal hyperandrogenism, as insulin can stimulate androgen production in the ovaries and adrenal glands [22] (Figure 2)

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Long-term management Dietary and lifestyle advice Moderate consumption of foods with high concentrations of copper such as chocolate, shellfish, nuts, liver and soy as well as establishing a water purifying system to avoid drinking water that may have flowed through copper pipes should be advised[18]