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3.2 GM and hormone metabolism disorders Hyperandrogenemia (HA) is also a pivotal clinical manifestation in patients with PCOS, potentially stemming from complex interplays involving the Hypothalamic-pituitary-gonadal (HPG) axis, adrenal function abnormalities, dysregulation of glucose and lipid metabolism, intestinal microbiota imbalances, chronic inflammation, and genetic predispositions (39)

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Mitchell JL, Lyons HS, Walker JK, et al

Table 3 summarizes the PIONEER trial programmes [35,36,37,38,39,40,41,42,43,44]

Patients education about these risks and discontinuation of the drug if concerning symptoms for thyroid carcinoma (neck mass, hoarseness of the voice, difficulty swallowing or breathing) develop is mandatory