Low AMH + mild insulin resistance. Is Ovasitol still appropriate? Testosterone dropping on metformin.

Hi all

Can someone help me make sense of what I’m dealing with? My situation feels confusing and I’d love some input from people who’ve navigated something similar.

I’m a 33-year-old female with mild insulin resistance and low AMH. Because my androgens were already on the low-normal side before starting metformin, my OB/GYN is now questioning whether I actually have PCOS.

A few specific questions:

1. Is it appropriate to take Ovasitol (40:1 myo-inositol + D-chiro-inositol) if my androgens were never elevated to begin with? I’m worried the DCI component will suppress testosterone further.

2. Could I be in a “hormone rebalancing” phase, where things look a little chaotic before stabilising? Or should I be genuinely concerned about my testosterone continuing to drop?

3. Has anyone else seen DHEA-S increase while testosterone dropped after starting metformin?

Current medication:
Metformin: 1000mg x 2
Levothyroxine: 25 mcg

Background:
Female, 33

Labs (format: baseline → most recent, ~6 weeks apart)

Metabolic

•	Fasting insulin: 10.8 → 8.3 µIU/mL  
•	Fasting glucose: 90 → 95 mg/dL  
•	TSH: 3.62 → 2.48 mIU/L  
•	Free T4: 1.30 → 1.26 ng/dL

Reproductive

•	AMH: 0.70 → 0.78 ng/mL  
•	Total testosterone: 26 → 15.5 ng/dL  
•	Free testosterone: 2.8 → 2.2 pg/mL  
•	SHBG: 35 nmol/L (not repeated)  
•	DHEA-S: 80 → 108 mcg/dL  
•	17-OH progesterone: 19 ng/dL (consistent with anovulatory cycle)

Inflammation

•	hs-CRP (baseline): \~18 mg/L  
•	CRP — standard cardio panel (\~1 month post-metformin): 14.8 mg/L  

Note: these are different assays so direct comparison is limited
• Homocysteine: 12.9 umol/L

Nutrients

•	Vitamin D: 32 ng/mL  
•	Folate: 13.2 ng/mL  
•	Vitamin B12: 457 pg/mL  
•	Iron: 76 → 57 mcg/dL (second draw taken during anovulatory breakthrough bleeding — may not reflect true baseline)  
•	Ferritin: 20 → 27 ng/mL