PCOS is a multifaceted syndrome that affects multiple organ systems with significant metabolic and reproductive manifestations. Treatment should be individualized based on the patient's presentation and desire for pregnancy (Figure 219,29–35). Devices and medications used to treat manifestations of PCOS, and their associated adverse effects, are described in Table 2.19,29–33,36
Two clinical studies examined the androgen lowering effects of Glycyrrhiza Glabra. A single arm clinical trial demonstrated reduced testosterone in healthy women aged 22–26 years (n = 9) over two menstrual cycles. Treatment with Glycyrrhiza glabra, 7 grams per day reduced testosterone from 27.8(±8.2) to 17.5 (±6.4), p < 0.05 [55]. Another single arm clinical trial investigated the effects of Glycyrrhiza glabra in women with PCOS, (n = 32). Glycyrrhiza glabra 3.5 g per day was added to anti-androgen pharmaceutical treatment, Spirinolactone 100 mg/day over two menstrual cycles. An unwanted side effect for Spirinolactone was the flare of androgens during the initial phase of treatment. This study demonstrated reduced concentrations of testosterone during the first four days of treatment at 103 ± 29 ng/d in the Spirinolactone group compared to 91 ng/d (±19) when combined with Glycyrrhiza glabra (p < 0.05) [54] (Table 1). Consistent laboratory and clinical outcomes were demonstrated however limitations included design shortcomings. Both clinical studies were open label observational design with small sample sizes; one included healthy participants. Rigorous studies are needed to confirm the androgen lowering effects of Glycyrrhiza spp. in hyperandrogenism and PCOS.
This can be a key element for dynamic health for women with polycystic ovarian syndrome and must be considered a regular a part of your routine. Exercise can definitely boost the body’s sensitivity to sugar and address insulin resistance. It is also a great way to feel good and maybe learn a new skill. There are so many types of exercise you should be able to find something that appeals to you and is appropriate for your fitness level. Some fun exercise choices could include walking, housework, gardening, biking, running, swimming, yoga, and weight lifting as well as sports like soccer, squash, softball, tennis, skiing or even salsa dancing.
Peer reviewers: Luciano Pirola, PhD, Epigenetics in Human Health and Disease Laboratory, Baker IDI Heart and Diabetes Institute, 5th floor, 75 Commercial Road, Melbourne VIC 3004 Australia; Marcin Baranowski, PhD, Department of Physiology, Medical University of Bialystok, Mickiewicza 2c, Bialystok 15-222, Poland; Christa Buechler, PhD, Department of Internal Medicine I, Regensburg University Hospital, Regensburg D93042, Germany
3. Serum hormones during follicular phase oestradiol, LH and FSH. Luteal progesterone measured day 21–23 of the cycle. Serum LH was 8.0 (±0.9) in the clomiphene group and 5.7 (±0.9) in the clomiphene plus Cimicifuga racemosa group (p < 0.001) and oestradiol was 228.3 (±30.2) in the clomiphene alone group and 299.5 (±38.9) \in the clomiphene plus Cimicifuga racemosa group (p = 0.01)
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The effectiveness of aromatase inhibitors in the treatment of PCOS remains controversial. A meta-analysis investigated 78 studies on the use of these medications in the infertility treatment of women with PCOS. Of these studies, 13 RCTs met the inclusion criteria. Six studies compared the use of letrozole versus CC and found that letrozole presented with a higher ovulation rate/patient (OR 2.90; 95% CI: 1.72- 4.88; p<0.0001); however, no significant differences in the rate of ovulation per cycle or better pregnancy, live birth, multiple pregnancy or miscarriages rates were noted. Letrozole also did not obtain better results regarding clinical pregnancy or live birth rates compared with placebo or CC + metformin in women with CC-resistant PCOS. The results of the comparison of the effects of letrozole and anastrozole on ovulation and pregnancy rates in women with CC-resistant PCOS are controversial 41.
A su hija la han diagnosticado una afección llamada síndrome del ovario poliquístico ("PCOS", por sus siglas en inglés). El PCOS es un desequilibrio hormonal. Afecta los ovarios. Estos son los órganos que guardan los óvulos de la mujer. El PCOS posiblemente también altere el resto del cuerpo. Si se deja sin tratar, el PCOS puede ocasionar graves problemas de salud. El tratamiento no puede curar el problema, pero sí ayuda a reducir los síntomas y a evitar trastornos de salud.
Quantitative insulin sensitivity check index (QUICKI) was developed to improve the sensitivity of fasting measurements. QUICKI is calculated as: 1/[log(insulin fasting) + log(glucose fasting)] and has been well correlated to clamp measurements in obese and non-obese patients[15]. QUICKI also demonstrates correlation with HOMA-IR[53]. QUICKI research calculations in young PCOS women are often identical to age matched women with DM[54].
About Blog Natural treatment for better hormones and better periods. With this blog, I strive to assemble some truths, and to dispel some myths. I always want to better understand what works for hormones, and why, so I strive to keep abreast of current research, and my main motivation is always to help the patient sitting across from me. Blog by Lara Briden.
76. Chen J-T, Tominaga K, Sato Y, Anzai H, Matsuoka R. Maitake mushroom (Grifola frondosa) extract induces ovulation in patients with polycystic ovary syndrome: a possible monotherapy and a combination therapy after failure with first-line clomiphene citrate. J Alternative Compl Med. 2010;16(12):1295–1299. doi: 10.1089/acm.2009.0696. [PubMed] [CrossRef]
PCOS es un complemento que ayuda a equilibrar los niveles hormonales (exceso de testosterona) en las mujeres con SOP. Esos desequilibrios hormonales provocan en la mayoría de los casos signos externos de hiperandrogenismo como exceso de vello, caída excesiva del cabello y acné. Al regular tus niveles hormonales, conseguirás suavizar y mejorar esos signos externos 🙂
PCOS treatment is different for different people. While there is no cure for PCOS, taking medicine and losing weight can help  your symptoms. If you don’t want to become pregnant, your doctor or nurse may recommend hormonal birth control, like the hormonal IUD, birth control implant, pill, patch, ring, or shot to treat your PCOS. The pill, patch, or ring may be particularly helpful if you’re struggling with acne or want more regular periods. If you’re trying to get pregnant, drugs that treat insulin resistance may help, as well as certain fertility drugs that can help you ovulate. Losing weight can also help with ovulation and fertility.
A pelvic ultrasound (transvaginal and/or pelvic/abdominal) is used to evaluate enlarged ovaries. Ultrasounds are often used to look for cysts in the ovaries and to see if the internal structures appear normal. In PCOS, the ovaries may be 1.5 to 3 times larger than normal and characteristically have more than 12 or more follicles per ovary measuring 2 to 9 mm in diameter. Often the cysts are lined up on the surface the ovaries, forming the appearance of a "pearl necklace." The follicles tend to be small and immature, thus never reaching full development. The ultrasound helps visualize these changes in more than 90% of women with PCOS, but they are also found in up to 25% of women without PCOS symptoms. (For more, see RadiologyInfo.org: Pelvic ultrasound.)
Any of the above symptoms and signs may be absent in PCOS, with the exception of irregular or no menstrual periods. All women with PCOS will have irregular or no menstrual periods. Women who have PCOS do not ovulate regularly; that is, they do not release an egg every month. This is why they do not have regular periods and typically have difficulty conceiving.

I've lived in pretty grimy situations in other times in my life where I couldn't control the common space or kitchen at all but I at least didn't let my bedroom or the bathroom get so gross that it looks like it could be on an episode of a haunted hoarder homes tv show. I'd like to find an old pic where they had a clean home/even just their bed and compare it to now but I don't think it's EVER been clean and I've been following her for more than 5 years. Sage- Blog.
oh ok thanks I didn't see that. wow he got that fast! maybe the bronx is faster at processing them. and yeah you'd think so. but especially with public defenders, they get paid by NY state, not the defendant obvi. the more hours they spend on a case, the more they get paid. also, the courts go on vacation usually for summer and Christmas/New Year's. Lurch got arrested in May but wasn't seen til July, prob due to summer vacation(s). one of my cases was still going on during the winter and I went to court in November and then didn't have to go again until mid January due to the holidays. so for a dopehead, that's 3 whole months of getting high without worrying about having to stop anytime soon.
Ang isang pulutong ng mga kababaihan resort sa yoga dahil ito ay nakakagamot epekto sa isip at katawan. Gayunman, ang pagsasanay ng mga tiyak na postures yoga ay maaaring maging kapaki-pakinabang sa pagharap sa mga hormone-sapilitan sakit kabilang ang PCOS. Maaari mong resort sa expert yoga gurus kung sino ang maaaring gagabay sa iyo tungkol sa tiyak na yoga poses na maaaring luwag ang stressed, hormonal glands sa katawan. Yoga ay maaari ring matulungan kang manatiling relaxed at stress-free.
Aunque el síndrome de ovario poliquístico (que antes se llamaba "síndrome de Stein-Leventhal") se identificó por primera vez en la década de los años treinta del siglo XX, los médicos todavía no conocen sus causas con certeza. Las investigaciones sugieren que puede estar relacionado con un aumento de la fabricación de insulina en el cuerpo. Las mujeres con síndrome de ovario poliquístico es posible que produzcan demasiada insulina, lo que estimula a sus ovarios a liberar un exceso de hormonas masculinas. El síndrome de ovario poliquístico parece darse por familias, de modo que si lo padece alguna pariente tuya, tú podrías ser proclive a desarrollarlo.
Consulte a su proveedor de atención médica si tiene periodos mensuales irregulares, dificultades para quedar embarazada o exceso de acné o de crecimiento de vello. Si le dicen que tiene SOP, los cambios de estilo de vida como la pérdida de peso (si tiene sobrepeso) y el aumento de actividad física pueden reducir la resistencia a la insulina, lo cual puede ayudar a controlar el SOP.
And that’s not all. Nurturing your health with smart daily choices also helps protect against heart disease and diabetes, major health risks for women with PCOS. And while there’s little research specifically in PCOS, a healthy diet plus exercise and stress reduction are also proven to help lift anxiety and depression, improve sleep, reduce fatigue and boost energy – additional pluses that can help you feel great.

Where PCOS is associated with overweight or obesity, successful weight loss is the most effective method of restoring normal ovulation/menstruation, but many women find it very difficult to achieve and sustain significant weight loss. A scientific review in 2013 found similar decreases in weight and body composition and improvements in pregnancy rate, menstrual regularity, ovulation, hyperandrogenism, insulin resistance, lipids, and quality of life to occur with weight loss independent of diet composition.[73] Still, a low GI diet, in which a significant part of total carbohydrates are obtained from fruit, vegetables, and whole-grain sources, has resulted in greater menstrual regularity than a macronutrient-matched healthy diet.[73]

hi doc bru ! ask ko lng po 7 years na po kami nagsasama ng asawa ko nagpafertility check naman po kami 2 years ago . ok nman po sperm count nia at ok nman din po ung ultrasound ko may nakita lng po na maliliit na bukol sa uterus ko . niresetahan po ako ng metmorfin fertyl at folic acid. regular nman po 28 days ung cycle ko! pero until now ndi pa din po kami nakakabuo . ano po ba the best way na gawin namin para magkababy na? i hope po na masagot nio .. thankyou en godbless po

Oh FUCK no. Someone please let the woman know; it's a matter of saving an animal from a lifetime of misery and despair. Siamese cats are much harder to properly keep than the average housecat and needs a household where they'll be stimulated and properly trained so they don't get aggressive. There's no way two lazy dirty junkies could take care of one.

Bragging moment! For the first time in 13 YEARS I'm having a normal period! Bleeding normally, NOT having excruciating cramps, NOT breaking out terribly and my hair is NOT falling out! I am so happy I could cry! The Insulite sytem helped me stay sane and given me my sanity back. I am in control of my body for the first time in my entire life. Truly a blessing.
A prospective, observational clinical trial examined the endocrine effects of Tribulus terrestris 750 mg per day, over five days in eight healthy women (aged 28–45). A significant increase in mean serum FSH concentration from 11 mIU/ml before treatment to 17.75 mIU/ml following treatment (P < 0.001) was demonstrated. Pre-treatment FSH levels returned following cessation of treatment (Table 1). Another clinical study evaluated the equivalence of Tribulus terrestris (Tribestan®) and pharmaceuticals for ovulation induction in women with oligo/anovular infertility (n = 148), [60]. During the three month follow up, ovulation rates were highest with epimestrol (74%), followed by Tribulus terrestris (60%), clomiphene (47%) and cyclofenil (24%). However, the evidence for Tribulus terrestris should be interpreted with caution due to risks for bias in clinical studies. One study was uncontrolled with a small number of healthy participants [56], the second study did not report baseline characteristics, methods for allocation to treatment groups and data were not statistically analysed [60] (Table 1).
The difference there and with many other cows is that they're narcs who believe that they're extremely handsome/beautiful when they're not. Luna knows that she's a fatty watty with cellulite and stretch marks and seems to accept it. Her fucked up body isn't related to her cowish nature (aside from her current foray into sex work, but even then she chose extralunchmoney because of her 'unique' look).
Because of its antiandrogenic effects, spironolactone is effective, but not FDA-approved, for this indication.22,23 A Cochrane review suggested that spironolactone is superior to finasteride.28 Combining spironolactone with oral contraceptives may be synergistic, but caution should be used in women taking drospirenone because each agent can cause hyperkalemia.2 Spironolactone is FDA pregnancy category C.
If a woman's weight is excessive, the physician should be aggressive in championing a weight-loss program. Medications effective for weight loss (in addition to lifestyle modifications) that have been specifically studied in women with PCOS include metformin, acarbose, sibutramine, and orlistat (Xenical). Metformin is probably the first-line medication for obesity or weight reduction in patients with PCOS. Metformin results in a decrease in body mass index (BMI) of 1 to 2 kg per m2 or weight loss up to 6 lb, 10 oz to 8 lb, 13 oz (3 to 4 kg)10,46,49; acarbose results in an approximate 3 kg per m2 decrease in BMI24; sibutramine results in a decrease in BMI of 5.8 kg per m2 and weight loss of 31 lb, 11 oz (14.4 kg)26; and orlistat results in weight loss of approximately 11 lb (5 kg).50 However, a recent systematic review suggested that metformin is not effective for lowering BMI in patients with PCOS.1
The advantages of CC use are low cost, oral administration, few side effects (flushing, headache, visual disturbances and abdominal discomfort), the induction of monofollicular development in most cases 16 and a low rate of multiple gestations (2 to 13%) 17. The initial dose is 50 mg/day for five days (starting between the second and fifth day of the menstrual cycle) and may be increased to 150 mg/day 17,18; however, doses greater than 100 mg/day usually do not offer additional benefits (may be useful in obese women) 18. The ovulation rate may reach 75 to 80% 19 with a conception rate of 22% per cycle 20 and a cumulative pregnancy rate between 60 and 70% in six cycles 9. There is no evidence that the administration of human chorionic gonadotropin (hCG) in the mid-cycle increases ovulation rates (OR 0.99; 95% CI: 0.36-2.77) or clinical pregnancy (OR 1.02; 95% CI: 0.56-1.89) 21,22. CC treatment should be limited to six ovulatory cycles and US monitoring is not mandatory (it is recommended only in the first ovulatory cycle to adjust the dose based on the ovarian follicular growth and development and for endometrial assessment) 17,18. Additional cycles of ovulation induction with CC (maximum of twelve cycles) may be individually evaluated based on the cost-effectiveness and age of women and after discussion with the couple 9. The incidence of ovarian hyperstimulation syndrome (OHSS; increased capillary permeability with consequent third-space fluid sequestration and hemoconcentration) associated with the use of CC is low, approximately 1 to 6% 17,23.
Combination oral contraceptives, especially those with progestins of norgestimate, desogestrel, or drospirenone (because of their low androgenic effects), are among the most commonly used medications for hirsutism in women with PCOS.2 However, they are not approved by the U.S. Food and Drug Administration (FDA) for this use. One study found that women taking desogestrel/ethinyl estradiol (Apri) had lower hirsutism scores on a standardized scale (i.e., the Ferriman-Gallwey hirsutism score).34 Finasteride (Propecia) and flutamide (formerly Eulexin) are effective, but are FDA pregnancy categories X and D, respectively; the use of these agents for hirsutism is strictly off-label.2
Our search identified 33 laboratory (pre-clinical) studies (Figure 1). Eighteen studies met the inclusion criteria, nine reported on receptor binding assays or ovarian or pituitary (brain) cell cultures, [36–44] and nine used an animal experimental model with hormone assays and/or post-mortem examination of ovarian, uterine and brain histology, [45–53] (Table 1). We excluded 15 studies for the following reasons; investigation of effects in male animals (n = 4) and investigations which commenced with constituents that were isolated from herbal medicines (n = 5). Six studies were excluded due to no clinical evidence found (n = 6).
Acne is common in the general population and in patients with PCOS. Hormonal contraceptives are first-line medications for treating acne associated with PCOS and can be used in conjunction with standard topical acne therapy (e.g., retinoids, antibiotics, benzoyl peroxide) or as monotherapy.19,34 Antiandrogens, spironolactone being the most common, can be added as second-line medications.19,34
Why does she act like everyone is either rich or dirt poor… She complains about being hungry than regularly spends $50+ on Amazon shit instead of food… Some people can live in big houses but still have to budget. Being clean and somewhat functional of a human being doesn't make someone rich & privileged. Using opportunities instead of squandering them doesn't mean being privileged. It's called not being a sack of lazy shit like you, Tuna.
Ang potent antioxidants naroroon sa green tea, lalo catechins, ikaw ang mananagot para sa nagdadala down ang antas ng mga hormones na nagiging sanhi ng ovarian cysts at mga kaugnay na mga sintomas. Insulin mga antas ay din nagdala sa ilalim ng control sa pamamagitan ng green tea antioxidants. Pag-inom green tea araw-araw na epekto din ang bigat ng nakuha na ay karaniwang nakikita sa PCOS at tumutulong sa iyo upang malaglag ang labis na timbang (10, 11).
GlucX is a combination of natural fibers designed to help regulate the absorption of glucose into the bloodstream while helping to maintain healthy cholesterol, triglycerides, blood pressure, and insulin levels.* Because high insulin levels promote PCOS, this product is essential to reducing insulin spiking.* Additionally, research demonstrates the benefits of high fiber intake on weight management and cardiovascular support.* GlucX contains fenugreek, a botanical, that decreases the absorption of carbohydrates into the bloodstream as well as prevents insulin spikes that occur with carbohydrate intake.* Fenugreek also has specific benefits for blood sugar balancing.
“When we compared participants with women in the general population, we found significantly higher scores on all of the symptoms evaluated and on corresponding psychological distress measures, particularly for anxiety, depression, somatization (the conversion of psychological distress to physical symptoms), and interpersonal sensitivity,” says lead author Judy McCook, PhD, RN, professor of nursing at East Tennessee State University.
Your doctor or nurse will look at your skin and measure your weight and blood pressure. They’ll ask questions about your period, any symptoms you may be having, and your personal and family health history. They may do a pelvic exam and blood tests to check your hormone levels, whether you may be pregnant, and more. In some cases, your doctor or nurse may recommend getting an ultrasound to check for ovarian cysts.  
Other pharmacological treatments have attempted to lower IR. Vitamin D has been shown to decrease HOMA-IR despite a lack of change in hyperandrogenism in young, obese PCOS women[99]. Animal studies have demonstrated that treatment with glycyrrhizic acid affecting lipoprotein lipase activity decreases serum insulin and HOMA-IR[100]. Although oral contraceptive pills positively affect hyperandrogenism, they have little to no effect on glucose metabolism by OGTT[101]. Long term oral contraceptive pill use may have some limited benefit in IR but data are limited[102]. A 6 mo course of oral contraceptive pill treatment in adolescent obese PCOS women has demonstrated some improvement in IR[103].
I feel like you're confused, which is fair Luna can be all over the place and cryptic. Her father in law type guy had hella health issues last year which was her main excuse for most of her e-begging when it was at its height. From my understanding he has some drinking issues and he and Lurch get in a lot of fights, but he's not a crackhead and it's not nice (I know this isn't a place where people come to be nice) to call sick old men gross.
The principle infertility treatment initially includes preconception guidelines and the use of drugs to induce mono- or bifollicular ovulation. Other therapeutic modalities may also be employed, such as exogenous gonadotropins or laparoscopic ovarian drilling, which are considered to be second-line treatments, or in vitro fertilization (IVF), which is a third-line treatment 9. Thus, the choice of the most appropriate treatment depends on the patient's age, presence of other factors associated with infertility, experience and duration of previous treatments and the level of anxiety of the couple.

El estilo de vida puede tener un gran impacto en la resistencia a la insulina, especialmente si una mujer tiene sobrepeso debido a su dieta o a la falta de actividad física. La resistencia a la insulina también es un rasgo de familia. Perder peso ayudará muchas veces a mejorar los síntomas, independientemente de lo que causó la resistencia a la insulina.

Although it has been known for many years that the ovary is innervated by catecholaminergic nerve fibers and much experimental evidence has strengthened the notion that catecholamines are physiologically involved in the control of ovarian function, scarce evidence has been presented as to the role of sympathetic activity in ovarian pathologies that affect reproductive function. The purpose of this article is to provide a succinct overview of the findings in this area and discuss them relative to the pathology of polycystic ovary syndrome, the most common ovarian pathology in women during their reproductive years.
As many as 70% of PCOS women are insulin resistant and 10% have DM[20-22]. In PCOS women with normal glucose metabolism initially, the rate of conversion to abnormal glucose metabolism can be 25% over just three years[23]. More alarming, insulin abnormalities are highly prevalent in adolescents with PCOS[24]. Almost 20% of young Thai women with PCOS actually have DM[25]. Overall, normal glucose levels on an OGTT do not predict IR and IR, despite normal glucose levels, is correlated with CRP, dyslipidemia and other CAD risk factors[26]. Therefore, glucose levels alone lack the sensitivity to predict metabolic risk in PCOS patients. Precursor states of insulin abnormalities likely predict long term CAD risk well before glucose abnormalities. IR can be just as severe in diabetics and non-diabetics[27], stressing the seriousness of this metabolic impairment as a precursor and not a separate disease. Animal models have shown that IR alone damages myocardial cells, providing direct evidence of end organ disease[28]. Human data link HOMA-IR to left ventricular dysfunction[29]. Abnormal glucose metabolism short of IGT and DM still deserves attention, identification and treatment[30].

Paeonia lactiflora in combination with Glycyrrhiza spp. Aqueous extract Shakuyaku- kanzo-to (TJ-68) One laboratory study examined the effects for the combination Paeonia lactiflora and Glycyrrhiza uralensis on testosterone, oestradiol, FSH and LH in sterilised female rats [53]. Two single arm clinical trials examined androgen concentrations Following treatment with Paeonia lactiflora and Glycyrrhiza uralensis in the Chinese herbal combination Shakuyaku-kanzo-to. One included infertile oligomenorrhoeic women with hyperandrogenism (n = 8) [58] and the other included women with oligo/amenorrhoea and PCOS (n = 34) [59]. 1. Reduced total and free testosterone [53, 58, 59].
Herbal remedies are found as dried extracts (teas, capsules or powders),glycerites or tinctures (alcohol extracts). You should never start any type of natural treatment for PCOS like herbs without talking to your doctor. Many people are under the misconception that because herbs are natural they cannot cause any damage to the body. This is incorrect. Herbs are very powerful and obviously impact the body strongly or you would not be considering them to treat physical symptoms and disorders. Most of the synthetic drugs on the market have base sources from herbs like Digitalis from foxglove. Herbs are like any other medication you might be taking which means they can also influence drugs and other herbs either positively or negatively. For example, some herbs can reduce the effectiveness of birth control pills (ued as a PCOS treatment) which could create some interesting surprises in your life.
More research is needed to clarify the complex pathophysiology of PCOS. No single test is currently available for its diagnosis. Additionally, once diagnosis is established, the options for treatment are of limited number and effectiveness because they target only the symptoms of PCOS. Finally, patients with PCOS have higher rates of metabolic complications, such as cardiovascular disease, but their impact on mortality is not clear. Therefore, more prospective epidemiologic studies on the topic are necessary.
Jump up ^ Legro, RS; Arslanian, SA; Ehrmann, DA; Hoeger, KM; Murad, MH; Pasquali, R; Welt, CK; Endocrine, Society (December 2013). "Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline". The Journal of Clinical Endocrinology and Metabolism. 98 (12): 4565–92. doi:10.1210/jc.2013-2350. PMC 5399492. PMID 24151290.