PCOS and weight loss — is this something that can only be cured with medication?

Hello everyone,

So for context, I recently got diagnosed with PCOS. I posted this in r/PCOS as well but I thought I should post this here too. My symptoms included:

• extreme fatigue
• sudden weight gain
• cystic acne
• unwanted hair growth (esp arms, neck, sideburns, stomach)

I am severely vitamin D deficient 4 ng/dL (range is 12-50 ng/dL). Because of this I have severe joint pain to the point where anything beyond walking is unbearably painful. I’ve been on vitamin d for 6 months and the level hasn’t risen. Doctor is trying a new type of vitamin d for me to take daily, and hopefully will have results.

I have slightly elevated cortisol, but nothing severe enough to suggest a tumor or Cushings. To be on the safe side, endo did a 24 urine and suppression blood test and am waiting on results.

Medication wise, I am currently on birth control. I was in spironolactone before but it did not benefit me even after taking it for a year, and my doctor is wary of me being on spiro and bc at the same time because of a family history of breast cancer (my mom got it at age 32).

Relevant labs: - TgAb: 2, above high normal (ref <or = IU/ml) - ACTH: 63, above high normal (ref 6-50 pg/ml) - Cortisol, total: 23.4 above high normal(ref 4-22 mcg/dL) - DHEA S: 410, above high normal (ref 18-390 mcg/dL) - Testosterone, total, ms: 28, normal (ref 2-45 ng/dL) - Testosterone, free: 1.4 normal(ref 0.2-5 pg/ml) - Glucose: 124 above high normal (ref 65-99 mg/dL) - Fasting glucose: 6.3 above high normal (ref 4.2–5.3 mmol/L) - Cholesterol: 220 above high normal (ref 0-199mg/dL) - LDL Calculated: 140 above high normal (ref 138 mg/dL)

I’m most concerned about the weight gain right now. I am 23 years old, 5”8 and 170 lbs. I know this is only slightly overweight, and I don’t look particularly overweight, but I have been slim my entire life until now. My symptoms kind of crept up on me two years ago. I went from 135 lbs to 170. I have always been active, I used to do HIIT and weightlifting, but because of my symptoms it’s been too painful to do those things anymore. However, as painful as it is, I make an effort to walk 4-5 miles every morning.

I’ve also always been very conscious of what I eat and I eat clean 90% of the time. I rarely drink alcohol, and I barely eat sugar (maybe I’ll have a slice of cake on a friend’s birthday but that’s about it) and avoid sugary drinks like the plague. I have also always tracked my caloric intake religiously. With the onset of these symptoms, my appetite started to decrease as well and I started to eat less than I should be. I eat 1000 calories or less a day. I used to eat around 1200 - 1400. I know this isn’t considered healthy, but I can barely stomach food for some reason.

Here’s what I eat on an average day:

Breakfast: 1 boiled egg, tomato and avocado with lemon juice. 1 cup black coffee Lunch: 1 1/2 cups salad with tofu, arugula, tomatoes, and egg. Half a Grapefruit on the side Dinner: baked salmon filet, half cup of brown rice

I weigh my food for the most accuracy, and I use salt sparingly. I also have always done intermittent fasting (9am - 5pm window).

Anyway, logically, being in a caloric deficit and eating healthy would result in weight loss, right? I’m stumped and so are my doctors. I am so scared of developing type 2 diabetes as it runs in my family and I feel like I’m heading that way. I have signs of insulin resistance as well. My endo just prescribed me metformin and is hoping that this will help, but I’m not too hopeful. Am I doing something wrong? Any insight would be helpful.

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