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Elevated insulin levels can drive excess androgen production, which in turn contributes to irregular ovulation and other symptoms of PCOS ( 9 )

Setoyama D, Lee HY, Moon JS, Tian J, Kang YE, Lee JH, et al

Despite that, those KO mice developed and grew normally, and their skeletal changes were minimal (3), suggesting that local IGF-I production is sufficient for supporting general growth and skeletal development