(changes in diet and exercise), it has been linked with lower body mass index and a reduction in menstrual problems. However, the use of metformin in women with PCOS should only be considered in patients with impaired glucose tolerance. Society and culture Because androgen excess is manifested in noticeable physical features (such as hirsutism), social stigma may be associated with it. Sports Current evidence-based studies show that unusually high levels of circulating testosterone are associated with increased athletic performance in women, unless they lack androgen sensitivity. However, controversy has emerged in the form of the claim that testosterone is not unlike any other physical parameter with reference to bestowing advantages or disadvantages on female athletes. Existing regulations throughout competitive sports are currently being refined to specifically address this particular claim. Following the case of South African athlete Caster Semenya, an athlete with a difference in sex development (DSD), the International Association of Athletics Federations introduced its hyperandrogenism regulations, which restricted women with high testosterone levels, whether the hormones were produced by ovaries, adrenals, or testes. These regulations replaced the earlier sex verification rules. Following a series of legal challenges, regulations called the Eligibility Regulations for the Female Classification (Athletes with Differences of Sexual Development) were released on 1 May 2019. These regulations apply only to athletes who have a DSD, high testosterone and virilization, and no longer include hyperandrogenism from non-DSD-related causes such as PCOS. Such DSDs, often seen in people who have a Y chromosome and testes, include 5α‐reductase deficiency, partial androgen insensitivity, and congenital adrenal hyperplasia. Social definition Cultural variation can define hyperandrogenism socially—apart from clinical and chemical definitions—to make some hair growth unacceptable even if it is considered clinically normal based on metrics like the Ferriman-Gallwey score. For example, only pubic and axillary hair may be tolerated in North American women, while other androgen-dependent hair such as growth on the upper lip, over the linea alba, on the thighs, and around the areola is not. Organizations Professional organizations such as the Androgen Excess and PCOS Society exist to promote the research, treatment, diagnosis, and prevention of such disorders and to educate the public and scientific community about them. See also Hypoandrogenism Hypergonadism Hypergonadotropic hypergonadism Hypogonadism Hyperestrogenism Hypoestrogenism Androgen-dependent condition References External links Endocrine gonad disorders Women's health Human female endocrine system Androgens and anabolic steroids Wikipedia medicine articles ready to translate Intersex variations