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<\/figure>\n<\/div>\n\n\nLH ( Luteinizing Hormone), ACTH (Adrenocorticotropic Hormone ), DHT (Dhydrotestosterone), ADT-G (Androsterone Glucuronide), 3\u03b1-DIOL-G (3\u03b1-Androstanedione Glucuronide) Erkeklik hormonlar\u0131n\u0131n (testosteron, dihidrotestosteron) b\u00fcy\u00fck bir k\u0131sm\u0131 b\u00f6brek \u00fcst\u00fc bezinde (Adrenal Gland) \u00fcretilen DHEA (Dehydroepiandrosterone) ve Androstenedione hormonlar\u0131n\u0131 hammadde olarak kullanarak k\u0131l k\u00f6kleri ve ya\u011f bezlerinin bulundu\u011fu deri gibi ayn\u0131 zamanda erkeklik hormonlar\u0131n\u0131n (testosteron, dihidrotestosteron) hedefi olan organlarda \u00fcretilirken ancak k\u00fc\u00e7\u00fck bir k\u0131sm\u0131 yumurtal\u0131k ve b\u00f6brek \u00fcst\u00fc bezinde \u00fcretilmektedir (8,9).<\/p>\n\n\n\n Kan dola\u015f\u0131m\u0131nda bulunan testosteron miktar\u0131 sadece yumurtal\u0131k ve b\u00f6brek \u00fcst\u00fc bezinden direk olarak sal\u0131nan miktar\u0131 g\u00f6stermektedir. Kad\u0131nlarda testosteron hormonunun b\u00fcy\u00fck k\u0131sm\u0131n\u0131n \u00fcretildi\u011fi deri, ya\u011f dokusu, meme gibi organlardan ancak k\u00fc\u00e7\u00fck bir miktar (%10) testosteron kan dola\u015f\u0131m\u0131na girmektedir(10).<\/p>\n\n\n Kan dola\u015f\u0131m\u0131na girmeyen testosteron hormonunun b\u00fcy\u00fck \u00e7o\u011funlu\u011fu ise 5- \u03b1 reduktaz (reductase) enzimi taraf\u0131ndan \u00fcretildi\u011fi k\u0131l k\u00f6klerinde t\u00fcylenme art\u0131\u015f\u0131na neden olan dihidrotestosteron (dhydrotestosterone) hormonuna d\u00f6n\u00fc\u015fmektedir(11,12,18). <\/p>\n\n\n\n Dihidrotestosteron hormonu testosteron hormonundan 10 kat daha g\u00fc\u00e7l\u00fc bir etkiye sahiptir(50).<\/mark><\/strong><\/p>\n\n\n\n Testosteron hormonunu dihidrotestosteron hormonuna d\u00f6n\u00fc\u015ft\u00fcren 5- \u03b1 reduktaz (reductase) enziminin 2 formu (isozyme) vard\u0131r(52,53). 5- \u03b1 reduktaz (reductase) tip 1 en \u00e7ok deri h\u00fccresinde (epidermis), k\u0131l k\u00f6klerinde, ya\u011f (sebaceous) bezlerinde ve ter bezlerinde bulunmaktad\u0131r. 5- \u03b1 reduktaz (reductase) tip 2 ise en \u00e7ok sa\u00e7l\u0131 deride bulunmaktad\u0131r(53,54,55). 5- \u03b1 reduktaz (reductase) enziminin etkinli\u011finde (activity) b\u00fcy\u00fck oranda anneden k\u0131z\u0131na genetik ge\u00e7i\u015f bulunmaktad\u0131r(51). Polikistik over sendromu olan kad\u0131nlar\u0131n bir k\u0131sm\u0131nda 5- \u03b1 reduktaz (reductase) tip 1 enziminin \u00fcretimini sa\u011flayan SRD5A1 geninin belirli b\u00f6lgelerinde genetik farkl\u0131l\u0131klar (variant) vard\u0131r. Bu genetik de\u011fi\u015fiklikler 5- \u03b1 reduktaz (reductase) tip 1 enziminin etkinli\u011fini (activity) artt\u0131rarak t\u00fcylenme art\u0131\u015f\u0131na neden olmaktad\u0131r(56,57,58).<\/p>\n\n\n\n Dihidrotestosteron hormonunun da testosteron hormonu gibi b\u00fcy\u00fck \u00e7o\u011funlu\u011fu (%90) kan dola\u015f\u0131m\u0131na girmemektedir. Kan dola\u015f\u0131m\u0131na girmeyen dihidrotestosteron hormonu \u00fcretildi\u011fi deri h\u00fccresinde bulunan k\u0131l k\u00f6klerinde t\u00fcylenme art\u0131\u015f\u0131na neden olmaktad\u0131r (12,13).<\/p>\n\n\n\n Deride (cilt) \u00fcretilen dihidrotestosteron (DHT) hormonunun b\u00fcy\u00fck \u00e7o\u011funlu\u011fu deri h\u00fccresini korumak amac\u0131yla UGT- enzimi ile herhangi bir hormon etkisi olmayan \u00fcr\u00fcnler (metabolit) olan 3 \u03b1- androstanediol glucuronide (3\u03b1 diol G) ve androsterone Glucuronide (ADT-G) d\u00f6n\u00fc\u015ferek deri h\u00fccresinden kan dola\u015f\u0131m\u0131na girmektedir(14,15,17). Kan dola\u015f\u0131m\u0131na kat\u0131lan 3 \u03b1- androstanediol glucuronide (3\u03b1 diol G) ve androsterone Glucuronide (ADT-G) idrar yolu ile v\u00fccuttan at\u0131lmaktad\u0131r(14, 15,16,17).<\/p>\n\n\n\n Kan dola\u015f\u0131m\u0131nda bulunan testosteron ve dihidrotestosteron sadece buz da\u011f\u0131n\u0131n g\u00f6r\u00fcnen k\u00fc\u00e7\u00fck k\u0131sm\u0131d\u0131r. K\u0131l k\u00f6klerinin bulundu\u011fu deri h\u00fccresinde \u00fcretilen kan dola\u015f\u0131m\u0131na girmeyen buz da\u011f\u0131n\u0131n g\u00f6r\u00fcnmeyen b\u00fcy\u00fck k\u0131sm\u0131 ise 3 \u03b1- androstanediol glucuronide (3\u03b1 diol G) ve androsterone Glucuronide (ADT-G) d\u00f6n\u00fc\u015ferek deri h\u00fccresinden kan dola\u015f\u0131m\u0131na girmektedir. Polikistik over sendromu\u2019nda erkeklik hormonlar\u0131n\u0131n miktar\u0131ndaki art\u0131\u015f\u0131 ve t\u00fcylenme art\u0131\u015f\u0131n\u0131 de\u011ferlendirirken buz da\u011f\u0131n\u0131n g\u00f6r\u00fcnmeyen k\u0131sm\u0131n\u0131 da unutmamam\u0131z gerekmektedir.<\/mark><\/strong><\/p>\n\n\n Polikistik over sendromu\u2019nda fazla kilolu ve \u015fi\u015fman olan veya normal kilolu fakat bel \u00e7evresi kal\u0131n (<\/a>erkek tipi ya\u011flanma)<\/a> olan kad\u0131nlar\u0131n b\u00fcy\u00fck \u00e7o\u011funlu\u011funda ins\u00fclin direnci vard\u0131r (19,20,21,22). \u0130ns\u00fclin direnci olan ki\u015filerde pankreas bu direnci yenmek i\u00e7in fazla miktarda ins\u00fclin \u00fcretir. Bunun sonucunda kan dola\u015f\u0131m\u0131nda bulunan ins\u00fclin miktar\u0131 artar (Hiperins\u00fclinemi). Polikistik over sendromu alt <\/a>gruplar\u0131n\u0131n (A,B,C) hepsinde ins\u00fclin direnci g\u00f6r\u00fclebilmektedir.<\/p>\n\n\n\n \u0130ns\u00fclin direncine ba\u011fl\u0131 olarak fazla miktarda \u00fcretilen ins\u00fclin hormonunun polikistik over sendromu olan kad\u0131nlarda t\u00fcylenme art\u0131\u015f\u0131na neden olan etki mekanizmalar\u0131 a\u015fa\u011f\u0131da belirtilmi\u015ftir;<\/strong><\/p>\n\n\n\n 1-<\/mark><\/strong>Kan dola\u015f\u0131m\u0131nda fazla miktarda bulunan \u0130ns\u00fclin hormonu do\u011frudan yumurtal\u0131\u011fa giderek yumurtal\u0131kta erkeklik hormonlar\u0131n\u0131n \u00fcretimini artt\u0131rmaktad\u0131r (hiperandrogenism)(23,24,25,26,27,28).<\/p>\n\n\n\n 2-<\/mark><\/strong>Kan dola\u015f\u0131m\u0131nda fazla miktarda bulunan ins\u00fclin hormonu beyinde yer alan hipofiz bezinde erkeklik hormonlar\u0131n\u0131n yumurtal\u0131kta yap\u0131lmas\u0131n\u0131 sa\u011flayan LH (luteinizing hormon) \u00fcretimini artt\u0131rmaktad\u0131r(29,30,31,32). LH (luteinizing hormon) miktar\u0131n\u0131n artmas\u0131 erkeklik hormonlar\u0131n\u0131n yap\u0131m\u0131n\u0131 artt\u0131rmaktad\u0131r (hiperandrogenism)(28,30,32,33). Yumurtal\u0131klarda erkeklik hormonlar\u0131 (androgen) teka h\u00fccrelerinde \u00fcretilmektedir(30,37). \u0130ns\u00fclin ve LH\u2019 n\u0131n teka h\u00fccrelerinde erkeklik hormonlar\u0131n\u0131n \u00fcretimini artt\u0131rmas\u0131n\u0131n yan\u0131nda polikistik over sendromu olan kad\u0131nlar\u0131n bir k\u0131sm\u0131nda hem teka h\u00fccrelerinin say\u0131s\u0131 fazla oldu\u011fu i\u00e7in hem de her bir teka h\u00fccresinde erkeklik hormonu \u00fcreten enzimin (CYP17 ) \u00fcretim kapasitesi fazla oldu\u011fu i\u00e7in (hyperactivity) daha fazla erkeklik hormonu \u00fcretilmektedir(29,30,37,38,39,40,41).<\/p>\n\n\n\n 3-<\/mark><\/strong>Karaci\u011ferde \u00fcretilen sex hormone binding globulin (SHBG) erkeklik hormonlar\u0131na ba\u011flanarak kan dola\u015f\u0131m\u0131nda serbest bulunan etkin formlar\u0131n (serbest testosteron) miktar\u0131n\u0131 azaltmaktad\u0131r(34,35). Kan dola\u015f\u0131m\u0131nda fazla miktarda bulunan ins\u00fclin hormonu sex hormone binding globulin (SHBG) \u00fcretimini azaltmaktad\u0131r(36).<\/p>\n\n\n\n V\u00fccutlar\u0131nda ya\u011f dokusu art\u0131\u015f\u0131 (adiposity) olan fazla kilolu, \u015fi\u015fman kad\u0131nlar ile normal kilolu fakat bel \u00e7evresi kal\u0131n (<\/em>erkek tipi ya\u011flanma)<\/em> olan kad\u0131nlar\u0131n b\u00fcy\u00fck \u00e7o\u011funlu\u011funda ins\u00fclin direnci nedeniyle artan ins\u00fclin hormonu karaci\u011ferde SHBG \u00fcretimini azaltarak kan dola\u015f\u0131m\u0131nda bulunan SHBG miktar\u0131n\u0131 azaltmaktad\u0131r (19,20,21,22,36,42,43,44,45).<\/p>\n\n\n\n Tiroid bezinin az \u00e7al\u0131\u015fmas\u0131 (Hypothyroidism) metabolizmay\u0131 yava\u015flatarak enerji t\u00fcketimini azalt\u0131r (v\u00fccut s\u0131cakl\u0131\u011f\u0131n\u0131n azalmas\u0131 gibi)(46). Enerji t\u00fcketiminin azalmas\u0131 kilo ve ya\u011f dokusu art\u0131\u015f\u0131na neden oldu\u011fu i\u00e7in SHBG miktar\u0131n\u0131 azalt\u0131r. Kan dola\u015f\u0131m\u0131nda SHBG miktar\u0131n\u0131n azalmas\u0131 erkeklik hormonlar\u0131n\u0131n serbest bulunan etkin formlar\u0131n\u0131n (serbest testosteron) miktar\u0131n\u0131 artt\u0131rmaktad\u0131r(47,49). Fazla kilolu kad\u0131nlarda oldu\u011fu gibi normal kilolu veya zay\u0131f kad\u0131nlarda da tiroid bezinin az \u00e7al\u0131\u015fmas\u0131 (Hashimoto\u2019s Thyroiditis) SHBG \u00fcretimini azaltarak t\u00fcylenme art\u0131\u015f\u0131na neden olabilmektedir(48).<\/mark><\/strong><\/p>\n\n\n\n Kan dola\u015f\u0131m\u0131nda bulunan sex hormone binding globulin (SHBG) miktar\u0131n\u0131n yar\u0131ya yak\u0131n\u0131n\u0131 anneden k\u0131z\u0131na genetik ge\u00e7i\u015f belirlemektedir (59). <\/p>\n\n\n\n Polikistik over sendromu olan kad\u0131nlar\u0131n bir k\u0131sm\u0131nda SHBG yap\u0131m\u0131n\u0131 sa\u011flayan genin belirli b\u00f6lgelerinde genetik farkl\u0131l\u0131klar (variant) vard\u0131r. Bu genetik de\u011fi\u015fikliklerin bir k\u0131sm\u0131 SHBG\u2019nin y\u0131k\u0131lmas\u0131n\u0131 azaltarak SHBG miktar\u0131n\u0131n artmas\u0131na neden oldu\u011fu i\u00e7in kan dola\u015f\u0131m\u0131nda serbest bulunan erkeklik hormonlar\u0131n\u0131n etkin formlar\u0131n\u0131n (serbest testosteron) miktar\u0131n\u0131 azaltmaktad\u0131r(60,64). B\u00f6ylece bu genetik de\u011fi\u015fiklikler t\u00fcylenme art\u0131\u015f\u0131na kar\u015f\u0131 koruyucu bir etki g\u00f6stermektedir. <\/p>\n\n\n\n Fakat, baz\u0131 genetik de\u011fi\u015fiklikler ise SHBG nin kan dola\u015f\u0131m\u0131nda bulunan miktar\u0131n\u0131 azaltarak t\u00fcylenme art\u0131\u015f\u0131na neden olmaktad\u0131r(61,62,63,64).<\/p>\n\n\n Erkeklik hormonlar\u0131 testosteron ve DHT (dihidrotestosteron) (dihydrotestosterone), erkeklik hormonlar\u0131n\u0131n hammaddesi DHEA (dehidroepiandrosteron)(dehydrotestosterone) ve erkeklik hormonlar\u0131n\u0131n y\u0131k\u0131m \u00fcr\u00fcnlerinin ADT-G (androsterone glucuronide) ve 3 \u03b1-diol-G ( 3 \u03b1-androstanediol glucuronide) kan dola\u015f\u0131m\u0131nda ve h\u00fccre i\u00e7inde (deri k\u0131l k\u00f6kleri ve ya\u011f bezleri) bulunan miktarlar\u0131n\u0131n da\u011f\u0131l\u0131m\u0131. Testosteron ve Dihidrotestosteron hormonlar\u0131n\u0131 g\u00f6steren mavi ve sar\u0131 dikd\u00f6rtgenlerin y\u00fckseklikleri bu maddelerin miktarlar\u0131 ile orant\u0131l\u0131d\u0131r.<\/em><\/strong><\/p>\n\n\n\n TEDAV\u0130;<\/strong><\/p>\n\n\n\n T\u00fcylenme art\u0131\u015f\u0131 tedavisine ba\u015flamadan \u00f6nce t\u00fcylenme art\u0131\u015f\u0131n\u0131n kayna\u011f\u0131n\u0131n yukar\u0131da anlatt\u0131\u011f\u0131m a\u015famalardan hangisi ya da hangileri oldu\u011fu belirlenmelidir.<\/mark><\/strong><\/p>\n\n\n\n Polikistik over sendromu olan kad\u0131nlarda epilasyon, a\u011fda, t\u0131ra\u015f gibi fiziksel y\u00f6ntemler t\u00fcylenme art\u0131\u015f\u0131 \u015fikayetinde ge\u00e7ici bir iyile\u015fme sa\u011flamakla birlikte, bu y\u00f6ntemlerle yap\u0131lan tedavi sonras\u0131nda t\u00fcylenme art\u0131\u015f\u0131 \u015fikayeti \u00e7o\u011funlukla tekrarlamaktad\u0131r. Bu durum fiziksel y\u00f6ntemlerin genellikle tekrar tekrar, d\u00fczensiz bir \u015fekilde kullan\u0131lmas\u0131na neden olmaktad\u0131r.<\/p>\n\n\n\n T\u00fcylenme art\u0131\u015f\u0131 tedavisinin kal\u0131c\u0131 olmas\u0131 i\u00e7in lazer ve i\u011fneli epilasyon gibi fiziksel y\u00f6ntemlerin t\u00fcylenme art\u0131\u015f\u0131n\u0131n nedeni bilinmeden kullan\u0131lmas\u0131 do\u011fru de\u011fildir(88,89,90).<\/mark><\/strong><\/p>\n\n\n\n Lazer ve foto epilasyon gibi fiziksel y\u00f6ntemler t\u00fcylenme art\u0131\u015f\u0131na neden olan erkeklik hormonlar\u0131 (testosteron, dihidrotestosteron) ve onlar\u0131n hammaddelerinde (DHEA, androstenedion) g\u00f6r\u00fclen art\u0131\u015f\u0131n (hiperandrogenism) tedavisi ile birlikte uyguland\u0131\u011f\u0131 zaman faydal\u0131 olmaktad\u0131r(88,89,90). Aksi taktirde epilasyonun etkisi az olmakta ve epilasyon sonras\u0131 t\u00fcylenme art\u0131\u015f\u0131 tekrarlamaktad\u0131r.<\/mark><\/strong><\/p>\n\n\n\n Polikistik over sendromu olan kad\u0131nlar\u0131n bir k\u0131sm\u0131nda lazer epilasyon veya foto epilasyon uygulanan b\u00f6lge ve onun \u00e7evresinde genellikle y\u00fcz ve boyun b\u00f6lgelerinde tam tersine daha fazla t\u00fcylenme art\u0131\u015f\u0131na (paradoxical hypertrichosis) neden olmaktad\u0131r(85,86,87)<\/strong>.<\/mark><\/p>\n\n\n\n Uzun etkili ve kal\u0131c\u0131 bir tedavi etkinli\u011finin olmamas\u0131na ve bacak damarlar\u0131n\u0131n p\u0131ht\u0131 ile t\u0131kanmas\u0131 (derin ven trombozu) ve ordan kopan p\u0131ht\u0131 par\u00e7as\u0131n\u0131n da akci\u011fer damarlar\u0131n\u0131 t\u0131kamas\u0131 (pulmoner emboli) ve meme kanseri ihtimalini artt\u0131rmas\u0131 gibi bir k\u0131sm\u0131 hayati tehlikeye sahip olan bir \u00e7ok yan etkiye sahip olmas\u0131na ra\u011fmen do\u011fum kontrol haplar\u0131 t\u00fcylenme art\u0131\u015f\u0131 tedavisinde halen yayg\u0131n olarak kullan\u0131lmaktad\u0131r(65,66,67,68,69,70,71,72).<\/p>\n\n\n\n Polikistik over sendromu\u2019nda t\u00fcylenme art\u0131\u015f\u0131 tedavisinde do\u011fum kontrol hap\u0131 kullan\u0131lmas\u0131 do\u011fru de\u011fildir.<\/mark><\/strong><\/p>\n\n\n\n Tedavi Y\u00f6ntemleri;<\/strong><\/p>\n\n\n\n Polikistik over sendromu\u2019nda t\u00fcylenme art\u0131\u015f\u0131 tedavisinde en g\u00fc\u00e7l\u00fc erkeklik hormonu olan dihidrotestosteron hormonuna d\u00f6n\u00fc\u015fen erkeklik hormonlar\u0131n\u0131n (testosteron, androstenedione, DHEAS) etkinli\u011finin ve miktar\u0131n\u0131n azalt\u0131lmas\u0131, dihidrotestosteron hormonuna d\u00f6n\u00fc\u015f\u00fcm\u00fcn azalt\u0131lmas\u0131 ve Sex Hormon Binding Globulin miktar\u0131n\u0131n artt\u0131r\u0131lmas\u0131 sonucunda kan dola\u015f\u0131m\u0131nda serbest bulunan erkeklik hormonlar\u0131n\u0131n etkin formlar\u0131n\u0131n (serbest testosteron) miktar\u0131n\u0131n azalt\u0131lmas\u0131 tedavinin temel amac\u0131d\u0131r.<\/p>\n\n\n\n 1-<\/mark><\/strong>\u0130ns\u00fclin direnci olan kad\u0131nlarda ins\u00fclin duyarl\u0131l\u0131\u011f\u0131n\u0131n ila\u00e7 tedavisi ile artt\u0131r\u0131lmas\u0131na ba\u011fl\u0131 olarak kan dola\u015f\u0131m\u0131nda bulunan ins\u00fclin miktar\u0131n\u0131n azalmas\u0131 yumurtal\u0131kta fazla miktarda \u00fcretilen erkeklik hormonlar\u0131n\u0131 (androstenedione, testosteron) azaltmaktad\u0131r(73,74). \u0130ns\u00fclin direncinin azalmas\u0131 ayn\u0131 zamanda karaci\u011ferde \u00fcretilen SHBG miktar\u0131n\u0131 artt\u0131rmakta ve erkeklik hormonlar\u0131n\u0131n serbest dola\u015fan etkin formlar\u0131n\u0131n (serbest testosteron ) miktar\u0131n\u0131n azalmas\u0131na neden olmaktad\u0131r(73,74).<\/p>\n\n\n\n 2-<\/mark><\/strong>Kan dola\u015f\u0131m\u0131nda bulunan erkeklik hormonlar\u0131n\u0131n bir k\u0131sm\u0131 k\u0131l k\u00f6klerinde al\u0131c\u0131lara (androgen receptor) tutunarak t\u00fcylenme art\u0131\u015f\u0131na neden olmaktad\u0131r. Erkeklik hormonlar\u0131n\u0131n k\u0131l k\u00f6klerindeki al\u0131c\u0131lara tutunmas\u0131n\u0131n engellenmesi (androgen receptor antagonist) di\u011fer bir tedavi se\u00e7ene\u011fidir(75,76,77). Bu ama\u00e7la kullan\u0131lan ila\u00e7lar\u0131n (androgen receptor antagonist) do\u011fum kontrol haplar\u0131 gibi hayati tehlikeye sahip yan etkileri ( bacak damarlar\u0131n\u0131n p\u0131ht\u0131 ile t\u0131kanmas\u0131 ve ordan kopan p\u0131ht\u0131 par\u00e7as\u0131n\u0131n da akci\u011fer damarlar\u0131n\u0131 t\u0131kamas\u0131 ve meme kanseri) yoktur(81,82,83).<\/p>\n\n\n\n 3-<\/mark><\/strong>Al\u0131c\u0131lara (receptor) tutunarak deri h\u00fccresine giren testosteron ile deri h\u00fccresinde \u00fcretilen testosteron hormonunun b\u00fcy\u00fck \u00e7o\u011funlu\u011fu 5- \u03b1 reduktaz (reductase) enzimi taraf\u0131ndan k\u0131l k\u00f6klerinde t\u00fcylenme art\u0131\u015f\u0131na neden olan dihidrotestosteron (dhydrotestosterone) hormonuna d\u00f6n\u00fc\u015fmektedir(11,12,18). 5- \u03b1 reduktaz (reductase)enziminin bu etkisinin engellenmesi ( 5- \u03b1 reductase inhibitor) de bir tedavi se\u00e7ene\u011fidir(74,76,77). Bu ama\u00e7la kullan\u0131lan ila\u00e7lar\u0131n ( 5-\u03b1 reductase inhibitor) do\u011fum kontrol haplar\u0131 gibi hayati tehlikeye sahip yan etkileri ( bacak damarlar\u0131n\u0131n p\u0131ht\u0131 ile t\u0131kanmas\u0131 ve ordan kopan p\u0131ht\u0131 par\u00e7as\u0131n\u0131n da akci\u011fer damarlar\u0131n\u0131 t\u0131kamas\u0131 ve meme kanseri) yoktur(84).<\/p>\n\n\n\n 4-<\/mark><\/strong>Polikistik over ameliyat\u0131 miktar\u0131 ve etkinli\u011fi artm\u0131\u015f olan erkeklik hormonlar\u0131n\u0131n (testosteron, dihidrotestosteron) etkinli\u011finin ve miktar\u0131n\u0131n azalt\u0131lmas\u0131 ve ins\u00fclin duyarl\u0131l\u0131\u011f\u0131n\u0131n artmas\u0131 sonucunda SHBG miktar\u0131n\u0131 artt\u0131rarak etki g\u00f6steren bir tedavi se\u00e7ene\u011fidir(78,79,80).<\/p>\n\n\n 5-<\/mark><\/strong>D\u00fczenli olarak yap\u0131lan spor (y\u00fcr\u00fcy\u00fc\u015f ve y\u00fczme gibi) kilodan ba\u011f\u0131ms\u0131z olarak yani ki\u015fi fazla kilolu olsa dahi v\u00fccutta bulunan ya\u011f dokusunun yerini kas dokusunun almas\u0131n\u0131 sa\u011flar. Ya\u011f dokusunun azalmas\u0131 hem erkeklik hormonlar\u0131n\u0131n \u00fcretimini azaltarak, hem de SHBG miktar\u0131n\u0131 artt\u0131rarak etki g\u00f6steren yard\u0131mc\u0131 bir tedavi se\u00e7ene\u011fidir.<\/p>\n\n\n\n 6-<\/mark><\/strong>Fazla miktarda t\u00fcketilen karbonhidratlar proteinlerden farkl\u0131 olarak yumurtal\u0131k ve b\u00f6brek \u00fcst\u00fc bezi gibi erkeklik hormonlar\u0131n\u0131n \u00fcretildi\u011fi b\u00f6lgelerden biri olan ya\u011f dokusu olarak depolanmaktad\u0131r. Bu nedenlerle karbonhidrat miktar\u0131 d\u00fc\u015f\u00fck, buna kar\u015f\u0131l\u0131k protein miktar\u0131 fazla olan besinleri t\u00fcketilmesi hem erkeklik hormonlar\u0131n\u0131n \u00fcretimini d\u00fc\u015f\u00fcrerek, hem de SHBG miktar\u0131n\u0131 artt\u0131rarak etki g\u00f6steren yard\u0131mc\u0131 bir tedavi se\u00e7ene\u011fidir.<\/p>\n\n\n\n Yukar\u0131da anlatt\u0131\u011f\u0131m tedavi se\u00e7eneklerinden hangisinin uygulanaca\u011f\u0131 t\u00fcylenme art\u0131\u015f\u0131n\u0131n kayna\u011f\u0131na, \u015fiddetine, s\u00fcresine, v\u00fccut da\u011f\u0131l\u0131m\u0131na ve ba\u015fka \u015fikayetlerin (sa\u00e7 d\u00f6k\u00fclmesi, sivilce,\u00a0adet d\u00fczensizli\u011fi) birlikte olup olmamas\u0131na ba\u011fl\u0131 olarak ki\u015fiden ki\u015fiye g\u00f6re de\u011fi\u015fmektedir. \u00c7o\u011funlukla\u00a0birden fazla tedavi se\u00e7ene\u011fi birlikte uygulanmaktad\u0131r.<\/strong><\/mark><\/p>\n\n\n\n Kaynaklar<\/strong><\/p>\n\n\n\n 1-Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome;towards a rational approach. In: Dunaif A, Givens JR, Haseltine F, editors. Polycystic ovary syndrome. Vol. 1992. Boston, MA: Black-well Scientific; 1992. pp. 377\u201384.<\/p>\n\n\n\n 2-Rotterdam ESHRE\/ASRM-sponsored PCOS Consencus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks relatedto polycystic ovary syndrome. Fertil Steril. 2004 Jan;81(1):19-25.<\/p>\n\n\n\n 3- Rotterdam ESHRE\/ASRM-sponsored PCOS Consencus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Hum Reprod. 2004 Jan;19(1):41-7.<\/p>\n\n\n\n 4-The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Azziz R, Dewailly D, Diamanti-Kandarakis E, Escobar-Morrreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF. 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Hogeveen KN, Cousin P, Pugeat M, Dewailly D, Soudan B, Hammond GL. J Clin Invest. 2002 Apr;109(7):973-81<\/p>\n\n\n\n 62-Influence of SHBG gene pentanucleotide TAAAA repeat and D327N polymorphism on serum sex hormone-binding globulin concentration in hirsute women. Cousin P, Calemard-Michel L, Lejeune H, Raverot G, Yessaad N, Emptoz-Bonneton A, Morel Y, Pugeat M.J Clin Endocrinol Metab. 2004 Feb;89(2):917-24<\/p>\n\n\n\n 63-Common Variants in the Sex Hormone-Binding Globulin (SHBG) Gene Influence SHBG Levels in Women with Polycystic Ovary Syndrome. Abu-Hijleh TM, Gammoh E, Al-Busaidi AS, Malalla ZH, Madan S, Mahmood N, Almawi WY. Ann Nutr Metab. 2016;68(1):66-74.<\/p>\n\n\n\n 64-Association of anthropometric, androgenic and insulin-related features with polymorphisms in exon 8 of SHBG gene in women with polycystic ovary syndrome. Hac\u0131hanefio\u011flu B, Aybey B, Hakan \u00d6z\u00f6n Y, Berkil H, Kar\u015f\u0131da\u011f K. Gynecol Endocrinol. 2013 Apr;29(4):361-4.<\/p>\n\n\n\n 65-Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis. Bird ST, Hartzema AG, Brophy JM, Etminan M, Delaney JA. CMAJ.\u00e7 2013 Feb 5;185(2):E115-20.<\/p>\n\n\n\n 66-Combined hormonal contraception and the risk of venous thromboembolism: a guideline. Practice Committee of the American Society for Reproductive Medicine. Fertil Steril. 2017 Jan;107(1):43-51.<\/p>\n\n\n\n 67-Different combined oral contraceptives and the risk of venous thrombosis:systematic review and network meta-analysis. Stegeman BH, de Bastos M, Rosendaal FR, van Hylckama Vlieg A, Helmerhorst FM, Stijnen T, Dekkers OM. BMJ. 2013 Sep 12;347:f5298.<\/p>\n\n\n\n 68-Pills-related severe adverse events: A case report in Taiwan. Chen CH, Chin HY et al. Taiwan J Obstet Gynecol . 2016 Aug;55(4):588-90.<\/p>\n\n\n\n 69-Oral contraceptives and breast cancer risk among younger women. Brinton LA, Daling JR, Liff JM et al. J Nath Cancer Inst. 1995 Jun 7;87(11):827-35.<\/p>\n\n\n\n 70-Contemporary Hormonal Contraception and the Risk of Breast Cancer. M\u00f8rch LS, Skovlund CW, Hannaford PC, Iversen L, Fielding S, Lidegaard \u00d8. N Engl J Med. 2017 Dec 7;377(23):2228-2239.<\/p>\n\n\n\n 71-Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies.Collaborative Group on Hormonal Factors in Breast Cancer.Lancet. 1996 Jun 22;347(9017):1713-27.<\/p>\n\n\n\n 72-Breast cancer among young U.S. women in relation to oral contraceptive use. White E, Malone KE, Weiss NS, Daling JR. J Natl Cancer Inst. 1994 Apr 6;86(7):505-14.<\/p>\n\n\n\n 73-Clinical review: Insulin sensitizers for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials. Cosma M, Swiglo BA, Flynn DN, Kurtz DM, Labella ML, Mullan RJ, Elamin MB, Erwin PJ, Montori VM. J Clin Endocrinol Metab. 2008 Apr;93(4):1135-42.<\/p>\n\n\n\n 74- Treatment Options for Hirsutism: A Systematic Review and Network Meta- Analysis . Barrionuevo P, Nabhan M, Altayar O, Wang Z, Erwin PJ, Asi N, Martin KA, Murad MH. J Clin Endocrinol Metab. 2018 Apr 1;103(4):1258-1264.<\/p>\n\n\n\n 75-The endocrine effects of spironolactone used as an antiandrogen. Young RL, Goldzieher JW, Elkind-Hirsch K. Fertil Steril. 1987 Aug;48(2):223-8.<\/p>\n\n\n\n 76-A systematic review of commonly used medical treatments for hirsutism in women. Koulouri O, Conway GS. Clin Endocrinol (Oxf). May;68(5):800-5.<\/p>\n\n\n\n 77-Comparison of spironolactone, flutamide, and finasteride efficacy in the treatment of hirsutism: a randomized, double blind, placebo-controlled trial. Moghetti P, Tosi F, Tosti A, Negri C, Misciali C, Perrone F, Caputo M, Muggeo M, Castello R. J Clin Endocrinol Metab. 2000 Jan;85(1):89-94.<\/p>\n\n\n\n 78-Long term follow-up of patients with polycystic ovarian syndrome after laparoscopic ovarian drilling: clinical outcome. Amer SA, Gopalan V, Li TC, Ledger WL, Cooke ID. Hum Reprod. 2002 Aug;17(8):2035-42.<\/p>\n\n\n\n 79-Effects of laparoscopic ovarian drilling on adrenal steroids in polycystic ovary syndrome patients with and without hyperinsulinemia. Saleh A, Morris D, Tan SL, Tulandi T. Fertil Steril. 2001 Mar;75(3):501-4.<\/p>\n\n\n\n 80-Success of laparoscopic ovarian wedge resection is related to obesity, lipid profile, and insulin levels. Duleba AJ, Banaszewska B, Spaczynski RZ, Pawelczyk L. Fertil Steril. 2003 Apr;79(4):1008-14.<\/p>\n\n\n\n 81-Spironolactone and risk of incident breast cancer in women older than 55 years: retrospective, matched cohort study. Mackenzie IS, Macdonald TM, Thompson A, Morant S, Wei L. BMJ. 2012 Jul 13;345:e4447.<\/p>\n\n\n\n 82-Spironolactone use and risk of incident cancers: a retrospective, matched cohort study. Mackenzie IS, Morant SV, Wei L, Thompson AM, MacDonald TM. Br J Clin Pharmacol. 2017 Mar;83(3):653-663.<\/p>\n\n\n\n 83-Spironolactone use and the risk of breast and gynecologic cancers. Biggar RJ, Andersen EW, Wohlfahrt J, Melbye M. Cancer Epidemiol. 2013 Dec;37(6):870-5.<\/p>\n\n\n\n 84-Adverse Effects and Safety of 5-alpha Reductase Inhibitors (Finasteride, Dutasteride): A Systematic Review. Hirshburg JM, Kelsey PA, Therrien CA, Gavino AC, Reichenberg JS. J Clin Aesthet Dermatol. 2016 Jul;9(7):56-62.<\/p>\n\n\n\n 85-Is paradoxical hair growth caused by low-level radiant exposure by home-use laser and intense pulsed light devices? Town G, Bjerring P. J Cosmet Laser Ther. 2016 Oct;18(6):355-62.<\/p>\n\n\n\n 86-Paradoxical effect after IPL photoepilation. Moreno-Arias G, Castelo-Branco C, Ferrando J. Dermatol Surg. 2002 Nov;28(11):1013-6; discussion 1016.<\/p>\n\n\n\n 87-Paradoxical hypertrichosis after laser therapy: a review. Desai S , Mahmoud BH, Bhatia AC, Hamzavi IH. Dermatol Surg. 2010 Mar;36(3):291-8.<\/p>\n\n\n\n 88-Laser hair reduction in the hirsute patient: a critical assessment. Sanchez LA, Perez M, Azziz R. Hum Reprod Update. 2002 Mar-Apr;8(2):169-81.<\/p>\n\n\n\n 89-Laser hair removal in women with polycystic ovary syndrome. McGill DJ, Hutchison C, McKenzie E, McSherry E, Mackay IR. J Plast Reconstr Aesthet Surg. 2007;60(4):426-31.<\/p>\n\n\n\n 90-Laser-assisted hair removal for facial hirsutism in women: A review of evidence. Lee CM. J Cosmet Laser Ther. 2018 Jun;20(3):140-144.<\/p>\n\n\n\n <\/p>\n","protected":false},"excerpt":{"rendered":" Erkeklerde g\u00f6r\u00fcld\u00fc\u011f\u00fc gibi b\u0131y\u0131k, \u00e7ene, favori, boyun, ense, g\u00f6\u011f\u00fcs aras\u0131, g\u00f6\u011f\u00fcs ucu, bel, omuz, s\u0131rt, kar\u0131n, kol ve bacak b\u00f6lgelerinde bulunan k\u0131llar\u0131n miktar\u0131nda art\u0131\u015f, koyula\u015fma, kal\u0131nla\u015fma ve sertle\u015fme olmas\u0131 polikistik over sendromu olan kad\u0131nlar\u0131n bir k\u0131sm\u0131nda erkeklik hormonlar\u0131n\u0131n (testosteron, dihidrotestosteron) miktar\u0131nda art\u0131\u015f ve erkeklik hormonlar\u0131na ba\u011flanarak onlar\u0131 etkisiz hale getiren Sex Hormone Binding Globulin (SHBG) miktar\u0131ndaki azalmaya […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-6463","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/pages\/6463","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/comments?post=6463"}],"version-history":[{"count":44,"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/pages\/6463\/revisions"}],"predecessor-version":[{"id":10800,"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/pages\/6463\/revisions\/10800"}],"wp:attachment":[{"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/media?parent=6463"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Erkeklerde g\u00f6r\u00fcld\u00fc\u011f\u00fc gibi b\u0131y\u0131k, \u00e7ene, favori, boyun, ense, g\u00f6\u011f\u00fcs aras\u0131, g\u00f6\u011f\u00fcs ucu, bel, omuz, s\u0131rt, kar\u0131n, kol ve bacak b\u00f6lgelerinde bulunan k\u0131llar\u0131n miktar\u0131nda art\u0131\u015f, koyula\u015fma, kal\u0131nla\u015fma ve sertle\u015fme olmas\u0131 polikistik over sendromu olan kad\u0131nlar\u0131n bir k\u0131sm\u0131nda erkeklik hormonlar\u0131n\u0131n (testosteron, dihidrotestosteron) miktar\u0131nda art\u0131\u015f ve erkeklik hormonlar\u0131na ba\u011flanarak onlar\u0131 etkisiz hale getiren Sex Hormone Binding Globulin (SHBG) miktar\u0131ndaki azalmaya ba\u011fl\u0131 olarak ortaya \u00e7\u0131kmaktad\u0131r
(1,2,3,4,5,6,7)<\/mark><\/strong><\/p>\n\n\n![\"\"](\"https:\/\/polikistikover.net\/yeni\/wp-content\/uploads\/2025\/09\/image-3.png\")
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<\/em><\/strong><\/p>\n\n\n\n![\"\"](\"https:\/\/polikistikover.net\/yeni\/wp-content\/uploads\/2025\/09\/image-4.png\")
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Y<\/em><\/strong>umurtal\u0131klar\u0131n ve b\u00f6brek \u00fcst\u00fc bezlerinin kan dola\u015f\u0131m\u0131nda ve h\u00fccre i\u00e7inde (deride k\u0131l k\u00f6kleri ve ya\u011f bezleri) bulunan testosteron miktarlar\u0131na olan katk\u0131lar\u0131<\/strong><\/em><\/p>\n\n\n\n![\"\"](\"https:\/\/polikistikover.net\/yeni\/wp-content\/uploads\/2025\/09\/image-30.png\")
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LH (Luteinizing Hormone), SHBG (Sex Hormone Binding Globulin)<\/em><\/strong><\/p>\n\n\n\n![\"\"](\"https:\/\/polikistikover.net\/yeni\/wp-content\/uploads\/2025\/10\/image-12.png\")
<\/figure>\n<\/div>\n\n\n![\"\"](\"https:\/\/polikistikover.net\/yeni\/wp-content\/uploads\/2025\/09\/image-32.png\")
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