Exercise improved testosterone, insulin resistance, and cholesterol in women with PCOS, without any weight loss: a randomized controlled trial of combined strength and cardio training

The numbers that matter

Can we actually trust this?

This is a true randomized controlled trial, and a well-run one. Participants were assigned to groups using a computer-generated sequence concealed in sealed, opaque envelopes, which is exactly the kind of rigorous randomization that prevents bias from creeping in. Every single participant completed the study, with zero dropouts. The exercise was supervised and the intensity was monitored with heart rate tracking, so we know the training actually happened as described.

The honest caveats: this is a small study (30 women, 15 in each group), and it was short (8 weeks). Small, short studies can detect real effects, but they need to be repeated in larger groups over longer periods before we treat the findings as settled. The researchers say this themselves. So the honest read is: this is a promising, rigorously-run study that adds to a growing body of evidence that exercise helps PCOS, with one especially encouraging finding about weight that deserves attention.

Does this apply to you?

This study is most relevant if:

• You have PCOS confirmed by Rotterdam criteria
• You are between 18 and 40 years old
• You are in the overweight or obese range (average BMI was about 30)
• You're able to do moderate strength and cardio exercise

Why this matters

If you have PCOS, you have almost certainly been told to lose weight. It's the default advice, handed out in nearly every appointment, often before anything else. And it's advice that can feel both impossible and demoralizing, especially because PCOS itself makes weight loss harder.

This study matters because it quietly dismantles the assumption underneath all of that advice.

The women who trained got meaningfully better on the markers that actually drive PCOS symptoms. Their testosterone dropped, which matters because elevated testosterone is what fuels acne, excess hair growth, and hair thinning. Their free androgen index dropped, which is an even more sensitive measure of active testosterone. Their insulin and insulin resistance dropped, and their insulin sensitivity improved, which matters enormously because insulin resistance sits at the root of so much of PCOS. Their cholesterol improved.

And their weight stayed essentially the same.

That last part is not a disappointing footnote. It's the whole point. It means the exercise was improving their hormones and their metabolic health directly, not as a downstream side effect of shrinking the number on the scale. For anyone who has been made to feel that nothing counts until they lose weight, this is a genuinely different message: your body responds to movement in ways that have nothing to do with weight, and those responses are real, measurable, and meaningful. And the benefits of movement aren't only physical: a separate trial found yoga eased PCOS-related anxiety better than conventional exercise.

To be clear about what didn't change: SHBG, fasting glucose, triglycerides, HDL cholesterol, and inflammation markers didn't shift significantly in eight weeks. Not everything moved. But the things that moved are among the most important drivers of how PCOS actually feels day to day. And the same weight-independent pattern shows up with food: a study of 224 women linked a Mediterranean diet to lower testosterone even after accounting for body weight.

If you want to try this

1. The program combined strength training and cardio, done back to back.

   This wasn't just cardio, and it wasn't just lifting. The women did their strength work first, then their cardio, in the same session. The combination is likely part of why the results were so strong.

2. Strength training: 8 exercises, 3 times a week.

   The study used bench press, barbell curl, lying triceps press, lat pulldown, leg press, leg extension, lying leg curl, and standing calf raise, a mix that covers all the major muscle groups. They did 3 sets of 10–16 reps. If you're new to this, the specific exercises matter less than the principle: hit your major muscle groups with resistance a few times a week.

3. Cardio: running, building from 25 to 40 minutes.

   After strength work, the women ran on a treadmill at 60–70% of their target heart rate. If running isn't your thing, brisk walking, cycling, or the elliptical at a moderate, slightly-out-of-breath pace works on the same principle.

4. Start moderate and progress gradually.

   This is the key to the whole protocol. In week one, the women trained at lower intensity (50% effort on strength, 60% on cardio) for shorter durations. Every week or two, they nudged the intensity and duration up, reaching 70% effort and 40-minute sessions by week eight. Starting where you are and building slowly is how you avoid injury and actually stick with it.

5. Take the weight pressure off.

   The single most freeing takeaway from this study: you can stop using the scale as your only measure of progress. Track how you feel, track your symptoms, track your strength and stamina improving. Those are the things changing under the surface, even when your weight doesn't.

FAQ

Can exercise help PCOS even if I don't lose weight?

Yes. In this study, women improved their testosterone, insulin resistance, and cholesterol through eight weeks of combined strength and cardio training, even though their weight and BMI didn't significantly change. The exercise improved their hormones and metabolic health directly, independent of weight loss.

What's the best type of exercise for PCOS?

This study used a combination of strength training and cardio done together, three times a week, and found significant hormonal and metabolic improvements. The researchers suggest the combination may be more effective than either strength or cardio alone, though more research is needed to confirm the ideal mix.

How long does it take for exercise to improve PCOS symptoms?

In this study, measurable improvements in testosterone, insulin, and cholesterol appeared after just eight weeks of training three times a week. Keep in mind that some markers (like SHBG and inflammation) didn't change in that window, so a longer commitment may be needed for fuller effects.

What is insulin resistance, and why does it matter for PCOS?

Insulin resistance is when your body's cells stop responding well to insulin, so your body produces more of it to compensate. In PCOS, this excess insulin drives your ovaries to make more testosterone, which fuels symptoms like acne, excess hair growth, and irregular cycles. Reducing insulin resistance (which exercise did in this study) targets PCOS closer to its root.

Study at a glance

Title

Modulation of hormonal, metabolic, inflammatory and oxidative stress biomarkers in women with polycystic ovary syndrome following combined (resistant and endurance) training: a randomized controlled trial

Authors

Nasiri M, Monazzami A, Alavimilani S, Asemi Z

Journal

BMC Endocrine Disorders, 2024

Volume

25(1); 1

DOI

10.1186/s12902-024-01793-0

Design

Parallel randomized controlled clinical trial

Setting

Imam Reza Hospital, Kermanshah, Iran

Sample

n = 30 women with PCOS (15 combined training, 15 control), ages 18–40, average BMI ~30

Follow-up

8 weeks

Intervention

8-week combined resistance + endurance training, 3x/week, progressive intensity (strength 50–70% 1RM; cardio 60–70% target heart rate) vs. no-exercise control