Diets · Metabolic & Cardiometabolic
ketogenic diet improves insulin resistance and androgen markers in PCOS
In plain terms: Does the ketogenic diet improve PCOS markers like insulin resistance and high testosterone?
Part of: 🥗 ketogenic diet
Yes in the short term — keto lowers weight, fasting insulin/HOMA-IR and free testosterone while raising SHBG in overweight PCOS, but evidence is low-to-moderate certainty and largely weight-loss-mediated.
📅 Last reviewed: 2026-07-15 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: All trials, pooled (Meta-analysis)
How the studies fall
What the evidence shows
In overweight women with polycystic ovary syndrome, ketogenic diets lower weight, fasting insulin and free testosterone and raise sex-hormone-binding globulin, pooled across 11 to 12 trials and reproduced in randomised comparisons against moderate-carbohydrate and Mediterranean diets. The trials are short, so durability beyond a few months is untested, and weight loss explains much of it.
The evidence (7)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Diha AM, Uddin MSS, Anha KM, Bekele FD, Naima J, Al-Khulaifi AAS, Nassar AA, Huq MS 2026 · Cureus | observational | supports | low | Systematic review of 14 studies (643 women): KD improved insulin sensitivity (fasting insulin, HOMA-IR), lowered total/free testosterone, raised SHBG and normalized LH/FSH, at low-to-moderate certainty. |
| Tosatti JAG, Magalhães FMV, Gomes KB 2026 · Br J Nutr | meta-analysis | supports | moderate | Meta-analysis of 11-12 clinical trials found very-low-carb ketogenic diet significantly reduced weight and improved metabolic/hormonal outcomes in women with PCOS. |
| Tsushima Y, Nachawi N, Pantalone KM, Griebeler ML, Alwahab UA 2024 · Frontiers in nutrition | observational | mixed | low | Retrospective n=30 PCOS keto ≥3mo: 100% regained regular menses, 55.6% pregnancy rate; no HOMA-IR/testosterone numbers given |
| Sharifi M, Saber A, Moludi J, Salimi Y, Jahan-Mihan A 2024 · Nutrition journal | RCT | supports | moderate | Keto vs portfolio-moderate-carb RCT, n=40 PCOS: both arms ↓FBG/insulin/LH/free-T/DHEA-s; keto>PMCD for BMI & LH |
| Paskaleva IN, Kaleva NN, Dimcheva TD, Ivanov IS 2026 · Children (Basel, Switzerland) | observational | supports | low | Subgroup 8/58 girls w/ PCOS: testosterone ↓, menses restored; whole-cohort insulin ↓ p<0.0001 (4mo keto) |
| Pandurevic S, Mancini I, Mitselman D, Magagnoli M, Teglia R, Fazzeri R, Dionese P, Cecchetti C, Caprio M, Moretti C, Sicinska J, Agostini A, Gazineo D, Godino L, Sajoux I, Fanelli F, Meriggiola CM, Pagotto U, Gambineri A 2023 · Endocr Connect | RCT | supports | moderate | 16-week RCT: very-low-calorie ketogenic diet vs Mediterranean low-calorie diet improved metabolic and reproductive parameters in obese PCOS women. |
| Rittig N, Christiansen Arlien-Søborg M, Svart MV, Thomsen HH, Kirkegaard K, Greve VH, Nielsen MM, Stochholm K, Ornstrup MJ, Gravholt CH 2025 · Eur J Endocrinol | RCT | mixed | moderate | RCT showing exogenous BHB (ketone) supplementation alone acutely lowered androgens and glucose in PCOS, suggesting ketone bodies mediate part of the effect independent of the full diet. |
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