What Actually Causes PCOS? A Mechanistic Reading of Polycystic Ovary Syndrome — What restoration looks like

A treatment approach anchored in the Host Capacity Model looks substantially different from standard PCOS care. The standard treatments continue where they are providing benefit. The upstream work proceeds in parallel. The sequence: First, identify the dominant drivers in the specific case. The phenotype assessment, the symptom pattern, and selected testing point to which drivers are operating. Most cases have multiple drivers; one or two are usually dominant. Second, address the gut dysbiosis. This is the most consistently impactful intervention across PCOS phenotypes. Comprehensive stool panel (GI-MAP or comparable) to identify the specific dysbiosis pattern. Targeted reduction of expanded inflammatory taxa, support for recolonization of obligate anaerobic core community, attention to barrier markers, and where indicated, treatment of concurrent SIBO per the recurrent SIBO framework. Third, address insulin resistance through the broader bioenergetic approach. Inositol supplementation (myo-inositol and d-chiro-inositol in 40:1 ratio at 4 grams daily) has strong evidence in PCOS for cycle regulation, insulin sensitivity, and ovulation. Berberine at 1500 mg daily has comparable evidence to metformin with a more favorable side effect profile. NAD+ precursor supplementation addresses the regulatory layer. Magnesium glycinate supports insulin signaling and mitochondrial function. V