What Actually Causes PCOS? A Mechanistic Reading of Polycystic Ovary Syndrome — The patterns that suggest the framework applies

PCOS cases that benefit most from the Host Capacity Model approach share specific features: Inadequate response to first-line treatments (metformin, combined oral contraceptives, spironolactone). "Lean PCOS" phenotype where weight loss is not the primary issue. Concurrent gastrointestinal symptoms (bloating, food sensitivities, IBS-pattern bowel changes). Concurrent Hashimoto's thyroiditis or other autoimmune conditions. Concurrent endometriosis or significant menstrual pain beyond what PCOS alone would predict. Inflammatory features (joint pain, skin issues beyond acne, sensitivities). Fatigue and brain fog that are disproportionate to the visible PCOS features. Post-pill PCOS where symptoms emerged after discontinuation of long-term hormonal contraception. History of significant antibiotic exposure preceding the PCOS onset. Family history of multiple metabolic and autoimmune conditions. Poor response to weight loss that has been achieved through diet and exercise.