Objective: This study aimed to compare the effects of metformin alone versus metformin combined with probiotics on testosterone levels, acne severity, and hirsutism in adolescents with PCOS.

Methods: In a randomized, double-blind, placebo-controlled trial, 80 adolescent females aged 13-19 with PCOS were enrolled. Participants were randomized into two groups: Group A received 500 mg of metformin twice daily, while Group B received the same metformin dosage plus daily probiotics (Lactobacillus acidophilus, Bifidobacterium bifidum, and Lactobacillus rhamnosus) for 12 weeks. Serum testosterone levels, acne severity (using a standardized grading scale), and hirsutism scores (using the modified Ferriman-Gallwey scoring system) were measured at baseline and after 12 weeks.

Results: Both groups showed significant reductions in serum testosterone levels, acne severity, and hirsutism scores. Group B exhibited a more substantial decrease in testosterone levels (53.21 ± 12.7 ng/dL vs. 60.32 ± 10.4 ng/dL, p=0.03) and acne severity (1.83 ± 0.16 vs. 2.12 ± 0.21, p=0.04) compared to Group A. However, there was no significant difference in the reduction of hirsutism scores between the groups (p=0.13). Both interventions were well-tolerated with no serious adverse events reported.

Conclusion: The addition of probiotics to metformin treatment significantly enhances the reduction of testosterone levels and improves acne severity in adolescents with PCOS compared to metformin alone. These findings suggest that probiotics may be a beneficial adjunct therapy in managing hyperandrogenism-related symptoms in PCOS.