Steroids have the ability to suppress adrenal androgen production and may be useful in treatment of PCOS with an adrenal component. Overall, their use is better in theory than practice and they are often discontinued by patients because of unwanted side effects. The effectiveness of corticosteroids in control of hirsutism is questioned and they should probably be considered third-line therapy. Some have reported an additive effect with clomiphene and patients with elevated DHEAS may be candidates for a trial of therapy. Doses as low as 0.25 mg. of dexamethasone can be used chronically with little fear of overly suppressing adrenal function. Because of the higher cortisol levels at night, suppression therapy is probably better given at bedtime.

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