Cystless Polycystic Ovarian Syndrome – Insulin Toxicity By Another Name

Majid Ali, M.D.

Cystless Polycystic Ovarian Syndrome (PCOS) Begins Neither As A Cystic Change Nor As An Ovarian Disorder

There is a disturbing rise in the incidence of insulin toxicity associated with hormonal and metabolic derangements in young girls and women. Equally disturbing is how often such cases are grossly mismanaged by their pediatricians and gynecologists. To address these problems, in this article, I introduce the term “Cystless PCOS (Polycystic Ovary Syndrome Without Cysts).” With this term I want to underscore the importance of early recognition of a symptom-complex caused by insulin toxicity and excess testosterone and unaccompanied by bilateral ovarian cysts. The clinical features of Pre-PCOS include facial and chest hair, acne, menstrual abnormalities, loss of menstruation, weight gain, fatigue, and problems of mood, memory, and mentation. All my patients with Cystless PCOS had allergy and recurrent upper respiratory infections for which they received multiple courses of antibiotics. Some of them also suffered from asthma and had received multiple courses of steroids. 

The importance of recognizing this as a specific condition is that the failure to detect ovarian cysts on pelvic ultrasound does not lead to inadequate diagnostic testing (missed detection of insulin toxicity) and neglect of the crucial hormonal and metabolic derangements. Recently, The England Journal of Medicine recommended the use of Metformin (which not only ignores the real issue of insulin toxicity but actually worsens the problem in the long run).

I include the clinical and laboratory features of two cases of Cystless PCOS to illustrate the main points of this article.

Case 1

A 16-yr-old 5′ 4″ girl weighing 189 lbs. presented with a history of facial hair, weight gain, inhalant allergy, asthma, muscle cramps, and irregular menstrual cycles. As an infant, she suffered from oral thrush. She received multiple courses of antibiotics for recurrent sore throats. Some years later she developed asthma for which she was administered Albuterol and, when that failed to control asthma attacks, multiple courses of steroids. 

Her salient lab tests results were: testosterone xxx ng/m; blood ferrintin level xx (indicating iron deficiency); and vitamin D level of 18.9 ng/ml indicating vitamin D deficiency. Her insulin and glucose values are shown in Table 1. Her insulin profile showed a peak insulin value of 208 units indicating severe insulin toxicity (healthy normal-weight teenagers usually have peak insulin values of less than 25 units). Her glucose profile (also shown in Table 1) would be considered unremarkable. For comparison, I present the insulin and glucose profile of a healthy person in Table 2.

Table 1. Case 1. Insulin and Glucose Profiles of a 16-yr-old 5” 4″ Girl Weighing 189 lbs.with Cystless PCOS



1/2 Hr

1 Hr

2 Hr

3 Hr













Table 2. Insulin and Glucose Profiles of a Healthy Individual for Comparison With Those of a Girls With Cystless PCOS (Case 1)



1 Hr

2 Hr

3 Hr

4 Hr













Case 2

A 19-yr-old 5′ 6″ girl weighing 152 lbs. (175 lbs. A year earlier) presented with a history of severe facial acne, some unwanted hair growth, weight gain, inhalant allergy, asthma, fatigue, headache, and irregular menstrual cycles with periods of complete loss of menstruation of six months. As an infant, she had oral thrush and eczema. She received multiple courses of antibiotics for recurrent sore throats. Some years later she developed asthma for which she took Abuterol and multiple courses of steroids. During the year before her presentation, she was also treated with progesterone. 

Her salient lab tests results were: testosterone 62, ng/mL (very high for a young woman); Estradiol 23 pg/mL; Progesterone 1.1 ng/mL; FSH 5.4 mIU; LH, 5.6 mIU/mL; blood ferritin level, 32 (lower than normal indicating iron deficiency); vitamin D level of 39.5; 

The Beginning of Cystless PCOS and PCOS

Both Cystless PCOS and PCOS begin with a cell membrane dysfunction involving the insulin receptor protein. This protein fails to respond to insulin when it becomes immobilized in chemicalized and hardened—plasticized, so to speak—cell membrane. The cell membrane dysfunction is caused by toxicities of foods, environment, and thoughts. The cell membrane harden, immobilizing the insulin receptors embedded in the membranes. This is one of the consequences of cellular membrane grease buildup due to mitochondrial dysfunction caused by dysoxygenosis (dysfunctional oxygen dysfunction).

Dr. Ali’s PCOS Reversal Protocol

To reverse Cystless PCOS, my primary objective is to eliminate insulin toxicity by making insulin work better. It has five components: 

1. A plan of food choices to prevent sugar spikes that trigger insulin spikes;
2. A plan to do daily gentle bowel and liver detox; 
3. A program of oxygen-stabilizing spices, herbs, and nutrients;
4. A program of non-competitive Limbic Exercise; and 
5. A personal goal of self-compassion

I present full details of the above five plans in my book entitled “Dr. Ali’s Plan for Reversing Diabetes” (available at In this book, I also describe at length my crank/crank shaft model of insulin receptor dysfunction with a crank/crank-shaft analogy. 

Cystless PCOS
(Polycystic Ovary Syndrome Without Cysts—One Face of Insulin Toxicity) 

Dr. Ali’s Course on Healing

To assist individuals interested in becoming their own primary physicians, I offer an eight-video self-learning course entitled “Dr. Ali’s Course on Healing.” It can be ordered as an easy download from . I suggest you download the first four seminars and view them in batches of two (estimated time 90 minutes), and then view them a second time before ordering the remaining four seminars. Again, you watch them twice. Test some of the natural remedies I suggest. Finally, two weeks later you review all seminars for the third time.

Suggested Book Reading

* Dr. Ali’s Plan for Reversing Diabetes. 2011. New York, Canary 21 Press. 

Links to Suggested Selected YouTube Videos

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