Wt loss, OCP ( 30-35 mcg Estradiol if < 40 y.o,) ( 20 mcg Estradiol if > 40) with low androgenic progesterone ( drosperinone) If no response in 6 mo consider Spironolactone 50 mg bid ( androgen receptor antagonist) Finasteride ( 5 alpha reductase inhibitor)