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Selenium deficiency also results in congestive cardiomyopathy, heart failure, cardiomegaly, increased risk of cancer, infection, inflammatory disease, diabetes, retarded wound healing, and infertility, while excess selenium results in brittle hair and brittle, thickened, stratified nails or loss of both hair and nails (Hariharan and Dharmaraj 2020

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15,16 One setting in which metformin is sometimes considered first-line treatment is in adolescents with PCOS, although oral contraceptives are important as well

Avoid administration during or immediately after intense exercise