I am F 24, 5'6" and 252lbs. I went to an endocrinologist for the first time this week to get a better opinion on what I should do to manage my PCOS symptoms as I have worked with my PCP and GYNO about it and they both just say lose some weight and give me no information. I am on a continous birth control pill (progesterone only) because of terrible and heavy periods (pill stops me from having periods) and I also have endometriosis which I had surgery for in August of 2024 but still deal with chronic pain. I also take 2 spironolactone a day which has helped with excess hair and acne.
When I saw the endocrinologist she looked at my past blood work and said I had insulin resistance and was very close to being pre diabetic. She prescribed Metformin. She said I had to lose weight if I want to have kids and weight loss was the only way I could get rid of my pcos symptoms. I told her about my eating disorder (previously orthorexic and anarexic, started bingeing in 2020 and gained a lot of weight. Went into eating disorder treatment year and a half ago for 4 months, currently see a dietician for it who I have been seeing since I started at the treatment center. I have not binged in over a year but also have not lost any weight) I am very used to hearing that I need to lose weight. But, I also had these same exact PCOS symptoms which I was 130lbs years ago. She ordered blood work which I got back today and it was mostly the same as the ones I had a year ago.
She said I needed to eat at max 1000 calories a day and no less than 800 a day. She said I needed to weight lift 3 times a week and walk 10,000 steps a day. Also that I was to follow the mediterrain diet and eat only up to 45grams of carbs a day. I was shocked, 1000 calories... Everything I have learned in eating disorder treatment, therapy, and with my dietician completely contradicts this. She said sweets and bread and junk food were bad and I had to stop eating those. But my dietician has engrained in me that all foods are okay in moderation. I explained to the endocrinologist that I had an eating disorder and went through treatment and my dietician would never let me eat 1000 calories a day. She said thats how badly and extreme I needed to lose weight and that my dietician was "obviously" not skilled in treating patients with PCOS. She said for my eating disorder I just needed to "change my mindset". I started tearing up and feeling overwhelmed and she said I was fine and that I needed to work 3 times harder to lose weight because of PCOS.
Yes I want to lose weight, but currently everything in my life is going really well and I am really happy how I am right now. But now with this I feel so guilty and ashamed of my weight. That I am so disgustingly heavy that I don't deserve to eat. That this is the punishment I deserve for doing this to myself. I told my dietician what happended and she said she was speechless, and that she thinks I need to see a different dietician in her office who could better help me. I feel like she is giving up on me, but I know it is probably because she does not know how to help patients with PCOS.
Is this realistic? I don't know what to do.
EDIT: She also is having me do a midnight saliva test for cortisol for a potential tumor on my adrenal gland. She looked and my stretch marks and said they looked consistant with high cortisol.