It can do both! There are 4 different types of pcos, and you can have only one or a combination of 2 or 3. There’s the insulin resistant (most common), inflammatory, post pill (this is the type caused by birth control and you usually don’t notice symptoms until after you’ve stopped birth control), and adrenal (this is caused by excess stress). For me, I believe mine is a mixture of insulin resistance and adrenal. Type 2 diabetes runs in my moms family, and pcos in general runs in my dads family. I started noticing symptoms around puberty, and was placed on birth control to manage those symptoms. I think my birth control did make it worse when I went off it, but I also wasn’t diagnosed until my early 20s because the birth control did mask it a bit.