reproductive endocrinology

Meet the patient

Meet a 29-year-old woman with oligomenorrhoea, hirsutism, a body-mass index of 33, an elevated free testosterone, polycystic ovaries on ultrasound, and impaired glucose tolerance on an oral glucose tolerance test. She meets Rotterdam criteria for polycystic ovary syndrome — and the decision is phenotype-driven: metabolic protection now, fertility later.^[1][2]

Two questions frame every reproductive endocrine presentation: where in the hypothalamic-pituitary-gonadal axis is the lesion, and what are the short- and long-term consequences of the disordered hormonal milieu that must be prevented alongside symptom relief?^[8][5]

References13ShowHide

1. [1]The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS) Hum Reprod, 2004.PMID 14688154
2. [2]Teede HJ, Tay CT, Laven JJE, Dokras A, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome J Clin Endocrinol Metab, 2023.PMID 37580314
3. [3]Alexander EK, Pearce EN, Brent GA, Brown RS, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum Thyroid, 2017.PMID 28056690
4. [4]De Groot L, Abalovich M, Alexander EK, Amino N, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline J Clin Endocrinol Metab, 2012.PMID 22869843
5. [5]Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline J Clin Endocrinol Metab, 2010.PMID 20525905
6. [6]Lincoff AM, Bhasin S, Flevaris P, Mitchell LM, et al. Cardiovascular Safety of Testosterone-Replacement Therapy N Engl J Med, 2023.PMID 37326322
7. [7]Snyder PJ, Bauer DC, Ellenberg SS, et al. Testosterone Treatment and Fractures in Men with Hypogonadism N Engl J Med, 2024.PMID 38231621
8. [8]Harlow SD, Gass M, Hall JE, Lobo R, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging J Clin Endocrinol Metab, 2012.PMID 22344196
9. [9]Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial JAMA, 2002.PMID 12117397
10. [10]Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline J Clin Endocrinol Metab, 2014.PMID 25279570
11. [11]Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women J Sex Med, 2021.PMID 33814355
12. [12]Teede HJ, Misso ML, Costello MF, Dokras A, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome Fertil Steril, 2018.PMID 30033227
13. [13]Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline J Clin Endocrinol Metab, 2011.PMID 21296991