Distinguishing Ovarian versus Peripheral Hormone Production

Understanding the Hormone Production Sources

Elevated FSH (>35 IU/L) and LH (>11 IU/L) indicate ovarian failure, meaning the ovaries are no longer producing significant estrogen, prompting compensatory pituitary hormone increases 3
LH:FSH ratio >2 suggests polycystic ovary syndrome with ovarian hyperandrogenism, where the ovaries are overproducing androgens 3
Suppressed FSH and LH indicate adequate estrogen feedback from either ovarian or peripheral sources, or exogenous hormone administration 1, 2
DHEA-S is the most reliable marker of adrenal androgen production, as it is exclusively produced by the adrenal glands 4, 5
Elevated DHEA-S (accounting for age and race) indicates adrenal contribution to total androgen pool, which can then be converted peripherally to testosterone and estrogens 4, 5
Normal or low DHEA-S with elevated testosterone suggests ovarian rather than adrenal androgen production 4, 5

If FSH >35 IU/L and LH >11 IU/L: Ovarian failure confirmed; any circulating estrogen is from peripheral conversion of adrenal androgens 3
If LH:FSH ratio >2: Ovarian hyperandrogenism (PCOS pattern); ovaries are primary androgen source 3
If FSH and LH are suppressed: Either adequate ovarian function or peripheral estrogen production is providing negative feedback 1, 2
Elevated DHEA-S (age-adjusted): Significant adrenal contribution to androgen pool, which undergoes peripheral conversion to testosterone and estrogens 4, 5
Low DHEA-S with elevated testosterone: Ovarian source is dominant 4, 5

Aromatase inhibitors in premenopausal women can paradoxically increase ovarian estrogen production by stimulating FSH/LH release, requiring confirmation of ovarian suppression with estradiol measurement 1, 2

DHEA-S has maximal value in premenopausal women (ages 20-30) and declines steadily thereafter, requiring age-adjusted reference ranges 4, 5

The combination of FSH/LH (ovarian function), DHEA-S (adrenal production), and testosterone (combined output) provides a complete picture of hormone source 4, 5, 3
In premenopausal women with hyperandrogenism, this panel distinguishes PCOS (ovarian) from adrenal causes 4, 5
In postmenopausal women on aromatase inhibitors, measuring estradiol with FSH/LH confirms adequate ovarian suppression, as incomplete suppression leads to treatment failure 1, 2