Hormone Work-Up for PCOS

Core Hormonal Testing to Establish Diagnosis

The American College of Family Physicians recommends that the essential hormone work-up for PCOS includes TSH, prolactin, and total testosterone (or free/bioavailable testosterone) 1, 2, 3
DHEA-S (dehydroepiandrosterone sulfate) helps exclude adrenal androgen-secreting tumors 1, 3
TSH level is used to rule out thyroid disease 1, 2, 3
Prolactin level is used to exclude hyperprolactinemia 1, 2, 3

The American College of Obstetricians and Gynecologists (ACOG) recommends fasting glucose followed by 2-hour glucose level after 75-gram oral glucose load for all PCOS patients due to increased diabetes risk 1, 2, 4, 5
Fasting lipid panel including total cholesterol, LDL, HDL, and triglycerides is mandatory 1, 2, 4, 5
PCOS patients frequently have dyslipidemia with elevated LDL, elevated triglycerides, and decreased HDL 1, 4
Calculate BMI and waist-hip ratio at initial evaluation 1, 4

Screen for Cushing's if patient has buffalo hump, moon facies, hypertension, abdominal striae, centripetal fat distribution, easy bruising, or proximal myopathies 1, 3
Measure total testosterone and DHEA-S urgently in cases of marked virilization or rapid symptom onset 1
Evaluate for early-onset body odor, axillary/pubic hair, accelerated growth, advanced bone age, and genital maturation in prepubertal children 6
Use growth charts and hand film for bone age as screening tools before specific hormonal testing in prepubertal children 6

Combination oral contraceptive pills are first-line for menstrual regulation and androgen suppression in non-pregnant patients 1, 4, 5
Weight loss and lifestyle modification should precede drug therapy for dyslipidemia 1, 4
Insulin-sensitizing agents (metformin) improve ovulation frequency based on good and consistent scientific evidence for fertility concerns 1, 4, 5