Reproductive endocrinology

Information

The endocrine team manage people with a wide variety of reproductive endocrine conditions in the general endocrine clinics at BGH.

In general couples with conception problems should be referred to the fertility clinic at BGH via gynaecology, but we can see men with documented hypogonadotrophic hypogonadism for optimisation-primary care should continue to organise sperm count in usual way. Please contact the diabetes and endocrine email inbox for advice.

Who to refer, who not to refer, how to refer

Who to refer - Women:

Women with signs of hyperandrogenism

Signs suggestive of hyperandrogenism include hirsutism, acne, male pattern baldness, deepening of the voice and clitoromegaly.

Women who develop these symptoms over a short time frame or who have testosterone >4 should be referred urgently.

Please include results of testosterone, free androgen index, prolactin, TSH, fT4/3, LH, FSH and oestradiol in the referral

Women with amenorrhoea/oligomenorrhoea

Women aged <45 years with amenorrhoea or oligomenorrhoea

Please exclude pregnancy prior to referral.

Please include the results of LH, FSH, oestradiol, prolactin, TSH and testosterone in the referral.

Women with PCOS with significant hyperandrogenism

Please include the results of random glucose, HbA1c, testosterone, free androgen index, LH, FSH and oestradiol on referral

Women with Turner Syndrome

Who to Refer - Men:

Men with hypogonadism

Testosterone should ideally be checked in the fasting state prior to 10am on at least two occasions prior to referral
LH, FSH and prolactin should also be requested with the second testosterone level

Men with Klinefelter Syndrome

Who not to refer:

Women

Those aged less than 16 years with pubertal delay or amenorrhoea – please refer to paediatrics.
Women with regular periods and abnormal vaginal bleeding – please refer to Gynaecology
Women with difficult menopausal symptoms – please refer to gynaecology
Women whose primary symptom is acne seeking secondary care input should be referred to dermatology but endocrinology can see for a broader work up of hyperandorgenism as necessary.
Women with PCOS whose primary concern is fertility – please refer to Gynaecology

Men

Men with erectile dysfunction and normal early morning testosterone-see urology guidance (at the time of writing this is available via Lothian RefHelp pages)

How to Refer:

Please refer all patients via Sci Gateway. If advice rather than clinic review is sought, please email the diabetes and endocrine inbox.

Primary care management

Women with PCOS can be diagnosed with two out of the following three criteria:

Infrequent periods (>35 day cycle length) or amenorrhoea
Clinical and/or biochemical evidence of androgen excess
Evidence of PCOS on ultrasound scan

Women who meet the first two criteria for PCOS do not need to have an US scan

Most women with PCOS benefit from weight loss in improving their symptoms, please provide advice or refer to the weight management team also

Women with PCOS are at higher risk of metabolic syndrome and screening for these features should be considered, including an annual fasting glucose to screen for pre-diabetes and diabetes.

Most women with PCOS can be managed in primary care, endocrinology can help with those with significant hyperandrogenic symptoms or diagnostic uncertainty.

Dermatology suggest follow the pathway below for decisions on treatment and referral for acne

https://rightdecisions.scot.nhs.uk/dermatology-pathways/acne/

Local service details

diabetes.endocrinology@borders.scot.nhs.uk

Next review date: 04/06/2027

Author(s): S Pacitti, B Muthukrishnan, R Williamson.

Author email(s): Siobhan.pacitti@nhs.scot.