Reproductive endocrinology

Who to refer:

Women

Women with signs of hyperandrogenism

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

Please also see investigation of suspected Polycystic Ovary Syndrome (PCOS).

Initial investigation should include:

• Testosterone
• Free androgen index
• Pelvic USS

Women with amenorrhoea/oligomenorrhoea

Women aged <45 years with amenorrhoea or oligomenorrhoea particularly if any of the following are present:

• Elevated prolactin
• Hirsutism
• Either elevated or low gonadotrophins (LH/FSH)

Initial investigation should include:

• LH
• FSH
• Estradiol
• Testosterone / free androgen index (FAI)
• Prolactin
• TSH and T4
• Pelvic USS

Please see investigation of possible PCOS

Men

Men with a low morning testosterone wishing to conceive

Please refer to the guidance on low testosterone and investigation of suspected hypogonadism. Men should be referred to the General Endocrinology Service, but If fertility is or likely to become an issue, referral to Reproductive Endocrinology may be more appropriate.

• Suggested investigation include:
• LH
• FSH
• Testosterone
• Prolactin

Who not to refer:

Women

• Those aged less than 18 years with pubertal delay or amenorrhoea – please refer to paediatrics
• Women with difficult menopausal symptoms – please refer to the Menopause Clinic via gynaecology.
• Women with hirsutism seeking laser therapy with no endocrine cause can be referred to Dermatology for treatment. 

Men

• Men not seeking to conceive with low early morning testosterone – if indicated, consider referral to General Endocrinology.

If referring women with suspected PCOS, please see the RefHelp PCOS guidance on appropriate investigations.

If referring men with low testosterone, please see resources and links for guidance on investigation of suspected hypogonadism and appropriate screening investigations