What blood work is recommended for Polycystic Ovary Syndrome (PCOS)?

From the Guidelines

The most recommended blood work for diagnosing Polycystic Ovary Syndrome (PCOS) includes total testosterone (TT) and free testosterone (FT) as the first-line laboratory tests to assess biochemical hyperandrogenism.

Key Blood Tests

• Total testosterone (TT)
• Free testosterone (FT) These tests should be performed using liquid chromatography with tandem mass spectrometry (LC-MS/MS) for high accuracy, as suggested by the most recent study 1.

Additional Tests

Other tests that may be considered include:

• Androstenedione (A4)
• Dehydroepiandrosterone sulfate (DHEAS)
• Luteinizing hormone (LH)
• Follicle-stimulating hormone (FSH)
• 17-hydroxyprogesterone to rule out congenital adrenal hyperplasia
• Prolactin to exclude hyperprolactinemia
• Thyroid function tests to eliminate thyroid disorders
• Fasting glucose and insulin levels to assess metabolic issues
• Lipid panel (cholesterol, triglycerides, HDL, LDL) to evaluate cardiovascular risk

Importance of Timing

Testing should ideally be performed during the early follicular phase of the menstrual cycle (days 3-5) for the most accurate hormone measurements, though this timing may be difficult with irregular cycles, as noted in 1.

Clinical Considerations

The diagnosis of PCOS should be based on a combination of clinical symptoms (irregular periods, excess hair growth, acne) and ultrasound findings of polycystic ovaries, in addition to the results of these blood tests, as discussed in 1 and 1.

From the Research

Blood Work for Polycystic Ovary Syndrome (PCOS)

The following blood work is recommended for PCOS:

• Total testosterone (TT) 2, 3, 4
• Androstenedione (Andro) 2
• Dehydroepiandrosterone sulfate (DHEAS) 2, 4
• Free androgen index (FAI) 2, 3, 4
• Calculated free testosterone (cFT) 3, 4
• Calculated bioavailable testosterone (cBT) 3, 4
• Luteinizing hormone (LH) 2, 3, 4
• Follicle-stimulating hormone (FSH) 2, 3, 4
• Sex hormone-binding globulin (SHBG) 3, 4, 5
• Insulin sensitivity index 2
• Fasting blood glucose 2, 5
• 2-hour postprandial blood glucose 2
• Anti-Mullerian hormone (AMH) 5
• Fibroblast growth factor 21 (FGF21) 6
• HbA1c 5
• Lipid profile 6
• Thyroid-stimulating hormone (TSH) 6
• Prolactin 6

Diagnostic Cut-Off Values

The following cut-off values have been established for PCOS diagnosis:

• cBT: 0.86 nmol/L 3
• FAI: 7.1% 3
• cFT: 0.8 pmol/L 3
• Andro: 0.65 (Youden index) 2

Correlations and Associations

The following correlations and associations have been found in PCOS patients:

• Positive correlation between FSH, LH, TT, FAI, insulin sensitivity index, and LH/FSH with Andro 2
• Negative correlation between fasting blood glucose and 2-hour postprandial blood glucose with Andro 2
• Positive correlation between FGF21 and LH and testosterone 6