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CPE-010 · Criteria
PC-03: Criterion: hyperandrogenism
Criterion: hyperandrogenism. Evaluates hirsutism (mFG ≥ 6, or ≥ 4 in some ethnicities) OR elevated total or free testosterone or free androgen index above 5 for the assay.
Condition
- hirsutism (mFG ≥ 6, or ≥ 4 in some ethnicities) OR elevated total or free testosterone or free androgen index > 5 for the assay
- acne and androgenic alopecia are weaker signs: they prompt biochemical testing and do not complete this criterion alone
What it reports
- Clinical or biochemical hyperandrogenism
Diagnostic boundary
- Needs a high-quality testosterone assay (preferably LC-MS/MS).
Evidence
- EV-PCOS-2023Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469.Supports: Adult diagnosis: irregular cycles plus hyperandrogenism once other causes are excluded; ultrasound or AMH when one is missing Adolescent criteria require both irregular cycles and hyperandrogenism Glycemic, cardiometabolic, sleep and mood assessment; endometrial risk in prolonged anovulation
- EV-ES-HIRSUTISM-2018Martin KA, Anderson RR, Chang RJ, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(4):1233-1257.Supports: Hirsutism assessment (modified Ferriman–Gallwey), biochemical evaluation, and markedly raised androgens or rapid onset as tumor signals
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
PCOS-FX-01
Irregular cycles and hirsutism, exclusions complete
A 26-year-old with 8 cycles a year and an mFG of 9.
PCOS-FX-03
Hyperandrogenism and polycystic ovaries with regular cycles
Ovulatory phenotype.
PCOS-FX-05
Criteria met, no exclusion tests
TSH, prolactin and 17-OHP missing.
PCOS-FX-06
Prolactin 68 ng/mL
Another cause of oligomenorrhea.
PCOS-FX-07
TSH 9.2 mIU/L
Thyroid disease explains irregular cycles.
PCOS-FX-08
17-hydroxyprogesterone 340 ng/dL
Non-classic CAH possible.
PCOS-FX-09
Total testosterone 215 ng/dL and rapid virilization
Not explained by PCOS.
PCOS-FX-10
Features of Cushing syndrome
Striae and proximal weakness.
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