This tool is for clinician-facing decision support. It does not diagnose a patient or replace local lab reference ranges, pregnancy evaluation, medication review, or specialist judgment.
Elevated total or calculated free testosterone supports biochemical hyperandrogenism. Low SHBG can amplify free androgen exposure and is often seen with insulin resistance, obesity, or hypothyroidism.
Interpret using a high-quality assay and the lab's sex- and age-specific reference range.Mild to moderate elevation can occur in PMOS. Marked elevation, rapid virilization, or abrupt symptom onset should prompt evaluation for adrenal or ovarian androgen-secreting tumors.
DHEA-S points more toward adrenal androgen contribution.In adults, AMH may be used instead of ultrasound to define polycystic ovarian morphology. AMH should not be used alone, and ultrasound or AMH is unnecessary when ovulatory dysfunction and hyperandrogenism are both present.
Do not use AMH or ultrasound for adolescent diagnosis.Draw urine or serum hCG in anyone with amenorrhea or pregnancy potential before attributing cycle changes to PMOS.
Positive hCG changes the pathway immediately.Abnormal TSH can indicate thyroid disease causing irregular cycles. Elevated prolactin can suppress ovulation and may require repeat fasting morning testing, medication review, pituitary evaluation, or endocrinology referral.
These are routine exclusion labs.Elevation screens for nonclassic congenital adrenal hyperplasia. Borderline or high values generally need confirmatory testing such as ACTH stimulation according to local endocrine protocols.
Best drawn in the morning, follicular phase if cycling.Use when amenorrhea is prolonged, body weight or exercise history suggests hypothalamic suppression, or premature ovarian insufficiency is possible. High FSH with low estradiol argues away from typical PMOS.
LH:FSH ratio is not required for diagnosis.Preferred for detecting dysglycemia in PMOS when feasible, especially before pregnancy or fertility treatment. Abnormal fasting, 1-hour, or 2-hour glucose should be managed using diabetes or prediabetes standards.
A1c can miss early dysglycemia in some patients.Useful when OGTT is not practical and for longitudinal monitoring. Interpret using standard diabetes and prediabetes cutoffs, while considering anemia, hemoglobin variants, pregnancy, and recent blood loss.
Repeat periodically based on risk.Elevated triglycerides, elevated LDL-C, low HDL-C, or high non-HDL cholesterol support cardiometabolic risk assessment and prevention planning.
Combine with blood pressure and waist/BMI context.Transaminases are not diagnostic for PMOS, but abnormal results can support evaluation for metabolic dysfunction-associated steatotic liver disease. Screen clinically for obstructive sleep apnea when symptoms or risk factors are present.
Use local pathways for abnormal results.For reproductive hormones, draw early morning when possible. If cycles are present, follicular-phase sampling is often easiest to interpret. Document cycle day, last menstrual period, and current medications.
Reference intervals vary by assay and cycle phase.Combined hormonal contraception can suppress endogenous androgens and alter SHBG, so biochemical androgen testing may be misleading during use or soon after stopping.
Use clinical history when labs are confounded.Rapid onset virilization, severe androgen elevation, Cushingoid features, galactorrhea with high prolactin, primary amenorrhea, or neurologic symptoms should shift from routine PMOS workup to targeted evaluation.
Escalate to endocrinology or urgent imaging when appropriate.There is no single universal "elevated AMH" cutoff for PMOS. The 2023 guideline says laboratories should use population- and assay-specific cutoffs, and AMH should not be used as a standalone diagnostic test.
Use standard diabetes criteria. A separate pregnancy pathway is needed for gestational diabetes screening.
These are common adult interpretive anchors. Always compare against the reporting lab's range, units, method, age, pregnancy status, and medication context.
PMOS metabolic screening should be interpreted with blood pressure, BMI/waist context, diabetes status, smoking, family history, pregnancy plans, and ASCVD risk.
