PCOS Articles - A Test For PCOS?? Read This Article...

01-19-2004, 02:14 PM
2003 Michael D. Birnbaum, MD, PC - All rights reserved

More and more, I am seeing women come into the office with classic Poly-Cystic Ovary Syndrome (PCOS) who have been told that they did not have it because their blood tests were all normal. If you believe you have PCOS, it is critically important that you understand that the blood tests that I do are not to make the diagnosis (or break it), they are simply to give me baseline information to help me assess your response to future therapy.

It is critically important to understand that PCOS is a clinical diagnosis - it is based upon a woman's history and physical exam. Although there is no universally accepted definition of PCOS, most Endocrinologists would agree that two criteria must be satisfied. First, the woman must have some abnormality of ovulation and, secondly, she must have either clinical or laboratory evidence of increased androgen (male hormone) production.

The two principal physical signs of excess androgen production are either acne or hirsutism (the presence of coarse dark hair on a woman's body in locations that it should not normally be found). The vast majority of women with excess androgen production will in fact have either acne or hirsutism. There are occasional women who do not have any physical signs of excess androgen but whose blood test will clearly show it.

One of the problems that creates the confusion is the fact that, on paper, many women with obvious androgen problems have "normal" serum androgen levels. There are two reasons for this. First, although the total testosterone may be normal, the free (the biologically active portion) testosterone level is frequently elevated.

More importantly, it is important to understand that the normal range for the serum testosterone that most labs use when they report their values is seriously in error. This has been known for many many years. The labs show no inclination to change it.

Most labs report that the upper limit for a serum testosterone level in women is in the range of 60 to 75 (the numbers vary slightly from lab to lab). In fact, it has been clearly shown that when the test is done properly, a normal woman never has a testosterone level in excess of 30. Therefore, if a physician draws a testosterone level on a woman and the result comes back 50 or 60, that woman will be told that she is "normal" when in fact she is not.

This was proven quite conclusively several years ago by a well respected Endocrinologist in Texas. He drew serum testosterone levels on his patients with obvious androgen problems and sent the result to 11 different commercial labs. He got back 11 completely different results and none of the results were anywhere near the true result that he obtained when he ran the test in his own lab.

It is important that you understand this so that you realize that you may in fact have PCOS even though you have been led to believe that you do not.