The blood tests that actually answer the question

What the evidence says

Guidance recommends total and free testosterone by mass spectrometry, plus TSH, prolactin, 17-hydroxyprogesterone and FSH to rule out look-alikes. A normal result does not rule the condition out: in one cohort of 1,218 women, about 4 in 10 had no raised blood androgen at all.

The 2023 international guideline recommends total and free testosterone, measured by mass spectrometry (LC-MS/MS) rather than a direct immunoassay; if testosterone is not raised, androstenedione and DHEAS can be considered. TSH, prolactin, 17-hydroxyprogesterone and FSH exclude other conditions with similar symptoms, including thyroid disease, prolactin excess and non-classical adrenal hyperplasia. On the combined pill, androgen results are very hard to interpret, so if androgen testing is essential the guideline advises stopping it for at least 3 months, with other contraception in the meantime.

What this does not show

This is a list of tests to discuss and interpret with a clinician. It is not a diagnosis, and one result inside or outside a range is not one either. The 4-in-10 figure comes from one cohort, and the study summary does not say which lab method was used; reference ranges are poorly standardised for women, and different lab methods disagree most exactly where the decision is made. The 3-month break is about interpreting androgen tests, never advice to stop contraception.

Sources, as Neta holds them

1. Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, 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):2447-69. doi:10.1210/clinem/dgad463

   Guideline synthesis

2. Livadas S, Pappas C, Karachalios A, et al. Prevalence and impact of hyperandrogenemia in 1,218 women with polycystic ovary syndrome. Endocrine. 2014;47(2):631-8. doi:10.1007/s12020-014-0200-7

   People compared with each other · 1,218 participants