Androgen excess is one of the most common endocrine disorders in women and is the most common cause of anovulatory infertility.

The most common presentation of androgenic disorders in women is with a complaint of hirsutism, possibly acne, and irregular and infrequent menses.

Polycystic ovary syndrome (PCOS) is the most common cause of androgen excess in women.

A working diagnosis of PCOS includes (1) clinical or biochemical evidence of hyperandrogenism; (2) functional or ultrasonographic abnormalities in ovarian function; and (3) the exclusion of other androgen excess or ovulatory disorders.

80% of women with PCOS are obese.

Insulin resistance leading to diabetes may be present in 30% to 40% of women with PCOS.

While a common finding, diagnosis of PCOS does not require abnormal gonadotropin levels (i.e., elevated luteinizing hormone [LH]:follicle-stimulating hormone ratio).

Diagnosis of PCOS does not require ultrasonographic evidence of the classic polycystic ovary (i.e., the “pearl necklace” ovary).

Late complications of PCOS include hypertension, hyperlipidemia, type 2 diabetes mellitus, all components of the metabolic syndrome.

In primary amenorrhea or amenorrhea occurring after only a few irregular cycles in young persons, a karyotype is also indicated.

The presence of Y chromosome in a phenotypic female subject requires the operative removal of the gonads because they are considered precancerous.