Information
There is some overlap between the services provided by general endocrinology and those provided by the Department of Reproductive Endocrinology which is situated within Edinburgh Fertility Centre. The referral guide provides advice on which patients should be referred to Reproductive Endocrinology.
Any patients seeking help with conception should be referred as a couple to the Fertility Service and not Reproductive Endocrinology.
Please see Sexual and Reproductive Health for guidance on the menopause and for advice on use of FSH in assessing contraceptive needs
Who to refer:
Women
Women with signs of hyperandrogenism
Signs suggestive of hyperandrogenism include hirsutism, acne, male pattern baldness and deepening of the voice.
Please also see investigation of suspected Polycystic Ovary Syndrome (PCOS).
Women with amenorrhoea/oligomenorrhoea
Women aged <45 years with amenorrhoea or oligomenorrhoea particularly if any of the following are present:
- Elevated prolactin
- Hirsutism
- Either elevated or low gonadotrophins (LH/FSH)
Initial investigation should include:
- LH
- FSH
- Estradiol
- Testosterone / free androgen index (FAI)
- Prolactin
- TSH and T4
Please see investigation of possible PCOS
Men
Men with a low morning testosterone wishing to conceive
Please refer to the guidance on low testosterone and investigation of suspected hypogonadism. Most such men should be referred to the General Endocrinology Service, but If fertility is or likely to become an issue, referral to Reproductive Endocrinology may be more appropriate.
- Suggested investigation include:
- LH
- FSH
- Testosterone
- Prolactin
Who not to refer:
Women
- Those aged less than 18 years with pubertal delay or amenorrhoea – please refer to paediatric endocrinology.
- Women with regular periods and abnormal vaginal bleeding – please refer to Gynaecology
- Women with difficult menopausal symptoms – please refer to the Menopause Clinic at the Chalmers Centre.
- Women with a known diagnosis of Turner’s syndrome requiring annual follow-up should be referred to the Menopause Clinic at the Chalmers Centre.
- Women with hirsutism seeking laser therapy with no endocrine cause can be referred to Dermatology for treatment.
Men
- Men with erectile dysfunction and normal early morning testosterone. Please see resources and links for the guidance on investigation of suspected hypogonadism and appropriate screening investigations. Consider referral to Erectile Dysfunction – RefHelp (nhslothian.scot)or to Chalmers when erectile dysfunction requires other approaches.
- Men not seeking to conceive with low early morning testosterone – if indicated, consider referral to General Endocrinology.
If referring women with suspected PCOS, please see the RefHelp PCOS guidance on appropriate investigations.
If referring men with low testosterone, please see resources and links for guidance on investigation of suspected hypogonadism and appropriate screening investigations
