How do I install the Endo Hirsutism Measure Free Testosterone If Indication skill?

Run npx skillmds@latest add dromlakhani/endo-hirsutism-measure-free-testosterone-if-indication in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

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Who published Endo Hirsutism Measure Free Testosterone If Indication?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Endo Hirsutism Measure Free Testosterone If Indication by dromlakhani

Name: Endo Hirsutism Measure Free Testosterone If Indication
Rating: 4.5 (4 reviews)
Author: dromlakhani

Endo Hirsutism Measure Free Testosterone If Indication

The clinician orders early morning serum total and free testosterone when total testosterone is normal but the patient presents with moderate to severe hirsutism or mild hirsutism accompanied by signs of hyperandrogenism such as menstrual irregularity or lack of response to therapy. This is indicated when a clinician questions whether to check free testosterone in a patient with normal total testosterone but worsening hirsutism and irregular periods.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Measure free testosterone when total testosterone is normal but clinical signs suggest hyperandrogenism

STEP 1 — Gather Information

Document hirsutism severity (Ferriman–Gallwey score or clinical assessment of sexual hair growth), menstrual pattern, prior therapeutic response, and any existing total testosterone level.

STEP 2 — Rule In / Rule Out

Is the serum total testosterone level normal? If abnormal, evaluate for hyperandrogenism; if normal, proceed to assess hair growth severity and clinical evidence of hyperandrogenism.

STEP 3 — Classify or Stratify

If sexual hair growth is moderate/severe OR mild with clinical evidence of a hyperandrogenic disorder (e.g., menstrual disturbance, lack of response to therapy), proceed to measure free testosterone; otherwise, consider idiopathic hirsutism.

STEP 4 — Decide

Order an early morning serum total and free testosterone using a reliable specialty assay; if criteria are not met, manage as idiopathic hirsutism with cosmetic measures or oral contraceptive therapy.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on total testosterone alone; ensure early morning sample when androgen levels peak; use a validated specialty assay (e.g., mass spectrometry) rather than routine immunoassays; avoid testing in eumenorrheic women with only local hair growth and no hyperandrogenic signs; be aware of SHBG variability affecting free testosterone interpretation; do not test if the patient is currently using combined oral contraceptives, which suppress androgen levels; consider pregnancy as a cause of menstrual changes; avoid repeating free testosterone testing if total and free testosterone are normal and there is no progression of hirsutism.

Concrete Clinical Example

A 28‑year‑old woman presents with mild hirsutism (Ferriman–Gallwey score 9) and worsening oligomenorrhea. Her total testosterone is normal, and she has had minimal improvement with topical therapy. According to the guideline, early morning serum total and free testosterone are ordered.

Source: Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2018, doi:10.1210/jc.2018-00241

---name: endo-hirsutism-measure-free-testosterone-if-indicationdescription: The clinician orders early morning serum total and free testosterone when total testosterone is normal but the patient presents with moderate to severe hirsutism or mild hirsutism accompanied by signs of hyperandrogenism such as menstrual irregularity or lack of response to therapy. This is indicated when a clinician questions whether to check free testosterone in a patient with normal total testosterone but worsening hirsutism and irregular periods.---# Measure free testosterone when total testosterone is normal but clinical signs suggest hyperandrogenism## STEP 1 — Gather InformationDocument hirsutism severity (Ferriman–Gallwey score or clinical assessment of sexual hair growth), menstrual pattern, prior therapeutic response, and any existing total testosterone level.## STEP 2 — Rule In / Rule OutIs the serum total testosterone level normal? If abnormal, evaluate for hyperandrogenism; if normal, proceed to assess hair growth severity and clinical evidence of hyperandrogenism.## STEP 3 — Classify or StratifyIf sexual hair growth is moderate/severe OR mild with clinical evidence of a hyperandrogenic disorder (e.g., menstrual disturbance, lack of response to therapy), proceed to measure free testosterone; otherwise, consider idiopathic hirsutism.## STEP 4 — DecideOrder an early morning serum total and free testosterone using a reliable specialty assay; if criteria are not met, manage as idiopathic hirsutism with cosmetic measures or oral contraceptive therapy.## Clinical Guardrails / Mimics / PitfallsDo not rely on total testosterone alone; ensure early morning sample when androgen levels peak; use a validated specialty assay (e.g., mass spectrometry) rather than routine immunoassays; avoid testing in eumenorrheic women with only local hair growth and no hyperandrogenic signs; be aware of SHBG variability affecting free testosterone interpretation; do not test if the patient is currently using combined oral contraceptives, which suppress androgen levels; consider pregnancy as a cause of menstrual changes; avoid repeating free testosterone testing if total and free testosterone are normal and there is no progression of hirsutism.## Concrete Clinical ExampleA 28‑year‑old woman presents with mild hirsutism (Ferriman–Gallwey score 9) and worsening oligomenorrhea. Her total testosterone is normal, and she has had minimal improvement with topical therapy. According to the guideline, early morning serum total and free testosterone are ordered.**Source:** Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2018, doi:10.1210/jc.2018-00241

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