17-hydroxyprogesterone

What is 17-hydroxyprogesterone?

17-hydroxyprogesterone, or 17-OHP, is a steroid hormone produced mainly in the adrenal glands, with smaller contributions from the ovaries and testes. It is an intermediate in the pathway from progesterone to cortisol. An elevated result can suggest that a later step in cortisol production is impaired, particularly when the enzyme 21-hydroxylase is less active. However, normal changes in hormone production and the testing method can also raise the result. A low value may reflect lower adrenal stimulation or medication-related suppression; it is not automatically a sign of better health. Progesterone background

Names for 17-OHP, and substances it should not be confused with

17-OHP, 17-OH-progesterone, 17α-hydroxyprogesterone, and 17-hydroxyprogesterone refer to the same analyte. If your report uses one of these names, it is describing the same hormone. Two similar names refer to different molecules: progesterone is an earlier intermediate used, among other purposes, to assess ovulation, while 17-hydroxypregnenolone belongs to the parallel Δ5 steroid pathway.

Another nearly identical name refers to a medication. Hydroxyprogesterone caproate is a synthetic injectable progestin that had been approved to reduce the risk of preterm birth in a specific population. The FDA withdrew approval of Makena and its generics in 2023. It is not the naturally produced hormone measured by this blood test. FDA announcement

How the adrenal glands and ovaries make 17-OHP

Steroid hormones begin with cholesterol. Enzymes process it through branching pathways that produce cortisol, aldosterone, and androgens. 17-OHP sits at one of these branches. When 21-hydroxylase works normally, 17-OHP is processed further toward cortisol. Reduced enzyme activity allows it to accumulate and increases the availability of precursors for androgens such as androstenedione and testosterone. The result is not a substitute for a cortisol measurement: it describes a precursor, not the amount of cortisol ultimately produced. Cholesterol background · Endocrine Society guideline

ACTH, a hormone released by the pituitary gland, stimulates the adrenal cortex. Its activity and the resulting steroid concentrations vary across the day. Stress can affect this system, and 17-OHP may change along with other cortisol precursors. For investigation of possible congenital adrenal hyperplasia, an early-morning sample before 8 a.m. is recommended. In people who menstruate, levels are lower in the follicular phase than in the luteal phase after ovulation. Circadian study · Guideline · Menstrual-cycle study

These variations are part of normal physiology. Comparable sampling conditions help distinguish a persistent pattern from a change caused by timing. They also reduce the risk of drawing conclusions from a single result taken in an unsuitable testing window.

What the 17-OHP test measures and why it is ordered

A serum 17-OHP test measures the concentration of 17-hydroxyprogesterone in blood. US reports commonly use ng/dL; other laboratories may use nmol/L. It is not a general wellness screening test. Its main purpose is to investigate whether a steroid precursor is accumulating around the 21-hydroxylase step and to support evaluation of congenital adrenal hyperplasia, or CAH.

There are four common settings: newborn screening for 21-hydroxylase deficiency, investigation of androgen-excess symptoms in adolescents and adults, selected fertility evaluations involving irregular cycles, and monitoring of established CAH. Newborn programs commonly begin with a dried blood spot rather than the serum test used later in life. The Dutch screening study illustrates how a second-tier test can help clarify initial screening results. Newborn screening study

When the test is used at different ages

• Newborns: Public screening programs commonly test a heel-prick dried blood spot during the first days of life. Timing and follow-up follow the local screening program.
• Children and adolescents: Early growth acceleration, premature body hair, or unexpectedly early signs of puberty may prompt investigation.
• Women: Testing can help when excess facial or body hair, persistent acne, irregular cycles, or difficulty conceiving raises the possibility of androgen excess. Hirsutism background · Acne background
• Men: Testing is less common and is usually part of a specific fertility or adrenal evaluation rather than routine screening.

How to interpret a 17-hydroxyprogesterone result

Age, sex, menstrual-cycle phase, pregnancy, medication use, and the laboratory method all affect interpretation. The same serum sample can produce different numerical results with an immunoassay and with liquid chromatography–tandem mass spectrometry, or LC-MS/MS.

A reference interval describes values in a reference population tested with that method. It is not an optimal target. There is also a distinction between a laboratory reference interval and a decision threshold used to investigate CAH. A screening threshold for an early-morning follicular-phase sample should not be confused with a broader interval that includes other cycle phases.

Reference values by age, sex, and menstrual-cycle phase

An adult woman’s early-morning follicular-phase result is commonly below 200 ng/dL, approximately 6 nmol/L. A value at or above that level is often a reason to consider further investigation for nonclassic CAH, rather than a diagnosis by itself. The appropriate threshold also depends on the assay and the clinical circumstances. Nonclassic CAH review · MedlinePlus

The following are broad examples, not universal laboratory cutoffs or newborn screening thresholds:

Group	Example value, ng/dL	Example value, nmol/L	What affects interpretation
Infant older than 24 hours	Below approximately 400–600	Below approximately 12–18	Values differ in low-birth-weight infants; screening programs use their own cutoffs
Premature or ill newborn	Can be substantially higher	Can be substantially higher	Screening thresholds account for gestational age and sometimes birth weight
Child before puberty	Around 100	Around 3	Values change with pubertal development
Adult woman	Below approximately 290	Below approximately 8.8	Lower in the follicular phase and higher after ovulation
Adult man	Below approximately 139	Below approximately 4.2	Morning sampling remains relevant
Pregnancy	Interpret separately	Interpret separately	A longitudinal study found an early decline followed by a rise later in pregnancy

The pregnancy pattern came from a cohort of 600 healthy Chinese women and should be interpreted using pregnancy- and method-specific intervals rather than a nonpregnant range. Newborn cutoff study · Cycle study · Pregnancy reference-interval study

Automated immunoassays and LC-MS/MS can give measurably different steroid results. Use the interval on your own laboratory report, and tell the clinician if the method has changed between tests. Analytical comparison

What a low result can mean

A low result may reflect reduced ACTH stimulation, the effect of prescribed glucocorticoids, the time of sampling, or the assay. It does not by itself establish adrenal insufficiency or good CAH control. If adrenal insufficiency is suspected, cortisol and the wider clinical assessment are needed.

An important exception to the idea that “lower is better” arises during treatment for CAH: fully suppressing 17-OHP is not the goal and can indicate glucocorticoid overtreatment. The clinician interprets the value alongside androgens, symptoms, growth or other clinical findings, and the timing of medication. Do not adjust or stop medication on the basis of this result alone. CAH guideline

What a result within the reference interval means

A correctly timed result in the appropriate interval makes a major 21-hydroxylase-related abnormality less likely, but is not an absolute exclusion of nonclassic CAH. A randomly timed measurement can be normal in someone with the condition. Persistent symptoms or a strong clinical suspicion can still justify further evaluation.

There is no established “optimal” 17-OHP target within a healthy reference interval. The test answers a diagnostic or monitoring question; it is not a number to minimize as part of a wellness program. CAH guideline

What an elevated result can mean

One important cause is 21-hydroxylase deficiency, which ranges from classic CAH to milder nonclassic forms. A markedly abnormal newborn screening result requires prompt specialist evaluation. A moderate early-morning elevation in an adolescent or adult can lead to an ACTH stimulation test, which assesses how the steroid pathway responds to stimulation. Clinical review

Commonly used decision ranges after infancy include the following. They are aids to a clinical workup, not universal assay-independent rules:

• Below 200 ng/dL, approximately 6 nmol/L, at baseline: An appropriately timed result makes nonclassic CAH less likely. It does not rule it out when symptoms or other findings remain concerning.
• Approximately 200–1,000 ng/dL, or 6–30 nmol/L, at baseline: This is a commonly used indeterminate range. A clinician may request cosyntropin stimulation to distinguish an enzyme defect from timing, cycle, or assay effects. The threshold should fit the laboratory method. Review
• Above approximately 1,000 ng/dL, or 30 nmol/L, after stimulation: This supports 21-hydroxylase deficiency in the appropriate setting. The full steroid response, assay, and clinical picture help distinguish nonclassic disease from other possibilities. Review

An elevation does not always mean an enzyme disorder. The luteal phase, daily rhythms, acute stress or illness, and cross-reactivity with related steroids can affect results. A mildly elevated result may therefore be repeated early in the morning and, where relevant, in the follicular phase. LC-MS/MS is preferred for suspected CAH. Persistent elevation is more informative when considered with androstenedione, testosterone, and symptoms. Stress background · Steroid assay study

Classic and nonclassic CAH compared

Both forms can result from 21-hydroxylase deficiency; the difference reflects the amount of residual enzyme activity and the resulting hormone deficiency. Classic CAH usually presents at birth or in infancy and can produce very high 17-OHP levels. The salt-wasting form can cause a life-threatening adrenal crisis. A concerning newborn screen needs prompt follow-up even before a child looks unwell. Not every classic case has salt wasting, but that distinction requires clinical evaluation. Guideline

Nonclassic CAH generally retains enough activity to avoid the severe salt-wasting presentation. It may appear later as androgen excess rather than an acute neonatal illness. Baseline 17-OHP can be mildly or moderately elevated, and stimulation testing can help establish the pattern. Cortisol reserve is not necessarily normal in every affected person, so its assessment matters in selected cases. Nonclassic CAH review

Distinguishing nonclassic CAH from PCOS

Nonclassic CAH and polycystic ovary syndrome, or PCOS, can cause similar symptoms. 17-OHP helps distinguish them, but no single number replaces the wider diagnostic assessment. PCOS background

Feature	Nonclassic CAH	PCOS
Common symptoms	Excess hair growth, acne, irregular cycles, reduced fertility	Excess hair growth, acne, irregular cycles, reduced fertility
Early-morning baseline 17-OHP	Often at or above 200 ng/dL, but lower results occur	Usually within the appropriate reference interval; mild elevations can occur
ACTH stimulation response	A value above approximately 1,000 ng/dL supports 21-hydroxylase deficiency, interpreted with the full profile	Does not ordinarily show the diagnostic steroid pattern of 21-hydroxylase deficiency
Typical first presentation	Childhood through adulthood	Usually from adolescence onward
Diagnostic confirmation	Stimulated steroid profile; CYP21A2 testing when indicated	Clinical diagnostic criteria after excluding other causes

Genetic testing is particularly useful when stimulation results are inconclusive, the test cannot be interpreted reliably, or genetic counseling is needed. Nonclassic CAH review · Hyperandrogenism study · Clinical review · 2023 PCOS guideline

Why results vary between blood draws

Both physiology and laboratory methods affect the result. A numerical change does not necessarily mean that the underlying condition has changed.

Factor	Possible effect	How to handle it
Daily ACTH rhythm	Steroid concentrations vary across the day	Use a consistent early-morning collection time
Menstrual-cycle phase	Higher after ovulation, lower in the follicular phase	Schedule in the early follicular phase when applicable
Acute stress, illness, or disrupted sleep	Can alter adrenal hormone output	Tell the clinician; postpone a nonurgent baseline test only if advised
Intense exercise	Can acutely raise ACTH and cortisol; the cited experiment did not measure 17-OHP	Report recent unusual exertion and follow the laboratory’s preparation instructions
Glucocorticoid medication	Can lower 17-OHP by suppressing ACTH	Record the dose and time taken; do not change treatment independently
Hormonal contraception	Can affect steroid concentrations and adrenal responses; effects depend on the formulation and population	Record the product and current use
Pregnancy	Concentrations change across gestation	Use pregnancy-specific interpretation
High-dose biotin	Can interfere with some immunoassays	Follow the laboratory’s advice about any pause
Assay platform	Different numerical results from the same serum	Prefer the same laboratory and method for follow-up

The exercise study measured ACTH and cortisol after a short, intense effort. It does not establish a specific change in 17-OHP or a validated 24-hour exercise restriction. Similarly, the contraception study examined ethinylestradiol with drospirenone in women with PCOS; it should not be generalized to every contraceptive. Circadian study · Cycle study · Exercise study · CAH guideline · Contraceptive study · Pregnancy study · Biotin interference review · Assay comparison

What happens during the test and how to prepare

The test usually requires a routine blood draw from a vein. Newborn screening generally uses a heel-prick sample. Fasting is not usually necessary for 17-OHP alone, although the laboratory may give different instructions if other tests are ordered at the same time. Timing and medication details are particularly important.

• Arrange an early-morning sample. For investigating suspected CAH after infancy, the guideline recommends sampling before 8 a.m. Guideline
• Consider the cycle phase. If you menstruate, early follicular sampling is generally preferred, often around cycle days 2–5. Confirm the timing with the clinician, especially if cycles are irregular. The cited cycle study supports hormone variation across the cycle, not a universal exact-day rule. Cycle study
• Mention high-dose biotin. Ask whether it affects the laboratory’s assay and whether a temporary pause is needed.
• Ask which method is used. LC-MS/MS is recommended for CAH evaluation because it is more specific than many immunoassays.
• Bring a medication list. Include glucocorticoids and hormonal contraceptives, with dose timing when relevant. Do not stop a prescribed medicine unless the clinician gives specific instructions.

Other measurements that help interpret 17-OHP

Other hormone results help place 17-OHP within the steroid pathway. The useful combination depends on the question being investigated, rather than on a fixed panel everyone needs.

Marker	What it adds	How it is interpreted
Cortisol	The end product of the pathway	High 17-OHP with inadequate cortisol can support a steroid-production defect, but does not identify the cause by itself
DHEA-S	An androgen produced predominantly by the adrenal glands	Helps assess adrenal androgen production; a normal value alongside high androstenedione does not by itself locate an enzyme defect
Total testosterone	A measure of downstream androgen production	Often interpreted with androstenedione; testicular production contributes substantially in men
FSH	Information about pituitary and gonadal function	Can help investigate irregular cycles or fertility problems; it is not a direct adrenal-versus-ovarian source test
LH	Additional information about reproductive signaling	Adds context to ovulatory assessment but does not independently diagnose PCOS

Cortisol background · DHEA-S background · Testosterone background · CAH guideline · FSH background · LH background

When a repeat measurement is useful

The conditions of a repeat test matter as much as the interval. During glucocorticoid treatment for CAH, follow-up is clinician-led. After the more frequent monitoring needed in early infancy, growing children are generally assessed every three to four months. Adult follow-up is individualized, with hormone measurements timed consistently relative to medication and time of day. Fully suppressing 17-OHP is not a treatment goal. Guideline

For follow-up or confirmation of a mildly abnormal result, use the same laboratory, a similar morning collection time, and the same cycle phase where possible. A change in analytical method can create an apparent trend that is not a biological change.

What happens after an elevated result?

An elevated result starts an investigation; it does not finish one. For a mildly abnormal result in a stable adolescent or adult, the process may include the following steps. An abnormal newborn screen or a person who is acutely unwell needs prompt assessment rather than waiting through a routine repeat-testing sequence.

• Check sampling conditions. A repeat early-morning, follicular-phase sample may clarify a mild elevation.
• Check the assay. If the first result came from an immunoassay, LC-MS/MS can help clarify interference from related steroids.
• Consider ACTH stimulation. A persistent indeterminate baseline result may lead to a stimulated steroid profile.
• Consider CYP21A2 testing when appropriate. It can clarify equivocal biochemical results, help when stimulation testing is difficult to interpret, or inform genetic and reproductive counseling. It is not automatically required after every elevated result. Review
• Arrange specialist evaluation. Markedly elevated values, an abnormal newborn screen, or a result that could change treatment merit endocrinology input.

The ACTH stimulation test, briefly

The test measures the adrenal response to synthetic ACTH, usually cosyntropin. A baseline sample is followed by another sample, commonly at 60 minutes, according to the testing protocol. When 21-hydroxylase activity is reduced, precursors can accumulate after stimulation.

A stimulated 17-OHP above approximately 1,000 ng/dL, or 30 nmol/L, supports 21-hydroxylase deficiency in the appropriate setting. Interpretation uses the assay and full steroid profile, including cortisol, rather than treating the cutoff as an infallible standalone diagnosis. A lower response makes the condition less likely but must still fit the clinical picture. Guideline · Review

Putting 17-OHP in context

A clear clinical question and appropriately timed sampling make this test useful. In newborn screening, the aim is early recognition of classic CAH. In adolescents and adults, it can help explain androgen-related symptoms such as acne, unwanted hair growth, irregular cycles, or difficulty conceiving. A pattern assessed under comparable conditions is often more informative than an isolated number.

A markedly elevated result needs timely clinical review, with urgency guided by age, symptoms, and the degree of abnormality. Possible adrenal crisis is an emergency. A mildly elevated value in an otherwise stable adult often needs standardized confirmation first. During glucocorticoid treatment, low values may reflect suppression, but very low or normalized 17-OHP is not automatically desirable and can indicate overtreatment.

17-OHP and progesterone are different tests with different clinical purposes. They may be offered together commercially, but being included in a package does not make both necessary for every person. Laboratory validation and FDA review are also different concepts; check the specific laboratory’s documentation rather than assuming that a commercial package has undergone FDA approval. Results support a clinical assessment and do not establish a diagnosis on their own. Commercial background · Example progesterone add-on

Frequently asked questions

What is 17-hydroxyprogesterone?

17-hydroxyprogesterone, or 17-OHP, is a steroid hormone made mainly by the adrenal glands, with smaller contributions from the ovaries and testes. It is an intermediate in the pathway from progesterone toward cortisol. If 21-hydroxylase activity is reduced, 17-OHP can accumulate and steroid production can shift toward androgens. Not every elevated result indicates an enzyme defect, however.

How is 17-OHP measured?

It is measured in a blood sample and usually reported in ng/dL or nmol/L. Standardized early-morning sampling improves comparability. In people who menstruate, the follicular phase is preferred because values rise after ovulation. LC-MS/MS provides more specific steroid measurement than many immunoassays and is recommended for CAH evaluation. Cycle study · Assay study

What is a normal 17-OHP range?

There is no single universal range. Age, sex, cycle phase, pregnancy, and assay all matter. Broad examples include values below approximately 290 ng/dL, or 8.8 nmol/L, in adult women and 139 ng/dL, or 4.2 nmol/L, in adult men. These are not substitutes for the interval on your own report. Separately, an early-morning follicular-phase value around 200 ng/dL, or 6 nmol/L, commonly prompts consideration of further testing for nonclassic CAH. That decision threshold depends on the method and clinical context. MedlinePlus · Review

What causes a high 17-OHP result?

An important cause is genetic 21-hydroxylase deficiency, ranging from classic CAH in infancy to milder nonclassic disease. Other explanations include the luteal phase, normal daily variation, acute illness or stress, and assay cross-reactivity. A single mild elevation often calls for repeat testing under standard conditions before drawing conclusions.

What symptoms occur with abnormal 17-OHP?

In nonclassic CAH, the associated androgen excess can cause acne, unwanted hair growth, irregular periods, or reduced fertility. Classic CAH can involve cortisol deficiency and, in the salt-wasting form, a life-threatening adrenal crisis. An isolated mild elevation may produce no symptoms at all. The laboratory value is a clue to the underlying physiology, not a symptom diagnosis by itself.

Does exercise affect 17-OHP?

Intense exercise can raise ACTH and cortisol. The cited experiment did not measure 17-OHP, so it does not prove a particular effect on this test or establish a required one-day exercise break. For comparable baseline measurements, report unusual recent exertion and follow the laboratory’s instructions. Keep collection time and prescribed medication timing consistent when advised. Exercise study

How often should 17-OHP be tested?

For most people it is a targeted test, not routine screening. It is used in newborn screening, androgen or fertility investigations, and follow-up of known CAH. Growing children with treated CAH are generally assessed every three to four months after the more intensive early-infancy period. Adult monitoring is individualized, with consistent timing relative to medication and time of day. Guideline

Which other biomarkers should be measured with 17-OHP?

Cortisol helps assess the end product of the same pathway. Androstenedione and testosterone add information about androgen production. DHEA-S, LH, and FSH can provide context when the question involves androgen excess, irregular cycles, or fertility. Renin, electrolytes, and sometimes aldosterone are relevant when salt balance or mineralocorticoid function is involved. The appropriate combination depends on the clinical question; none of these accompanying tests is automatically necessary for everyone.

Sources and references

• U.S. Food and Drug Administration (2023). FDA Commissioner and Chief Scientist announce decision to withdraw approval of Makena. https://www.fda.gov/news-events/press-announcements/fda-commissioner-and-chief-scientist-announce-decision-withdraw-approval-makena

• Speiser PW, Arlt W, Auchus RJ, Baskin LS, Conway GS, Merke DP, Meyer-Bahlburg HFL, Miller WL, Murad MH, Oberfield SE, White PC (2018). Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline. The Journal of clinical endocrinology and metabolism, 103(11), 4043-4088. https://doi.org/10.1210/jc.2018-01865 Source

• Debono M, Mallappa A, Gounden V, Nella AA, Harrison RF, Crutchfield CA, Backlund PS, Soldin SJ, Ross RJ, Merke DP (2015). Hormonal circadian rhythms in patients with congenital adrenal hyperplasia: identifying optimal monitoring times and novel disease biomarkers. European journal of endocrinology, 173(6), 727-737. https://doi.org/10.1530/EJE-15-0064 Source

• Aedo AR, Landgren BM, Diczfalusy E (1981). Studies on ovarian and adrenal steroids at different phases of the menstrual cycle: II. A comparative assessment of the circadian variation in steroid and lutropin levels during the follicular, periovulatory and luteal phases. Contraception, 23(4), 407-424. https://doi.org/10.1016/0010-7824(81)90030-5 Source

• Stroek K, Ruiter A, van der Linde A, Ackermans M, Bouva MJ, Engel H, Jakobs B, Kemper EA, van den Akker ELT, van Albada ME, Bocca G, Finken MJJ, Hannema SE, Mieke Houdijk ECA, van der Kamp HJ, van Tellingen V, Paul van Trotsenburg AS, Zwaveling-Soonawala N, Bosch AM, … Boelen A (2021). Second-tier Testing for 21-Hydroxylase Deficiency in the Netherlands: A Newborn Screening Pilot Study. The Journal of clinical endocrinology and metabolism, 106(11), e4487-e4496. https://doi.org/10.1210/clinem/dgab464 Source

• Carmina E, Dewailly D, Escobar-Morreale HF, Kelestimur F, Moran C, Oberfield S, Witchel SF, Azziz R (2017). Non-classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency revisited: an update with a special focus on adolescent and adult women. Human reproduction update, 23(5), 580-599. https://doi.org/10.1093/humupd/dmx014 Source

• MedlinePlus (2025). 17-OH progesterone. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/003713.htm

• Pode-Shakked N, Blau A, Pode-Shakked B, Tiosano D, Weintrob N, Eyal O, Zung A, Levy-Khademi F, Tenenbaum-Rakover Y, Zangen D, Gillis D, Pinhas-Hamiel O, Loewenthal N, de Vries L, Landau Z, Rachmiel M, Abu-Libdeh A, Eliakim A, Strich D, … Almashanu S (2019). Combined Gestational Age- and Birth Weight-Adjusted Cutoffs for Newborn Screening of Congenital Adrenal Hyperplasia. The Journal of clinical endocrinology and metabolism, 104(8), 3172-3180. https://doi.org/10.1210/jc.2018-02468 Source

• Lau SL, Yuen LY, Ho CS, Chan MHM, Ma RCW, Tam WH (2024). Gestational Age-specific Reference Intervals for Androgens in Pregnancy. The Journal of clinical endocrinology and metabolism, 110(1), 176-184. https://doi.org/10.1210/clinem/dgae382 Source

• Debeljak Ž, Marković I, Pavela J, Lukić I, Mandić D, Mandić S, Horvat V, Šerić V (2020). Analytical bias of automated immunoassays for six serum steroid hormones assessed by LC-MS/MS. Biochemia medica, 30(3), 030701. https://doi.org/10.11613/BM.2020.030701 Source

• Honour JW (2014). 17-Hydroxyprogesterone in children, adolescents and adults. Annals of clinical biochemistry, 51(4), 424-440. https://doi.org/10.1177/0004563214529748 Source

• Dahl SR, Nermoen I, Brønstad I, Husebye ES, Løvås K, Thorsby PM (2018). Assay of steroids by liquid chromatography-tandem mass spectrometry in monitoring 21-hydroxylase deficiency. Endocrine connections, 7(12), 1542-1550. https://doi.org/10.1530/EC-18-0453 Source

• New MI (2006). Extensive clinical experience: nonclassical 21-hydroxylase deficiency. The Journal of clinical endocrinology and metabolism, 91(11), 4205-14. https://doi.org/10.1210/jc.2006-1645 Source

• Escobar-Morreale HF, Sanchón R, San Millán JL (2008). A prospective study of the prevalence of nonclassical congenital adrenal hyperplasia among women presenting with hyperandrogenic symptoms and signs. The Journal of clinical endocrinology and metabolism, 93(2), 527-533. https://doi.org/10.1210/jc.2007-2053 Source

• Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, Costello MF, Boivin J, Redman LM, Boyle JA, Norman RJ, Mousa A, Joham AE (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. The Journal of clinical endocrinology and metabolism, 108(10), 2447-2469. https://doi.org/10.1210/clinem/dgad463 Source

• Buono MJ, Yeager JE, Hodgdon JA (1986). Plasma adrenocorticotropin and cortisol responses to brief high-intensity exercise in humans. Journal of applied physiology, 61(4), 1337-1339. https://doi.org/10.1152/jappl.1986.61.4.1337 Source

• De Leo V, Morgante G, Piomboni P, Musacchio MC, Petraglia F, Cianci A (2007). Evaluation of effects of an oral contraceptive containing ethinylestradiol combined with drospirenone on adrenal steroidogenesis in hyperandrogenic women with polycystic ovary syndrome. Fertility and sterility, 88(1), 113-117. https://doi.org/10.1016/j.fertnstert.2006.11.137 Source

• Samarasinghe S, Meah F, Singh V, Basit A, Emanuele N, Emanuele MA, Mazhari A, Holmes EW (2017). Biotin interference with routine clinical immunoassays: understand the causes and mitigate the risks. Endocrine practice, 23(8), 989-998. https://doi.org/10.4158/EP171761.RA Source

• Gröschl M, Rauh M, Schmid P, Dörr HG (2001). Relationship between salivary progesterone, 17-hydroxyprogesterone, and cortisol levels throughout the normal menstrual cycle of healthy postmenarcheal girls. Fertility and sterility, 76(3), 615-617. https://doi.org/10.1016/S0015-0282(01)01960-4 Source