Severe Hyperandrogenism Secondary to Polycystic Ovarian Syndrome in a Gender-diverse Adolescent

The development of gender identity takes place under the influence of a complex interplay of social, psychological, and biological factors. Studies in individuals with disorders of sex development have suggested that exposure to androgens during fetal development and across the lifespan may contribute to a more masculine gender identity. We describe here an individual designated female at birth who presented with severe hyperandrogenism (total testosterone 337 ng/dL, 11.7 nmol/L) (reference range, 6-50 ng/dL [0.21-1.74 nmol/L]) and virilization secondary to polycystic ovarian syndrome in the setting of gender identity exploration. On presentation the patient endorsed a masculine gender identity, and after GnRH analog therapy reduced total testosterone to the cisgender female range, endorsed a feminine gender identity. This case adds to what is known about the possible range of androgen excess in polycystic ovarian syndrome and demonstrates the diagnosis and treatment of polycystic ovarian syndrome in a gender diverse adolescent.