There is considerable controversy over the earliest age at which it is clinically, morally, and legally safe to use GnRH analogues, and for how long. The sixth edition of the World Professional Association for Transgender Health 's Standards of Care permit it from Tanner stage 2 but do not allow the addition of hormones until age 16, which could be five or more years later. Sex steroids have important functions in addition to their role in puberty, and some skeletal changes (such as increased height) that may be considered masculine are not hindered by GnRH analogues.
Follicle Stimulating Hormone (FSH) - In women FSH is often used as a gauge of ovarian reserve. In general, under 6 is excellent, 6-9 is good, 9-10 fair, 10-13 diminished reserve, 13+ very hard to stimulate. In PCOS testing, the LH:FSH ratio may be used in the diagnosis. The ratio is usually close to 1:1, but if the LH is higher, it is one possible indication of PCOS. Basic hormone testing for males often only includes testosterone and FSH. However, in cases such as Klinefelters Syndrome doctors will usually look at both FSH and LH levels. In males FSH stimulates the Sertoli cells in the testes to produce androgen-binding proteins, testosterone, and a protein called inhibin. Inhibin, in turn, travels in the blood back to the pituitary gland whre it creates a "negative feedback loop" that decreases the output of FSH. Since FSH stimulates testosterone production, and testosterone can be converted to DHT and estradiol, an increase of any or all three can also create a "feedback loop" that decreases FSH secretion.
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