Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Feb 23;12(3):e220275.
doi: 10.1530/EC-22-0275. Print 2023 Mar 1.

Serum LH/FSH ratios in 87 infants with differences of sex development

Marie Lindhardt Ljubicic  1   2 , Trine Holm Johannsen  1   2 , Margit Bistrup Fischer  1   2 , Emmie N Upners  1   2 , Alexander S Busch  1   2 , Katharina M Main  1   2   3 , Anna-Maria Andersson  1   2 , Casper P Hagen  1   2 , Anders Juul  1   2   3
Affiliations
Review

Serum LH/FSH ratios in 87 infants with differences of sex development

Marie Lindhardt Ljubicic et al. Endocr Connect. .

Abstract

The ratio between luteinizing hormone (LH) and follicle-stimulating hormone (FSH) has previously been described as an excellent marker of sex in healthy infants. However, LH/FSH remains not fully described in patients with differences of sex development (DSD). The aim was therefore to describe LH/FSH in infants with DSD. This was a retrospective study of DSD patients, all aged 0-1.2 years. In total, 87 infants with DSD and at least one serum sample per infant were included. Longitudinal samples from single patients were included whenever possible. Serum LH/FSH ratios in these patients were plotted against recently published age-related and sex-dimorphic cutoffs. Overall, LH/FSH sometimes corresponded to assigned sex without any obvious pattern in terms of diagnoses. LH/FSH corresponded to the biological sex in all patients with Turner or Klinefelter syndrome. In patients with 46,XX or 46,XY DSD (except congenital adrenal hyperplasia (CAH)), the ratios did not correspond to the assigned sex in all cases and were interchangeably within the male and female range. In patients with CAH, the ratio corresponded to biological sex (based on sex chromosomes) in some cases but also ranged across the cutoffs. In the 15 patients with 45,X/46,XY mosaicism, the LH/FSH ratios corresponded to the assigned sex in all cases (12 were raised as males, 3 as females) and at all time points in cases with multiple sampling. While this study describes LH/FSH in infants with DSD, the exact clinical role of the ratio in the management of these patients remains to be further elucidated.

Keywords: DSD; FSH; LH; LH/FSH; gonadotropins; minipuberty.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of this review.

Figures

Figure 1
Figure 1
The ratio of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), i.e. the LH/FSH ratio in serum, according to age in patients with Turner syndrome and variants (A) or Klinefelter syndrome and variants (B). Patient data are plotted against a previously published cutoff (solid black line (3)).
Figure 2
Figure 2
The ratio of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), i.e. the LH/FSH ratio in serum, according to age in patients with 46,XX DSD (A) or 46,XY DSD (B). Patient data are plotted against a previously published cutoff (solid black line (3)). CAIS, complete androgen insensitivity syndrome; NR5A1, nuclear receptor subfamily 5 group A member 1 mutation; PMDS, persistent Müllerian duct syndrome; SRY, sex-determining region of the Y chromosome.
Figure 3
Figure 3
The ratio of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), i.e. the LH/FSH ratio in serum, according to age in patients with congenital adrenal hyperplasia (CAH) (A) or 45,X/,46,XY mosaicism (B). Patient data are plotted against a previously published cutoff (solid black line (3)). NC, non-classical; SW, salt-wasting.
See this image and copyright information in PMC

References

    1. Johannsen TH, Main KM, Ljubicic ML, Jensen TK, Andersen HR, Andersen MS, Petersen JH, Andersson AM, Juul A. Sex differences in reproductive hormones during mini-puberty in infants with normal and disordered sex development. Journal of Clinical Endocrinology and Metabolism 20181033028–3037. (10.1210/jc.2018-00482) - DOI - PubMed
    1. Ljubicic ML, Jespersen K, Aksglaede L, Hagen CP, Petersen JH, Andersen HR, Linneberg A, Main KM, Andersson AM, Johannsen THet al.The LH/FSH ratio is not a sex-dimorphic marker after infancy: data from 6417 healthy individuals and 125 patients with differences of sex development. Human Reproduction 2020352323–2335. (10.1093/humrep/deaa182) - DOI - PubMed
    1. Ljubicic ML, Busch AS, Upners EN, Fischer MB, Main KM, Andersson AM, Johannsen TH, Hagen CP, Juul A. Dynamic changes in LH/FSH ratios in infants with normal sex development. European Journal of Endocrinology 2022187135–142. (10.1530/EJE-21-0999) - DOI - PubMed
    1. Lee PA, Houk CP, Ahmed SF, Hughes IA. Consensus statement on management of intersex disorders. Pediatrics 2006118e488–e500. (10.1542/peds.2006-0738) - DOI - PubMed
    1. Weidler EM, Pearson M, Leeuwen K van, Garvey E. Clinical management in mixed gonadal dysgenesis with chromosomal mosaicism: considerations in newborns and adolescents. Seminars in Pediatric Surgery 201928 150841. (10.1016/j.sempedsurg.2019.150841) - DOI - PMC - PubMed

LinkOut - more resources