In disorders that affect menstrual regularity, the dynamic interactive chain of events between the hypothalamus, pituitary, and ovary is perturbed. Patients with hypothalamic anovulation have a relative deficiency of both FSH and LH. In polycystic ovary syndrome, the production of LH relative to FSH is excessive. The accompanying increased LH-to-FSH ratio results in the production of elevated androgen levels from the ovarian stroma that cannot be aromatized to estradiol by an immature cohort of developing follicles. These excess ovarian androgens, in concert with adrenal androgens, are mostly aromatized to weak estrogens in the adipose tissues, an event that further inhibits pituitary increases of FSH. The result is a self-perpetuating cycle leading to the clinical symptoms of obesity, hirsutism, and anovulation with subsequent infertility. More recently, studies in women who are normal in weight and cycle length and who do not have a history of an eating disorder have been found to have abnormal associations between leptin, LH pulsatility, and metabolic rate. 30 As more is learned about this underlying pathophysiology, alternative and more selective approaches to ovulation induction may evolve.
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But I'm not more aggressive—a behavior change often tied to testosterone. That's not surprising to Robert Sapolsky, ., a neuroendocrinologist at Stanford University and a leading researcher on stress and behavior. "It's really not the case that testosterone 'causes' aggressive behavior," he says. "Instead, it makes the brain more sensitive to social cues that trigger aggression. And in support of that, a guy's testosterone level isn't a very good predictor of how likely he is to be aggressive."