David and/or Wendy, I have a client with suspected PCOS. Short and light cycles, cycle this month started at 18 days from start of last cycle, horrendous menstrual cramps, cystic acne, etc. She is 20 years old and very fit. Not a shred of obesity. This individual also has multiple food allergies (confirmed with bloodwork), biliousness, probable low HCL and gall bladder congestion. Tongue diagnosis is indicating liver qi stagnation and inflammation in the stomach. She really wants the acne to go away, as prior to the last 10 months, she has had very nice skin. Her dermatologist said her acne is cystic, and the "go to" is to prescribe spironolactone to address the acne. She's not interested in the pharmaceutical. Here are my questions: Do you ever treat clients with herbs for PCOS without an official diagnosis if the symptom pattern is pointing in that direction? If further testing is indicated, what might that include? Hormone panel, fasting insulin, fasting glucose, HbA1c, etc. Any recommended imaging? How can one ascertain if the issue is stemming from excessive androgen production in the adrenal glands as opposed to poor hormone clearance via detoxification pathways? Or is it generally a combination of both? Can you be diagnosed with PCOS without evidence of cysts on the ovaries? If bloodwork indicates normal hormone levels, and imaging is within normal limits, what are other possible causes of cystic acne? Thank you for entertaining the "rapid fire" line of questioning. Jami Platt

Possibly, but her symptoms do not entirely suggest PCOS. So if the symptoms clearly fit, then yes I would treat PCOS, if as in this case there are other possible causes, no, not till I understand what is actually occurring. Has anyone checked for endometriosis (she is young for this, but it is possible), she could have elevated androgens w/o PCOS and Thyroid issues. BTW blood tests for food allergies can be notoriously inaccurate. Hormone panel, fasting insulin, fasting glucose, HbA1c, etc. Any recommended imaging? yes, to all (Wendy needs to be asked about imaging, beyond my scope). Can you be diagnosed with PCOS without evidence of cysts on the ovaries - I have seen cases where the answer is yes. Other possible causes of cystic acne are gut dysbiosis and hepatic torpor.

David, Thank you:)