During gonadal dysfunction, the typical hormonal profile is:

• A. High estrogen with low FSH and LH
• B. Low estrogen with low FSH and LH
• C. Low estrogen with high FSH and LH
• D. Normal hormones with FSH/LH

Answer: (C)

When the gonads fail to produce enough sex steroids, the usual signal that keeps pituitary FSH and LH in check drops. Estrogen levels fall, which reduces negative feedback on the hypothalamus and pituitary. In response, GnRH pulse frequency increases and the pituitary pumps out more FSH and LH. But because the gonads aren’t functioning, estrogen stays low despite high gonadotropins. So the classic hormonal profile is low estrogen with high FSH and LH, reflecting primary gonadal failure. In contrast, central causes would show low FSH/LH with low estrogen, and estrogen excess or exogenous estrogen would suppress FSH/LH. Normal hormones would imply intact gonadal function.