Claude Skills by dromlakhani

Recommends performing hormonal testing for central hypogonadism in males in the absence of acute/subacute illness, before 10 AM after an overnight fast, combined with serum prolactin measurement. Use when scheduling hormonal tests for male hypogonadism; triggers include preparing to order hypogonadism labs in male patients.

Recommends testosterone replacement for adult males with central hypogonadism and no contraindications to prevent anemia related to T deficiency; reduce fat mass; and improve BMD, libido, sexual function, energy levels, sense of well-being, and muscle mass and strength. Triggers include consideration of testosterone replacement in males with central hypogonadism (e.g., low serum testosterone with symptoms of deficiency).

Recommends gonadal hormone treatment for premenopausal women with central hypogonadism when no contraindications exist. Triggered when evaluating hormonal replacement in a premenopausal woman with oligomenorrhea or amenorrhea suggestive of central hypogonadism.

Recommends against diagnosing androgen deficiency syndrome in healthy women because there is no well-defined syndrome and no data linking androgen levels to specific signs or symptoms. Triggered when a clinician considers diagnosing androgen deficiency in a woman without known pituitary, adrenal, or gonadal disease.

Recommends against routine use of dehydroepiandrosterone in women because indications are inadequate and evidence of efficacy and long-term safety is lacking. Triggers include a clinician considering DHEA supplementation for general well‑being, adrenal insufficiency, or other non‑specific indications.

This skill recommends against using bisphosphonates, denosumab, testosterone, or leptin to improve bone mineral density in adolescents and women with functional hypothalamic amenorrhea (FHA) due to insufficient evidence and potential risks. Use when a clinician asks, 'Should we give her denosumab for low BMD?' or encounters language such as 'Avoid bisphosphonates in FHA' or 'Do not use leptin or testosterone or leptin for bone health'.

This skill recommends against using kisspeptin or leptin to treat infertility in patients with functional hypothalamic amenorrhea (FHA) except within research or closely monitored trials due to limited evidence. Use when a clinician states, “Let’s not prescribe kisspeptin for her infertility,” or encounters triggers such as “Avoid kisspeptin outside trials” or “Do not use leptin for ovulation induction.”

This skill advises against prescribing oral contraceptive pills solely to induce menstruation or enhance bone mineral density in patients with functional hypothalamic amenorrhea (FHA). Use when a clinician considers, 'Should I give her OCPs to get her period back?' or encounters statements such as 'Don’t use OCPs just for menses' or 'Avoid OCPs as a sole BMD strategy'.

This skill advises obtaining a baseline bone mineral density (BMD) measurement by dual‑energy X‑ray absorptiometry (DXA) for any adolescent or woman with six or more months of amenorrhea, and earlier when severe nutritional deficiency, other energy deficit states, or skeletal fragility are suspected. Trigger phrases include 'Get BMD after six months of amenorrhea' or 'Order DXA early due to suspected malnutrition'.

This skill recommends obtaining a baseline BMD measurement by DXA in adolescents or women with functional hypothalamic amenorrhea (FHA) and concurrent polycystic ovary syndrome (PCOS) who have six or more months of amenorrhea, and earlier if there is history or suspicion of severe nutritional deficiency, other energy deficit states, or skeletal fragility. Use when a clinician states, “She has PCOS and no periods for seven months—let’s get a DXA,” or similar triggers such as “Check BMD in PCOS...

This skill recommends obtaining a brain MRI with pituitary slices and contrast in adolescents or women with presumed functional hypothalamic amenorrhea (FHA) who have severe/persistent headaches, non-self-induced vomiting, changes in vision/thirst/urination, lateralizing neurologic signs, or clinical/laboratory evidence of pituitary hormone deficiency or excess. Triggers include phrases such as “MRI for persistent headache and vomiting” or “Get pituitary MRI if there are neuro signs”.

This skill recommends increasing caloric intake, improving nutrition, and/or decreasing exercise activity to restore energy balance and reactivate the hypothalamic–pituitary–ovarian axis in functional hypothalamic amenorrhea. It is triggered when a clinician states, 'We need to fix her energy deficit to bring back her periods,' or hears phrases like 'Increase calories and reduce exercise' or 'Focus on nutritional rehabilitation and weight gain'.

This skill guides clinicians to confirm that anatomic or organic causes of amenorrhea have been ruled out before labeling the condition as functional hypothalamic amenorrhea. Triggers include statements such as “We need to exclude organic causes first” or “Before calling it FHA, let’s get an MRI and prolactin level.”

This skill directs clinicians to initiate a diagnostic workup for functional hypothalamic amenorrhea (FHA) when menstrual cycles persistently exceed 45 days or amenorrhea lasts three months or longer. Trigger phrases include 'cycle longer than 45 days' or 'three months of no menses warrants evaluation'.

This skill involves educating patients with functional hypothalamic amenorrhea who use oral contraceptive pills for contraception that the pills may conceal the return of spontaneous menses and that bone loss can persist if an energy deficit remains. Use when a clinician says, “Let’s explain how OCPs might hide her recovery,” or when hearing triggers such as “Warn her OCPs can mask menses” or “Tell her bone loss may persist despite OCPs if she stays underweight.”

This skill guides clinicians to obtain an initial endocrine laboratory evaluation for functional hypothalamic amenorrhea, measuring serum TSH, free T4, prolactin, LH, FSH, estradiol, and AMH, with addition of total testosterone and DHEA-S if hyperandrogenism is present and 8 AM 17-hydroxyprogesterone if late-onset CAH is suspected. Use when a clinician states, “We need a full endocrine panel to assess thyroid, gonadal, and adrenal function,” or uses trigger phrases such as “Check TSH, prolact...

This skill suggests considering a trial of cognitive behavioral therapy (CBT) to restore ovulation and fertility in women with functional hypothalamic amenorrhea (FHA) who desire pregnancy, based on a small study showing efficacy with minimal harm. Clinicians may use this when they hear phrases such as "Try CBT to improve fertility" or "Consider psychotherapy before medical ovulation induction".

This skill suggests a trial of clomiphene citrate for ovulation induction in women with functional hypothalamic amenorrhea (FHA) who have an adequate endogenous estrogen level, as determined by baseline estradiol measurement. Use when a clinician asks, 'Her estrogen is measurable—should we try clomiphene?' Triggers include language like 'If E2 is sufficient, try clomiphene' or 'Consider clomiphene after confirming estrogen production'.

This skill advises exercising caution when using gonadotropin therapy (FSH/LH) for ovulation induction in patients with functional hypothalamic amenorrhea (FHA), particularly monitoring for ovarian hyperresponse and multiple gestations. It is triggered when a clinician states, “We’ll use gonadotropins but watch for overstimulation,” or phrases such as “Use gonadotropins cautiously” or “Monitor estradiol and follicle count during gonadotropin therapy”.

This skill recommends initiating fertility treatment with pulsatile GnRH as the first-line approach to induce ovulation in women with functional hypothalamic amenorrhea (FHA) who desire pregnancy, followed by gonadotropin therapy if GnRH is unavailable. Use when a clinician states, 'She wants to conceive—let’s start with pulsatile GnRH.' Triggers include language like 'First try pulsatile GnRH for ovulation' or 'Use GnRH pump before gonadotropins'.

This skill advises close monitoring for an exaggerated ovarian response when using exogenous gonadotropins for ovulation induction in patients with functional hypothalamic amenorrhea (FHA) who also have underlying polycystic ovary syndrome (PCOS). Use when a clinician remarks, 'She’s on gonadotropins and has PCOS—watch for overstimulation,' or notes phrases such as 'Monitor for hyperresponse to gonadotropins' or 'Check estradiol frequently during gonadotropin therapy in PCOS'.

This skill guides clinicians to assess patients with functional hypothalamic amenorrhea (FHA) for hospital admission when they exhibit severe bradycardia, hypotension, orthostasis, or significant electrolyte abnormalities. Use when a clinician says, “Her heart rate is 40 and she’s dizzy—should we admit her?” or notes phrases like “Admit for hypotension and bradycardia” or “Check for orthostatic vitals and electrolytes.”

This skill guides clinicians to evaluate congenital or acquired Müllerian tract anomalies in patients with primary amenorrhea using physical exam, progestin challenge test, and imaging. Trigger phrases include 'Rule out imperforate hymen with exam' or 'Consider ultrasound for Müllerian anomalies'.

This skill states that ovulation induction should be pursued only in women with functional hypothalamic amenorrhea (FHA) who have a body mass index (BMI) of at least 18.5 kg/m² and only after attempts to correct the underlying energy deficit. Use when a clinician asks, 'Her BMI is 18.2—should we hold off on ovulation drugs?' or hears triggers such as 'Wait until BMI is at least 18.5' or 'Don’t induce ovulation until weight is normalized'.

This skill involves informing patients that irregular menses during recovery from functional hypothalamic amenorrhea do not require immediate evaluation and that menstrual irregularity does not prevent conception. It is used when a clinician says, 'Let’s explain what to expect as her cycles return,' or when statements like 'Tell her irregular periods are okay' or 'Reassure her she can still conceive while cycles normalize' are made.

This skill guides clinicians to obtain a detailed personal and family history focusing on diet, eating disorders, exercise, weight, sleep, stressors, mood, menstrual pattern, fractures, substance abuse, and familial endocrine/reproductive disorders when evaluating suspected functional hypothalamic amenorrhea. Use when clinicians state they need to know about her exercise routine, diet, and family history of eating disorders, or when they ask about weight fluctuations, sleep, and stressors, or...

This skill directs clinicians to conduct a thorough physical exam, including external and selected bimanual gynecologic exam, to identify signs of anatomic or organic causes of amenorrhea. Use when clinicians state, 'Let’s check for thyroid enlargement, galactorrhea, or pelvic masses,' or 'Perform bimanual to rule out outflow tract anomalies' or 'Look for hirsutism, acne, or signs of androgen excess'.

This skill involves administering a progestin challenge (e.g., medroxyprogesterone acetate 5–10 mg daily for 5–10 days) to induce withdrawal bleeding, which indicates adequate estrogen exposure and evaluates outflow tract integrity. Use when a clinician states, “Let’s do a progestin challenge to see if she bleeds,” or gives orders such as “Give 10 mg medroxyprogesterone for 10 days and check for bleed” or “Use progestin challenge to assess endometrial estrogen effect”.

This skill suggests offering psychological support, particularly cognitive behavioral therapy, to address stress and maladaptive coping mechanisms in patients with functional hypothalamic amenorrhea. Trigger phrases include “Recommend CBT for anxiety and perfectionism” or “Consider psychotherapy to improve coping”.

This skill suggests that short-term recombinant parathyroid hormone 1-34 (rPTH) may be considered in rare adult functional hypothalamic amenorrhea (FHA) cases with delayed fracture healing and markedly reduced bone mineral density. Use when a clinician notes, 'Her fracture isn’t healing and her Z-score is -3—could rPTH help?' or considers rPTH for poor fracture healing or teriparatide in severe osteoporosis with FHA.

This skill recommends obtaining initial screening laboratory tests for functional hypothalamic amenorrhea (FHA) to rule out pregnancy and systemic illness. Use when a clinician states, 'Let’s get basic labs to rule out pregnancy and systemic illness,' or similar phrases such as 'Order a chem panel and pregnancy test' or 'Check CBC and metabolic panel'.

This skill recommends a short course of transdermal estradiol combined with cyclic oral progestin (not oral contraceptives) for adolescents and women with functional hypothalamic amenorrhea who have not resumed menses after a reasonable trial of nutritional, psychological, and/or modified exercise interventions. It is triggered when a clinician states, 'She’s tried diet and CBT but still no periods—let’s try transdermal E2,' or similar phrases such as 'Consider transdermal estrogen after life...

This skill guides clinicians to add an antiandrogen after six months of monotherapy with an oral contraceptive when patient‑important hirsutism shows an inadequate response. Trigger phrases include “patient‑important hirsutism”, “6 months of OC monotherapy”, and “suboptimal hirsutism response”.

Suggests adding electrolysis or laser/photoepilation after pharmacologic therapy when the patient desires additional cosmetic improvement beyond medication alone. Triggered by clinician statements such as "She’s improved on the pill but wants smoother skin; should we add laser?"

Add eflornithine 13.9% cream to photoepilation for faster hirsutism reduction in women with patient-important hirsutism who desire a quicker cosmetic response. Trigger when the patient reports inadequate speed of hair reduction after initiating laser or intense pulsed light therapy.

Image the adrenal glands with CT and the ovaries with transvaginal ultrasound when biochemical evaluation suggests an androgen‑secreting tumor, such as markedly elevated DHEAS or testosterone, rapid progression of hirsutism, or virilization. Trigger phrases include “sudden‑onset hirsutism,” “virilization (clitoromegaly, deepening voice),” “DHEAS > 700 µg/dL,” “testosterone in male range,” or “progressive hirsutism despite therapy.”

Assesses the adrenal response to cosyntropin stimulation by measuring 17-hydroxyprogesterone and other steroid precursors to exclude rare forms of congenital adrenal hyperplasia in women with hirsutism. Triggered when evaluating hyperandrogenic patients with high-risk features (e.g., positive family history, high-risk ethnicity) despite normal baseline androgens.

Assess for Cushing syndrome, thyroid dysfunction, acromegaly, or hyperprolactinemia when clinical features suggestive of these disorders are present in a woman with hirsutism. Trigger phrases include "Cushingoid features," "hypothyroidism signs," "acromegalic changes," or "galactorrhea/menstrual disturbance."

Assess urinary corticoid metabolites by mass spectrometry to exclude apparent cortisone reductase deficiency. Indicated when a woman presents with moderate/severe hirsutism or mild hirsutism accompanied by clinical evidence of a hyperandrogenic endocrine disorder such as menstrual disturbance, progression despite therapy, or signs of virilization.

Guidance to avoid antiandrogen monotherapy unless adequate contraception is in place. Trigger phrases include patient-important hirsutism despite cosmetic measures, sexually active status, inadequate contraception, desire for pregnancy, permanent sterilization, or long-acting reversible contraception.

The clinician avoids GnRH agonist therapy for hirsutism unless the patient has severe hyperandrogenemia (e.g., ovarian hyperthecosis) and has demonstrated a suboptimal response to combined oral contraceptives plus an antiandrogen. Trigger phrases include "severe hyperandrogenemia," "suboptimal response to OC/antiandrogen," and "ovarian hyperthecosis."

This skill advises against using insulin‑lowering drugs (e.g., metformin, thiazolidinediones) solely to treat hirsutism in premenopausal women. Apply when evaluating patient‑important hirsutism despite cosmetic measures or when insulin‑lowering therapy is considered for hyperandrogenism without other indications.

The skill recommends against testing for elevated androgen levels in eumenorrheic women with only unwanted local hair growth and no abnormal hirsutism score. Trigger phrases include statements like, “She only has stray facial hair but regular periods; do we need androgen labs?”

The skill advises clinicians to avoid prescribing topical antiandrogen agents (e.g., spironolactone or finasteride cream) for hirsutism in premenopausal women. Trigger phrases include “patient wants a topical cream for facial hair,” “considering eflornithine for hirsutism,” or “requests antiandrogen topical therapy.”

Consider oral contraceptive‑antiandrogen combination therapy for severe hirsutism causing emotional distress or after inadequate response to OC monotherapy. Avoid using this combination as first‑line treatment; reserve for patients with severe distress or prior OC failure.

Perform dexamethasone suppression testing to evaluate functional adrenal androgen excess in women with hirsutism. Trigger phrases include “moderate/severe hirsutism with normal total testosterone,” “clinical evidence of hyperandrogenic disorder despite normal androgens,” or “progression of hirsutism despite therapy.”

For a premenopausal woman presenting with mild hirsutism (Ferriman–Gallwey score 8–15) and no clinical evidence of an endocrine disorder (eumenorrheic menses, absence of hyperandrogenic signs), the clinician should consider either pharmacologic therapy or direct hair removal as initial management options. Choose pharmacologic therapy (e.g., combined oral contraceptive) or direct hair removal (laser/photoepilation or electrolysis) based on patient preference, contraceptive needs, and hair char...

Recommend lifestyle changes for obese women with PCOS who present with hirsutism and seek improvement of androgen-related symptoms. Trigger phrases include BMI ≥30, PCOS diagnosis, hirsutism (Ferriman–Gallwey score ≥8), and desire for non-pharmacologic management.

This skill guides selection of a low‑dose estrogen oral contraceptive combined with a low‑risk progestin for premenopausal women with hirsutism who are at increased venous thromboembolism risk (e.g., obesity or age >39 years). It triggers when a patient presents with patient‑important hirsutism requiring pharmacologic therapy and has VTE risk factors without estrogen contraindications.

Measure serum androstenedione or other steroid intermediates in premenopausal women with hirsutism when atypical features raise suspicion for adrenal pathology, such as rapid progression, virilization, or high-risk ethnicity for nonclassic congenital adrenal hyperplasia. This step follows a normal total and free testosterone but persistent clinical evidence of hyperandrogenism.