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The criteria for participation were: amenorrhea for 6+ months and not pregnant normal development no markers of metabolic disease weight stable for the last 12 months (noted that subjects were 5-9% below ideal weight) normal adrenal and thyroid hormones Patients were divided into two groups 10 patients with LH less than 3 IU/mL (average of 0.9 +/- 0.1) and 10 with LH greater than 3 IU/mL (average of 7.1 +/- 1.5)

Four specific conditions qualify for Tier 3 (BMI 27 or higher): (1) prediabetes per American Diabetes Association criteria (typically A1c 5.7 to 6.4 percent, fasting glucose 100 to 125, or 2-hour oral glucose tolerance test 140 to 199), (2) previous heart attack (myocardial infarction), (3) previous stroke, and (4) symptomatic peripheral artery disease