If my hormones are -ALL- normal including total, free, and bioavail testosterone and I have PCOS, what is causing my elevated LH:FSH ratio 3:1?

PCOS. PCOS causes an elevated LH:FSH ratio. This is one of the findings of PCOS. The cause is unknown. There is an abnormal signal to the hypothalamus that inhibits the production of FSH. This signal is associated with obesity and elevated levels of insulin.