Dermatologist noticed slightly elevated testesterone test but didn't recommend followup?

my teenage niece is a very beautiful girly girl. who loves wearing nice clothing, having manicures/pedicures, facials and neat hair. she%26#039;s a trained dancer and is quite athletic. however, i%26#039;ve noticed she%26#039;s muscular (arms/legs) for her tiny frame (5%26#039;7 or 5%26#039;8 @120lbs) and her neck bone/shoulder blades are visible. even as a young child she had naturally toned arms. i don%26#039;t know how this info may be helpful but she started her menses at 11yrs old and experiences monthly stomach cramps and blood clots, which her pediatrician said was normal for her and suggested she take tylenol. could she have pcos or be trans-gender. what steps should we take to look into this and what treatment options are available. would a pelvic ultrasound be useful. i%26#039;m not sure how we will handle the trans-gender thing though.|||Why are you looking into a trans gender option for a niece ? why, why? does she want to be a man ? what%26#039;s her opinion on this matter ? Of course there are doctors that practice this all over the country but, you%26#039;d have to search them out or find someone that had it done and talk to them about this. I do know that it takes a year of heavy psychological thinking and another year of lot%26#039;s of drugs like testerone before a change will be made and, not all at once. It would take about three years for a total for five years to change.