Hormone testing is a crucial step in assessing your health, especially if you suspect you have a hormonal imbalance or want to get pregnant. Unlike other tests though, some of the hormonal ones need to be done at specific times in your cycle to give you the correct results. Here’s a little glimpse into what you should test and when.
FSH, LH, Estrogen, Progesterone, Prolactin
The classic women’s hormonal panel includes estrogen, progesterone, FSH, and LH. But what do they tell you and when do you test?
FSH (Follicle Stimulating Hormone) – should be tested on day 2 or 3 of your cycle (though some doctors say day 3-5). Counting from the first day of full bleeding (not spotting), you should go testing on the 2nd or 3rd day. If they are on a weekend and no labs are available, day 4 will do. This is usually done for women who are approaching menopause, but other hormonal imbalances can be detected through it. For instance, the ratio between LH and FSH can confirm a suspicion of polycystic ovarian syndrome.
LH (luteinizing hormone) – it is mostly used in the above-mentioned LH to FSH ratio to determine the existence of PCOS.
Estrogen – or estradiol, which the form usually tested – should be usually done on day 2-4 of your cycle. Some doctors recommend days 3-5. Depending on the suspected imbalances, you might benefit from testing both estrogen and progesterone on the same day, to see their ratio.
Progesterone is a test performed seven days post-ovulation. You might have heard it recommended on day 21. But if you do not ovulate on day 14, then doing it on day 21 will be useless. Here’s again a chance to see why every woman should use the fertility awareness method to track her cycles. Even if you don’t use the method as birth control, you will know approximately when you ovulated and you’ll be able to do this test at the right time. The method cannot tell you the exact date of ovulating, as the temperature shift could happen 1-2 days after. But you will know you DID ovulate and you are not running the test in vain. If your doctor wants to look at the ratio, estrogen should also be performed. For the ratio, your doctor might recommend a different day in your cycle – work with their recommendations.
Prolactin is a hormone that increases when you are pregnant, as your body prepares to make milk for the baby. It can be elevated by birth control pills, in which case the pill should be stopped immediately. It can also be increased with PCOS and with pituitary tumors called prolactinoma (they are benign most of the time). It is best tested on day 3 of your cycle, or any day if you are on the pill.
Androgens
Androgens, namely, testosterone, androstenedione, DHEA-S are tests that are run when a hormonal imbalance is suspected. Some might test for them when you want to get pregnant, but they are not necessarily routine tests. These are some confusing tests, and sadly some doctors do not run them the proper way.
Testosterone – the most commonly tested androgen, testosterone should not be tested alone. That is, you should have both total and FREE testosterone tested. It is very possible to have normal levels of total testosterone, but too much of the free one. Also, for a proper assessment, SHBG (sex hormone-binding globulin) should be tested. These tests will give you a real overview of how much testosterone you produce, how much circulates free and how much is used. This is a short explanation, and I’m sure an endocrinologist can do a much better job at explaining. With these tests, one can also calculate an important factor, called the free androgen index.
Androstenedione – this is a more complex androgen as it is produced both by the ovaries and by the adrenals. It is also less tested, but not less important. For instance, you can have PCOS with normal testosterone levels and a good free androgen index but still have high androstenedione. So if you have symptoms of high androgens like irregular periods, cystic acne, hirsutism, hair loss, ask for this test as well.
DHEA-S is the last androgen in this list and is the one that signals adrenal PCOS. It is the more rare type, and also the hardest to treat. When reading about it, you will see there is DHEA and DHEA-S. The second stays longer in the body and is, therefore, a better measure of the total amount of DHEA in your blood, which is why it is the one you should test for. If you’re looking for more understanding about DHEA, I suggest reading this article.
Hormone testing for your thyroid
When you are struggling with irregular periods, and especially if all the above tests come back normal, the thyroid might be next in line to be checked. The most commonly performed test is TSH, but sadly, it is one that says very little about the thyroid. If you only test for TSH, you are at a risk for having a thyroid issue undiagnosed. The complete thyroid panel includes free T3, free T4, TPO & thyroglobulin antibodies.
TSH is a brain hormone and therefore, it only indirectly measures the thyroid function. T4 however, is produced by the thyroid and converted into the active form, T3. Finally, TPO & thyroglobulin are the antibodies that can help identify autoimmune thyroid issues, such as Hashimoto’s. For more information, check out this comprehensive article on the roles of each of these tests in assessing thyroid function.
To conclude
I hope you found this post informative. Hormone testing for us women is definitely not an easy art. For many of these tests, you will need an endocrinologist for a proper interpretation, especially if you have symptoms of a hormonal imbalance. Most of them are not tests to be analyzed on their own but as a whole. Also, please keep in mind that there are some issues, like endometriosis or adenomyosis, that are not necessarily revealed on blood work alone. Depending on your intentions (conceiving or not) or your age, more tests might be required. For instance, AMH (Anti-Mullerian Hormone) assesses the ovarian reserve. This test is not dependant on the day of the cycle, so it can be done at any time.
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