From the Guidelines
Sex hormone testing, including FSH, LH, testosterone, and estrogen levels, should be initiated when patients present with symptoms of hormonal imbalance or specific clinical indications, such as irregular menstrual cycles, amenorrhea, infertility concerns, suspected premature ovarian insufficiency, or menopausal symptoms in women, and erectile dysfunction, decreased libido, infertility, gynecomastia, or suspected hypogonadism in men, as recommended by the most recent guidelines 1.
Key Indications for Sex Hormone Testing
- Women with irregular menstrual cycles, amenorrhea, infertility concerns, suspected premature ovarian insufficiency, or menopausal symptoms
- Men with erectile dysfunction, decreased libido, infertility, gynecomastia, or suspected hypogonadism
- Adolescents with delayed or precocious puberty
Timing and Interpretation of Sex Hormone Tests
- In women of reproductive age, FSH and estradiol should be measured during the early follicular phase (days 2-5 of the menstrual cycle) for accurate interpretation
- For menopausal assessment, FSH levels above 30-40 IU/L on two occasions at least one month apart, combined with symptoms, can confirm menopause
- In men, testosterone should be measured in the morning when levels are highest, preferably before 10 AM, with repeat testing recommended if initial results are abnormal, as suggested by recent studies 1
Additional Considerations
- Further testing, such as luteinizing hormone and follicle-stimulating hormone levels, may be needed to determine the etiology of testosterone deficiency or to distinguish between primary and secondary hypogonadism, as recommended by the guidelines 1
- The use of anti-Müllerian hormone (AMH) as a marker of ovarian reserve may be useful in certain populations, such as female survivors of childhood, adolescent, and young adult cancer, but its interpretation should be done with caution, especially in young women, as noted in recent research 1
From the Research
Initiation of Sex Hormone Testing
Sex hormone testing, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and estrogen levels, is crucial in diagnosing and managing various reproductive disorders. The decision to initiate sex hormone testing should be based on clinical presentation and medical history.
Indications for Testing
- Patients with symptoms of polycystic ovary syndrome (PCOS), such as oligomenorrhea, hirsutism, and infertility, should undergo sex hormone testing, including LH, FSH, and testosterone levels 2.
- Women with anovulatory amenorrhea and low serum gonadotropins may require testing for LH and FSH deficiency 3.
- Men with infertility issues may need testing for FSH and testosterone levels to evaluate spermatogenesis and potential testicular failure 4.
Timing of Testing
- In regularly menstruating women, serum samples for sex steroids and gonadotropins should be collected in the early follicular and mid-luteal phases of the menstrual cycle 5.
- The timing of hormone determinations is crucial in investigating the gonadotropin and androgen status in normally menstruating women 5.
Interpretation of Results
- The LH/FSH ratio can be used as a diagnostic criterion for PCOS, but its sensitivity is low, and other hormonal markers, such as testosterone and androstenedione, may be more useful 2.
- An FSH level >4.5 IU/L may be associated with abnormal semen analysis in men, and the normal range for FSH may need to be reconsidered 4.
- The reference intervals for serum sex steroids and gonadotropins vary depending on the assay method used, and the timing of sample collection is essential for accurate interpretation of results 5.
Key Hormonal Markers
- Testosterone is a key hormonal marker for PCOS, and its levels are often elevated in women with the condition 2, 6.
- LH and FSH levels are essential in evaluating gonadotropin deficiency and spermatogenesis in men and women 3, 4.
- Estrogen levels, including estradiol, are important in assessing reproductive function and diagnosing disorders such as PCOS 2, 5.