What laboratory tests do you order when checking a woman's hormones?

Laboratory Tests for Evaluating Women's Hormones

When checking a woman's hormones, you should order total testosterone, free testosterone, TSH, prolactin, LH, FSH, and estradiol as the core hormone panel, with additional tests based on clinical presentation and suspected conditions. 1

Core Hormone Panel

• Reproductive Hormones:

  • Follicle-stimulating hormone (FSH)
  • Luteinizing hormone (LH)
  • Estradiol
  • Total testosterone
  • Free testosterone or Free Androgen Index (FAI)
  • Sex hormone binding globulin (SHBG)
  • Prolactin

• Thyroid Function:

  • Thyroid-stimulating hormone (TSH)

Additional Tests Based on Clinical Presentation

For Suspected PCOS

• Androstenedione (if testosterone levels are not elevated)
• Dehydroepiandrosterone sulfate (DHEAS)
• 17-hydroxyprogesterone (to rule out congenital adrenal hyperplasia)
• Two-hour oral glucose tolerance test with 75g glucose load
• Fasting lipid profile (total cholesterol, LDL, HDL, triglycerides) 1

For Suspected Premature Ovarian Insufficiency

• Anti-Müllerian hormone (AMH)
• Fragile-X premutation testing
• 21-hydroxylase antibodies (21OH-Ab) or adrenocortical antibodies (ACA)
• Thyroid peroxidase antibodies (TPO-Ab) 2

For Menstrual Irregularities

• Progesterone (mid-luteal phase) to confirm ovulation
• Complete blood count
• Fasting glucose and insulin levels 2

Timing of Tests

• FSH, LH, and estradiol should be measured between days 3-6 of the menstrual cycle
• Progesterone should be measured during the mid-luteal phase (approximately day 21 of a 28-day cycle)
• For amenorrheic women, hormones can be measured at any time 2

Interpretation Considerations

• Laboratory values must be interpreted in context of clinical presentation
• Age and ethnicity may affect normal reference ranges for androgens
• FSH is not a reliable marker of menopausal status in women with prior chemotherapy, pelvic radiation exposure, or in women on tamoxifen 2
• Liquid chromatography with tandem mass spectrometry (LC-MS/MS) is the preferred method for measuring testosterone due to superior sensitivity and specificity 1

Special Considerations

For Cancer Survivors

• Baseline LH, FSH, and estradiol levels should be assessed at age 13 years in prepubertal survivors
• In sexually mature patients, evaluation should include menstrual and pregnancy history 2

For Bone Health Assessment

• Consider bone mineral density testing for women with signs of hypogonadism
• For women with amenorrhea or oligomenorrhea, especially if exercise-related or associated with low body weight 2

Common Pitfalls to Avoid

• Relying solely on FSH to determine menopausal status in women with prior chemotherapy
• Failing to check thyroid function when evaluating menstrual irregularities
• Not considering timing of the menstrual cycle when interpreting hormone levels
• Overlooking the need to rule out pregnancy before hormone testing
• Using inappropriate assay methods for testosterone measurement in women (immunoassays may lack sensitivity)

By following this comprehensive hormone assessment approach, you can effectively evaluate a woman's hormonal status and identify potential endocrine disorders that may require further management.