From the Guidelines
For a 27-year-old female concerned about hormone levels and anxiety, I strongly recommend checking thyroid function tests (TSH, free T4), cortisol levels (morning cortisol), and sex hormones (FSH, estrogen) as initial steps. When evaluating hormone levels in relation to anxiety, it's crucial to consider the potential impact of various hormonal imbalances. According to the guideline update from the Journal of Clinical Oncology 1, the workup and evaluation for hormonal deficiencies should include assessing TSH, free T4, and cortisol levels, among others. Given the patient's age and sex, and considering the guideline's suggestion to evaluate FSH and estrogen in premenopausal females with symptoms like mood changes, checking FSH and estrogen levels is particularly relevant. Additionally, considering the broad impact of hormonal imbalances on mental health, evaluating LH and testosterone, though more commonly considered in males, could provide additional insight into the patient's hormonal status. However, the primary focus should remain on thyroid function and sex hormones, as these are more directly linked to anxiety and mood disorders in females. It's also important to note that the timing of these tests, particularly for sex hormones, can be crucial and should be discussed with a healthcare provider to ensure the tests are conducted at the most informative points in the menstrual cycle. Basic metabolic tests like vitamin D, B12, and iron studies could also be considered, as deficiencies in these areas can contribute to anxiety symptoms, but the initial focus should be on the hormone panels most directly related to the patient's concerns.