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Lab Interpretation and Testing

Hormone Panel Explained: What Each Test Measures and Why

A complete guide to hormone blood tests — what FSH, LH, estradiol, progesterone, testosterone, SHBG, DHEA-S, and cortisol measure, normal ranges, and what to do with results.

Holistic Health Editorial Team · · 14 min read

Reviewed by Holistic Health Clinical Team

Hormone Panel Explained: What Each Test Measures

Key Takeaways

  • ✓FSH measures ovarian reserve signaling — elevated FSH indicates the pituitary is working harder to stimulate declining ovarian function.
  • ✓Estradiol (E2) is the dominant active estrogen and the most commonly tested; its meaning depends heavily on cycle day when drawn.
  • ✓Progesterone below 10 ng/mL in the luteal phase suggests either anovulation or inadequate corpus luteum function.
  • ✓SHBG (sex hormone-binding globulin) often matters more than total testosterone — it determines how much free, active testosterone is available.
  • ✓A comprehensive thyroid panel (not just TSH) is essential when investigating hormonal symptoms, since thyroid dysfunction mimics and worsens hormone imbalances.
  • ✓Functional ranges are often narrower than lab reference ranges — many women feel optimal at the higher end of 'normal' vitamin D, progesterone, and free T3.

The HPG Axis: The Command Center

The HPG (hypothalamic-pituitary-gonadal) axis is the master control network: the hypothalamus releases GnRH, which signals the pituitary to release FSH and LH, which signal the ovaries to produce estrogens, progesterone, and androgens. When something goes wrong anywhere in this axis, the disruption cascades and appears in your lab results.

FSH (Follicle-Stimulating Hormone)

FSH stimulates ovarian follicle development. Elevated FSH on cycle days 2-4 indicates the pituitary is working harder to stimulate declining ovarian function. Reference ranges: reproductive age 3–10 mIU/mL, perimenopause 10–25 mIU/mL, postmenopause >25 mIU/mL. Always combine with AMH and estradiol for the full picture.

LH (Luteinizing Hormone)

LH triggers ovulation and stimulates progesterone production. A high LH:FSH ratio (>2:1 in follicular phase) is a classic PCOS finding. The mid-cycle LH surge (>25 mIU/mL) triggers ovulation — this is what ovulation predictor kits detect.

Estradiol (E2)

The primary active estrogen. Its value is entirely context-dependent on cycle day: early follicular 25–75 pg/mL; mid-follicular 100–200 pg/mL; ovulatory peak 200–400 pg/mL; postmenopause <30 pg/mL. High estradiol early in the follicular phase (>80 pg/mL days 2-3) can paradoxically indicate poor ovarian reserve.

“One of the most common mistakes I see is doctors interpreting hormone labs without knowing cycle day. A progesterone of 3 ng/mL is entirely normal at cycle day 5 and concerning at cycle day 21. Context is literally everything in hormone interpretation.”

Dr. Mark Hyman, MD

Founder, UltraWellness Center · Source: The UltraWellness Solution

Progesterone

Produced by the corpus luteum after ovulation. Mid-luteal levels: <3 ng/mL suggests anovulation; 3–10 ng/mL is suboptimal; 10–20 ng/mL is adequate; 20+ ng/mL is excellent. Functional medicine practitioners often consider >15 ng/mL optimal for symptom resolution in women with PMS or estrogen dominance.

Testosterone and Free Testosterone

Request LC-MS/MS testing — standard immunoassay is poorly accurate at low concentrations typical in women. Women's reference: total testosterone 15–80 ng/dL, free testosterone 1–8 pg/mL. Elevated levels suggest PCOS or adrenal androgen excess; low levels contribute to fatigue, low libido, and cognitive fog.

SHBG (Sex Hormone-Binding Globulin)

SHBG determines the free, active fraction of sex hormones. High SHBG (from oral estrogens, hyperthyroidism) reduces free testosterone and estradiol. Low SHBG (from insulin resistance, obesity) increases free androgens — relevant for PCOS evaluation. Calculate the Free Androgen Index alongside total testosterone.

DHEA-S

The most abundant human hormone — primarily an adrenal marker and hormone precursor. Low DHEA-S suggests adrenal insufficiency or aging; elevated suggests adrenal hyperplasia or PCOS. Stable, not cycle-dependent — a convenient adrenal health baseline. Compare to age-matched reference ranges.

AMH (Anti-Müllerian Hormone)

Reflects the primordial follicle pool and ovarian reserve. Not cycle-dependent, not affected by oral contraceptives. Age 25-30: 2.5–6.0 ng/mL; age 36-40: 1.0–2.5 ng/mL; 46+: <1.0 ng/mL. Low AMH with elevated FSH indicates significantly diminished ovarian reserve.

Prolactin

Elevated prolactin (hyperprolactinemia) suppresses LH and FSH, causing irregular cycles and fertility issues. Normal: 2–25 ng/mL. Investigate if irregular periods with no pregnancy, unexplained infertility, or galactorrhea is present.

Cortisol

Chronic high cortisol suppresses the HPG axis and steals precursors from progesterone synthesis. Morning blood cortisol screens for Addison's/Cushing's but misses functional patterns. Use 4-point salivary cortisol or DUTCH Complete for full diurnal mapping.

Reading Your Results: Patterns

  • Estrogen Dominance: Elevated estradiol, low luteal progesterone, elevated 16a-OHE1 on DUTCH
  • PCOS: LH:FSH >2:1, elevated free testosterone, low SHBG, elevated insulin
  • Perimenopause: Rising FSH, declining AMH, absent luteal progesterone rise
  • HPA Dysregulation: Flat cortisol curve, low DHEA-S, low progesterone

For testing timing guidance, see when to test your hormones. For estrogen imbalance next steps, see our estrogen dominance diet guide.

This article is for educational purposes only. Hormone test results should always be interpreted by a qualified healthcare provider.

Frequently Asked Questions

What is a normal hormone panel for a woman?▾
Normal ranges vary by age, cycle day, and whether you're pre- or postmenopausal. For a premenopausal woman in the early follicular phase: FSH 3–10 mIU/mL, LH 2–10 mIU/mL, estradiol 25–75 pg/mL, progesterone <1 ng/mL (rises to 10–25 ng/mL in luteal phase after ovulation). Total testosterone typically ranges from 15–80 ng/dL in reproductive-age women. SHBG 20–130 nmol/L. These are laboratory reference ranges — many functional medicine practitioners use tighter 'optimal' ranges within these.
What does high FSH mean in women?▾
Elevated FSH (above 10–12 mIU/mL when tested on cycle days 2-4) typically indicates diminished ovarian reserve — the pituitary is releasing more FSH to try to stimulate ovaries that are less responsive. This can occur with aging, premature ovarian insufficiency (POI), or damage from surgery/chemotherapy. Very high FSH (>25–40 mIU/mL) suggests ovarian failure (menopause). A single elevated FSH should always be confirmed with a repeat test and AMH measurement for context.
What does low progesterone mean?▾
Low progesterone in the luteal phase (below 10 ng/mL, ideally tested 7 days post-ovulation) can indicate: anovulation (no ovulation occurred that cycle), luteal phase defect (corpus luteum insufficient), perimenopause (anovulatory cycles becoming more common), or chronic stress (cortisol shunting progesterone precursors). Low progesterone relative to estrogen contributes to estrogen dominance symptoms including heavy periods, PMS, breast tenderness, and bloating.
What is SHBG and why does it matter?▾
SHBG (sex hormone-binding globulin) is a protein produced by the liver that binds sex hormones — particularly testosterone and estradiol — making them inactive. High SHBG reduces the free, active fraction of hormones available to cells. Oral estrogen therapy, liver disease, and hyperthyroidism raise SHBG. Low SHBG (from insulin resistance, obesity, hypothyroidism) means more free testosterone — relevant for PCOS evaluation. SHBG level is essential for understanding free testosterone and the androgenic environment.
What is DHEA-S and what does it tell you?▾
DHEA-S (dehydroepiandrosterone sulfate) is the most abundant hormone in the body and is primarily produced by the adrenal glands. It's a precursor to both androgens and estrogens. DHEA-S declines significantly with age (peaking in the 20s). Low DHEA-S can indicate adrenal insufficiency, chronic stress, or simply aging. Elevated DHEA-S can suggest adrenal hyperplasia or adrenal tumor. DHEA-S is one of the most stable hormones for measurement (not cycle-dependent) and serves as a general adrenal health marker.
Do I need a hormone panel if I'm on birth control?▾
Hormonal contraceptives significantly alter hormone testing. Combined oral contraceptives suppress LH and FSH, dramatically alter SHBG (oral estrogen increases SHBG 3-5x), and interfere with progesterone measurement. Testing sex hormones while on hormonal birth control gives you the picture of the pill's hormonal environment, not your baseline. If you want to understand your own hormonal baseline, testing should ideally be done 3 months after stopping hormonal contraceptives — though AMH (ovarian reserve) can be tested anytime.

References

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  2. 2.Kanakis GA, et al. Measuring testosterone in women and men. Maturitas. 2019;125:41-44. PubMed ↩
  3. 3.Ahmad N, et al. The optimal timing of blood collection during the menstrual cycle for the assessment of endogenous sex hormones. Cancer Epidemiol Biomarkers Prev. 2002;11(1):147-51. PubMed ↩
  4. 4.Oosthuyse T, et al. Understanding the female athlete: molecular mechanisms underpinning menstrual phase differences in exercise metabolism. Eur J Appl Physiol. 2023;123(3):423-450. PubMed ↩
  5. 5.Effect of delays in processing blood samples on measured hormone levels. 2007. PubMed ↩