Female Hormone Testing

The following is for informational purposes only. Please consult with your doctor when ordering tests.

None of these tests need to be done while fasting

We recommend testing sex hormones every three to four (3-4) months while determining a good treatment dose. After you have found your treatment dose, then we recommend testing every six to nine (6-9) months to make sure you are maintaining those optimal levels.

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If you are taking ANY sex hormones in ANY form, please do NOT test via saliva or urine. Sex hormones are estrogens, progesterone, DHEA, testosterone, or pregnenolone. Please ONLY test via blood/serum.

The number of inaccurate saliva and urine results has increased exponentially. We believe this is due to several factors, which include the following:

  • saliva can pick up tissue levels from topical above the waist application and any application used without gloves
  • saliva can pick up tissue concentrations regardless of application
  • urine can be contaminated when vaginal application is followed without cleansing before collection

Testing while on cream, oral, or suppository hormones
Please plan to test 8-10 hours after your last dose. If you split dose, you may combine your hormones for ease in testing. You may combine them to either AM or PM. Please make sure you combine doses for 3 days before testing.

When testing, you may go as early as 6 hours but patient experience has shown that levels are sometimes falsely elevated. Likewise, you may go as late as 12 hours but in this case, patient experience has shown that levels are sometimes falsely suppressed. Please do not test after 12 hours because your levels will not show how well your hormone is working.

Testing while on patches
Please plan to test 12-24 hours AFTER applying a new patch. Please apply the patch opposite to the venipuncture site.

Recommended Sex Hormone Tests
Ovulating Women. This includes women who have had recent partial hysterectomies (kept ovaries) AND women who have had ablations.

Test 7 days after ovulation (7 dpo)

This is considered the luteal peak. Luteal peak is the midpoint of the cycle. It is the primary progesterone peak and the secondary estrogen peak. It is the best time to determine the balance between estrogen and progesterone.

  • Progesterone (P)
  • Estradiol (E2)
    • If you are taking T3 or NDT thyroid medications, it is also worth testing FREE Estradiol. Many doctors and labs say that the FREE Estradiol test does not exist. Use code 500649 for Labcorp and code 36169 for Quest Diagnostics. This test is not necessary if you will be testing SHBG.
  • Sex Hormone Binding Globulin (SHBG)
    • SHBG’s job is to preferentially bind up DHT, testosterone, androstenediol (not androstenedione), estradiol, and then estrone, in that order. DHEA, but not DHEAs, can also bind, albeit weakly.

Test anytime during cycle

  • Testosterone, FREE and/or TOTAL (T, FT or TT) – If your doctor will only order TOTAL testosterone (T or TT), then SHBG must also tested. We need to know how much of your testosterone is bound and how much is free for use by your body.
  • Sex Hormone Binding Globulin (SHBG) – SHBG’s job is to preferentially bind up DHT, testosterone, androstenediol (not androstenedione), estradiol, and then estrone, in that order. DHEA, but not DHEAs, can also bind, albeit weakly.
  • DHEA Sulfate (DHEAs) – Generally speaking, we care less about DHEAs levels in and of themselves and more about what those levels point to. Low DHEAs is indicative of later stage adrenal fatigue while high or over range DHEAs is an indication of PCOS (especially if testosterone or DHT is also high) or early stage adrenal fatigue.
  • Dihydrotestosterone (DHT) – DHT is the most potent androgen. Test this in addition to FREE testosterone if you have high androgen symptoms (losing hair, abnormal hair growth, acne, etc)
  • Prolactin – Test this if you are having breast discharge, irregular periods, or unexplained infertility. If this has tested normal in the past and you do NOT have the above symptoms, this does not need to be retested.  Must be tested within 3 hours of waking for an accurate level

Test on days 2, 3 or 4, with day 3 being ideal

  • Follicle Stimulating Hormone (FSH)
    • FSH is a gonadotropin and is produced by the pituitary gland. It regulates the development, growth, pubertal maturation, and reproductive processes of the body. FSH and luteinizing hormone (LH) work together in the reproductive system. It stimulates the growth and recruitment of immature ovarian follicles in the ovary. In the luteal-follicle phase transition period, the serum levels of progesterone and estrogen (primarily estradiol) decrease and no longer suppress the release of FSH, consequently FSH peaks at about day 3. If fertility status is critical, please test on day 3.
  • Lutenizing Hormone (LH)
    • This does not need to be run often. We use this primarily for PCOS diagnosis.

Menopausal and Post Menopausal Women. This includes both natural AND surgical menopause. If you have had a complete hysterectomy or an oophorectomy or if your partial was longer than 10 years ago, you are in this category.

Test anytime

  • Estrone (E1)
  • Estradiol (E2)
  • Estriol (E3)
    • There is a relatively recent test developed by Quest Diagnostics that will test all three estrogens at once. There does not appear to be a corresponding test at Labcorp.
    • Test Code 36742: Estrogens, Fractionated, LC/MS/MS
  • Progesterone (P)
  • Testosterone, FREE and/or TOTAL (T, FT or TT)
    • If your doctor will only order TOTAL testosterone (T or TT), then SHBG must also tested. We need to know how much of your testosterone is bound and how much is free for use by your body.
  • Sex Hormone Binding Globulin (SHBG)
    • SHBG’s job is to preferentially bind up DHT, testosterone, androstenediol (not androstenedione), estradiol, and then estrone, in that order. DHEA, but not DHEAs, can also bind, albeit weakly.
  • DHEA Sulfate (DHEAs)
    • Generally speaking, we care less about DHEAs levels in and of themselves and more about what those levels point to. Low DHEAs is indicative of later stage adrenal fatigue while high or over range DHEAs is an indication of PCOS (especially if testosterone or DHT is also high) or early stage adrenal fatigue.
  • Dihydrotestosterone (DHT)
    • DHT is the most potent androgen. Test this in addition to FREE testosterone if you have high androgen symptoms (losing hair, abnormal hair growth, acne, etc)