The 7 Hormones You Should Be Testing
UPDATED: July 2025
Hormone testing always comes up in my clinical practice. Oftentimes someone wants to get to the bottom of their menstrual irregularities, if there any particular conditions are contributing to a delayed time to conception, getting an explanation about why they feel so tired, etc.
I get it. I’ve had my hormones tested as well - especially during critical periods of my life (like while I was trying to conceive and during pregnancy).
While we may be experiencing undesirable symptoms, having more information can validate our experience, and hopefully help to achieve a positive resolution.
Symptoms associated with hormonal imbalance
Hormones can affect your health in so many ways including:
Weight gain OR weight loss
Breast tenderness
Abdominal cramping
Bloating
Skin changes
Low sex drive
Insomnia
1. Estrogen
You have 3 types of estrogen: estradiol, estrone and estriol. Estradiol is the main hormone of your menstrual cycle, especially in the first half. Estrogen is mainly produced by your ovaries, adrenal glands, and fat cells (but in smaller quantities).
How estrogen works
There are SO many things that estrogen does! Including: controlling vaginal moisture, enhancing sex drive, preventing UTIs and urinary incontinence. And it also has effects on your brain, nervous system and skin.
When to test estrogen
Day 3 (ex. the third day of your period/active bleeding)
Why you should test estrogen
If you have yet to experience a period (ever) or have experienced a period before but not anymore - you should test estrogen as it may be low.
Optimal Lab Range
Follicular Phase: 40-200 pmol/L
What it means
Low estrogen may be indicative of a previous anovulatory cycle (so you had a period, but did not ovulate) or overall low ovarian function. Low estrogen is also seen in late-perimenopause and menopause.
Higher estrogen can be a sign of a LOOP (luteal out of phase) cycle which is indicative of perimenopause. This is a type of irregular cycle, when a new ovulatory cycle starts before the last one ends. High estrogen may also be seen in PCOS.
2. Progesterone
Progesterone is the other main hormone in your menstrual cycle, especially in the luteal phase. When ovulation happens, something called the corpus luteum (think of it as an egg shell) begins to produce progesterone. And will continue to do so in the early stages of pregnancy. When fertilization doesn't happen, your progesterone levels drop, and signals the start of your period.
How progesterone works
Progesterone promotes urination, improves sleep, supports mood, and works with the thyroid to stimulate metabolism.
When to measure progesterone
Day 21 (or 7 days after ovulation)
Optimal Lab Range
8-50ng/mL (25-150nmol/L)
What it means
Progesterone can be either normal or low in PCOS (because of anovulatory cycles), primary ovarian insufficiency, perimenopause, and hypothalamic amenorrhea (the absence of a menstrual cycle for >3 months).
Low progesterone may also contribute to early pregnancy loss (miscarriage).
3. Testosterone
This is a male hormone (an androgen) that is made in the ovaries and adrenal glands. As you age, you'll notice a decrease in testosterone.
How testosterone works
This hormone is usually low and is associated with sex drive, bone density, muscle mass and strength.
When to measure testosterone
Anytime during the cycle in the morning, fasted, and within 2-3 hours of waking.
Optimal Lab Range
Free testosterone: 8-25 pmol/L
Total testosterone: 0.8-2.08 pmol/L
Don't forget to test
DHEA-S and SHBG (sex hormone binding globulin)
What it means
High testosterone is associated with a common condition called Polycystic Ovary Syndrome (PCOS). One of the criteria of PCOS is clinical/biochemical hyperandrogenism. This may show as elevated via the blood. However, it may also present a physical symptoms like male pattern hair growth (think hair above the upper lip, chin, chest, around the nipples, below the belly button, lower back, upper thighs, upper arms) and/or hair loss.
Congenital adrenal hyperplasia or an ovarian/adrenal gland tumour may also present as high testosterone. Women who are also taking forms of estrogen, may have higher testosterone levels.
Low testosterone is associated with fatigue, loss of muscle mass and strength, low libido, lack of motivation, and lowered mood.
4. Cortisol
Known as your stress hormone, cortisol is produced by your adrenal glands.
How cortisol works
Cortisol helps your body adapt to daily stressors. But if you keep on experiencing stress, your adrenal glands might get tired and stop producing it.
Is testing worth it?
Testing cortisol once isn’t considered clinically helpful or valuable. A single cortisol test isn’t effective because it doesn’t provide enough context about your overall health or stress levels. What if you woke up one morning - you were able to journal, meditate, drink a cup of tea, and 30mins later found yourself stuck in traffic late to your lab appointment. Your cortisol level may be high, right?
Why test
A one-time cortisol test may be helpful in diagnosing Cushing's disease or Addison's disease.
5. Thyroid Stimulating Hormone (TSH)
Your thyroid is incredibly important your metabolism and how your body functions! It controls how regular your menstrual cycle is, your fertility, weight, energy, heart rate and more.
How TSH works
TSH is your body's barometer, and tells you if your thyroid gland is working properly (basically how T3 is working in your pituitary).
When to measure TSH
TSH levels can fluctuate widely for an individual from day to day or even within the same day.
Don't forget to test
Usually thyroxine (T4) is tested alongside TSH. Sometimes it’s not.
Testing thyroid antibodies (thyroid peroxidase and thyroglobulin antibodies) may also be helpful in diagnosing any autoimmune conditions like Hashimoto’s Thyroiditis. Thyroid antibodies may also be elevated in other autoimmune conditions like Type 1 Diabetes. High TPO antibodies may also contribute to postpartum depression.
Optimal Lab Range
0.4 and 4.5 mIU/L. For those interested in becoming pregnant, a TSH of less than 2.5mIU/L is recommended.
What it means
Low TSH is indicative of hyperthyroidism.
High TSH is indicative of hypothyroidism.
6. Follicle Stimulating Hormone (FSH)
Follicle stimulating hormone is produced by your pituitary gland and it helps your follicles grow.
How FSH works
This hormone stimulated your ovary in preparation for ovulation. As you age, FSH becomes the predominant pituitary hormone.
When to test FSH
Morning of day 3
Don't forget to test
FSH should not be interpreted in isolation. At the very least, LH and estradiol should be tested alongside FSH.
Optimal Range
Follicular phase: 3-8 IU/L
What it means
FSH levels will increase during perimenopause, as your pituitary gland tries to get your ovary to release a follicle. Levels may also be high in primary ovarian insufficiency.
Low FSH may occur with amenorrhea (ex. due to restricted eating or an eating disorder). It may also be low when there is a delay in puberty.
7. Lutenizing Hormone (LH)
How LH works
Lutenizing hormone is produced by your pituitary gland as high amounts of estradiol are being released from the dominant follicle. A surge of LH trigger's your egg maturation, and causes it to be released from the follicle. This tells your body that ovulation is ready happen.Using ovulation tests is a good way to see the LH surge. You can also pay attention to other ovulatory signs like the slight increase in body temperature (thanks to progesterone) and egg-white cervical fluid. LH and FSH should be equal, if it's not, you may have PCOS.
When to test LH
Morning of day 3
Don't forget to test
FSH and estradiol
Optimal Range
Normal LH levels typically range from 1.37 to 9 IU/L during most of the menstrual cycle. However, during the LH surge (just before ovulation), levels can rise to 6-26 IU/L.
What it means
High LH levels may be indicative of PCOS, primary ovarian insufficiency or menopause as the body is trying to produce more LH to stimulate the ovaries.
Low LH may be affect future fertility including irregular or absent periods. It may also be indicative of a luteal phase defect as not enough LH may cause insufficient progesterone production during the luteal phase.
Bonus Tests
Ferritin
It's never a bad idea to test your ferritin levels. Ferritin is the storage form of iron. If you're experiencing heavy periods, you may actually be deficient iron which can cause it's own array of unwelcome symptoms.
Pregnancy can radically deplete ferritin levels and if it’s not addressed then it may increase the risk of preterm birth. In the postpartum it may increase the risk of postpartum depression, and exacerbate postpartum hair loss. And most importantly - it impacts energy levels.
Optimal Range
Below 30: If ferritin is less than 30, you are iron deficient. You likely need to supplement or have an iron infusion (dependent on hemoglobin levels).
30-100: This range may indicate adequate iron levels, but could also be affected by inflammation pushing the levels up slightly. Additional testing may be needed.
Above 100: Ferritin levels above 100 generally suggest adequate iron levels. It's difficult for ferritin to reach this level without sufficient iron stores.
Above 200: Levels this high typically indicate the presence of inflammation, but also suggest that iron levels are likely sufficient.
Tips for your visit with a ND
Type of Test
Blood/Serum
This is your standard blood test performed in a laboratory. Most research refers to serum levels. Your medical doctor will assess your health history via serum levels.
Saliva
The accuracy of saliva testing for hormone levels is questionable, particularly when compared to blood testing. Unfortunately, there is no robust data comparing the consistency between salivary and blood hormone tests. Most research studies use blood samples rather than saliva.
Urine
Similar to saliva testing, the accuracy of urine testing for hormone levels is questionable, particularly when compared to blood testing.
There are certain tests that are marketed towards fertility or menopausal women, that may not provide anymore meaningful information when compared to blood.
Next Steps
Your lab work tells one side of the story. Your symptoms tell the other.
How often do you have a period?
Tell me about your personal history, your family history, how puberty went, etc.
Are you tracking your body’s signs of fertility?
Which hormonal symptoms are you experiencing? For example: breast tenderness, cramping, bowel changes, headaches, hot flashes, acne, unwanted hair growth, mood changes, changes in bleeding.
Do these symptoms happen all the time? Did they only happen once?
Using all this information, I aim to get to the root of the issue and create an evidence-based treatment plan to help you meet your goals. Doing blood work is incredibly important, and while not all of the above tests need to be done - we do want information to guide the treatment plan.
If you've been suffering with unwanted symptoms for years, if you want to get pregnant or if you’re wanting to start caring for yourself again after childbirth please feel free to book an appointment with me.