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Polycystic Ovary Syndrome (PCOS) affects millions of women, disrupting hormone balance and causing symptoms like irregular periods, acne, excess hair growth, and fertility challenges. Testing key hormones helps identify imbalances and guides treatment. Here are the five hormones you should test for PCOS:
- FSH (Follicle-Stimulating Hormone): Often normal or slightly low in PCOS, but an imbalanced LH-to-FSH ratio can indicate ovulation issues. Test on days 2-4 of your cycle.
- LH (Luteinizing Hormone): Typically elevated in PCOS, with an LH-to-FSH ratio of 2:1 or higher. Test on days 5-9 of your cycle.
- Testosterone: Elevated levels contribute to symptoms like acne, hirsutism, and hair loss. Test in the morning for accuracy.
- Insulin: Insulin resistance is common in PCOS and linked to weight gain and metabolic issues. Fasting for 10-12 hours is required for testing.
- Androstenedione: Elevated levels can worsen symptoms like acne and irregular cycles. Testing time varies but is often done in the morning.
Testing these hormones provides a clearer picture of your PCOS-related imbalances, enabling tailored treatment options. Hormone levels can fluctuate, so repeat testing may be necessary for accurate diagnosis and management.
Hormones Tests to Diagnose Polycystic Ovary Syndrome
1. Follicle-Stimulating Hormone (FSH)
Follicle-Stimulating Hormone (FSH) plays a key role in ovarian follicle development. It works alongside other hormones to regulate your menstrual cycle and fertility. When it comes to PCOS, understanding FSH levels can shed light on hormonal imbalances.
Role in PCOS Diagnosis and Symptoms
In PCOS, FSH testing often shows normal or slightly low levels. However, when paired with elevated luteinizing hormone (LH) levels, it creates an imbalanced LH-to-FSH ratio. This imbalance is a common factor behind irregular menstrual cycles and ovulation issues. Monitoring FSH levels can help guide treatment strategies to address these challenges.
Typical Reference Ranges (US Units)
FSH levels fluctuate depending on the phase of your menstrual cycle and your stage of life. For women of reproductive age, FSH levels typically range from 3.5 to 12.5 mIU/mL during the early part of the menstrual cycle. Testing during this phase offers the clearest picture of ovarian function.
Timing and Preparation for Testing
To get the most accurate results, FSH should be tested between days 2 and 4 of your menstrual cycle, with day 3 being ideal. If you’re on hormonal birth control, it’s important to discuss all medications and supplements with your healthcare provider, as they could influence the test results. Next, we’ll explore another hormone that’s crucial in evaluating PCOS.
2. Luteinizing Hormone (LH)
Luteinizing Hormone (LH) plays a crucial role in understanding the hormonal dynamics of Polycystic Ovary Syndrome (PCOS). Together with Follicle-Stimulating Hormone (FSH), LH helps regulate ovulation and maintain hormonal equilibrium. However, in women with PCOS, LH levels are often elevated, disrupting the usual balance between LH and FSH.
Role in PCOS Diagnosis and Symptoms
In PCOS, LH levels are commonly elevated, often falling between 10–20 mIU/mL. Ideally, the LH-to-FSH ratio is balanced at 1:1, but in women with PCOS, this ratio frequently shifts to 2:1 or even 3:1.
"In women with polycystic ovaries the LH to FSH ratio is often higher – for example 2:1, or even 3:1." – Advanced Fertility Center of Chicago
This imbalance occurs because LH levels in PCOS patients are often two to three times higher than FSH levels. For instance, an LH level of 18 mIU/mL compared to an FSH level of 6 mIU/mL results in a 3:1 ratio.
Although an elevated LH-to-FSH ratio can be a helpful clue when diagnosing PCOS, it is not a definitive marker. Its sensitivity and specificity for PCOS diagnosis are relatively limited.
Typical Reference Ranges (US Units)
In healthy, fertile women, LH levels typically range from 4–8 mIU/mL, or 5–20 mIU/mL during the early phase of the menstrual cycle. In PCOS, the key observation is not just the absolute LH level but its disproportionate elevation relative to FSH levels, especially when compared to what’s expected for a woman’s age and cycle phase.
Timing and Preparation for Testing
Getting accurate LH measurements requires proper timing and preparation. Blood samples should ideally be taken early in the morning while fasting. For women with regular menstrual cycles, the best time for testing is between days 5 and 9 of the cycle.
If you are using oral contraceptives, it’s essential to discuss this with your healthcare provider, as these medications can influence hormone levels and complicate test interpretation. To ensure accurate results, it’s often recommended to stop oral contraceptives about three months before testing.
Next, we’ll explore testosterone, another key hormone that sheds light on the hormonal imbalances seen in PCOS.
3. Testosterone
Testosterone plays a crucial role in understanding PCOS symptoms. While often associated with men, women also produce small amounts of this hormone. However, in PCOS, testosterone levels can rise, leading to several hallmark symptoms.
Role in PCOS Diagnosis and Symptoms
In PCOS, elevated luteinizing hormone (LH) and insulin resistance overstimulate the ovaries, causing an increase in testosterone production. This excess testosterone is linked to symptoms like hirsutism (unwanted hair growth on the face and body), acne, male-pattern hair loss, and irregular menstrual cycles. These disruptions in ovulation can make it challenging for women with PCOS to conceive.
To evaluate testosterone, healthcare providers measure total testosterone and free testosterone. Total testosterone reflects the overall amount in your bloodstream, while free testosterone represents the active form available for your body to use. Free testosterone is particularly important because it directly impacts PCOS symptoms.
Typical Reference Ranges (US Units)
For women of reproductive age, normal total testosterone levels typically range from 15–70 ng/dL. In PCOS, levels often exceed 50 ng/dL, with many patients showing values between 60–100 ng/dL or even higher. Free testosterone normally falls between 0.3–3.2 pg/mL, but in PCOS, it frequently rises above 2.5 pg/mL, strongly correlating with symptoms like acne and unwanted hair growth.
It’s important to note that reference ranges can vary between laboratories due to differences in testing methods and equipment. Your healthcare provider will interpret your results based on the specific standards used by the lab that processes your test.
Timing and Preparation for Testing
Unlike some hormones, testosterone testing doesn’t require specific cycle timing, making it easier to schedule. However, there are factors to consider to ensure accurate results.
- Morning testing is ideal since testosterone levels naturally peak in the early hours of the day.
- While fasting isn’t usually required, some providers may recommend it if other hormone tests are being conducted simultaneously.
If you’re on hormonal contraceptives, it’s essential to discuss this with your provider before testing. Birth control pills can significantly lower testosterone levels, potentially masking any elevations. Many healthcare professionals suggest stopping contraceptives for at least three months before comprehensive hormone testing to get accurate baseline readings.
Additionally, biotin supplements can interfere with certain testing methods. To avoid inaccurate results, it’s best to stop taking biotin at least 72 hours before your blood draw. Be sure to inform your provider about any medications or supplements you’re using, as they could influence hormone levels or test accuracy.
When combined with FSH and LH assessments, testosterone testing provides a clearer understanding of the hormonal imbalances associated with PCOS. Up next, we’ll explore the role of insulin, another key hormone linked to PCOS.
4. Insulin
Insulin, a hormone produced by the pancreas, plays a crucial role in helping cells absorb glucose. In the case of PCOS, insulin resistance - when cells don't respond effectively to insulin - becomes a major factor in hormonal imbalances. This resistance can lead to symptoms like acne, excess facial hair, thinning hair, irregular periods, and challenges with weight management. It also raises the likelihood of developing type 2 diabetes and metabolic syndrome.
Reference Ranges
Fasting insulin reference ranges differ between laboratories and depend on the specific testing method used. Your healthcare provider will evaluate your results in the context of your overall metabolic health.
Timing and Preparation for Testing
Insulin testing is best done in the morning after fasting for 10 to 12 hours to ensure accurate and stable hormone levels. During this fasting period, only water is allowed. If you are taking high-dose biotin (vitamin B7) supplements, it's important to stop them 24 hours before the test, as they may interfere with results. Additionally, discuss any medications or supplements you are using with your healthcare provider before the test, and never adjust prescribed medications without consulting them first.
Monitoring your insulin levels offers valuable insights into the metabolic challenges associated with PCOS and helps shape personalized treatment plans. Continue to the next section on androstenedione to learn more about PCOS.
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5. Androstenedione
Androstenedione, a hormone produced by the ovaries and adrenal glands, serves as a precursor to testosterone and estrogen. In cases of PCOS, elevated levels of androstenedione can lead to symptoms like hirsutism, acne, and irregular menstrual cycles.
Role in PCOS Diagnosis and Symptoms
High androstenedione levels are frequently observed in individuals with PCOS. Healthcare providers often measure this hormone alongside other androgens to get a better understanding of your hormonal profile.
Typical Reference Ranges (US Units)
The normal range for androstenedione can vary depending on the laboratory and testing method. That said, typical levels for women generally fall between 0.7 and 3.1 ng/mL (nanograms per milliliter). When reviewing results, healthcare providers also consider factors like your age, menstrual cycle phase, and overall health. While elevated levels are common in PCOS, not everyone with the condition will have androstenedione levels above the normal range.
Timing and Preparation for Testing
Androstenedione levels fluctuate throughout the day and across the menstrual cycle. Your healthcare provider can advise you on the best time for testing.
If your test uses a radioimmunoassay method, it’s important to avoid any radioactive scans during the week before your blood sample is taken. Unlike tests for insulin, fasting is usually not required for androstenedione measurements. However, it’s essential to follow any specific instructions from your healthcare provider and let them know about any medications or supplements you’re using.
Hormone Reference Ranges and PCOS Findings
Here’s a quick breakdown of five key hormones, their normal reference ranges in the U.S., and how they typically appear in individuals with PCOS:
| Hormone | Normal Reference Range | Typical PCOS Findings | Associated PCOS Symptoms |
|---|---|---|---|
| FSH | 3.5-12.5 mIU/mL (follicular phase) | Normal to low levels | Irregular ovulation, fertility challenges |
| LH | 2.4-12.6 mIU/mL (follicular phase) | Elevated levels | Irregular periods, ovulation problems |
| Testosterone | 15-70 ng/dL | Above 70 ng/dL | Hirsutism, acne, male-pattern hair loss |
| Insulin | Less than 25 μIU/mL (fasting) | Elevated fasting levels | Weight gain, difficulty losing weight, acanthosis nigricans |
| Androstenedione | 0.7-3.1 ng/mL | Above normal range | Hirsutism, acne, irregular cycles |
Hormone levels can shift depending on factors like age, menstrual phase, time of day, and stress levels. Healthcare providers take these variables into account, alongside symptoms, when evaluating for PCOS. This context is essential to ensure accurate interpretation of test results.
Pay attention to the LH-to-FSH ratio - while a typical ratio is 1:1 or 2:1, many individuals with PCOS exhibit a ratio of 3:1 or higher. However, this ratio is just one part of a bigger picture and should be used alongside other diagnostic criteria.
It’s also important to remember that lab techniques may cause slight differences in reference ranges. Always discuss your results with your healthcare provider to understand what they mean for you.
Additionally, fasting insulin and glucose tolerance tests can uncover insulin resistance, even when fasting glucose levels appear normal. When reviewing your results, focus on overall patterns rather than getting caught up in individual numbers. Diagnosing PCOS involves considering a combination of hormone levels, physical symptoms, and other findings. Hormone testing is just one piece of the puzzle.
When and How to Test These Hormones
Timing and preparation are key to getting accurate results from hormone tests. Here's a breakdown of when and how to schedule these tests for the best outcomes.
FSH and LH tests should be done on Day 3 of your menstrual cycle, or within days 2–4. This timing helps assess how well your brain and ovaries are communicating and provides insight into ovarian function. If your cycles are irregular, tracking them for a few months can help pinpoint the best testing days based on your pattern. For those with amenorrhea, testing FSH, LH, and free testosterone can still provide valuable diagnostic information.
Testosterone testing is more flexible and can be done at any time. However, it's most accurate in the morning, when levels are naturally higher. To get a full picture, your doctor might order tests for total and free testosterone, along with sex hormone-binding globulin (SHBG).
Insulin testing requires fasting for 8–12 hours to get reliable baseline levels. In some cases, your doctor may also recommend a glucose tolerance test to check for insulin resistance.
Androstenedione testing doesn't depend on your menstrual cycle, but, like testosterone, testing in the morning often provides the most consistent results.
These guidelines serve as a helpful starting point for scheduling your tests. If you're working with a telehealth provider, they can coordinate with local labs to ensure proper timing and fasting requirements, tailored to your cycle patterns.
It's also worth noting that a single test may not reveal the full picture. Hormone levels can fluctuate from month to month, so your doctor might suggest repeat testing to confirm results or track changes over time. This is especially important when evaluating conditions like PCOS, where a combination of hormone patterns and symptom history helps create a more complete clinical understanding.
Personalized PCOS Treatment Through Telehealth
Treating PCOS effectively starts with customized care, and telehealth makes this process more accessible and flexible. By combining precise diagnosis with ongoing, adaptable treatment, telehealth offers a modern way to manage PCOS.
Using insights from hormonal testing, personalized telehealth care tailors treatments to your specific needs. Oana Health, a platform specializing in female hormonal health and PCOS, provides science-based, individualized care. Their licensed medical professionals review your health history and hormone test results to create treatment plans that directly address your symptoms.
For insulin resistance, available options include:
- Oral Metformin ER ($22/month)
- Metformin & Spironolactone combination ($32/month)
- Advanced GLP-1 & Metformin combinations ($199/month)
- Topical Metformin HCL Lotion 20% ($43/month)
For elevated testosterone and androgen-related concerns, treatments include:
- Spironolactone ($14/month)
- Topical spironolactone ($43/month)
- Eflornithine 12% ($69/month)
- Oral Minoxidil ($25/month)
After your online consultation, licensed medical professionals prescribe the treatments, which are then delivered straight to your door with free shipping - eliminating the need for frequent in-person visits.
Weight management, a common challenge tied to insulin resistance in PCOS, is addressed with oral Semaglutide GLP-1, priced at $199 per month. For mental health support, Bupropion XL is available at $25 per month, helping to manage the emotional aspects of PCOS.
Oana Health partners with FDA-regulated and compounding pharmacies to ensure treatments are both affordable and high-quality. This makes prescription-grade PCOS care accessible to women who might otherwise face financial or logistical barriers in traditional healthcare settings.
What truly sets telehealth apart is its ability to adapt treatments as your symptoms and hormone levels change. Through follow-up hormone testing and regular monitoring, your medical team can adjust dosages, switch medications, or combine treatments to better suit your evolving needs - all while maintaining the convenience of remote care. This dynamic approach ensures that your PCOS management stays aligned with your health goals.
Conclusion
Testing for FSH, LH, testosterone, insulin, and androstenedione provides essential insights into the hormonal imbalances linked to PCOS. From elevated LH interfering with ovulation to high testosterone contributing to hirsutism and insulin resistance impacting weight, these tests reveal the underlying issues driving symptoms.
Understanding your hormone levels turns PCOS into something you can address with targeted treatments. For example, elevated testosterone or insulin resistance highlights specific treatment options, allowing for a more precise, science-based approach. This way, you're not left guessing about what might work - you’re following a plan tailored to your body's unique needs.
Telehealth platforms like Oana Health take this a step further by combining comprehensive hormone testing with personalized care. Instead of relying on one-size-fits-all advice, you receive treatments designed to match your individual hormone profile. This approach recognizes that PCOS affects every woman differently and requires solutions that reflect those differences.
Since hormone levels naturally change over time, regular testing becomes key. It allows your healthcare team to adjust your treatment plan as your body evolves, ensuring that your care remains effective. By staying on top of these changes, you can maintain better health and improve your quality of life for years to come.
FAQs
Why is it important to test specific hormones when evaluating PCOS symptoms?
Testing key hormones like FSH, LH, and testosterone plays a crucial role in pinpointing the underlying causes of PCOS symptoms. For example, elevated levels of LH or testosterone are often telltale signs of PCOS, helping to distinguish it from other conditions that share similar symptoms, such as thyroid disorders or high prolactin levels.
Accurate testing not only aids in diagnosis but also allows healthcare providers to design a treatment plan specifically for you. This approach ensures that symptoms like irregular periods, excessive facial hair, or acne are managed in the best way possible, giving you care that truly addresses your needs.
How often should I check my hormone levels to manage PCOS effectively?
For managing PCOS effectively, it's typically advised to check hormone levels every 3 to 6 months, depending on your treatment plan and how your symptoms are changing. Regular testing plays a key role in tracking progress, assessing how well treatments are working, and making any needed adjustments to tackle issues like hormonal imbalances or insulin resistance.
Your healthcare provider will recommend the best testing schedule tailored to your specific needs and goals.
Can lifestyle changes help balance hormones linked to PCOS?
Yes, lifestyle changes can make a big difference in managing hormones linked to PCOS. For starters, regular exercise and eating a well-rounded, nutritious diet can help lower insulin resistance, which is a major factor in PCOS. When insulin resistance decreases, it can lead to lower levels of androgens (like testosterone), which may help with symptoms such as irregular periods, acne, and excess hair growth.
On top of that, reaching and maintaining a healthy weight through these habits can further support hormonal balance, reduce inflammation, and boost overall health. Even small, steady changes to your daily routine can have a meaningful impact on managing PCOS symptoms.
