Hormone Tests: What to Get, When, and How to Read the Results

"Get your hormones checked" is one of the most common pieces of advice people give each other for fatigue, weight changes, skin problems, or mood shifts. But which hormones? When should you get tested? And what do the numbers actually mean? Let's work through this clearly, without unnecessary complexity.

Which Hormones Are Checked First

There is no single universal "hormone panel." The right tests depend on your symptoms. Here is what is most commonly ordered:

TSH (thyroid-stimulating hormone) — the first test when thyroid problems are suspected. It governs the production of T3 and T4.
Free T4 (FT4) — the main active thyroid hormone in the blood. Ordered alongside TSH when values are abnormal.
Cortisol — the adrenal "stress hormone." Checked for chronic fatigue, obesity, and suspected Cushing's syndrome or adrenal insufficiency.
Insulin and C-peptide — for suspected insulin resistance, prediabetes, or diabetes.
Sex hormones (LH, FSH, estradiol, progesterone, testosterone, prolactin) — for irregular periods, fertility concerns, menopause symptoms, low libido, or acne.

The specific panel should be ordered by a doctor — endocrinologist, gynecologist, urologist, or GP — based on the clinical picture. Randomly testing "all hormones" often uncovers incidental results that cause unnecessary alarm.

Thyroid Hormones (TSH, T3, T4): Normal Ranges

The thyroid regulates metabolism, body temperature, heart rate, skin and hair condition, mood, and energy. A hormonal imbalance here produces a wide spectrum of symptoms.

TSH (thyroid-stimulating hormone) is produced by the pituitary gland and controls the thyroid. If the thyroid is underactive, TSH rises. If it is overactive, TSH falls.

Normal TSH: 0.4–4.0 mIU/L (reference ranges may vary slightly between labs).
TSH above 4.0 mIU/L — hypothyroidism suspected.
TSH below 0.4 mIU/L — hyperthyroidism suspected.

Free T4 (FT4): normal range — 9–20 pmol/L (0.7–1.6 ng/dL). The main circulating thyroid hormone.

Free T3 (FT3): normal range — 3.5–6.5 pmol/L. The active form that directly affects cellular metabolism.

Anti-TPO antibodies: normal — below 34–35 IU/mL. Elevated levels indicate autoimmune thyroiditis (Hashimoto's disease) — the most common cause of hypothyroidism.

Important: a normal TSH with symptoms present is not grounds to dismiss those symptoms. Subclinical hypothyroidism (slightly elevated TSH with normal T4) warrants endocrinology follow-up.

Sex Hormones in Women and Men

Sex hormone levels change with age — and in women, with the phase of the menstrual cycle. For this reason, the day of the cycle when you get tested is critically important.

Women's hormones and normal ranges (follicular phase, days 2–5 of the cycle, unless noted otherwise):

LH (luteinizing hormone): 1.1–11.6 IU/L (follicular phase); surges sharply at ovulation.
FSH (follicle-stimulating hormone): 1.7–7.7 IU/L (follicular phase). Elevated with reduced ovarian reserve (menopause, premature ovarian insufficiency).
Estradiol (E2): 68–1,269 pmol/L (follicular phase). In menopause — below 100 pmol/L.
Progesterone: below 3 nmol/L in the follicular phase; on day 21–22 (luteal phase) — 6–89 nmol/L. Low progesterone in the luteal phase indicates anovulation.
Prolactin: 109–557 mIU/L (4.8–23.3 ng/mL). Elevated with a pituitary adenoma, certain medications, or hypothyroidism.
Total testosterone in women: 0.26–1.22 nmol/L. Elevated in PCOS.

Men's hormones:

Total testosterone: 9.9–27.8 nmol/L (280–800 ng/dL). Declines with age. Deficiency symptoms: reduced libido, fatigue, loss of muscle mass, erectile dysfunction.
LH: 1.7–8.6 IU/L.
FSH: 1.5–12.4 IU/L.
Prolactin in men: 73–407 mIU/L (3.0–18.6 ng/mL). Elevated prolactin suppresses testosterone and libido.

Cortisol and Stress

Cortisol is an adrenal hormone that is released in response to stress and regulates metabolism, immunity, and blood pressure.

Normal blood cortisol:

Morning (8:00–10:00 AM) — 138–635 nmol/L (5–23 µg/dL). Morning is the peak production time.
Afternoon (4:00–6:00 PM) — 83–441 nmol/L (3–16 µg/dL).

Cortisol must be drawn strictly in the morning, fasting, and in a calm state. After exercise, stress, or illness, cortisol is physiologically elevated and results will not be interpretable.

Elevated cortisol without an obvious stressor is a reason to rule out Cushing's syndrome. This involves 24-hour urinary cortisol or an overnight low-dose dexamethasone suppression test.

Low cortisol may indicate adrenal insufficiency (Addison's disease) — a rare but serious condition.

Insulin and Blood Sugar

Insulin is produced by the pancreas and allows cells to take up glucose from the blood.

Normal values:

Fasting insulin: 2.6–24.9 µIU/mL.
Fasting glucose: 3.9–5.5 mmol/L (70–99 mg/dL).
HOMA-IR index (insulin resistance) = (glucose × insulin) / 22.5. Normal: below 2.7. Above 2.7 — indicates insulin resistance.
HbA1c (glycated hemoglobin): normal — below 5.7%. 5.7–6.4% — prediabetes. 6.5% and above — diabetes mellitus.

Insulin must be drawn strictly fasting (at least 8–12 hours). The day before: no sweets, alcohol, or exercise. Without a simultaneous glucose measurement, insulin results are difficult to interpret meaningfully.

When to See an Endocrinologist

Reasons to consult an endocrinologist:

Fatigue, unexplained weight gain or loss.
Menstrual irregularities, fertility problems.
Symptoms of hypo- or hyperthyroidism (as described above).
Elevated blood sugar or HbA1c on tests.
Suspected Cushing's syndrome, acromegaly, or pituitary adenoma.
Low libido or erectile dysfunction in men.
Osteoporosis or calcium-phosphate metabolism disorders.

Not sure which specialist you need? Symptomatica will help you choose.

Frequently Asked Questions

On which day of the cycle should women get hormone tests?

LH, FSH, estradiol, and prolactin — on days 2–5 of the cycle (the first days of menstruation). Progesterone — on day 21–22 (for a 28-day cycle) or 7 days before the expected period. Testosterone and TSH can be drawn on any day of the cycle. If the cycle is irregular, the doctor will advise on timing.

Should hormones be tested fasting?

Yes. Most hormones should be drawn fasting in the morning: TSH, insulin, cortisol, and sex hormones. Food intake affects several values. Exceptions exist for specific protocols — confirm with your lab.

TSH is normal but I have symptoms — what should I do?

TSH is a good screening test, but it does not cover every condition. If TSH is normal and symptoms persist, consider checking FT4, anti-TPO antibodies, cortisol, sex hormones, a complete blood count, and ferritin. Sometimes the thyroid is not the issue at all.

What is subclinical hypothyroidism?

TSH is elevated (usually 4–10 mIU/L), but FT4 is still normal, and there may be no symptoms. This is an early stage of hypothyroidism. Some patients are monitored without treatment; others are started on levothyroxine — the decision is made by an endocrinologist based on the clinical picture and TSH level.

Can I interpret my own hormone test results?

This article helps you understand the terminology and reference ranges. But interpreting hormone tests requires taking symptoms, age, cycle phase in women, current medications, and other test results into account. A single out-of-range value does not equal a diagnosis. Always discuss results with your doctor.

Symptomatica is an informational reference service. Not a medical service; does not diagnose or prescribe treatment. For any symptoms, please consult a doctor.

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