Hormone Testing Guide: Which Tests to Get and When

The Complete Hormone Panel

When to Test: Timing Matters

Blood draw timing:

• Morning (7-9 AM): Required for testosterone (peaks in early morning; afternoon levels are 20-40% lower) and cortisol (follows diurnal rhythm)
• Fasting (12 hours): Required for insulin, glucose, and lipids
• Consistent timing: If retesting, always test at the same time of day for valid comparison

Menstrual cycle timing (women):

• Day 3 (early follicular): FSH, LH, estradiol — assess ovarian reserve
• Day 19-21 (mid-luteal): Progesterone — confirms ovulation (should be >10 ng/mL)
• Any day: TSH, Free T3/T4, DHEA-S, fasting insulin, testosterone, SHBG

Perimenopausal women: Hormones fluctuate significantly; testing on day 3 (if still cycling) or random testing (if irregular) with clinical correlation. AMH is a more stable marker of ovarian reserve.

Perimenopause Test: Hormones to Check During the Transition

A perimenopause test should answer two questions: are ovarian hormones changing, and are other systems making symptoms worse? FSH, LH, estradiol, and progesterone can help, but they fluctuate enough that one normal result does not exclude perimenopause. Pair reproductive hormones with thyroid markers, ferritin, vitamin D, fasting insulin, A1C, lipids, and cortisol rhythm when fatigue, weight gain, brain fog, or insomnia are prominent.

If cycles are still predictable, test progesterone about 7 days after ovulation and consider FSH/estradiol early follicular. If cycles are irregular, interpret results with symptom history rather than relying on a single cutoff. See the perimenopause guide for symptom-based next steps.

At-Home Testosterone Test vs. Lab Draw

An at home testosterone test can be useful for screening, especially when it uses a validated dried blood spot or saliva collection method and clear timing instructions. But for diagnostic decisions, serum testing from a morning blood draw remains the standard. At-home kits may be less reliable for low female testosterone ranges, free testosterone calculation, SHBG interpretation, and follow-up decisions about TRT or fertility-preserving alternatives. If an at-home result is low, high, or does not match symptoms, confirm with a morning lab panel that includes total testosterone, free testosterone, SHBG, albumin, LH/FSH, estradiol, prolactin, and thyroid markers.

How to Prepare for Hormone Testing

• 12-hour overnight fast (water and black coffee are okay)
• Arrive by 8-9 AM for morning cortisol and testosterone accuracy
• No intense exercise for 24 hours before testing (transiently affects cortisol, testosterone, and inflammation markers)
• Avoid biotin supplements for 48-72 hours before testing (biotin interferes with immunoassays and can falsely elevate or suppress thyroid and hormone values — an underrecognized issue that causes misdiagnosis)
• Note all medications — oral contraceptives increase SHBG and CBG, affecting total testosterone and cortisol interpretation; statins may lower testosterone; PPIs affect B12 and magnesium
• Sleep normally the night before — sleep deprivation acutely lowers testosterone and raises cortisol
• Minimize stress on the day of testing — acute anxiety raises cortisol by 20-50%

Interpreting Results: Standard vs. Optimal Ranges

Lab reference ranges represent the middle 95% of the tested population — which includes many unhealthy individuals. Functional optimal ranges are based on the levels associated with minimal symptoms and disease risk:

When your results fall in the 'normal' range but below 'optimal,' you may have symptoms that a standard interpretation would dismiss. This is the functional medicine approach to lab interpretation — and why we use tighter ranges based on clinical outcomes research.