Hormone Lab Tests Explained: Estrogen, Progesterone, Cortisol, DHEA & More
Hormone testing can reveal powerful insights about your health, but only if you look beyond the numbers on the page.
A lab report is more than a checklist of values that fall inside or outside a reference range. Even “normal” results can be misleading if they are not interpreted in the context of your age, health history, cycle phase, or life stage.
If you want to learn more about why “normal” does not always mean “optimal,” see our article Normal vs. Optimal: Understanding Lab Work in Functional and Integrative Medicine.
When we sit down to review lab work with you, it’s never a perfunctory “everything looks fine.” Rather, it’s sorting through results with a fine-tooth comb and in light of your health concerns, priorities, risk factors and prior test results. We’re interpreting your results through the lens that is uniquely you.
Estrogens and Progesterone
Estrogen and progesterone fluctuate during your menstrual cycle, so it’s important to take cycle timing into account when reviewing results.
Results that look normal at first glance can actually be out of range, depending on where you are in your cycle or post-menopause.
Make sure to note when your last period started relative to your blood draw date, and ask your doctor if you should go on a specific day for testing.
Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH)
LH and FSH act as signaling hormones.
During a menstrual cycle, they are highest around the time of ovulation.
When a woman is approaching menopause, the overall drop in hormones also causes LH and FSH to rise.
The ratio of LH:FSH can sometimes be used as a soft sign of hormonal imbalance like in PCOS, but many providers are using alternative lab tests like androstenedione and AMH alongside DHEA and testosterone.
Dihydrotestosterone (DHT)
Testosterone is converted to DHT by the enzyme 5-alpha reductase.
For males, increased DHT can play a role in male pattern hair loss, prostate enlargement/BPH and prostate cancer.
For females, high DHT can be a factor in PCOS, acne and excess hair growth as well as hair loss.
Dehydroepiandrosterone (DHEA)
DHEA is an important precursor for your body’s production of sex hormones.
Low or suboptimal DHEA levels can impact estrogen and testosterone levels.
DHEA is also impacted by stress and cortisol. When you’re feeling increased stress, your body amps up cortisol production, which can decrease DHEA. Short term repletion of DHEA can be helpful for some people.
DHEA is also being used in fertility medication as a way to optimize those with lower ovarian reserve.
Cortisol (Salivary, Multi-point)
You probably know cortisol as the stress hormone. It’s also involved in many other aspects of health, including cardiometabolic, immune and reproductive. Everything is connected!
When cortisol is high, your body prioritizes the stress response for survival above reproduction (if your body thinks you’re in a stress state, it doesn’t think it’s the safest time to reproduce).
Cortisol has a natural rhythm, starting off high in the morning and decreasing throughout the day. The pattern of your daily cortisol rhythm is important to take into account. Checking your cortisol one time in the morning close to the time you woke up can sometimes be helpful, but the best test is a 4-point saliva test taken throughout the day.
Given how much interplay and network effects occur throughout your body, it’s important to view hormone test results both as a whole and at the biomarker level.
The Bottom Line
You are an individual and you deserve accurate interpretation of your lab results. At the very least, your doctor should have a discussion about your menstrual cycle or life stage when interpreting results.
With lab results, it’s not just about making sure you’re within the reference range.
It’s about understanding at a deeper level how everything in your body functions together, how patterns play out and how to interpret lab results in the context of your unique health picture.
References include:
Reed BG, Carr BR. The Normal Menstrual Cycle and the Control of Ovulation. [Updated 2018 Aug 5]. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279054/
Pratama, G., Wiweko, B., Asmarinah et al. Mechanism of elevated LH/FSH ratio in lean PCOS revisited: a path analysis. Sci Rep 14, 8229 (2024).
Kinter KJ, Amraei R, Anekar AA. Biochemistry, Dihydrotestosterone. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557634/
Erceg N, Micic M, Forouzan E, Knezevic NN. The Role of Cortisol and Dehydroepiandrosterone in Obesity, Pain, and Aging. Diseases. 2025 Feb 1;13(2):42. doi: 10.3390/diseases13020042. PMID: 39997049; PMCID: PMC11854441.
Moslem Ahmad H, Aldahham BJM, Yakdhan Saleh M. Dehydroepiandrosterone supplementation improves diminished ovarian reserve clinical and in silico studies. Steroids. 2024 Nov;211:109490. doi: 10.1016/j.steroids.2024.109490. Epub 2024 Aug 13. PMID: 39147007.
Adam EK, Quinn ME, Tavernier R, McQuillan MT, Dahlke KA, Gilbert KE. Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology. 2017 Sep;83:25-41. doi: 10.1016/j.psyneuen.2017.05.018. Epub 2017 May 24. PMID: 28578301; PMCID: PMC5568897.
