Hormone Tests for Women

Modern medicine has led us to believe that, for most medical issues, there's a single test that will confirm a clear and concise diagnosis. This is about as helpful as a 6-minute doctor visit, and springs from the same limited thinking. Women are especially hurt by this kind of medical approach to hormonal imbalance. That's because hormone panels and other tests aren't as helpful as you might wish. But in the hands of a skilled doctor who will take the time to "connect the dots", the tests can be very meaningful. Here's a general overview of the basic hormone tests and what they mean to your health and hormonal balance. When is hormone testing helpful? By dividing women into three generalized groups it will help you understand who benefits from hormone testing and who may not.

Women with fertility issues. For women in this category, hormone panels are key, both as a diagnostic and a therapeutic tool. So many fertility problems can be traced to irregularities in the menstrual cycle, and your practitioner needs to understand what's wrong in order to give you the right support.

Women with ordinary symptoms of hormonal imbalance. Women often ask us: is there a test to tell whether I'm in menopause? The short answer is no. You're menopausal when you haven't had a period for a year. Hormone tests are not required for this largest group of women. The symptom patterns are very individual, but the first line therapy is mostly the same: build a nutritional foundation, take the right basic supplements to restore balance, and make meaningful lifestyle changes.

Women with severe symptoms of hormonal imbalance. For women with debilitating or intractable symptoms, a hormone panel is essential. When dealing with PCOS, fibroids, diagnosed alopecia (hair loss), and other more severe hormone issues, your practitioner simply can't treat you without knowing where your hormones are.

Key tests in a hormone panel When it comes to key tests in a hormone panel, what they measure and what the results mean, levels and ranges will vary from lab to lab. This chart gives you a very general idea of what high or low levels of a particular hormone may indicate.

Female Hormone Panel

BP Health Lab Work and Why We Do Them - FSH

FSH - Follicle-stimulating Hormone; FollitropinHow is it used?

The test for follicle-stimulating hormone (FSH), a hormone associated with reproduction and the development of eggs in women and sperm in men, has several uses.

In both women and men, the test may be used with other hormone tests such as luteinizing hormone (LH), testosterone,estradiol, and/or progesterone to help:

• Determine the cause of infertility
• Diagnose conditions associated with dysfunction of the ovaries or testicles
• Aid in the diagnosis of pituitary or hypothalamus disorders, which can affect FSH production

In women, FSH levels are also useful in:

• The investigation of menstrual irregularities
• Predicting onset or confirmation of menopause

In men, FSH levels are used to help determine the reason for a low sperm count.

In children, FSH and LH are used to help diagnose delayed or precocious (early) puberty. Irregular timing of puberty may be an indication of a more serious problem involving the hypothalamus, the pituitary gland, the ovaries or testicles, or other systems. The measurement of LH and FSH may differentiate between benign symptoms and true disease. Once it is established that symptoms are a result of true disease, further testing can be done to discern the underlying cause.

When is it ordered?

For a woman, an FSH test may be ordered when she is having difficulty getting pregnant or has irregular or an absence of menstrual periods.

FSH may be ordered when a woman's menstrual cycle has stopped or become irregular, to determine if the woman has entered menopause.

For a man, the test may be ordered when his partner cannot get pregnant, when he has a low sperm count, or when he has low muscle mass or decreased sex drive, for example.

In both women and men, testing may be ordered when a health practitioner suspects that a pituitary disorder is present. A pituitary disorder can affect the production of several different hormones, so there may be signs and symptoms in addition to some of those listed above. They can include fatigue, weakness, unexplained weight loss, and decreased appetite to name a few.

In children, FSH and LH may be ordered when a boy or girl does not appear to be entering puberty at an appropriate age (either too late or too soon). Signs of puberty may include:

• Breast enlargement in girls
• Growth of pubic hair
• Growth of the testicles and penis in boys
• Beginning of menstruation in girls
• What does the test result mean?

Results of an FSH test are typically considered with results of other hormone tests, such as LH , estrogens, and/or testosterone.

As part of an infertility workup, a high or low FSH is not diagnostic but provides a piece of information on what may be the cause. For example, a hormone imbalance may affect a woman's menstrual cycle and/or ovulation. A health practitioner will consider all the information from the workup to establish a diagnosis. See the Infertility article for more on this.

In Women

FSH and LH levels can help to differentiate between primary ovarian failure (failure of the ovaries themselves) and secondary ovarian failure (failure of the ovaries due to disorders of either the pituitary or the hypothalamus).

High levels of FSH and LH are consistent with primary ovarian failure. Some causes of primary ovarian failure are listed below.

Developmental defects:

• Failure to develop ovaries (ovarian agenesis)
• Chromosomal abnormality, such as Turner syndrome
• Defect in the steroid production by the ovaries, such as 17 alpha hydroxylase deficiency
• Premature failure of the ovaries due to:

  Radiation exposure

• Chemotherapy
• Autoimmune disease

Chronic failure to ovulate (anovulation) due to:

Polycystic ovary syndrome (PCOS)

• Adrenal disease
• Thyroid disease
• Ovarian tumor

When a woman enters menopause and her ovaries stop working, FSH levels will rise.

Low levels of FSH and LH are consistent with secondary ovarian failure due to a pituitary disorder or hypothalamic problem. Low FSH serum levels have been associated with increased risk of ovarian cancer.

In Men

High FSH levels are due to primary testicular failure. This can be the result of developmental defects in testicular growth or to testicular injury, as indicated below.

Developmental defects:

• Failure to develop gonads (gonadal agenesis)
• Chromosomal abnormality, such as Klinefelter syndrome

Testicular failure:

• Viral infection (mumps)
• Trauma
• Radiation exposure
• Chemotherapy
• Autoimmune disease
• Germ cell tumor

Low levels are consistent with pituitary or hypothalamic disorders. See the article on Pituitary Disorders for more information.

In Children

High levels of FSH and LH with the development of secondary sexual characteristics at an unusually young age are an indication of precocious puberty. This is much more common in girls than in boys. This premature development is usually due to a problem with the central nervous system and can have a few different underlying causes. Examples include:

• Central nervous system tumor
• Brain injury, trauma
• Inflammation within the central nervous system (e.g. meningitis, encephalitis)
• Brain surgery
• Normal prepubescent levels of LH and FSH in children exhibiting some signs of pubertal changes may indicate a condition call "precocious pseudopuberty." The signs and symptoms are brought on by elevated levels of the hormones estrogen or testosterone. This may be caused by:

• Hormone-secreting tumors
• Adrenal gland tumors
• Ovarian tumors or cysts
• Testicular tumors

Normal FSH and LH levels with a few signs of puberty can also be a benign form of precocious puberty with no underlying or discernable cause or may just be a normal variation of puberty.

In delayed puberty, LH and FSH levels can be normal or below what is expected for a youth within this age range. Some of the causes for delayed puberty can include:

• Dysfunction of the ovaries or testicles
• Hormone deficiency
• Turner syndrome
• Klinefelter syndrome
• Chronic infections
• Cancer
• Eating disorder (anorexia nervosa)

  Is there anything else I should know?

FSH results can be increased with use of certain drugs, including cimetidine, clomiphene, digitalis, and levodopa. FSH results can be decreased with oral contraceptives, phenothiazines, and hormone treatments. FSH will also be low when women are pregnant. A recent nuclear medicine scan may interfere with results of the FSH test if it is measured by a radioimmunoassay, which is seldom used any more.

Testosterone Therapy: No Link with Blood Clot Disorders

Source: EurekaAlert! A new study from The University of Texas Medical Branch at Galveston of more than 30,000 commercially insured men is the first large comparative analysis to show that there is no link between testosterone therapy and blood clots in veins. The study found that middle-aged and older men who receive testosterone therapy are not at increased risk of this illness. The findings are detailed in Mayo Clinic Proceedings.

Venous thromboembolism is a disease where blood clots form in the veins and cause blockages. The most common forms of VTE are deep vein thrombosis, which occurs often in the legs and pulmonary embolism, which is a clot in the lungs. VTE is the third most common cardiovascular illness, after heart attack and stoke.

"In 2014, the Federal Drug Administration required manufacturers to add a warning about potential risks of VTE to the label of all approved testosterone products," said Jacques Baillargeon, professor of epidemiology in the department of preventive medicine and community health and lead author of the study. "The warning, however, is based primarily on post-marketing drug surveillance and case reports. To date, there have been no published comparative, large-scale studies examining the association of testosterone therapy and the risk of VTE."

As a result of this conflicting evidence and the broad media attention it has received, there are many men with medically confirmed low testosterone who are afraid to receive testosterone therapy and there may be physicians who are reluctant to prescribe testosterone therapy based on this conflicting information.

The case-control study included 30,572 men 40 years and older who were enrolled in one of the nation's largest commercial insurance programs between Jan. 1, 2007 and Dec. 31, 2012. Cases were defined as men who had a primary diagnosis of VTE and received an anticoagulant drug or an intravascular vena cava filter in the 60 days following their diagnoses. Cases were matched with three control subjects on age, geographic region, diagnosis of low testosterone and diagnosis of any underlying pro-clotting condition.

The researchers found that having a prescription for testosterone therapy was not associated with an increased risk of VTE. In addition, none of the specific routes of administration examined -- topical creams, transdermal patches or intramuscular injections -- were associated with an increased risk. There were no differences between men who received the therapy 15, 30 or 60 days before being diagnosed with VTE.

"It is important to acknowledge, for a man who has medically-diagnosed low testosterone, that there are clear risks to not receiving testosterone therapy, including osteoporosis, sexual dysfunction, increased amounts of fat tissue, decreased lean muscle mass, possible metabolic syndrome and cardiovascular disease," said Baillargeon. "It's also important to note that further research needs to be conducted to rigorously assess the long-term risks of testosterone therapy.

These findings may help to inform the benefit-risk assessment for men with testosterone deficiency considering treatment.

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Other authors include UTMB's Randall J. Urban, Gwen Baillargeon, Gulshan Sharma and Yong-Fang Kuo; Abraham Morgentaler from Men's Health Boston at Harvard Medical School and Charles J. Glueck from Jewish Hospital at Mercy Medical Physicians in Cincinnati, OH.

This research was supported by the National Institutes of Health.