In this article
The short version
- Test testosterone in the morning, fasting, and confirm a low result with a second test.
- Urology guidelines use a total testosterone below 300 ng/dL, plus symptoms, to support a low T diagnosis.
- Women 45 and older with classic symptoms usually don't need a hormone test to confirm perimenopause.
- A thyroid test is worth it for both sexes, since up to 60% of people with thyroid disease don't know it.
- One number never tells the whole story. Symptoms and repeat tests matter just as much.
You got your labs back. There's a column of numbers, a few flagged in bold, and a lot of abbreviations. Is a testosterone of 310 low? Why is your estradiol "high"? And what on earth is SHBG?
Your lab report can tell you a lot about your energy, mood, sex drive, and weight, if you know how to read it. Here's what each common hormone test measures, for men and for women, what the numbers mean in plain words, and when testing is actually worth it.
The golden rules of hormone testing
Before any single number, know these four rules:
- Timing matters. Testosterone peaks in the morning, so guidelines call for a fasting, early-morning test.
- One test isn't enough. A low testosterone result should be confirmed with a second morning test before anyone calls it low T.
- Numbers need symptoms. A diagnosis like low testosterone requires both a low level and symptoms. A "normal" number with real symptoms still deserves a conversation.
- Ranges vary by lab. Always read your result against the range printed on your own report.
Hormone tests for men
- Total testosterone. All the testosterone in your blood. The American Urological Association uses a level below 300 ng/dL, on two early-morning tests, plus symptoms like low sex drive, low energy, or erection problems, to support a diagnosis of low T.
- Free testosterone. The small share that isn't tied up and is ready to use. It's most helpful when total testosterone is borderline or your SHBG is unusual.
- SHBG (sex hormone-binding globulin). A protein that carries testosterone through your blood. Think of SHBG as taxis: testosterone riding in a taxi can't get out and do its job. When there are more taxis, less testosterone is free, even if your total looks fine.
- LH and FSH. Signals from your brain telling the testicles to make testosterone and sperm. They help your clinician figure out whether low testosterone starts in the testicles or in the brain's signaling.
- Estradiol. Yes, men make estrogen too, mostly by converting testosterone. Your clinician may check it if you have symptoms like breast tenderness, especially on testosterone therapy.
- Prolactin. A pituitary hormone. High levels can push testosterone down, so it's often checked when testosterone is low.
If you're on testosterone therapy, follow-up labs usually include testosterone, hematocrit (how thick your blood is with red cells), and a prostate cancer risk check with PSA for men who need one. Guidelines aim for testosterone in the mid-normal range during treatment, not as high as possible.
Not sure your symptoms point to low T? Read the signs of low testosterone.
Hormone tests for women
Here's the surprise: for many women, a hormone panel isn't how menopause is diagnosed.
- Perimenopause and menopause. UK national guidelines say women 45 and older with new hot flashes and cycle changes can be identified as perimenopausal without lab tests. Menopause is 12 months without a period.
- FSH. This brain signal rises as the ovaries slow down. But in perimenopause it can bounce from normal to high and back. It's most useful for women aged 40 to 45, or younger women with suspected early menopause. It isn't reliable if you're on combined birth control.
- Estradiol. Your main estrogen swings wildly in perimenopause and can even run higher than before. A single estradiol result can't diagnose menopause.
- Testosterone. Experts say a testosterone level shouldn't be used to diagnose low desire in women. It is useful for monitoring: if you start testosterone, your clinician checks a baseline, rechecks in 3 to 6 weeks, and keeps you in the normal female range.
- Other labs that matter more. A blood count and iron if periods are heavy, plus cholesterol and blood sugar, since heart risk rises after menopause.
For the full picture, see our women's hormone health plan for 2027.
The thyroid test everyone should know: TSH
TSH (thyroid-stimulating hormone) is your brain's signal to your thyroid. It works like a thermostat calling for heat:
- High TSH usually means your thyroid is underactive. Your brain is calling louder because the thyroid isn't keeping up. Think fatigue, weight gain, low mood, and forgetfulness.
- Low TSH can mean an overactive thyroid. Think nervousness, poor sleep, and unexplained weight loss.
This one matters for men and women alike. About 20 million Americans have some form of thyroid disease, and up to 60% don't know it. Women are 5 to 8 times more likely to have thyroid problems, and the symptoms overlap with low testosterone and perimenopause.
When to test
- You have symptoms. Low sex drive, low energy, low mood, weight changes, or erection problems are all good reasons to check.
- Your symptoms are unclear. Labs help rule out look-alikes like thyroid problems or low iron.
- You're starting treatment. Testosterone therapy needs baseline labs before you begin.
- You're on treatment. Follow-up labs make sure your dose is helping, not overshooting.
Get accurate results
- Book an early-morning draw for testosterone, and come fasting if asked.
- List your supplements and medicines. Biotin, a common supplement ingredient, can interfere with some lab tests. Ask whether to pause it before your draw.
- Mention birth control or hormones you use, since they change several results.
- Bring old results with dates and times, so trends are easy to see.
How Nirvanix uses labs
At Nirvanix, labs guide care, not the other way around. Your clinician reviews your symptoms and history online, decides which baseline and follow-up tests you actually need, and explains every result in plain words. You won't be told to buy a giant panel just because it exists. The consultation is included.
The bottom line
Hormone labs are powerful when they're timed right, repeated when needed, and read alongside your symptoms. For men, morning testosterone, SHBG, and a few related tests tell most of the story. For women over 45, symptoms usually matter more than a hormone panel, and a thyroid test is worth it for everyone.
Want a clinician to look at the whole picture? Take the two-minute quiz to see where to start.
Common questions
What is a normal testosterone level for men?
Ranges vary by lab, but the American Urological Association uses a total testosterone below 300 ng/dL as a reasonable cutoff to support a diagnosis of low testosterone. The diagnosis also requires symptoms, and the low result should be confirmed on a second early-morning test.
What is SHBG on a blood test?
SHBG, or sex hormone-binding globulin, is a protein that carries testosterone and estrogen in your blood. Hormone bound tightly to SHBG isn't available for your body to use. If your SHBG is high or low, your clinician may check free testosterone to see how much is actually available.
Can a blood test tell if I'm in menopause?
Often it doesn't need to. For women 45 and older with new hot flashes and cycle changes, UK national guidelines say perimenopause can be identified without lab tests, because hormone levels swing so much from day to day. FSH testing may help in women aged 40 to 45, or younger women with suspected early menopause.
What time of day should I get my testosterone tested?
In the morning, ideally fasting. Testosterone runs highest early in the day, and guidelines are based on morning results. If your first result is low, a second morning test is recommended to confirm it.
Should women get their testosterone checked?
Not to diagnose low desire. Experts say a testosterone level shouldn't be used to diagnose low sexual desire in women. If you start testosterone therapy, your clinician should check a baseline level and recheck it a few weeks later to keep you in the normal female range.
