--- title: "Hormone Testing for PCOS" entity: "blog" canonical_url: "https://www.drgri.com/blog/hormone-testing-for-pcos" markdown_url: "https://www.drgri.com/llms/blog/hormone-testing-for-pcos" lastmod: "2021-03-17T04:00:00.000Z" --- Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions, affecting approximately 15-20% of reproductive age women worldwide. Symptoms vary but often include irregularities in the timing of a menstrual cycle, elevated levels of androgens (hormones such as testosterone that cause acne and unwanted hair growth), and weight gain or difficulty with weight loss. Many women with PCOS go years before they are formally diagnosed, which is partially due to the high variability in symptom presentation. Once PCOS is diagnosed, conventional treatment typically includes the oral contraceptive pill, metformin, and/or recommendations for weight loss. This approach is generally helpfully in regulating the menstrual cycle and treating the elevated androgens, but doesn’t address the underlying cause of the hormonal imbalance, or set up a woman for success when she’s ready to start a family. Each woman with PCOS is different, and my first step when working with women with PCOS is to better understand her unique subtype. This involves taking a detailed medical history, asking questions about her diet and lifestyle, and testing her hormones. The most common blood tests to aid in the diagnosis and treatment of PCOS include: FSH (follicle stimulating hormone) and LH (luteinizing hormone) These two important hormones are released by the pituitary gland in our brain and signal to our ovaries to start preparing an egg for ovulation. The best time to test these hormones is on day 2 or 3 of a woman’s menstrual cycle. During this phase FSH is normally higher than LH. In PCOS, however, LH is often higher than FSH. Fasting Insulin and Glucose These two metabolic markers are used to diagnose insulin resistance, a condition leading to high levels of insulin circulating in the blood. Insulin resistance is important to identify and correct, as it is a major driver of the hormonal imbalances seen in PCOS. Insulin resistance also makes weight loss very difficult and elevates one’s risk for developing diabetes. Testosterone and Sex Hormone Binding Globulin (SHBG) Testosterone is produced primarily by our ovaries and is often the initial test to determine whether you are producing excess androgens. High levels can halt a menstrual cycle and contribute to acne, hair loss and hirsutism (coarse hair growth on the face or chest). However, levels often come back normal, despite a woman having clear signs of excess androgens. Part of the reason is that testosterone can be converted to a more potent androgen called dihydrotestosterone ( DHT), which has a stronger action on the skin. The other common reason is the liver is producing low amounts of a protein called sex hormone binding globulin (SHBG). When SHBG is low, more testosterone is available to have an effect on the surrounding tissues. SHBG can also be tested for, and levels often come back low in women with PCOS and insulin resistance. Androstenedione Androstenedione is an androgen that is produced by our ovaries and adrenal glands. It can be converted to testosterone in the liver, and is estimated to provide up to 50% of all testosterone in women. Normal levels vary between 1 – 6.98 nmol/L, and reduce naturally with age. DHEA-S DHEA-S is an androgen that is secreted by our adrenal glands rather than our ovaries. Different tissues in the body convert DHEAS to androstenedione and testosterone, and excess levels often contribute to acne, hair loss and hirsutism. It is estimated that up to 50% of women with PCOS have elevated DHEA-S on blood workups. It is important to note that DHEA-S is highest when we are young, and naturally reduces with age. Normal levels for women in their 20s, 30s and 40s is up to 10.29 umol/L, 7.29umol/L and 6.48 umol/L, respectively. Vitamin D While not part of the diagnostic criteria for PCOS, I often test vitamin D as low levels can contribute to insulin resistance and excess sebum production. Vitamin D also plays an important role in our reproductive health, influencing follicle development, menstrual cycle regularity, and progesterone production. I like to see blood levels of vitamin D around 120nmol/L. Deciding which blood tests to run depends on a woman’s health history and goals (for example, weight loss, establishing menstrual regularity, treating acne, hair loss and/or family planning). Test results provide valuable information to help better understand a woman’s unique PCOS subtype and design a treatment plan individualized to her needs. Next steps… Do you need help interpreting your test results, or determining which tests are most important to help you navigate the root of your health concerns? [Click here](https://drgri.janeapp.com)to book a consultation with Dr. Gri, ND. References https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310679/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3846536/ https://pubmed.ncbi.nlm.nih.gov/29227165/ https://pubmed.ncbi.nlm.nih.gov/31525346/ Disclaimer: The information provided on this blog is for educational and informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional before making any changes to your health regimen. The content shared here is based on the author’s research and personal experiences, and individual results may vary. The author and blog are not responsible for any adverse effects or consequences resulting from the use of any suggestions, preparations, or procedures discussed on this site.