Hormone Testing: What to Test and How to Interpret Results

Through your primary care physician (typically covers basic panels); through an endocrinologist (specialist, most appropriate for complex thyroid, adrenal, or pituitary conditions); through a functional medicine or integrative physician (typically most comprehensive testing); or directly through DTC labs (Quest Diagnostics, Labcorp, Everly Health, Function Health) where you can order specific panels without a physician order — useful for comprehensive testing that your PCP may not order.

SHBG (sex hormone binding globulin) is a protein that binds testosterone (and estrogen) in the blood, making it unavailable to cells. High SHBG — common in older men, women on oral contraceptives, and people with elevated thyroid hormone — means that even normal total testosterone may result in low free (bioavailable) testosterone and its associated symptoms. Total testosterone can appear normal while free testosterone is genuinely low. This is why free testosterone and SHBG must be measured together with total testosterone.

Baseline testing before initiating any hormone therapy. On therapy — every 3-6 months until stable, then annually once levels and symptoms are well-controlled. For monitoring specific conditions — thyroid disease every 6-12 months once stable; PCOS annually plus when symptoms change; post-menopausal hormone therapy annually. Periodic retesting even without therapy allows tracking of age-related changes.

DTC hormone tests are useful for getting comprehensive testing your physician might not order, identifying areas for further investigation, and understanding your baseline. Limitations — results without clinical context can be misleading; DTC tests vary in quality and may miss important clinical context; some require follow-up with a physician for interpretation and treatment. Use them as a starting point for conversation with a knowledgeable physician, not as a standalone diagnostic tool.