Should You Get Your Hormones Tested? A Framework

“Get your hormones checked” is easy advice to give and surprisingly easy to do wrong. The test itself isn’t the hard part — knowing when to order it, which version of it to order, and what a result actually means is where most people (and some clinics) get it wrong.

Test because something changed, not because a birthday passed

The Endocrine Society’s guideline on testosterone therapy is explicit that hypogonadism diagnosis requires low levels and symptoms — and it specifically recommends against routine population screening for men with no symptoms.^[1] The equivalent marker for women is cycle-length variability, not a single hormone snapshot — the STRAW+10 criteria define perimenopause onset as seven or more days of variation between consecutive cycles.^[2] In both cases, the trigger for testing is a specific, noticed change — not turning 40 or 45.

Ordering the right version of the test

For men, “total testosterone” is the default panel, but it’s incomplete on its own. Sex hormone-binding globulin (SHBG) rises with age and binds a larger share of circulating testosterone, which can make total testosterone look artificially low even when the biologically active (free) fraction is normal. Calculated free-testosterone formulas are a reasonable estimate, but validation studies comparing them against the equilibrium-dialysis gold standard found roughly a quarter of samples deviate meaningfully from the reference method — worse at higher SHBG levels, which is exactly the population most likely to be getting tested.^[3] Practical takeaway: ask for total and SHBG at minimum, and note that no free-testosterone number should be treated as precise to the decimal point.

For women in the perimenopausal window, a single hormone panel is often less useful than it sounds — estrogen and FSH fluctuate enough during this transition that one blood draw can look “normal” on a day symptoms are active. A cycle-length and symptom log kept for a few months is more diagnostically useful than a single lab value, and it’s the input a clinician actually needs to place you on the STRAW+10 timeline.

The testing checklist

1. Write down what changed and when — libido, energy, sleep, mood, cycle length — before you book anything.
2. For men: request two morning draws (testosterone peaks in the morning and a single afternoon result is close to meaningless), total testosterone plus SHBG, and ask your clinician which free-testosterone method their lab uses.
3. For women: track cycle length for at least 2-3 cycles before testing, and bring that log to the appointment — it’s more diagnostic than a single hormone panel.
4. Rule out confounders first. Thyroid dysfunction, sleep apnea, uncontrolled diabetes, and chronic stress all produce symptoms that overlap with hormone changes and are worth checking in the same visit.

None of this is a reason to avoid testing — it’s a reason to walk in with the right data instead of a birthday and a hunch.

References

[1] Bhasin S, et al. “Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline.” Journal of Clinical Endocrinology & Metabolism. 2018;103(5):1715-1744. DOI: 10.1210/jc.2018-00229. Finding: diagnosis requires low T plus symptoms; routine population screening is not recommended. ↑︎

[2] Harlow SD, et al. “Executive Summary of the Stages of Reproductive Aging Workshop + 10.” Journal of Clinical Endocrinology & Metabolism. 2012. DOI: 10.1210/jc.2011-3362. Finding: perimenopause onset is defined by cycle-length variability (7+ days), not a hormone snapshot. ↑︎

[3] Jasuja GK, et al. “Reference Intervals for Free Testosterone in Adult Men Measured Using a Standardized Equilibrium Dialysis Procedure.” Andrology. 2023. DOI: 10.1111/andr.13310. Finding: calculated free-testosterone formulas deviate meaningfully from the equilibrium-dialysis reference method in roughly a quarter of samples, worse at higher SHBG. ↑︎

Kurt Greiner

Kurt is a digital strategist and IT professional blending emerging technology with practical application to help businesses and individuals streamline their digital presence. His current work focuses on the intersection of intentional living and technological resilience, exploring how individuals can leverage modern tools to navigate the second half of life with purpose.