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 recommends diagnosing hypogonadism only in men who have symptoms and signs consistent with testosterone deficiency and unequivocally, consistently low testosterone levels.^[1] The equivalent marker for women is cycle-length variability, not a single hormone snapshot — the STRAW+10 criteria define the early menopausal transition, where perimenopause begins, as a persistent difference of 7 days or more in the length of consecutive cycles, meaning it recurs within 10 cycles, and they treat menstrual cycle criteria as the most important, with hormone tests as supportive.^[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, the guideline names fasting morning total testosterone as the initial test and recommends repeating it to confirm the result.^[1] That panel can be incomplete on its own. For men whose total testosterone is near the lower limit of normal, or who have a condition that alters sex hormone-binding globulin (SHBG), the guideline recommends also getting a free testosterone value, either by equilibrium dialysis or by an accurate formula.^[1] Free testosterone is not a standardized number. In a 2023 study that measured it by a standardized equilibrium dialysis procedure in 145 healthy, nonobese men, the authors noted that measurement methods and reference intervals vary among laboratories, and free testosterone was lower with higher SHBG, higher BMI, and older age.^[3] Practical takeaway (our suggestion, not the guideline’s): ask for total and SHBG at minimum, ask which free-testosterone method the lab uses, and don’t treat any free-testosterone number as precise to the decimal point.

For women in the perimenopausal window, a single normal result does not rule out the transition, and a clearly raised FSH can support it — STRAW+10 describes extreme hormone fluctuations in the late transition, with FSH sometimes elevated and sometimes within the range of the earlier reproductive years, so one blood draw can look “normal” on a day symptoms are active.^[2] Because the workshop treats menstrual cycle criteria as the most important, a cycle-length and symptom log kept for a few months is more useful than a single lab value, and it’s the input a clinician 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 morning draws (the guideline’s initial test is fasting morning total testosterone, repeated to confirm), 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 (our suggestion; the STRAW+10 definition of a persistent change spans up to 10 cycles), and bring that log to the appointment — STRAW+10 treats cycle criteria as more important than a single hormone panel. If you have gone three months without a period, bleed heavily or between periods, are under about 45 with irregular cycles, or are on hormonal birth control or have had a hysterectomy, the cycle log will not work: see a clinician now.
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

^↑︎ Bhasin S, Brito JP, Cunningham GR, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. DOI: https://doi.org/10.1210/jc.2018-00229

^↑︎ Harlow SD, Gass M, Hall JE, et al. Executive Summary of the Stages of Reproductive Aging Workshop + 10: Addressing the Unfinished Agenda of Staging Reproductive Aging. J Clin Endocrinol Metab. 2012;97(4):1159-1168. DOI: https://doi.org/10.1210/jc.2011-3362

^↑︎ Jasuja R, Pencina KM, Spencer DJ, et al. Reference intervals for free testosterone in adult men measured using a standardized equilibrium dialysis procedure. Andrology. 2023;11(1):125-133. DOI: https://doi.org/10.1111/andr.13310

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.