Interpreting sex hormone levels
How to time and read testosterone, SHBG, LH, FSH, oestradiol and progesterone, with worked examples of the common patterns in men and women, assay pitfalls (immunoassay at low levels, biotin, ethinylestradiol) and the results that change management.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- A sex hormone result means little without its timing, the SHBG and the gonadotrophins. Always read testosterone with LH and FSH, and oestradiol with FSH and the cycle day.
- Primary gonadal failure: low sex steroid, high LH and FSH. Secondary (hypothalamic or pituitary): low sex steroid, low or inappropriately normal LH and FSH.
- Suppressed LH and FSH with a high sex steroid means an external or autonomous source: exogenous testosterone, an oestrogen- or androgen-secreting tumour, or hCG.
Loading the rest of the note…
Finished reading?
Sources
- Yeap BB et al. Endocrine Society of Australia position statement on male hypogonadism (part 1): assessment and indications for testosterone therapy. Med J Aust 2016;205:173-8AU/NZEndocrine Society of Australia, 2016
- Bhasin S et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2018;103:1715-44Endocrine Society, 2018
- Travison TG et al. Harmonized reference ranges for circulating testosterone levels in men of four cohort studies in the United States and Europe. J Clin Endocrinol Metab 2017;102:1161-73Journal of Clinical Endocrinology and Metabolism, 2017
- Vermeulen A et al. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 1999;84:3666-72Journal of Clinical Endocrinology and Metabolism, 1999
- ESHRE guideline: management of premature ovarian insufficiencyESHRE, ASRM, CRE-WHiRL and IMS, 2024
- Teede HJ et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndromeAU/NZMonash University Centre for Research Excellence in Women's Health in Reproductive Life, 2023
- Pharmaceutical Benefits Scheme, testosterone (androgen deficiency restriction)AU/NZAustralian Government Department of Health, Disability and Ageing
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback