Women’s Hormone Panel

Not feeling like yourself?

Common Symptoms Include

Irregular or loss of menstruation

Hot flashes, sweating

Reduced sex drive

Changes in energy or mood

Reduction in breast tissue

Reduced bone density

Weight gain


As we age, our bodies change and hormone levels change too. Feeling your best means your hormones need to be in balance. Getting tested will help you and your doctor discover what your body needs to be in balance.


Medication Related Hormone Changes

Medications like oral contraceptives and opioid therapy may contribute to hormone deficiency

As such, clinicians should consider the type of progestin in a patient's oral contraceptive formulation and the degree to which it may suppress or promote androgen production.

Testosterone is generally used under very limited circumstances in menopausal women and DHEA supplementation, although controversial in terms of efficacy, has been shown in some studies to counter the effects of low androgens in women with OPIAD or sex hormone deficiencies.4

Interfering Medications

  • Oral Contraceptives
  • Steroids
    (e.g., corticosterone, prednisone)
  • Pain Medication
    (e.g., opioids)
  • Antidepressants
    (e.g., Celexa, Cymbalta, Lexapro, Paxil, Prozac, Zoloft)
  • Benzodiazepines
    (e.g., xanax)
  • Beta blockers

What is tested?

 

Test

Clinical significance as related to E2 or female hormone regulation

Total Testosterone

This is the total amount of testosterone circulating in the blood, whether bound to protein or free (unbound and biologically active fraction). A low overall level, in concert with low E2 and DHEA-S, may be consistent with a diagnosis of female hypogonadism or OPIAD.

Free Testosterone

In recent years the diagnosis of Low T has favored the use of Free Testosterone, which is the portion (~3-4%) in blood not bound to sex hormone binding globulin (SHBG), and to a lesser extent to albumin. Thus it is available for the body to use. The amount of testosterone that is bound is very consistent, so Free T can be calculated (instead of directly measured). This calculation is based on measurement of total testosterone, SHBG, and albumin.

Bioavailable Testosterone

In addition to SHBG, Testosterone is bound weakly to Albumin (~30% bound). Because testosterone bound to albumin may dissociate, this fraction is also considered “bioavailable” to cells. The bioavailable fraction as it relates to albumin can therefore also be calculated and added to free testosterone for clinical consideration.

TSH

Measurement of thyroid stimulating hormone (TSH) may assist in diagnosing or confirming the cause of hypogonadism in women. Secondary hypogonadism in women, caused by hypopituitarism, will not only result in low E2 (and likely DHEA-S and progesterone), but also secondary hypothyroidism. Conversely if E2 is high (estrogen dominance) this causes thyroid binding globulin (TBG) to increase leading to less free thyroid hormone (and increased TSH in response), which can also cause hypothyroid symptoms in women.

LH

Luteinizing hormone (LH) is a gonadotropin released by the pituitary glands that acts synergistically with follicle stimulating hormone (FSH) to enhance estradiol production in women (secreted by maturing follicles). In cases of Low E, it is important to know if there is an underlying issue with the pituitary gland that would lead to reduced production; LH will be low or low-normal in secondary hypogonadism and high in primary hypogonadism.

FSH

FSH is another gonadotropin released by the pituitary gland that recruits immature follicles to the ovary and sustains their maturation. As follicles mature they secrete significant amounts of estradiol (E2). FSH measurement (along with LH) can help indicate whether primary (high FSH) or secondary (low or low-normal FSH) hypogonadism is the underlying cause of low E2.

DHEA-S

Dehydroepiandrosterone sulfate (DHEA-S) is the most abundant circulating steroid hormone and is produced in the adrenal glands, gonads, and brain; it is the key upstream hormone in the adrenal pathway for testosterone, and subsequently E2, production. If DHEA-S levels are low, over the counter supplements can be given to help correct some of the symptoms of hypogonadism in women.

Progesterone

Progesterone is a powerful counter-balance for estrogen. Progesterone is also an intermediate precursor in the production of testosterone, E2, and other sex steroids, mineralocorticoids, and glucocorticoids. Estrogen dominance, as progesterone begins to decline in early menopause, can be a cause of some of the early symptoms experienced with menopause. As a result hormone replacement therapies (HRT) have been developed with varying amounts of estrogen and/or progesterone (progestin) to counter-act some of these effects. Normal progesterone levels also appear to play a role in the maintenance of healthy thyroid hormone levels. Because of its regulatory role in cellular functions (progesterone receptors are present on many cells) there is a great interest in researching the effect of progesterone maintenance with age in both sexes 5

Estradiol (E2)

Low E2, particularly in younger women, has several primary and secondary causes including pituitary failure, excessive exercise or eating disorders, congenital conditions like Turner syndrome and chronic opioid use. Because E2 and gonadotropin concentrations vary during the menstrual cycle, clinical interpretation is difficult in women with irregular menstruation. That said measurement of E2, LH, and FSH together can help determine if there is a gonadotropic failure (secondary cause), or a disruption to ovarian production (primary cause).6

25-OH Vitamin D

25-OH Vitamin D is a hormone precursor that plays a role in many pathways from maintaining healthy bone density, to inflammatory processes, etc. As it pertains to female reproductive health mounting evidence has shown that maintaining a sufficient 25-OH vitamin D level (≥30 ng/mL) is important in IVF, additionally vitamin D supplementation may improve metabolic parameters in PCOS, and a reduced risk of endometriosis. Chronically low vitamin D may also play a role in the incidence of acute and chronic pain overall.7,8

Test Code: 6805

CPT: 84702;82530;82627;82670;82677;83001;83002;84144;84146;82306
Tests Included DHEA-S, Estradiol (E2), FSH, LH, Progesterone, TSH, 25OH Vitamin D
Patient Preparation None
Sample Serum or Plasma
Tube 2x Red, Green or Tiger Top
Test Turnaround Time 5 Days
Intended Patient Population 18+ and Older Adult Females
Shipping Requirements Overnight, Refrigerated
Specimen Stability 7 Days RT
5 Days RF
Reject Criteria See Individual Component Test Requirements
Laboratory Developed Test (LDT) Yes
CMS Guidance LCD L36692

References

  1. K. Vincent, I. Tracey, Hormones and their Interaction with the Pain Experience, Rev Pain. 2008 Dec; 2(2): 20–24.
  2. Endocrine Society. "Testosterone therapy may help improve pain in men with low testosterone." ScienceDaily. ScienceDaily, 17 June 2013. <www.sciencedaily.com/releases/2013/06/130617142047.htm>
  3. T.W. Kragstrup, MD, Vitamin D supplementation for patients with chronic pain, Scand J Prim Health Care. 2011 Mar; 29(1): 4–5
  4. S. Colameco, MD, MEd; J. Coren, DO, MBA, Opioid-Induced Endocrinopathy, The Journal of the American Osteopathic Association, January 2009, Vol. 109, 20-25.
  5. M. Oettel and A. K. Mukhopadhyay, Progesterone: the forgotten hormone in men? The Aging Male 2004;7:236–257
  6. Cohen PG, The role of estradiol in the maintenance of secondary hypogonadism in males in erectile dysfunction. Med Hypotheses. 1998 Apr;50(4):331-3.
  7. E. E. Shipton and E. A. Shipton, Vitamin D Deficiency and Pain: Clinical Evidence of Low Levels of Vitamin D and Supplementation in Chronic Pain States, Pain Ther. 2015 Jun; 4(1): 67–87.
  8. Lerchbaum E1, Rabe T., Vitamin D and female fertility. Curr Opin Obstet Gynecol. 2014 Jun;26(3):145-50.

Changing the World. One Test at a Time.

Contact Us

231 W. Chestnut Ave. Monrovia, CA 91016
Office: (626) 386-5277 | Fax: (888) 677-7748 |
Email: info@InSourceDx.com

Follow Us

Facebook Instagram LinkedIn Youtube Twitter

HIPAA | Terms and Conditions | Privacy Policy

© 2018 InSource Diagnostics. All Rights Reserved.