Hormone Panel

The mainstream lower bound of 300 was calibrated from hospital populations including men with documented hypogonadism. Low 200s in a healthy 35-year-old is suboptimal regardless of what the reference range says.

Total testosterone without free testosterone is an incomplete picture. SHBG binding determines what is actually bioavailable to tissues. Two men with the same total testosterone can have radically different free testosterone.

Relevant for both men and women. In men: low estradiol signals conversion problems; elevated signals excess aromatization. In women: the primary sex hormone with wide normal variation across cycle phase.

Adrenal precursor to testosterone and estrogen. Declines with chronic stress and age. Barrett-Connor et al. NEJM 1986 and subsequent research identified DHEA-S as an independent longevity marker.

HPA axis function. Morning draw only. Cortisol follows a diurnal rhythm and afternoon testing is not useful for baseline assessment. Training load, sleep debt, and chronic psychological stress all elevate this value.

High SHBG reduces free testosterone. Lifestyle interventions exist for elevated SHBG including reducing alcohol, lowering refined carbohydrate intake, and adequate zinc intake.

Elevated prolactin suppresses testosterone and LH production. Routinely missed on standard panels. Can be elevated from medications, thyroid dysfunction, or pituitary adenoma.

Growth hormone proxy. Reflects recovery capacity, protein synthesis, and tissue repair capacity. Relevant under training load and as a longevity marker. Declines significantly with age.

The only thyroid marker most GPs order. A TSH of 4.0 is within the mainstream range and is consistent with significant hypothyroid symptoms in many patients. Functional medicine consensus puts optimal under 2.0.

The active thyroid hormone. Conversion from T4 to T3 can fail independently of TSH. Low free T3 with normal TSH and normal T4 is a conversion problem, not adequate thyroid function.

The storage form. Normal T4 with low free T3 confirms a conversion problem, pointing to selenium deficiency, elevated reverse T3, or systemic inflammation.

The marker most thyroid patients are never tested for. Elevated reverse T3 blocks T3 receptor sites and produces hypothyroid symptoms with completely normal TSH, T4, and sometimes even normal T3. Elevated under chronic stress, caloric restriction, and systemic illness.

Low progesterone relative to estradiol causes estrogen dominance symptoms even when estradiol is within range. This is one of the most common hormonal imbalances in perimenopausal women and is almost never assessed on standard panels.

Luteinizing hormone. Context for estradiol and testosterone. Elevated LH in reproductive-age women may indicate PCOS.

Follicle-stimulating hormone. Relevant for cycle irregularities, fertility assessment, and perimenopause evaluation. Elevated FSH in reproductive-age women indicates reduced ovarian reserve.