Hormonal biomarkers
A comprehensive panel for testosterone, estrogen, adrenal, thyroid, and growth hormone signaling.
Key takeaways
- Free testosterone and estradiol require sensitive assays to be interpretable.
- SHBG explains most of the gap between total and free testosterone.
- LH and FSH separate primary from secondary causes and change the protocol.
- For IGF-1, providers generally prefer a mid-range result over one near the top of the reference range, since sustained excess is what carries risk.
Testosterone, Free and Total. Total testosterone alone is frequently misleading. Free testosterone, the bioavailable fraction, is what actually determines clinical effects. Targets differ substantially by sex, and Free Testosterone is only accurate when measured by equilibrium dialysis or ultrafiltration, a standard immunoassay result is not interchangeable with this target. Standard: male total 300 to 1000 ng/dL. Optimal: male total 700 to 1000 ng/dL, free 21 to 26 pg/mL. Female total 40 to 70 ng/dL, free 2 to 5 pg/mL (LC-MS/MS assay only). Moved by: sleep, resistance training, zinc, stress management, hormonal protocols if indicated.
SHBG (Sex Hormone-Binding Globulin). Binds testosterone and renders it biologically inactive. High SHBG can produce symptoms of low testosterone even with a normal total testosterone reading. Women naturally run higher SHBG than men. Rarely included in standard panels. Standard: 10 to 80 nmol/L. Optimal: 20 to 40 nmol/L (men), 40 to 80 nmol/L (women). Moved by: addressed through overall hormonal protocol, influenced by thyroid status and insulin resistance.
LH and FSH. Pituitary hormones driving testosterone and estrogen production. Essential for telling apart primary from secondary causes of hormonal decline. Standard: normal reference range. Optimal: within range with appropriate context. Moved by: depends on underlying cause, guides protocol selection.
Estradiol E2. Relevant for both sexes. In men, excess conversion causes symptoms even with normal total testosterone, and should be measured by a sensitive LC-MS/MS assay, standard immunoassay is unreliable at these levels. In women, the appropriate target shifts significantly by cycle phase and menopausal status, best discussed directly with your provider rather than a single fixed number. Standard: male 10 to 40 pg/mL, female varies by cycle phase. Optimal: male 20 to 30 pg/mL (LC-MS/MS assay). Moved by: addressed through hormonal protocol, aromatase inhibition in appropriate cases.
DHEA-S. An adrenal hormone that declines progressively with age, roughly 10 to 20% per decade, one of the most reproducible aging signals in endocrinology. Affects energy, immune function, body composition, and skin repair capacity. Standard: age-dependent wide range. Optimal: 450 to 560 µg/dL (men), 280 to 395 µg/dL (women). Moved by: DHEA supplementation where prescribed, sleep quality, stress management.
Progesterone. In women, balances estrogen and supports sleep quality, mood, and bone density, declining from perimenopause onward. In men, a precursor to testosterone and cortisol, relevant in hormonal optimization. Standard: female varies by cycle phase, male 0.3 to 1.2 ng/mL. Optimal: cycle-phase appropriate in women, low-normal in men. Moved by: hormone replacement where clinically indicated, assessed as part of a full panel.
Cortisol (AM). Reflects adrenal output and stress response, drawn between 8 and 9am. Chronically elevated cortisol suppresses testosterone, disrupts sleep, and drives fat accumulation. Chronically low morning cortisol can indicate adrenal or stress axis dysregulation. Standard: 6 to 23 mcg/dL (AM draw). Optimal: 10 to 18 µg/dL. Moved by: sleep quality, stress management, lifestyle modification, rarely addressed with medication alone.
PSA Total and Free. Required baseline for men before starting any testosterone-adjacent hormonal protocol. A single reading is one of the least useful numbers in medicine on its own, the trend over time matters far more than any one result. Standard: total under 4 ng/mL (age-dependent). Optimal: under 1.0 ng/mL (under 50), under 1.5 (50 to 59), under 2.0 (60 to 69), under 2.5 (70+). Free-to-total ratio above 25%. Moved by: urological evaluation if elevated, baseline documentation before hormonal protocols, repeat testing to establish a trend rather than acting on one result.
Thyroid Panel (TSH, Free T3, Free T4). The most commonly missed driver of cognitive and energy symptoms. TSH alone misses subclinical dysfunction, and Free T3, the active form, is often below optimal even when TSH looks normal. Standard: TSH 0.5 to 4.5 mIU/L. Optimal: TSH 1 to 2 mIU/L, Free T3 in upper third of range. Moved by: thyroid optimization protocol if indicated, selenium adequacy, stress management.
IGF-1. Reflects growth hormone axis activity and is a reliable marker of tissue repair capacity. Required for evaluating GH optimization protocols. The goal is the middle of the age-adjusted range, not the upper end, chronically high IGF-1 is linked to increased cancer risk. Standard: age-adjusted reference range. Optimal: middle of age-adjusted range, not the upper third. Moved by: deep sleep, resistance training, adequate protein, GH secretagogue protocols if indicated.
What this means for you
A hormone panel is read as a pattern. Any single value pulled out of it, including total testosterone, can point the wrong direction.