HORMONE TESTING

Understanding your hormones can provide important clues about your overall health, energy levels, fertility, and more. In this post, we explore key hormones tested in both men and women, their roles in the body, and what abnormal levels might suggest.

Please keep in mind: this information is purely educational. For proper diagnosis, interpretation of results, or treatment, it’s essential to consult a licensed medical professional.

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Follicle-Stimulating Hormone (FSH)

  • What it is & its primary function

    Follicle-stimulating hormone (FSH) is a glycoprotein hormone secreted by the anterior pituitary gland in response to gonadotropin-releasing hormone (GnRH) from the hypothalamus. It plays a central role in the regulation of the reproductive system in both females and males.

    In women, FSH stimulates the growth and maturation of ovarian follicles, which are essential for ovulation and estrogen production. In men, FSH acts on Sertoli cells in the testes to support sperm production (spermatogenesis).

    Beyond reproduction, recent research highlights that FSH may also be involved in regulating bone density, lipid metabolism, and body composition, particularly during menopause and aging (Taneja et al., 2019; PMC6992500).

  • Significance in Females

    - Menstrual Cycle: FSH levels fluctuate throughout the menstrual cycle, peaking in the follicular phase to promote follicle maturation and estrogen synthesis. A mid-cycle surge in luteinizing hormone (LH), in coordination with FSH, triggers ovulation.
    - Fertility: Adequate levels of FSH are crucial for normal ovulatory cycles and fertility. Abnormally high or low levels may indicate ovarian dysfunction or endocrine disorders.
    - Menopause: As ovarian reserve declines with age, FSH levels rise significantly due to reduced negative feedback from estrogen. Elevated FSH is a hallmark of the menopausal transition and is used clinically to support the diagnosis of menopause.
    - Metabolism and Bone Health: Postmenopausal elevations in FSH have been associated with decreased bone mineral density, increased fat mass, and adverse metabolic changes independent of estrogen (PMC6992500; PMC7947831).

  • Significance in Males

    Spermatogenesis: FSH plays a critical role in stimulating Sertoli cells, which support the development of sperm within the seminiferous tubules. It is essential for maintaining male fertility.
    Infertility Evaluation: In men with idiopathic infertility, recombinant FSH has been used to improve sperm parameters, especially in those with specific FSH receptor gene variants (PMC6543808).
    Bone and Metabolic Health:While the role of FSH in male metabolism is less clear than in women, emerging evidence suggests it may influence body composition and bone density in aging men (PMC9389074).
    Aging:FSH levels may decline in the context of obesity, type 2 diabetes, or central hypogonadism (low gonadotropin secretion), potentially impacting both reproductive and systemic health (Basic and Clinical Andrology, 2025).

  • Possible Causes of Elevated FSH

    • Menopause or Ovarian Failure: As ovarian function declines, the pituitary increases FSH production due to reduced estrogen feedback.

    • Primary Gonadal Failure: Conditions like Turner syndrome, premature ovarian insufficiency, or testicular failure can result in high FSH.

    • Chemotherapy or Radiation: Damage to gonadal tissue can lead to elevated FSH as the body attempts to stimulate impaired gonads.

    • Certain Medications: Agents that suppress sex steroid production can remove the negative feedback on the pituitary, increasing FSH levels.

    • Aging: Natural decline in sex hormone production with age can lead to increased FSH, particularly in postmenopausal women and aging men.

    • Metabolic Syndrome: High FSH levels may be linked to metabolic dysfunction and bone loss in postmenopausal women (PMC6992500).

  • Possible Causes of Low FSH

    • Hypothalamic or Pituitary Dysfunction: Disorders affecting GnRH or pituitary secretion, such as tumors or trauma, can suppress FSH production.

    • Chronic Stress or Malnutrition: These factors can reduce hypothalamic-pituitary function, leading to low FSH.

    • Obesity and Type 2 Diabetes: Men with metabolic syndrome may have lower FSH levels, possibly linked to altered hypothalamic regulation (Basic and Clinical Andrology, 2025)

    • Hyperprolactinemia: Elevated prolactin levels can suppress GnRH and therefore lower FSH secretion.

    • Hormonal Contraceptives or Exogenous Hormones: External hormones provide feedback to the pituitary, reducing FSH production.

Luteinizing Hormone (LH)

  • What it is & its primary function

    LH is a glycoprotein hormone secreted by the anterior pituitary gland in response to pulses of gonadotropin-releasing hormone (GnRH) from the hypothalamus. It works in close coordination with follicle-stimulating hormone (FSH) to regulate reproductive function in both sexes.

    • In females, LH is responsible for triggering ovulation—the release of a mature egg from the dominant ovarian follicle—and for maintaining the corpus luteum, which produces progesterone during the second half of the menstrual cycle (Filicori et al., 1999).

    • In males, LH stimulates Leydig cells in the testes to produce testosterone, which is essential for sperm production and the development of male secondary sexual characteristics (Oduwole et al., 2021; Esteves & Humaidan, 2025).

    Emerging evidence suggests that LH also plays roles in bone health, central nervous system function, and metabolic regulation in aging adults (Kim et al., 2022; Bhatta et al., 2018).

  • Significance in Females

    - Ovulation: A surge in LH mid-cycle is the critical hormonal signal that triggers ovulation, marking the transition from the follicular phase to the luteal phase.
    - Corpus Luteum Maintenance: After ovulation, LH supports the corpus luteum, which secretes progesterone needed for uterine lining maintenance and potential implantation.
    - Fertility Treatments: In assisted reproduction, LH activity is manipulated to optimize follicle development and induce ovulation. Personalized approaches using recombinant LH or hCG are common in IVF protocols (Filicori et al., 1999; Conforti et al., 2025).
    - Perimenopause and Menopause: s ovarian reserve diminishes, LH levels rise significantly due to reduced negative feedback from estrogen. These elevated LH levels are typical in postmenopausal women and correlate with symptoms like hot flashes and mood changes.
    - Cognitive Health: Research suggests that high postmenopausal LH levels may be associated with age-related cognitive decline, possibly through its effects on neuronal receptors (Bhatta et al., 2018).

  • Significance in Males

    Testosterone Production: LH directly stimulates Leydig cells to produce testosterone, which is necessary for spermatogenesis, libido, muscle mass, and bone health (Oduwole et al., 2021).
    Fertility: LH, together with FSH, is critical for normal spermatogenesis. In cases of hypogonadotropic hypogonadism (where LH and FSH are low), LH supplementation is often necessary to induce spermatogenesis and restore fertility (Esteves & Humaidan, 2025).
    Metabolic and Bone Health: LH may influence bone density and adipose tissue regulation, although the mechanisms in men are still under investigation (Kim et al., 2022).

  • Possible Causes of Elevated LH

    • Primary Gonadal Failure: When the gonads fail to produce sex hormones, the pituitary compensates by increasing LH secretion (e.g., premature ovarian failure, Klinefelter syndrome).

    • Polycystic Ovary Syndrome (PCOS): Elevated LH/FSH ratio is a common feature of PCOS and contributes to anovulation.

    • Menopause: Declining estrogen levels reduce negative feedback on the hypothalamus and pituitary, leading to high LH levels.

    • Ovarian or Testicular Resistance: Genetic mutations in LH receptors can lead to elevated circulating LH due to ineffective feedback.

    • Certain Pituitary Adenomas: Though rare, some pituitary tumors may secrete excess LH.

    • Drugs or Hormonal Therapies: GnRH agonists, clomiphene, or other fertility medications can cause transient LH elevations.

  • Possible Causes of Low LH

    • Hypothalamic or Pituitary Disorders: Conditions like hypopituitarism, pituitary adenomas, or head trauma can impair LH secretion.

    • Functional Hypothalamic Amenorrhea: Excessive exercise, stress, or low body weight can suppress GnRH and lower LH.

    • Hyperprolactinemia: High prolactin levels inhibit GnRH, leading to decreased LH (and FSH) production.

    • Chronic Illness or Systemic Stress: These conditions can suppress the hypothalamic-pituitary-gonadal axis, lowering LH output.

    • Exogenous Steroid Use: Use of anabolic steroids or testosterone therapy can suppress endogenous LH via negative feedback.

    • Aging and Obesity: Low LH has been observed in obese individuals and those with type 2 diabetes, especially in males (Esteves & Humaidan, 2025).

Estradiol (E2)

  • What it is & its primary function

    Estradiol is the most potent natural estrogen in humans and belongs to the class of steroid hormones. It is primarily produced in the ovaries in women and in smaller amounts by the testes in men. In both sexes, adipose tissue and the adrenal glands also contribute to its synthesis through the aromatization of androgens.

    Estradiol is crucial for:
    • Regulating reproductive cycles
    • Supporting bone density
    • Modulating lipid and glucose metabolism
    • Influencing mood and cognitive function
    • Promoting cardiovascular health
    (Trenti et al., 2018; Frontiers in Endocrinology, 2022)

  • Significance in Females

    Estradiol plays a central role in almost every phase of a woman’s reproductive life:
    • Menstrual Cycle: Estradiol stimulates the growth of the endometrial lining and supports follicular development. A rise in estradiol levels during the follicular phase triggers the luteinizing hormone (LH) surge and ovulation.
    • Pregnancy: Estradiol levels increase dramatically during pregnancy, contributing to uterine growth, blood flow, and placental function.
    • Menopause: After menopause, ovarian production of estradiol decreases significantly, leading to symptoms such as hot flashes, mood swings, and vaginal dryness. Long-term effects include reduced bone density and increased cardiovascular risk (Frontiers in Endocrinology, 2022).
    • Metabolism and Weight: Estradiol helps regulate appetite, fat distribution, and insulin sensitivity, protecting against metabolic syndrome in premenopausal women (Trenti et al., 2018).

  • Significance in Males

    Although present at lower levels, estradiol is also essential for male health:
    Fertility: Estradiol plays a role in regulating the hypothalamic-pituitary-gonadal axis and is necessary for spermatogenesis. It helps maintain the function of Sertoli and Leydig cells, which are critical for sperm production (Oduwole et al., 2021; Asian Journal of Andrology, 2016).
    Libido and Sexual Function: Estradiol influences sexual behavior, erectile function, and libido. Disruptions in estradiol levels can negatively affect sexual health.
    Bone Health: Estradiol is critical in maintaining bone mass in men, with low levels associated with increased fracture risk (J Clin Endocrinol Metab, 2022).
    Metabolism and Brain Function: Estradiol affects fat metabolism, glucose regulation, and cognitive processes in men, suggesting its broader endocrine role beyond reproduction (PubMed Review, 2019).

  • Possible Causes of Elevated Estradiol

    • Hormone-Secreting Tumors: Estrogen-producing ovarian or testicular tumors can raise estradiol levels.

    • Liver Disease: Impaired estrogen metabolism by the liver can result in elevated serum estradiol.

    • Exogenous Estrogen Therapy: Hormonal replacement therapy, birth control, or anabolic steroid use can elevate estradiol.

    • Polycystic Ovary Syndrome (PCOS): Women with PCOS may have higher estrogen levels due to chronic anovulation.

    • Obesity: Increased aromatase activity in adipose tissue can lead to elevated estradiol synthesis.

    • Hyperthyroidism: Increased metabolic clearance of binding proteins may result in higher bioavailable estradiol.

  • Possible Causes of Low Estradiol

    • Menopause or Premature Ovarian Failure: Decreased ovarian function leads to lower estradiol production.

    • Hypogonadism: In men, primary or secondary hypogonadism can reduce estradiol synthesis.

    • Hypopituitarism: Pituitary insufficiency impairs the stimulation of gonadal hormone production.

    • Excessive Exercise or Eating Disorders: Functional hypothalamic amenorrhea due to energy deficit can suppress estradiol.

    • Chronic Illness or Stress: Systemic inflammation and stress may impair endocrine signaling.

    • Aromatase Inhibitor Use: These drugs, often used in breast cancer or infertility, lower estradiol by blocking conversion from androgens.

Prolactin (PRL)

  • What it is & its primary function

    Prolactin (PRL) is a peptide hormone primarily produced by the anterior pituitary gland. While it is most well-known for stimulating milk production postpartum, prolactin actually exerts a wide range of effects across multiple organ systems.

    Its primary roles include:
    • Lactation: Stimulates mammary gland development and milk synthesis during and after pregnancy.
    • Reproductive regulation: Inhibits gonadotropin-releasing hormone (GnRH), affecting fertility.
    • Metabolic modulation: Supports insulin sensitivity, lipid metabolism, and fat storage.
    • Immunological function: Enhances immune surveillance and inflammatory response.
    • Neuroendocrine action: Interacts with dopaminergic pathways in the brain and may influence mood.
    (Macotela et al., 2022; Kirsch et al., 2022; Ghoreshi et al., 2022)

  • Significance in Females

    • Lactation and Pregnancy: Prolactin levels naturally rise during pregnancy and postpartum to promote breast development and milk production. It works alongside estrogen and oxytocin.
    • Menstrual Cycle and Fertility: Chronically elevated prolactin suppresses the release of FSH and LH by inhibiting GnRH, which may lead to irregular menstrual cycles or amenorrhea and can impair ovulation.
    • PCOS and Hyperprolactinemia: In women with polycystic ovary syndrome (PCOS), mildly elevated prolactin may exacerbate anovulation and androgen excess.
    • Menopause: While prolactin levels tend to decline after menopause, persistent elevation may indicate pituitary pathology or be linked to thyroid dysfunction.
    (Archives of Medical Research, 2024; Thyroid Research Journal, 2024)

  • Significance in Males

    • Fertility: Prolactin plays a role in regulating testosterone secretion by modulating GnRH activity. Excess prolactin can lead to hypogonadism, reduced libido, erectile dysfunction, and infertility.
    • Sexual Function: High levels of prolactin are associated with decreased sexual desire and performance. Dopamine agonists that lower prolactin levels often restore normal sexual function.
    • Metabolic Health: At physiological levels, prolactin supports insulin action and may protect against fatty liver and metabolic syndrome. However, both excessively high and low prolactin can be metabolically detrimental.
    (Kirsch et al., 2022; Macotela et al., 2022; Asian J Andrology)

  • Possible Causes of Elevated Prolactin

    • Pituitary Tumors (Prolactinomas): The most common pathological cause of high PRL. Tumors in the pituitary gland autonomously secrete prolactin.

    • Hypothyroidism: Low thyroid hormone levels lead to increased TRH, which stimulates prolactin release. Treating hypothyroidism usually normalizes PRL.

    • Medications: Antipsychotics, antidepressants, antiemetics, and some antihypertensives can elevate prolactin by antagonizing dopamine receptors.

    • Pregnancy and Breastfeeding: Physiological states with naturally high prolactin levels.

    • Chest Wall Injury or Irritation: Including surgery or trauma; can stimulate the hypothalamus to increase PRL.

    • Stress and Sleep Deprivation: Transient increases in prolactin have been documented under psychological and physical stress.
    (Archives of Medical Research, 2024; Thyroid Research Journal, 2024; Ghoreshi et al., 2022)

  • Possible Causes of Low Prolactin

    • Hypopituitarism: Damage or dysfunction of the pituitary gland can reduce prolactin and other hormone levels.

    • Dopamine Overactivity or Medications: Drugs that enhance dopamine signaling (e.g., levodopa, bromocriptine) can suppress prolactin secretion.

    • Sheehan’s Syndrome: Postpartum pituitary infarction that results in global pituitary hormone deficiency, including PRL.

    • Severe Stress or Illness: Chronic physical or emotional stress may blunt normal prolactin production in some individuals.

    • Radiation or Surgery: Targeted pituitary interventions for tumors may impair prolactin secretion long-term.
    (Macotela et al., 2022; Kirsch et al., 2022)

Total Testosterone

  • What it is & its primary function

    Testosterone is a steroid hormone primarily produced in the testes in males and the ovaries and adrenal glands in females. “Total testosterone” includes testosterone bound to sex hormone-binding globulin (SHBG), albumin, and the free (unbound) fraction.

    Testosterone plays multiple roles, including:
    • Supporting sexual development and function
    • Regulating muscle and bone mass
    • Influencing mood, energy, and cognitive function
    • Participating in fat distribution and metabolic homeostasis

    Measurement of total testosterone is a cornerstone for evaluating hypogonadism, polycystic ovary syndrome (PCOS), infertility, and other endocrine disorders.
    (Anawalt, 2012; Vesper et al., 2015; Guzelce et al., 2022)

  • Significance in Females

    Although women produce much lower levels of testosterone compared to men, the hormone is still biologically important:
    • Reproductive Health: Testosterone contributes to ovarian follicle development and libido.
    • Menstrual Cycle Regulation: Elevated testosterone can disrupt ovulatory cycles and is often observed in conditions like PCOS.
    • Menopause: IPostmenopausal women may experience changes in testosterone levels, which can affect sexual desire, energy, and bone health.
    • Muscle Mass and Metabolism: Plays a modest but significant role in muscle maintenance and insulin sensitivity.
    (Vesper et al., 2015; Rivas et al., 2014)

  • Significance in Males

    Testosterone is the principal male sex hormone and is essential for:
    • Pubertal Development: Deepening of the voice, growth of facial/body hair, and genital maturation.
    • Sperm Production: Maintains testicular function and supports spermatogenesis.
    • Muscle and Bone Health: Supports lean muscle mass, bone density, and physical strength.
    • Mood and Cognitive Performance: Low testosterone has been associated with fatigue, depression, and reduced concentration.
    • Metabolic Regulation: Influences fat distribution and insulin sensitivity.
    (Anawalt, 2012; Rivas et al., 2014; Arver et al., 2009)

  • Possible Causes of Elevated Testosterone

    • Polycystic Ovary Syndrome (PCOS): In women, excess androgen production is a hallmark of PCOS.

    • Congenital Adrenal Hyperplasia (CAH): Overproduction of adrenal androgens can elevate testosterone.

    • Anabolic Steroid Use: Exogenous testosterone or steroid abuse can increase total levels.

    • Testicular or Adrenal Tumors: Rare tumors can cause excessive testosterone production.

    • Insulin Resistance: Especially in women with PCOS, elevated insulin may increase ovarian testosterone synthesis.
    (Guzelce et al., 2022; Rivas et al., 2014)

  • Possible Causes of Low Testosterone

    • Primary Hypogonadism: Damage to the testes due to injury, infection, or genetic conditions like Klinefelter syndrome.

    • Secondary Hypogonadism: Pituitary or hypothalamic disorders that impair stimulation of testosterone production.

    • Aging: Testosterone levels gradually decline with age, often after age 30.

    • Chronic Illness or Stress: Conditions like diabetes, obesity, and depression are linked to lower testosterone.

    • Medications: Opioids, glucocorticoids, and some antidepressants can suppress testosterone.

    • Malnutrition or Overtraining: Nutritional deficits and excessive physical stress can reduce hormone production.
    (Rivas et al., 2014; Arver et al., 2009; Vesper et al., 2015)

Anti-Müllerian Hormone (AMH)

  • What it is & its primary function

    AMH is a glycoprotein hormone secreted by granulosa cells in female ovarian follicles and Sertoli cells in male testes. It plays different roles depending on the sex and stage of life:

    • In women, AMH is produced by small growing follicles and is widely recognized as a biomarker of ovarian reserve, i.e., the number of eggs remaining in the ovaries.

    • In men, AMH is secreted by the testes during fetal life and childhood, where it plays a role in the regression of Müllerian ducts and in sexual differentiation.

    AMH levels can help assess fertility potential, guide assisted reproduction strategies, and signal certain pathologies like polycystic ovary syndrome (PCOS) or granulosa cell tumors.

  • Significance in Females

    - Ovarian Reserve Indicator: AMH levels reflect the remaining pool of viable eggs. Higher AMH usually means a better ovarian reserve, while lower levels suggest reduced fertility potential.
    - Throughout the Lifecycle: AMH is low during childhood, rises in adolescence, peaks in early adulthood, and declines with age—becoming undetectable at menopause (Moolhuijsen & Visser, 2020).
    - IVF and ART: AMH helps guide dosing for ovarian stimulation in IVF. It correlates with oocyte yield, though not necessarily with pregnancy success (Xu et al., 2021; Shah, 2024).
    - Menstrual Irregularities and PCOS: Women with PCOS often have elevated AMH due to an increased number of small antral follicles. It’s considered a helpful diagnostic adjunct (Shrikhande et al., 2020).
    - Fertility Preservation & Oncology: AMH is used to assess ovarian function before and after chemotherapy, aiding oncofertility counseling (Xu et al., 2021).

  • Significance in Males

    Adult Males: AMH levels naturally decline after puberty and are not used as markers for fertility or hormone status in adult men. However, they may help assess testicular damage or gonadal disorders in select cases.

  • Possible Causes of Elevated AMH

    • Polycystic Ovary Syndrome (PCOS): Elevated AMH is one of the hallmarks of PCOS, due to an increased number of small, undeveloped follicles.

    • Granulosa Cell Tumors: Rare ovarian tumors that produce large amounts of AMH; monitoring levels can aid in diagnosis and follow-up (Shrikhande et al., 2020).

    • Ovarian Hyperstimulation: AMH can be temporarily elevated after aggressive stimulation protocols in fertility treatments.

  • Possible Causes of Low AMH

    • Aging: AMH declines steadily with age and becomes undetectable at menopause.

    • Primary Ovarian Insufficiency: Low or undetectable AMH may indicate diminished ovarian reserve or premature ovarian failure (Moolhuijsen & Visser, 2020).

    • Post-Chemotherapy or Radiation: Treatments that damage ovarian tissue can lead to a sharp drop in AMH levels (Xu et al., 2021).

    • Surgical Removal of Ovaries: Oophorectomy eliminates AMH production completely

    • Hypogonadotropic Hypogonadism: Reduced gonadotropin stimulation may impair follicular development and AMH secretion.

Sex Hormone‑Binding Globulin (SHBG)

  • What it is & its primary function

    SHBG is a glycoprotein produced mainly by the liver that binds sex steroids—testosterone, dihydrotestosterone (DHT), and estradiol—in the bloodstream. It regulates the balance between free (bioavailable) and bound hormones, playing a critical role in modulating hormone activity.

  • Significance in Females

    • Hormone regulation & reproductive health: High SHBG limits free testosterone and estrogen exposure—reducing risks such as hirsutism and endometrial hyperstimulation.

    • PCOS & insulin resistance: Low SHBG is a hallmark of PCOS and is associated with insulin resistance and metabolic syndrome.

    • Pregnancy adaptation: SHBG rises 5–10× during pregnancy to buffer fetal hormone exposure.

    • Breast cancer risk: Elevated SHBG levels may reduce the risk of estrogen receptor-positive breast cancer in postmenopausal women.

  • Significance in Males

    • Testosterone bioavailability: SHBG controls the fraction of free testosterone; elevated SHBG may lead to symptoms resembling hypogonadism, even with normal total testosterone.

    • Age‑related changes: Men’s SHBG increases with age, lowering bioavailable testosterone and contributing to age-related muscle and libido decline.

    • Interplay with metabolic health: Low SHBG in men signals insulin resistance and increased risk for type 2 diabetes and cardiovascular disease.

  • Possible Causes of Elevated SHBG

    • Hormonal factors: High estrogen states (e.g., pregnancy, contraceptive therapy, hormone replacement).

    • Thyroid & metabolic factors: Hyperthyroidism stimulates SHBG production.

    • Liver conditions & nutritional status: Liver disease and anorexia increase SHBG.

    • Low androgen or growth hormone levels: Seen in hypothyroidism, GH deficiency, or hypogonadism.

    • Age: Natural rise in SHBG as men age.

  • Possible Causes of Low SHBG

    • Insulin resistance/increased insulin: Low SHBG is a recognized biomarker for insulin resistance.

    • Obesity & metabolic syndrome: Directly associated with decreased SHBG.

    • Hypothyroidism: Associated with SHBG reductions.

    • High androgen or growth hormone states: e.g., anabolic steroid use suppresses SHBG.

    • PCOS in women: Common finding of low SHBG due to hyperandrogenism and insulin resistance.

    • Genetic factors: Rare hereditary SHBG deficiency

Androstenedione

  • What it is & its primary function

    Androstenedione, also called 4-androstene-3,17-dione (AD), is a steroid hormone synthesized by the adrenal glands, ovaries, and testes. It acts as a key intermediate (“prohormone”) in steroidogenesis, converting to testosterone via 17β‑HSD or to estrogens (estrone, estradiol) via aromatase in peripheral tissues . It impacts:
    • Sexual development & reproduction
    • Bone density & muscle growth
    • Metabolic health and energy
    • Secondary sex characteristics

  • Significance in Females

    • Estrogen precursor: Accounts for ~50% of testosterone and nearly all estrone production in women.

    • Menstrual & reproductive health: Balanced androstenedione supports regular cycles; imbalance can cause irregular menses and fertility issues.

    • PCOS and hyperandrogenism: Elevated AD is a common marker in PCOS, contributing to acne, hirsutism, oligomenorrhea, and infertility.

    • Puberty & development: In girls, contributes to pubic hair growth and normal sexual maturation (pubarche).

    • Bone & cardiovascular health: Through estrogen synthesis, it supports bone vitality and may protect cardiovascular health.

  • Significance in Males

    • Testosterone precursor: Essential for peripheral testosterone production—especially relevant in the testes and adrenals.

    • Muscle & bone mass:: Through downstream testosterone, supports muscle strength and bone integrity.

    • Sexual function: Vital for libido, sperm production, and erectile function.

    • Estrogen effects: Some AD converts to estrogens; over-conversion can cause gynecomastia in men

  • Possible Causes of Elevated Androstenedione

    • PCOS: Adrenal and ovarian overproduction leads to increased AD in women.

    • Congenital Adrenal Hyperplasia (3β‑HSD or 21‑hydroxylase deficiency): Enzymatic defects cause AD accumulation.

    • Adrenal or gonadal tumors: Can cause pronounced AD elevation; levels ≥500 ng/dL strongly suggest a tumor.

    • Supplement use: Athletes often use androstenedione to boost testosterone, though effects are inconsistent and banned in sports.

    • Early adrenarche: May cause mild, idiopathic elevation in children.

  • Possible Causes of Low Androstenedione

    • Adrenal insufficiency or hypopituitarism: Reduced AD production due to impaired adrenal/gonadal function.

    • Testicular or ovarian failure: Causes diminished downstream androgen/estrogen synthesis.

    • Chronic illness/nutritional deficiency: Impacts steroidogenesis in long-term disease or malnutrition contexts.

    • Aging: Like other adrenal androgens, AD declines with age (“adrenopause”)—dropping ~2% per year after age 30.

17-Hydroxyprogesterone (17-OHP)

  • What it is & its primary function

    17-Hydroxyprogesterone (17-OHP) is a steroid hormone produced primarily in the adrenal glands and, to a lesser extent, in the ovaries and testes. It is an intermediate in the synthesis of cortisol and androgens, particularly in the 21-hydroxylase pathway.

    Its key function is to help regulate:
    • Cortisol production (essential for stress response, metabolism, and immune function)
    • Androgen production, particularly in the context of adrenal steroidogenesis

    Although it has little intrinsic hormonal activity, abnormal levels—especially elevated—can signal congenital adrenal hyperplasia (CAH) or other disorders of adrenal or gonadal function.

  • Significance in Females

    • Menstrual Cycle Regulation: In women, 17-OHP rises during the luteal phase as a byproduct of corpus luteum progesterone production. Abnormal levels may indicate ovulatory dysfunction or adrenal/ovarian disorders.

    • Pregnancy: Though not directly involved in maintaining pregnancy, it can be elevated as a result of increased progesterone synthesis. However, markedly elevated levels may signal non-classical CAH, even during pregnancy.

    • Polycystic Ovary Syndrome (PCOS): Elevated 17-OHP may help differentiate between PCOS and non-classical CAH, which presents similarly (hirsutism, acne, irregular cycles).

    • Adrenal Tumors: Rarely, women with adrenal neoplasms may present with elevated 17-OHP mimicking CAH.

  • Significance in Males

    • Adrenal Function Marker: In men, 17-OHP is an important marker for adrenal steroidogenesis and can help detect non-classical or classical CAH when levels are persistently high.

    • Fertility: Elevated levels due to CAH can lead to impaired spermatogenesis, testicular adrenal rest tumors (TARTs), and subfertility in men.

    • Androgen Balance: Since 17-OHP is a precursor in androgen biosynthesis, disturbances can result in symptoms of androgen excess or deficiency (e.g., acne, hair loss, gynecomastia, or reduced libido).

    • Muscle/Energy: While 17-OHP itself does not directly influence energy or muscle mass, its downstream products (like cortisol and testosterone) do. Abnormalities in its levels may indirectly affect these systems.

  • Possible Causes of Elevated 17-OHP

    • Congenital Adrenal Hyperplasia (CAH): Most common cause, especially due to 21-hydroxylase deficiency. In classic forms, 17-OHP levels are typically >10,000 ng/dL.

    • Non-classical CAH (NCCAH): Milder, late-onset form that may present during adolescence or adulthood.

    • Adrenal tumors: Rare, but hormonally active adrenal adenomas can produce high 17-OHP.

    • Stress/ACTH stimulation: ACTH (adrenocorticotropic hormone) can increase adrenal steroid production, including 17-OHP.

    • Luteal phase in menstruating women: Mild physiologic elevation due to normal ovarian activity.

  • Possible Causes of Low 17-OHP

    • Adrenal insufficiency: Primary or secondary adrenal failure can lead to reduced synthesis of 17-OHP.

    • Hypopituitarism: Low ACTH from pituitary dysfunction suppresses adrenal steroidogenesis.

    • Over-treatment in CAH: Excessive glucocorticoid therapy suppresses adrenal activity and can lead to abnormally low 17-OHP levels.

    • Certain medications: Steroids or hormonal treatments that suppress adrenal output can decrease 17-OHP.

    • Chronic illness/malnutrition: Systemic suppression of endocrine function may cause low steroid hormone levels.

DHEA & DHEA-SULFATE

  • What it is & its primary function

    Dehydroepiandrosterone (DHEA) is a steroid hormone produced primarily by the adrenal glands, and to a lesser extent by the gonads and brain. It serves as a precursor to androgens (like testosterone) and estrogens (like estradiol).

    DHEA-Sulfate (DHEA-S) is a sulfated, more stable form of DHEA with a longer half-life in circulation. DHEA is rapidly converted into DHEA-S in the liver and peripheral tissues.

    Together, these hormones influence:
    • Metabolism
    • Mood and cognition
    • Immune response
    • Sexual function
    • Bone density and muscle mass

    DHEA levels peak in early adulthood and decline progressively with age, making it one of the most abundant circulating steroids in youth and one of the earliest markers of endocrine aging.

  • Significance in Females

    • Menstrual Health: DHEA contributes to estrogen biosynthesis, which plays a role in regulating the menstrual cycle.

    • Fertility: DHEA supplementation has been studied in women with diminished ovarian reserve, as it may improve oocyte quality and fertility outcomes.

    • Pregnancy: Adrenal production of DHEA-S contributes to estrogen levels needed to sustain pregnancy.

    • Menopause: Postmenopausal women often have lower levels of DHEA and DHEA-S, which may contribute to fatigue, mood disturbances, reduced libido, and bone loss. Some studies suggest DHEA supplementation may improve well-being and vaginal health in postmenopausal women, though evidence is mixed (Davis, 2011).

    • PCOS: Women with polycystic ovary syndrome may have elevated DHEA-S due to adrenal hyperandrogenism, contributing to acne, hirsutism, and ovulatory dysfunction.

  • Significance in Males

    • Testosterone Precursor: In men, DHEA serves as a substrate for peripheral testosterone production, especially relevant in aging when testicular output declines.

    • Erectile Function: Some evidence links low DHEA levels to erectile dysfunction, potentially due to endothelial dysfunction or impaired nitric oxide synthesis.

    • Muscle & Bone Health: DHEA has been associated with preservation of lean mass and bone density in aging males.

    • Mood & Energy: Low DHEA may be involved in fatigue, depression, and reduced quality of life, particularly in older men.

    • Metabolic Health: Lower DHEA-S levels are linked to insulin resistance, type 2 diabetes, and cardiovascular disease risk.

  • Possible Causes of Elevated DHEA

    • Adrenal tumors (benign or malignant): Can cause overproduction of DHEA-S independently of ACTH regulation.

    • Polycystic Ovary Syndrome (PCOS): A common cause in women, with adrenal contribution to hyperandrogenism.

    • Congenital Adrenal Hyperplasia (CAH): Enzyme deficiencies (e.g., 21-hydroxylase) lead to androgen excess.

    • Exogenous DHEA supplementation: Over-the-counter or prescribed use can significantly raise levels.

    • Stress & ACTH stimulation: Acute or chronic stress can transiently elevate adrenal steroids.

    • Certain medications: Like danazol, can increase DHEA-S levels.

  • Possible Causes of Low DHEA

    • Adrenal insufficiency: Primary or secondary failure results in reduced adrenal steroid output.

    • Aging: Low Natural age-related decline, beginning around age 30.

    • Hypopituitarism: Reduced ACTH leads to lower adrenal steroid synthesis.

    • Chronic illness or stress: Conditions like HIV, lupus, or chronic fatigue may lower DHEA.

    • Glucocorticoid therapy: Suppresses adrenal function, often decreasing DHEA-S.

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