As I mentioned in my previous posts, PCOS is a collection of symptoms. There is no one straight forward test to tell you whether you have PCOS or not. So the first thing the doctors do is order a lot of blood work. When I went for my first test it was very scary to see them take 10 vials of blood. It was even more scary to see the results – bunch of tests with weird sounding names and out of range values, without knowing the meaning of it all. Even if you don’t have PCOS, it is good to have a basic knowledge of the tests, the approximate hormone levels, ranges and what it actually means to fall above or below the range. Here are some common tests categorized based on what they are used for and the normal values. I have included an explanation of out of range values. This is what I learned from my 10 years of tests and more tests.
There are few things you should keep in mind
- These values are the average. Sometimes a lab might have a different protocol which means the values might be a little different.
- This is not information purposes only and based on my tests (Read my disclaimer again) and online resources. Use this to better understand your results and ask your doctor about any questions you may have. Don’t use this for self-diagnosis. ALWAYS consult with your doctor.
- These are the ranges for the hormone tests done via blood work. I will include the ranges for the hormone test from saliva in an upcoming post.
- These ranges are those seen during normal period. NOT during pregnancy. Pregnancy values are different.
Female Hormone Levels
|Hormone to Test
to Test (Days of a menstrual cycle)
|What Value Means
|Follicle Stimulating Hormone (FSH)||Day 3||3-20 mIU/ml||FSH is often used as a gauge of ovarian reserve. In general, under 6 is excellent, 6-9 is good, 9-10 fair, 10-13 diminished reserve, 13+ very hard to stimulate. In PCOS testing, the LH:FSH ratio may be used in the diagnosis. The ratio is usually close to 1:1, but if the LH is higher, it is one possible indication of PCOS.|
|Estradiol (E2)||Day 3||25-75 pg/ml||Levels on the lower end tend to be better for stimulating. Abnormally high levels on day 3 may indicate existence of a functional cyst or diminished ovarian reserve.|
|Estradiol (E2)||Day 4-5 of meds||100+ pg/ml or 2x Day 3||There are no charts showing E2 levels during stimulation since there is a wide variation depending on how many follicles are being produced and their size. Most doctors will consider any increase in E2 a positive sign, but others use a formula of either 100 pg/ml after 4 days of stims, or a doubling in E2 from the level taken on cycle day 3.|
|Estradiol (E2)||Surge/hCG day||200 + pg/ml||The levels should be 200-600 per mature (18 mm) follicle. These levels are sometimes lower in overweight women.|
|Luteinizing Hormone (LH)||Day 3||< 7 mIU/ml||A normal LH level is similar to FSH. An LH that is higher than FSH is one indication of PCOS.|
|Luteinizing Hormone (LH)||Surge Day||> 20 mIU/ml||The LH surge leads to ovulation within 48 hours.|
|Prolactin||Day 3||< 24 ng/ml||Increased prolactin levels can interfere with ovulation. They may also indicate further testing (MRI) should be done to check for a pituitary tumor. Some women with PCOS also have hyperprolactinemia.|
|Progesterone (P4)||Day 3||< 1.5 ng/ml||Often called the follicular phase level. An elevated level may indicate a lower pregnancy rate.|
|Progesterone (P4)||7 dpo||> 15 ng/ml||A progesterone test is done to confirm ovulation. When a follicle releases its egg, it becomes what is called a corpus luteum and produces progesterone. A level over 5 probably indicates some form of ovulation, but most doctors want to see a level over 10 on a natural cycle, and a level over 15 on a medicated cycle. There is no mid-luteal level that predicts pregnancy. Some say the test may be more accurate if done first thing in the morning after fasting.|
|Thyroid Stimulating Hormone (TSH)||Day 3||.4-4 uIU/ml||Mid-range normal in most labs is about 1.7. A high level of TSH combined with a low or normal T4 level generally indicates hypothyroidism, which can have an effect on fertility.|
|Free Triiodothyronine (T3)||Day 3||1.4-4.4 pg/ml||Sometimes the diseased thyroid gland will start producing very high levels of T3 but still produce normal levels of T4. Therefore measurement of both hormones provides an even more accurate evaluation of thyroid function.|
|Free Thyroxine (T4)||Day 3||.8-2 ng/dl||A low level may indicate a diseased thyroid gland or may indicate a non- functioning pituitary gland which is not stimulating the thyroid to produce T4. If the T4 is low and the TSH is normal, that is more likely to indicate a problem with the pituitary.|
|Total Testosterone||Day 3||6-86 ng/dl||Testosterone is secreted from the adrenal gland and the ovaries. Most would consider a level above 50 to be somewhat elevated.|
|Free Testosterone||Day 3||.7-3.6 pg/ml|
|Dehydroepiandrosterone Sulfate (DHEAS)||Day 3||35-430 ug/dl||An elevated DHEAS level may be improved through use of dexamethasone, prednisone, or insulin-sensiting medications.|
|Androstenedione||Day 3||.7-3.1 ng/ml|
|Sex Hormone Binding Globulin (SHBG)||Day 3||18-114 nmol/l||Increased androgen production often leads to lower SHBG|
|17 Hydroxyprogesterone||Day 3||20-100 ng/dl||Mid-cycle peak would be 100-250 ng/dl, luteal phase 100-500 ng/dl|
|Fasting Insulin||8-16 hours fasting||< 30 mIU/ml||The normal range here doesn’t give all the information. A fasting insulin of 10-13 generally indicates some insulin resistance, and levels above 13 indicate greater insulin resistance.|
Blood Glucose Levels
|Type of Test||Time to
|What value means|
|Fasting Glucose||8-16 hours fasting||70-110 mg/dl||A healthy fasting glucose level is between 70-90, but up to 110 is within normal limits. A level of 111-125 indicates impaired glucose tolerance/insulin resistance. A fasting level of 126+ indicates type II diabetes.|
|Glycohemoglobin / Glycosylated Hemoglobin (HbA1c)||anytime||< 6 %||An HbA1c measures glucose levels over the past 3 months. It should be under 6% to show good diabetic control (postprandial glucose levels rarely going above 120). Good control reduces the risk of miscarriage and birth defects.|
Glucose Tolerance Test with Insulin (GTT / IGTT)
|Time||Normal Glucose Values||Normal Insulin Values||What the Results Mean|
|Fasting||< 126 mg/dl||< 10 mIU/ml||Normal glucose results are 70-90, 111 or over is impaired, 126 or over is diabetic. Insulin levels above 10 show insulin resistance.|
|0.5 hour||< 200 mg/dl||40-70 mIU/ml||A truly normal glucose response will not exceed 150.|
|1 hour||< 200 mg/dl||50-90 mIU/ml||Some want to lower the threshold on glucose to < 180 to identify early stages of diabetes. Insulin > 80 shows insulin resistance, or a level 5 times that of the fasting level (i.e., a fasting of 11 followed by a 1 hour > 55)|
|2 hours||< 140 mg/dl||6-50 mIU/ml||A truly normal glucose response is 110 or lower.
Insulin > 60 is IR.
|3 hours||< 120 mg/dl|
|4 hours||< 120 mg/dl|
Cholesterol, Triglycerides and C-Peptide
|What to Test||Time to Test||Normal
|What value means|
|Triglycerides (TG)||8-16 hours fasting||< 200 mg/dl||Borderline high is 200-400, high is 400-1000, and very high is >1000. Elevated levels are a risk factor for coronary artery disease.|
|Cholesterol Total||8-16 hours fasting||< 200 mg/dl||A level of 200-239 is borderline high, and a level 240+ is high. Increased levels are associated with increased risk of heart disease.|
|low-density lipoprotein cholesterol (LDL)||8-16 hours fasting||< 160 mg/dl||This is the “bad” cholesterol. In someone with one risk factor for heart disease, < 160 is recommended, with 2 risk factors < 130, and those with documented coronary heart disease the target is < 100|
|high-density lipoprotein cholesterol (HDL)||8-16 hours fasting||> 34 mg/dl||This is the “good” cholesterol which may be increased through a healthy diet and exercise. The HDL level is usually estimated by taking total cholesterol and subtracting LDL, rather than by direct measure.|
|C-peptide||8-16 hours fasting||0.5 to 4.0 ng/ml||Levels increase with insulin production.|
|Creatinine||< 1.4 mg/dl||Levels 1.4 mg/dl and higher may indicate renal (kidney) disease or renal dysfunction.|
Hope this gives you an understanding of what to expect from the test and what it means. Now you can ask informed questions of your doctor. I will add the pregnancy values & saliva test value and include a pdf with all the results. If you see any inaccuracies please let me know.