28/07/2026
🧪Most women who come to me with hormonal concerns have already had bloodwork…and most of those results were reported as normal.
Here is what a standard panel typically includes and what it does not tell us.
Standard hormonal workup for most women:
→TSH
→possibly an FSH and LH if periods are irregular
→an estradiol if menopause is being assessed
→a testosterone level if androgen symptoms are present
All checked at a random point in the cycle with no notation of where in the cycle the draw was taken.
Hormones are not static. They move dramatically across the cycle. An estradiol drawn on day 2 versus day 12 versus day 21 tells three completely different stories. A progesterone drawn on day 23 is clinically meaningful. The same value drawn on day 7 is meaningless.
What a comprehensive functional hormone assessment adds:
→Serum progesterone drawn on day 19 to 21 of the cycle, the luteal phase peak. This is the only way to assess whether progesterone is actually adequate in the phase where it should be highest.
→Full estrogen panel including estradiol, estriol, and estrone plus estrogen metabolites . Estrogen metabolism matters as much as estrogen levels.
→SHBG (s*x hormone binding globulin). High SHBG binds testosterone and estrogen, making them biologically unavailable even when total levels appear adequate. Low SHBG in the context of insulin resistance frees excess androgens. Total hormone levels without SHBG are incomplete.
→Cortisol rhythm via 4-point salivary testing. Because cortisol and the s*x hormones share the same cholesterol precursor (pregnenolone) and compete through the pregnenolone steal mechanism.
→Thyroid panel including free T3, free T4, and thyroid antibodies. Because thyroid hormone is required for progesterone synthesis and proper LH pulsatility. Subclinical hypothyroidism is one of the most treatable causes of irregular cycles, luteal phase defects, and PMS.
