Estradiol, FSH, SHBG, Testosterone Free and Total

The following is a list of what is included in the item above. Click the test(s) below to view what biomarkers are measured along with an explanation of what the biomarker is measuring.


Estradiol (estradiol-17 beta, E2) is part of an estrogen that is a group of steroids that regulate the menstrual cycle and function as the main female sex hormones. Estrogens are responsible for the development of female sex organs and secondary sex characteristics and are tied to the menstrual cycle and pregnancy. They are considered the main sex hormones in women and are present in small quantities in men. Estradiol (E2) is the predominant form of estrogen and is produced primarily in the ovaries with additional amounts produced by the adrenal glands in women and in the testes and adrenal glands in men. Estradiol levels are used in evaluating ovarian function. Estradiol levels are increased in cases of early (precocious) puberty in girls and gynecomastia in men. Its main use has been in the differential diagnosis of amenorrhea – for example, to determine whether the cause is menopause, pregnancy, or a medical problem. In assisted reproductive technology (ART), serial measurements are used to monitor follicle development in the ovary in the days prior to in vitro fertilization. Estradiol is also sometimes used to monitor menopausal hormone replacement therapy.

Also known as: Follicle Stimulating Hormone, FSH Follicle Stimulating Hormone


Also known as: Sex Hormone Binding Globulin SHBG, SHBG, TeBG, Testosterone-estrogen Binding Globulin

Sex Hormone Binding

The sex hormone binding globulin (SHBG) test measures the concentration of SHBG in the blood. SHBG is a protein that is produced by the liver and binds tightly to testosterone, dihydrotestosterone (DHT), and estradiol (an estrogen). In this bound state, it transports them in the blood as an inactive form. The amount of SHBG in circulation is affected by age and sex, by decreased or increased testosterone or estrogen production and can be affected by certain diseases and conditions such as liver disease, hyperthyroidism or hypothyroidism, and obesity. Changes in SHBG levels can affect the amount of testosterone that is available to be used by the body's tissues. A total testosterone test does not distinguish between bound and unbound testosterone but determines the overall quantity of testosterone. If a person's SHBG level is not normal, then the total testosterone may not be an accurate representation of the amount of testosterone that is available to the person's tissues.

Also known as: Testosterone Free Dialysis and Total LCMSMS

Free Testosterone

In many cases, measurement of total testosterone provides the doctor with adequate information. However, in certain cases, for example when the level of SHBG is abnormal, a test for free or bioavailable testosterone may be performed as it may more accurately reflect the presence of a medical condition.


A testosterone test measures the amount of the male hormone, testosterone, in the blood. Both men and women produce this hormone. In males, the testicles produce most of the testosterone in the body. Levels are most often checked to evaluate signs of low testosterone: In boys -- early or late puberty and in men -- impotence, low level of sexual interest, infertility, thinning of the bones In females, the ovaries produce most of the testosterone and levels are most often checked to evaluate signs of higher testosterone levels, such as: decreased breast size, excess hair growth, increased size of the clitoris. irregular or absent menstrual periods and male-pattern baldness or hair thinning.
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The Estradiol, FSH, SHBG, Testosterone Free and Total panel contains 4 tests with 5 biomarkers.

Brief Description: The Estradiol, FSH, SHBG, Testosterone Free and Total Panel is a comprehensive hormonal assessment used to evaluate a person's reproductive health, hormonal balance, and overall endocrine function. This panel provides crucial insights into the levels of key hormones that play significant roles in bodily functions, including development and maintenance of reproductive tissues, sexual function, bone health, and muscle mass. It is particularly useful in diagnosing various hormonal disorders and conditions related to the reproductive system, metabolism, and more.

This panel contains Estradiol #4021 which is not intended for patients under the age of 18 years old. For patients under 18 years old, order Estradiol, Ultrasensitive LC/MS/MS #30289. If Estradiol #4021 is ordered for a patient under 18, the lab will automatically change the code to and charge for Estradiol, Ultrasensitive LC/MS/MS #30289.

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No prepration required.

When and Why the Panel May Be Ordered

This panel may be ordered for a variety of reasons, including evaluating infertility issues, diagnosing conditions related to hormonal imbalances such as polycystic ovary syndrome (PCOS), assessing sexual dysfunction, investigating menstrual irregularities, and monitoring hormone replacement therapy. It is also ordered when symptoms suggest conditions that could be influenced by hormone levels, such as unexplained weight changes, hair loss, or abnormal growth patterns.

What the Panel Checks For

The panel includes several key tests, each providing valuable information about different hormonal aspects:

  • Estradiol: This test measures the amount of estradiol, the primary form of estrogen in the body. Estradiol is crucial for the regulation of the menstrual cycle, reproductive system, and secondary sexual characteristics. It also plays a role in bone health.

  • FSH (Follicle Stimulating Hormone): FSH is integral to the reproductive process, stimulating the growth of ovarian follicles in women and spermatogenesis in men. This test helps assess fertility, ovarian function, and menstrual health.

  • Sex Hormone Binding Globulin (SHBG): SHBG regulates the availability of sex hormones to the body's tissues. It binds to hormones like testosterone and estradiol. Measuring SHBG can help understand conditions related to excess or deficient sex hormone levels.

  • Testosterone, Free and Total: This test measures both the free (bioavailable) and total levels of testosterone, a key hormone in both males and females that affects sexual development, muscle mass, and bone density. It is crucial for diagnosing conditions related to androgen levels.

Conditions or Diseases Detected by the Panel

This panel is adept at diagnosing a range of conditions:

  • Polycystic Ovary Syndrome (PCOS): Characterized by hormonal imbalance that affects ovulation, PCOS can be suggested by elevated testosterone levels, disrupted FSH and estradiol levels, and sometimes increased SHBG levels.

  • Infertility: Both male and female infertility can be investigated through this panel by assessing FSH and testosterone levels, which are vital for reproductive function and health.

  • Menopausal and Perimenopausal Disorders: Changes in estradiol and FSH levels are indicative of menopause or perimenopause, helping to manage symptoms and hormonal therapy.

  • Hypogonadism: In males, low testosterone levels alongside discrepancies in FSH can indicate hypogonadism, affecting fertility and secondary sexual characteristics.

  • Hormonal Imbalances: The panel can detect various hormonal imbalances affecting the body, such as excessive or deficient production of sex hormones.

Utilizing the Panel in Treatment and Monitoring

For each condition, the panel provides valuable data for managing and treating hormonal issues:

  • PCOS: Treatment may involve lifestyle changes, medication to regulate menstrual cycles, and interventions to manage symptoms. Hormone levels are monitored to assess treatment efficacy.

  • Infertility: Hormonal therapy or other treatments may be guided by panel results, with ongoing monitoring to optimize fertility treatments.

  • Menopausal and Perimenopausal Disorders: Hormone replacement therapy can be adjusted based on estradiol and FSH levels to alleviate symptoms and maintain health.

  • Hypogonadism: Testosterone replacement therapy may be prescribed, with regular testing to ensure appropriate testosterone levels are maintained.

The Estradiol, FSH, SHBG, Testosterone Free and Total Panel is an essential tool in the assessment and management of a wide range of hormonal disorders and conditions affecting reproductive health. By providing a comprehensive overview of hormone levels, healthcare professionals can diagnose conditions more accurately, tailor treatments to individual needs, and monitor the effectiveness of interventions, ensuring optimal health outcomes for patients facing hormonal imbalances.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

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