HH-4. Hormone Health - Women

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.

Also known as: Dehydroepiandrosterone Sulfate, DHEA SO4, DHEA Sulfate Immunoassay, DHEAS, Transdehydroandrosterone


DHEA-sulfate test measures the amount of DHEA-sulfate in the blood. DHEA-sulfate is a weak male hormone (androgen) produced by the adrenal gland in both men and women.


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: Estrogen Total Serum

Estrogen, Total, Serum

Estrogen 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.

Also known as: Estrone LCMSMS

Estrone, LC/MS/MS

Estrone is primarily derived from metabolism of androstenedione in peripheral tissues, especially adipose tissues. Individuals with obesity have increased conversion of androstenedione to Estrone leading to higher concentrations. In addition, an increase in the ratio of Estrone to Estradiol may be useful in assessing menopause in women. Estrone levels may be elevated in patients with polycystic ovarian syndrome and endometriosis. Tests may be used to aid in the diagnosis of an ovarian tumor, Turner syndrome, and hypopituitarism. In males, it may help in the diagnosis of the cause of gynecomastia or in the detection of estrogen-producing tumors.

Also known as: Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), Follicle Stimulating Hormone and Luteinizing Hormone



Also known as: IGF-1, IGFI LCMS, Insulin-Like Growth Factor, Insulin-like Growth Factor - 1, Somatomedin C, Somatomedin-C

Igf I, LC/MS

The insulin-like growth factor-1 (IGF-1) test is an indirect measure of the average amount of growth hormone (GH) being produced by the body. IGF-1 and GH are polypeptide hormones, small proteins that are vital for normal bone and tissue growth and development. GH is produced by the pituitary gland, a grape-sized gland located at the base of the brain behind the bridge of your nose. GH is secreted into the bloodstream in pulses throughout the day and night with peaks that occur mostly during the night. IGF-1 is produced by the liver and skeletal muscle as well as many other tissues in response to GH stimulation. IGF-1 mediates many of the actions of GH, stimulating the growth of bones and other tissues and promoting the production of lean muscle mass. IGF-1 mirrors GH excesses and deficiencies, but its level is stable throughout the day, making it a useful indicator of average GH levels.

Z Score (Female)

z Score. A z-score (aka, a standard score) indicates how many standard deviations an element is from the mean. A z-score can be calculated from the following formula. z = (X - µ) / s where z is the z-score, X is the value of the element, µ is the population mean, and s is the standard deviation.

Also known as: Pregnenolone LCMSMS

Pregnenolone, LC/MS/MS

Also known as: Progesterone Immunoassay


Serum progesterone is a test to measure the amount of progesterone in the blood. Progesterone is a hormone produced mainly in the ovaries. In women, progesterone plays a vital role in pregnancy. After an egg is released by the ovaries (ovulation), progesterone helps make the uterus ready for implantation of a fertilized egg. It prepares the womb (uterus) for pregnancy and the breasts for milk production. Men produce some amount of progesterone, but it probably has no normal function except to help produce other steroid hormones.

Also known as: PRL


Prolactin is a hormone produced by the anterior portion of the pituitary gland, a grape-sized organ found at the base of the brain. Prolactin secretion is regulated and inhibited by the brain chemical dopamine. Normally present in low amounts in men and non-pregnant women, prolactin's primary role is to promote lactation (breast milk production). Prolactin levels are usually high throughout pregnancy and just after childbirth. During pregnancy, the hormones prolactin, estrogen, and progesterone stimulate breast milk development. Following childbirth, prolactin helps initiate and maintain the breast milk supply. If a woman does not breastfeed, her prolactin level soon drops back to pre-pregnancy levels. If she does nurse, suckling by the infant plays an important role in the release of prolactin. There is a feedback mechanism between how often the baby nurses and the amount of prolactin secreted by the pituitary as well as the amount of milk produced. Another common cause of elevated prolactin levels is a prolactinoma, a prolactin-producing tumor of the pituitary gland. Prolactinomas are the most common type of pituitary tumor and are usually benign. They develop more frequently in women but are also found in men. Problems resulting from them can arise both from the unintended effects of excess prolactin, such as milk production in the non-pregnant woman (and rarely, man) and from the size and location of the tumor. If the anterior pituitary gland and/or the tumor enlarge significantly, it can put pressure on the optic nerve, causing headaches and visual disturbances, and it can interfere with the other hormones that the pituitary gland produces. In women, prolactinomas can cause infertility and irregularities in menstruation; in men, these tumors can cause a gradual loss in sexual function and libido. If left untreated, prolactinomas may eventually damage the tissues around them.

Also known as: Testosterone Total And Free And Sex Hormone Binding Globulin

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.

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.


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 HH-4. Hormone Health - Women panel contains 10 tests with 14 biomarkers.

Brief Description: The HH-4 Hormone Health - Women panel represents the most comprehensive evaluation in the series of hormone health panels designed for women. It includes an extensive array of tests, encompassing DHEA Sulfate, Estradiol, Estrogen Total, Estrone, Follicle Stimulating Hormone (FSH), Insulin-like Growth Factor-1 (IGF-1), Luteinizing Hormone (LH), Pregnenolone, Progesterone, Prolactin, Sex Hormone Binding Globulin (SHBG), and Testosterone Free and Total. This panel is designed to offer an in-depth insight into a woman's hormonal balance, reproductive health, and potential risk factors for a range of conditions.

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Overnight fasting is preferred

When and Why the HH-4 Panel May Be Ordered

The HH-4 Hormone Health - Women panel is typically ordered for women experiencing complex symptoms indicative of hormonal imbalances or disorders, such as irregular or absent menstrual cycles, symptoms related to menopause, infertility issues, and signs of conditions like polycystic ovary syndrome (PCOS) or thyroid disorders. It's also invaluable for those undergoing hormone replacement therapy, providing a thorough overview to guide treatment and monitor its effectiveness.

What the HH-4 Panel Checks For

  • DHEA Sulfate: This test measures the level of DHEA sulfate, a precursor to both male and female sex hormones, providing insights into adrenal function and overall vitality.

  • Estradiol: As a primary form of estrogen in women of reproductive age, estradiol levels are crucial for assessing ovarian function and reproductive health.

  • Estrogen Total: This test measures all forms of estrogen, offering a comprehensive view of estrogen activity within the body, which is vital for various physiological processes.

  • Estrone: Estrone levels become more significant post-menopause and can provide insights into the body's estrogen production and potential risks associated with elevated levels.

  • Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH): These tests are key for evaluating menstrual cycle health and ovulatory function, with implications for fertility and menopausal status.

  • Insulin-like Growth Factor-1 (IGF-1): IGF-1 levels provide insights into growth hormone activity, affecting a wide range of bodily functions from metabolism to bone health.

  • Pregnenolone: As a precursor to many other hormones, pregnenolone levels can shed light on the body's overall hormone production and balance.

  • Progesterone: Progesterone testing is essential for understanding the health of the menstrual cycle, particularly the luteal phase, and is crucial for pregnancy.

  • Prolactin: Elevated prolactin levels can affect menstrual function and fertility, making this test important for diagnosing conditions like hyperprolactinemia.

  • Sex Hormone Binding Globulin (SHBG): SHBG levels affect the availability of sex hormones in the body, influencing a range of conditions from hormonal imbalances to metabolic syndrome.

  • Testosterone Free and Total: Although typically considered a male hormone, testosterone levels in women are crucial for understanding conditions like PCOS and assessing overall hormonal health.

Conditions Detected by the HH-4 Panel

The HH-4 Hormone Health - Women panel can assist in diagnosing and managing a variety of conditions:

  • Polycystic Ovary Syndrome (PCOS): Abnormal levels of testosterone, LH, and SHBG can indicate PCOS, a condition characterized by hormonal imbalances and metabolic issues.

  • Menopause and Perimenopause: Fluctuations in FSH, LH, estradiol, and progesterone levels can help determine menopausal status, guiding treatment for symptoms and long-term health risks.

  • Thyroid Disorders: Abnormal prolactin levels, alongside other hormonal imbalances, may suggest thyroid function disorders, requiring further investigation.

  • Adrenal Disorders: Variations in DHEA sulfate and pregnenolone levels can point to adrenal health issues, impacting overall hormonal balance and well-being.

Using HH-4 Panel Results in Treatment and Monitoring

Healthcare professionals leverage the comprehensive data from the HH-4 Hormone Health - Women panel to:

  • Manage PCOS: Treatment may include lifestyle changes, medication to regulate menstrual cycles, and interventions to address fertility issues.

  • Navigate Menopause: Hormone replacement therapy and other strategies can be tailored based on a woman's specific hormonal profile to alleviate menopausal symptoms and address long-term health risks.

  • Address Thyroid and Adrenal Disorders: Treatment plans can be developed to manage these conditions, with ongoing monitoring to adjust therapy as needed.

The HH-4 Hormone Health - Women panel stands as the pinnacle of hormonal health assessment for women, offering a detailed and comprehensive evaluation of a wide range of hormones. This panel is instrumental in diagnosing, treating, and monitoring a variety of conditions, from reproductive health issues like PCOS and menopause to broader concerns such as thyroid and adrenal disorders. With the insights gained from this panel, healthcare providers can offer highly personalized and effective treatment plans, ensuring optimal health and well-being for women at every stage of life.

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

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