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normal ranges for hormone tests in women

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Introduction

Sex hormones, or steroidal hormones, are important for hair growth. A lack of one or more of these hormones could lead to a absence of body hair in adults, but more significantly an over expression of steroidal hormones and/or a lack of antagonists to steroidal hormones can result in hirsutism (excessive body hair) and/or the development of female pattern baldness. Because of this a blood test to examine hormone levels may be desirable if a tentative diagnosis of androgen induced hirsutism or androgenetic alopecia is made.

It is rare for a man to suffer from systemic hormone abnormalities, although hyperandrogenicity in men is possible with some prostate and adrenal gland disorders. For women pre-menopause the story is somewhat different. Women may also rarely have an adrenal gland disorder, but much more common is a disorder of hormone production in the ovaries. Polycystic ovary syndrome (PCOS) is the most common problem that leads to a net excessive steroidal hormone activity. This may be associated with hirsutism, and in more severe cases, female pattern baldness. One of the simplest methods of diagnosing PCOS is with a blood test. In many cases of PCOS the hormone and hormone antagonist levels are altered. However, it is possible to have PCOS, but to have blood hormone values within the normal ranges. If a blood test comes back normal, but symptoms still suggest hormones are involved, doctors may need to resort to ultra sound scanning of the ovaries to confirm a PCOS diagnosis. A normal blood test result for a premenopasual woman still does not rule out androgen action on hair follicles, but it does help to determine if systemic problems like PCOS are behind the hair problem.

Post menopausal women may experience some degree of androgenetic alopecia as estrogen, an indirect antagonist of testosterone, diminishes. In severe cases women may develop a male pattern alopecia presentation with hairline recession. A blood test can be useful to confirm that hair loss post menopause is androgen mediated.

A comprehensive blood test (primarily for women) for steroidal hormones and antagonists would include:

  • Sex hormone binding globulin (SHBG)
  • Estrogens (usually only the estradiol (E2) form is tested)
  • Progesterone
  • 17 Hydroxyprogesterone (tested sometimes)
  • Dehydroepiandrosterone sulfate (DHEAS) and/or Dehydroepiandrosterone (DHEA)
  • Total testosterone (T)
  • Free testosterone (that testosterone which is not bound to other molecules like SHBG)
  • Androstenedione (possibly androstenediol too)
  • Prolactin (PRL)
  • Follicular stimulating hormone (FSH)
  • Lutinizing hormone (LH)

Although dihydrotestosterone (DHT) is the primary promoter of androgenetic alopecia it is not generally tested because DHT is a relatively unstable molecule and levels can vary significantly over a short space of time. In addition, the DHT in the blood stream is not a particularly good reflection of the DHT in hair follicles. Steroid hormone responsive hair follicles produce their own DHT through enzyme conversion of DHEAS and T that they receive through the blood stream. To define excessive systemic androgen activity doctors look at the DHEAS, testosterone, and androstenedione results.

Depending on the tentative diagnosis, other tests may be done alongside steroidal hormone tests. For PCOS, blood is also often tested for insulin levels to define insulin resistance which can be associated with PCOS. Thyroid hormones may also be tested as part of the evaluation as these hormones, though not steroidal in nature nor antagonists of steroid hormones, can have a significant impact on hair growth.

Note that in terms of understanding hirsutism and androgenetic alopecia, blood test results only present part of the story. The blood test results indicate what is going on systemically in terms of hormone production. A blood test does not provide an insight into hormonal activity in the skin and hair follicles. Skin and hair follicles produce their own enzymes that can convert mild androgens like DHEA into potent androgens like DHT. So it is possible to have normal blood test results but have significant androgenic activity in the hair follicles. A normal blood test result does not rule out a diagnosis of androgen induced hirsutism or androgenetic alopecia.


Standard test ranges of hormones in women

Note; only the basic adult ranges are listed here. During pregnancy, or when using hormone contraceptives, normal hormone activity undergoes significant changes that are not listed below. The values for children are also significantly different. Normal ranges will be slightly different in different laboratories as there is no calibration of the tests between different labs.

Hormone / antagonist
Estrus cycle / Life stage
Value
Progesterone (nanograms per milliliter or nano-moles per liter) Follicular phase < 1.5 ng/ml
(< 3.18 nmol/L)
  Mid luteal phase 3 20 ng/ml
(9.54 63.6 nmol/L)
  Postmenopausal 0 15 ng/ml
17-Hydroxyprogesterone (nanograms per deciliter or nano-moles per liter) Follicular phase 20 100 ng/dL
(0.6 3.0 nmol/L)
  Midcycle peak 100 250 ng/dl
(3 7.5 nmol/L)
  Luteal phase 100 500 ng/dl
( 3 15 nmol/L)
  Postenopausal < 70 ng/dl
(< 2.1 nmol/L)
17-Hydroxypregnenolone (nanograms per milliliter or nano-moles per liter) Pubertal 44 235 ng/ml
(1.3 7.1 nmol/L)
  Adult 53 357 ng/ml
(1.6 10.7 nmol/L)
18-Hydroxycorticosterone (nanograms per deciliter or pico-moles per liter) Recumbent (morning value) 22.9 27.7 ng/dL
(630 762 pmol/L)
  Upright (midday value) 43.7 53.5 ng/dL
(1202 1472 pmol/L)
Estrone (picograms per milliliter or pico-moles per liter) Follicular phase 30 100 pg/ml
(111 370 pmol/L)
  Ovulatory phase > 150 pg/ml
(> 555 pmol/L)
  Luteal phase 90 160 pg/ml
(333 592 pmol/L)
  Postmenopausal 20 40 pg/ml
(74 148 pmol/L)
Estriol (nanograms per milliliter or nano-moles per liter) Non pregnant < 2 ng/ml
(< 7 nmol/L)
  30 32 weeks pregnant 2 12 ng/ml
(7 42 nmol/L)
  33 35 weeks pregnant 3 19 ng/ml
(10 66 nmol/L)
  36 38 weeks pregnant 5 27 ng/ml
(17 94 nmol/L)
  39 40 weeks pregnant 10 30 ng/ml
(35 104 nmol/L)
Estradiol (picograms per milliliter or pico-moles per liter) Follicular phase

50 145 pg/ml
(184 532 pmol/L)

  Midcycle peak 112 443 pg/ml
(411 1626 pmol/L)
  Luteal phase

50 241 pg/ml
(184 885 pmol/L)

  Postmenopausal < 59 pg/ml
(< 217 pmol/L)
FSH (units per liter) Follicular phase 3.0 20.0 U/L
  Ovulatory phase 9.0 26.0 U/L
  Luteal phase 1.0 12.0 U/L
  Postmenopausal 18.0 153.0 U/L

LH (units per liter)

Follicular phase 2.0 15.0 U/L
  Ovulatory phase 22.0 105.0 U/L
  Luteal phase 0.6 19.0 U/L
  Postmenopausal 16.0 64.0 U/L
SHBG (nanomoles per liter) Follicular phase 24 200 nmol/L
  Luteal phase 48 185 nmol/L
  Contraceptives 89 379 nmol/L
  Postmenopausal 46 200 nmol/L
Dehydroepiandrosterone (DHEA) (nanograms per deciliter or nano-moles per liter)   130 980 ng/dl
(4.5 34.0 nmol/L)
Dehydroepiandrosterone sulfate (DHEAS) (micrograms per deciliter) Premenopausal

12 535 µg/dl

  Postmenopausal 30 260 µg/dl
Androstenedione (nanograms per milliliter or nano-moles per liter) Premenopausal 0.8 2.3 ng/ml
(2.8 8.0 nmol/L)
  Postmenopausal 0.3 0.8 ng/ml
(1.0 2.8 nmol/L)
Androstenediol (nanograms per milliliter)   0.2 2 ng/ml
Total testosterone - morning sample (nanograms per deciliter or nano-moles per liter)   6 86 ng/dl
( 0.21 2.98 nmol/L)
Free testosterone - morning sample (picrograms per milliliter or pico-moles per liter) 20 40 yr 0.6 3.1 pg/ml
( 20.8 107.5 pmol/L)
  41 60 yr 0.4 2.5 pg/ml
( 13.9 86.7 pmol/L)
  61 80 yr 0.2 2.0 pg/ml
( 6.9 69.3 pmol/L)
Dihydrotestosterone (nanograms per milliiliter or nano-moles per liter) Adult 6 33 ng/ml
(0.2 1.1 nmol/L)
Cortisol (micrograms per milliliter or nano-moles per liter) Morning sample 5 20 µg/ml
(140 552 nmol/L)
  Afternoon sample 2.5 10 µg/ml
(69 276 nmol/L)
Prolactin (nanograms per milliliter) Premenopausal 2 20 ng/ml
  Postmenopasual 0 15 ng/ml


An explanation of test results for sex hormones in women

Testosterone - Testosterone levels should be fairly low in women as compared to men. It is possible for a woman to have no testosterone production and still be healthy other than perhaps a diminished sex drive. In healthy women the majority of testosterone production (up to 70%) is derived from the conversion of DHEAS and androstenedione by enzymes within the skin. The rest is secreted direct from the ovaries and adrenal glands. An excess of testosterone, above the normal range signals a potential problem. Most doctors would consider a level above 50 ng/dl to be somewhat elevated. Above 100 ng/dl of testosterone in women is symptomatic of some kind of hyperandrogenism. If the testosterone is over 200 ng/dl an ovarian ultrasound is used to look for any ovarian tumors. The higher the testosterone level the more risk of hirsutism or androgenetic alopecia if there is no corresponding rise in androgen antagonists (estrogens and SHBG).

Estrogens - Estrogens come in several shapes and sizes but the common one and the one usually tested for is estradiol (E2). Estradiol concentrations in women vary considerably depending on age and the stage of the reproductive cycle. The normal range may be anywhere between 50-700 picograms per milliliter. At the time of ovulation the range may be between 100-400 picograms per milliliter. Estrogens antagonize (cancel out) the actions of androgen hormones so more estrogen in effect reduces androgen hormone activity. As such, an estrogen level at the higher end of the normal range is preferable in terms of reducing susceptibility to androgenetic alopecia. Currently, there is much debate about how estrogens may directly act on hair follicles. Hair follicles do express estrogen receptors so the follicle are directly responsive to estrogen hormone molecules. However, there is confusion as to what estrogens do to the follicles - whether they stimulate or inhibit hair growth. There may be a different response depending on the estrogen type. Abnormally high estrogen levels on day 3 may indicate existence of a functional cyst or diminished ovarian reserve - however, there are no reports of hair loss in association with abnormally high estrogen levels so the risk of hair loss seems to be a minor one.

Dehydroepiandrosterone (DHEA) - Dehydroepiandrosterone sulfate (DHEAS) is the sulfated form of Dehydroepiandrosterone (DHEA). DHEA is a relatively unstable molecule and it mostly gets converted to DHEAS before circulating in the blood stream. For the purpose of understanding androgenetic alopecia, DHEA and DHEAS can be regarded as basically the same thing. If DHEAS is over 700 micrograms per deciliter, an MRI is ordered to rule out and adrenal tumor. If the DHEAS is between 500 - 700 micrograms per deciliter, then further endocrine testing is usually needed to rule out adrenal hyperfunction such as adrenal hyperplasia. An elevated DHEAS level may be improved through use of dexamethasone, prednisone, or insulin-sensitizing medications. DHEA can be converted into more potent androgen forms, ultimately it can be converted into dihydrotestosterone by enzymes in the hair follicles. As such, A high DHEA level potentially suggests an increased susceptibility to hirsutism or androgenetic alopecia if there is no corresponding rise in androgen antagonists.

Follicle Stimulating Hormone (FSH) - 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. For healthy hair growth then, the ratio of FSH to LH should be roughly equal.

Luteinizing Hormone (LH) - A normal LH level is similar to FSH. An LH that is higher than FSH is one indication of PCOS.

Prolactin - 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 and associated hair problems also have hyperprolactinemia.

Progesterone (P4) - An elevated level may indicate a reduced fertility. 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 progesterone test may be more accurate if done first thing in the morning after fasting.

Sex Hormone Binding Globulin (SHBG) - Increased androgen production often leads to lower SHBG. This is a potential problem in terms of hair growth as SHBG is an antagonist to testosterone. SHBG binds to testosterone and renders it inactive. Bound testosterone cannot interact with androgen receptors on cells so it has no impact on hair follicles. A reduced SHBG level suggests a possible increase in susceptibility to hirsutism or androgenetic alopecia. The more SHBG there is the better in terms of healthy hair growth.


Normal ranges for hormone tests references

  • Fischbach FT. A manual of laboratory and diagnostic tests. Lippincott, Philadelphia, ISBN: 039755186X. 1998
  • Kratz A, Lewandrowski KB. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Normal reference laboratory values. N Engl J Med. 1998 Oct 8;339(15):1063-72.
  • Pasquali R, Vicennati V, Bertazzo D, Casimirri F, Pascal G, Tortelli O, Labate AM. Determinants of sex hormone-binding globulin blood concentrations in premenopausal and postmenopausal women with different estrogen status. Virgilio-Menopause-Health Group. Metabolism. 1997 Jan;46(1):5-9.
  • Greenspan FS, Baxter JD. Basic & Clinical Endocrinology. 4th ed. Norwalk: Appleton-Lange, 1994
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