Hormone Panel

Sex hormone-binding globulin (SHBG) is a protein produced by the liver that binds sex hormones in the bloodstream, making them biologically inactive. Only the unbound fraction — free hormone — is available to cells and tissues. High SHBG is common in perimenopausal women, women on oral estrogen therapy (oral estrogen significantly raises SHBG), and women with thyroid dysfunction or high-carbohydrate diets. When SHBG is elevated, a woman can have total hormone levels that appear normal but free (biologically active) levels that are frankly deficient — producing deficiency symptoms that a total hormone panel alone will miss completely.

A comprehensive hormone panel for women should include: estradiol, progesterone, total and free testosterone, DHEA-S, SHBG, LH, FSH, prolactin, TSH, free T3, free T4, and when indicated thyroid antibodies (TPO-Ab, TgAb), cortisol, and IGF-1. This is significantly more comprehensive than the two or three markers that routine primary care panels include. The combination of all of these markers — interpreted together with a patient's symptoms and clinical history — is what allows SPOKEmed to identify specific hormonal deficiencies and imbalances that standard care consistently misses.

Timing matters significantly for premenopausal women. Progesterone is best tested at days 19 to 21 of a 28-day cycle (mid-luteal phase), when it peaks. Estrogen and testosterone are best tested at days 3 to 5 (early follicular phase). FSH and LH are tested at day 2 to 3 for reproductive evaluation. For perimenopausal women with irregular cycles, testing is often done at multiple time points or through a DUTCH test, which captures a more integrated picture across the day.