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Fertility and hormone testing guide · 2026
Blood LH and a urine ovulation strip measure the same hormone for very different purposes. Confusing the two wastes cycles.
Luteinising hormone (LH) is a pituitary hormone that triggers ovulation in women and stimulates testosterone production in men. A blood LH is usually drawn on cycle day 2 to 4 alongside FSH and estradiol to assess the hypothalamic-pituitary-ovarian axis. Home urine ovulation kits detect the mid-cycle LH surge for timing intercourse — a different job entirely. In men, LH separates a testicular cause of low testosterone from a pituitary one.
| Cycle timing (assessment) | Day 2–4, with FSH and estradiol |
|---|---|
| Ovulation timing | Home urine LH kits from around cycle day 10, not a blood draw |
| In men | With morning total testosterone and FSH |
| Key ratio | LH:FSH, sometimes raised in PCOS but not diagnostic on its own |
| Collection | At home in Bangkok or at 20+ MedEx sites nationwide; nurse-at-home draw available |
| Price | Listed on the MedEx lab test catalogue — same price nationwide |
Baseline assessment. A day 2–4 blood LH, with FSH and estradiol, tells you how the pituitary and ovary are communicating at rest. This is the version ordered in a fertility or cycle-disturbance workup.
Ovulation prediction. The mid-cycle LH surge lasts roughly a day and precedes ovulation by around 24 to 36 hours. Detecting it needs frequent sampling, which is why urine strips exist — a single blood draw is a poor tool for catching it unless carefully timed.
People often book a blood LH hoping to confirm ovulation and receive a low mid-follicular number that tells them nothing. If confirming ovulation is the goal, a day 21 progesterone (or seven days before the expected next period) is the appropriate blood test.
In polycystic ovary syndrome, LH is often disproportionately elevated relative to FSH, and a ratio above roughly 2:1 is a frequently quoted finding. It is a supportive observation, not a diagnostic criterion.
Current international guidance diagnoses PCOS on a combination of irregular ovulation, clinical or biochemical androgen excess, and ultrasound findings or AMH, with other causes excluded. LH:FSH appears nowhere in the diagnostic criteria — a substantial share of people with PCOS have a normal ratio, and the ratio can be raised in people without PCOS.
If PCOS is the question, the more useful draw is total testosterone, SHBG, DHEA-S, LH, FSH, prolactin, TSH, plus fasting glucose, HbA1c and a lipid profile. See the dedicated functional lab test panels for how these are grouped.
Confirming ovulation? A day-21 progesterone is the test you want.
LH stimulates the Leydig cells of the testis to make testosterone. When testosterone is confirmed low on two morning samples, LH tells you where the fault lies:
That last pattern matters. Anabolic steroid use suppresses the axis and can cause prolonged infertility; testing honestly and early gives more options. A confidential doctor consultation is the right setting for that discussion.
Low LH and FSH in women with absent periods raises functional hypothalamic amenorrhoea — typically driven by low energy availability, intensive exercise, significant weight loss or psychological stress — as well as pituitary causes. This needs clinical assessment, not more hormone panels.
High LH and FSH in women under 40 with absent periods suggests primary ovarian insufficiency and should be confirmed on a repeat sample 4 to 6 weeks later before any conclusion is drawn.
Raised prolactin suppresses LH and FSH and is a readily treatable cause of cycle disturbance and low libido, so it belongs in the same panel.
Not reliably. The LH surge lasts around a day, so a single blood draw usually misses it. To confirm that ovulation occurred, a progesterone level taken about seven days before your expected period is the appropriate test.
A ratio above roughly 2:1 is often quoted in polycystic ovary syndrome, but it is a supportive observation rather than a diagnostic criterion. Many people with PCOS have a normal ratio.
For baseline assessment, day 2 to day 4 of the cycle alongside FSH and estradiol. For ovulation prediction, home urine LH kits from around day 10 are the practical tool.
Alongside low testosterone, it points to a pituitary or hypothalamic cause rather than a testicular one. Suppressed LH with high testosterone strongly suggests exogenous androgen or anabolic steroid use.
Yes. Combined hormonal contraception suppresses LH and FSH, so results taken during use do not reflect underlying ovarian function.
Irregular cycles, acne or hair changes? Test the full panel in one draw.
Medical disclaimer: This article is general health information and does not replace medical advice, diagnosis or treatment. Laboratory reference ranges differ between laboratories and results must be interpreted alongside your symptoms, medicines and medical history. Speak with a qualified clinician before starting, stopping or changing any treatment. Service details, inclusions and prices can change — confirm them with MedEx before booking.
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