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Women's hormone testing guide · 2026
PCOS is diagnosed by combining findings, not by a single abnormal hormone. The blood panel exists mostly to exclude the conditions that mimic it.
There is no single PCOS blood test. Current international guidance diagnoses polycystic ovary syndrome when at least two of three features are present — irregular or absent ovulation, clinical or biochemical androgen excess, and polycystic ovarian morphology on ultrasound or a raised AMH — after other causes have been excluded. The laboratory panel therefore has two jobs: document androgen excess, and rule out thyroid disease, hyperprolactinaemia, non-classical congenital adrenal hyperplasia, Cushing’s syndrome and androgen-secreting tumours. A metabolic panel is then added because insulin resistance and cardiometabolic risk drive much of the long-term impact.
| Diagnosis | 2 of 3: ovulatory dysfunction, androgen excess, polycystic morphology or raised AMH |
|---|---|
| Core hormones | Total testosterone, SHBG, free androgen index, DHEA-S, LH, FSH, estradiol |
| Exclusion tests | TSH, free T4, prolactin, 17-hydroxyprogesterone (early morning, follicular) |
| Metabolic tests | Fasting glucose, HbA1c or OGTT, lipid profile, liver panel |
| Note on adolescents | Ultrasound and AMH are not used for diagnosis within 8 years of menarche |
| Price | Listed on the MedEx lab test catalogue — same price nationwide |
The 2023 international evidence-based guideline retains the Rotterdam approach: two of three features, with other causes excluded.
In adolescents within eight years of their first period, ultrasound and AMH should not be used for diagnosis, because multifollicular ovaries and high AMH are normal at that age. Irregular cycles are also common in the first years after menarche.
Total testosterone alone is often normal in PCOS. The more sensitive approach is total testosterone with SHBG, allowing calculation of a free androgen index or calculated free testosterone — SHBG is frequently low in PCOS because of insulin resistance, so the free fraction is raised even when the total is not.
DHEA-S is added to identify an adrenal contribution. A modest elevation is common and does not change management; a marked one changes the workup entirely.
Immunoassays are unreliable at female testosterone concentrations, so where the result will drive a decision, a laboratory using liquid chromatography-mass spectrometry is preferable. Check which methods are available in the MedEx lab directory.
Testing should ideally be done off combined hormonal contraception, which suppresses androgens and raises SHBG. A washout period is usually advised — discuss it with a clinician rather than stopping contraception unplanned.
| Thyroid disease | TSH and free T4 — both hypo- and hyperthyroidism disturb cycles |
|---|---|
| Hyperprolactinaemia | Prolactin — a treatable cause of irregular or absent periods |
| Non-classical congenital adrenal hyperplasia | 17-hydroxyprogesterone, drawn early morning in the follicular phase |
| Cushing’s syndrome | Screened only where clinical features are present, not routinely |
| Androgen-secreting tumour | Considered with rapid-onset virilisation and markedly raised testosterone or DHEA-S |
| Pregnancy | Excluded where periods have stopped |
These all run from a single draw with correct timing. The team can assemble the combination through MedEx functional lab testing.
Order the full PCOS panel — hormones, exclusions and metabolic markers in one draw.
Insulin resistance is present in a large share of people with PCOS, independent of weight, and drives much of the long-term risk — type 2 diabetes, dyslipidaemia, fatty liver, hypertension and gestational diabetes.
Guidance recommends assessing glycaemic status at diagnosis and periodically thereafter, with an oral glucose tolerance test preferred over HbA1c alone in higher-risk groups, including those planning pregnancy. A lipid profile and liver panel complete the picture, and blood pressure and weight should be recorded at every review.
Routine fasting insulin and HOMA-IR are not recommended for clinical diagnosis, despite their popularity online, because they are poorly standardised and rarely change management.
Where weight and glycaemic control are central, the MedEx weight and metabolic health service addresses the driver directly.
A PCOS diagnosis is the beginning of a management conversation, not the end of one. Priorities differ depending on what matters most to you: cycle regulation, managing hirsutism or acne, reducing metabolic risk, or conceiving.
Combined hormonal contraception is first line for cycle and androgen symptoms where pregnancy is not the goal. Metformin has a role in metabolic features. For those trying to conceive, letrozole is the recommended first-line ovulation induction agent. Lifestyle measures improve metabolic markers and ovulation, and should be framed around health rather than weight alone.
Book a doctor consultation or a specialist teleconsultation to build a plan around your own priorities.
No. PCOS is diagnosed by combining irregular ovulation, androgen excess and either polycystic ovarian morphology or a raised AMH, with other causes excluded. The blood panel documents androgen excess and rules out mimics.
Total testosterone and SHBG (for a free androgen index), DHEA-S, LH, FSH and estradiol; plus TSH, free T4, prolactin and early-morning follicular 17-hydroxyprogesterone as exclusions; plus fasting glucose or an OGTT, HbA1c, lipids and liver function.
Combined hormonal contraception suppresses androgens and raises SHBG, so results are not representative. A washout period is usually advised, but do not stop prescribed contraception without discussing it first.
International guidance does not recommend routine fasting insulin or HOMA-IR for clinical PCOS assessment, as they are poorly standardised and rarely change management. An OGTT or HbA1c is preferred.
In adults, current guidance accepts a raised AMH as an alternative to ultrasound for the polycystic morphology criterion. Neither should be used for diagnosis in adolescents within eight years of menarche.
No. Total testosterone is often normal in PCOS while the free fraction is raised, because SHBG is low. This is why SHBG should be measured alongside.
A diagnosis is only useful with a plan attached.
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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