Written by Jillian Gordon
Medically reviewed by Dr. Haleem Mohammed, Chief Medical Officer at Gameday Men’s Health
At a Glance
- A hormone panel looks beyond testosterone alone to see what’s behind your symptoms.
- Total testosterone measures what’s in your bloodstream, while free testosterone shows how much is readily available for your body to use.
- LH and FSH offer important clues about why testosterone is low and can help guide treatment.
- No single number tells the whole story. Your clinician will review your levels alongside your symptoms to make a proper diagnosis.
If you’ve recently made an appointment at a men’s health clinic to see if you might have a testosterone deficiency, chances are you want to know one thing: What’s your testosterone level? But your testosterone number only tells part of the story. Instead, your clinician will likely run a full hormone panel to look at all the hormones that might help explain your symptoms and provide a better overall picture of your health.
At Gameday Men’s Health, your initial workup doesn’t just focus on testosterone but on all key markers that can influence everything from energy and sex drive to fertility and how your body might respond to treatment.
Here’s a closer look at the key markers on a men’s hormone panel and what these numbers actually mean.
Testosterone and Free Testosterone
Before we get to the other key markers tested in a hormone panel, let’s start with the obvious: testosterone. When you get your testosterone checked, you might be surprised to see two numbers: one for “total testosterone” and the other measuring “free testosterone.”
“Total testosterone tells me how much testosterone is in the bloodstream. It doesn't tell me how much of it your body can actually use,” explains Dr. Haleem Mohammed, MD, MBA, Global Chief Medical Officer of Gameday Men’s Health.
Free testosterone, on the other hand, is the small portion that isn't bound to proteins and is therefore more readily available for your body to use. This is why looking beyond your total testosterone number is so important. You might experience the symptoms of low T but have a total testosterone number that falls in the normal range. Looking at both your total and free testosterone numbers helps your clinician better understand how much testosterone your body is actually using.
And a borderline result? That may require further exploration, says Dr. Hal. “A single number on a single day can mislead you. Testosterone moves around with sleep, illness, and time of day, so a borderline result may require more extensive labs like free testosterone.”
SHBG
Sex hormone-binding globulin (SHBG) is a protein that binds to testosterone and helps transport it through the bloodstream. Measuring SHBG levels can help your clinician better understand your total and free testosterone numbers. How? When SHBG levels are high, more testosterone is bound to the protein, leaving less free testosterone in the body. Low SHBG can have the opposite effect, resulting in more free testosterone.
“I tell patients to think of testosterone as money. Total testosterone is your net worth. SHBG is a locked savings account,” says Dr. Hal. “It grabs testosterone and holds it tight, and you can't spend it. A smaller amount sits loosely on albumin (a protein), which is like money in checking. You can get to it pretty easily. Free testosterone is the cash in your wallet. It's only about 2% of the total, and it's the testosterone that gets into your cells and does the work.”
Estradiol
You might think estradiol is a female-only hormone, but men need it too. In men, estradiol, the primary form of estrogen, is produced in part when testosterone is converted through a process called aromatization. Healthy estradiol levels play an important role in bone health, sexual function and overall hormonal balance.
Estradiol is also an indication of body fat, explains Dr. Hal. “Fat tissue converts testosterone to estrogen, and high estrogen tells the pituitary to shut down,” he shares. “In a heavy guy with low T, low LH and high estradiol, weight loss is part of the treatment.”
Estradiol may be measured during your initial evaluation, particularly when a clinician wants a fuller picture of a man's hormonal status, but it can also become important during ongoing testosterone replacement therapy (TRT) monitoring. Since testosterone can be converted to estradiol, estradiol levels may rise after treatment begins.
LH and FSH
If you’re wondering why your testosterone might be low to begin with, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are usually good indicators. LH signals the testes to produce testosterone, while FSH plays an important role in sperm production.
“If testosterone is low and LH and FSH are high, the brain is yelling and the testicles can't answer. That's primary hypogonadism, and TRT is usually the right move,” says Dr. Hal.
When testosterone is low but LH and FSH are also low or unexpectedly normal, the issue may involve the signaling between the brain to the testes, known as secondary hypogonadism. Understanding the difference can help your clinician prescribe the right course of treatment, especially for men who want to preserve fertility.
The Rest of the Hormone Panel
Beyond testosterone and reproductive hormones, your hormone panel may include several other markers that help your clinician better understand the source of your symptoms. These markers include:
- Prolactin: Elevated levels of this hormone produced by the pituitary gland can interfere with the signals involved in testosterone production and may warrant further evaluation.
- DHEA-S: An androgen produced primarily by the adrenal glands that can provide insight into adrenal hormone production.
- Cortisol: Often called the “stress hormone,” abnormal levels may contribute to symptoms that overlap with low T, including fatigue.
- IGF-1: A marker used to assess growth hormone activity, which plays a role in metabolism, muscle and tissue health.
- PSA: Prostate-specific antigen can provide a baseline for monitoring prostate health before and during TRT.
- TSH + Free T4: These markers evaluate thyroid function. Thyroid disorders can cause fatigue, weight changes, mood changes, and other symptoms that can sometimes be confused with low testosterone.
These numbers can help your provider determine whether low testosterone is behind your symptoms or whether another hormonal or health issue may be contributing to how you’re feeling.
How Doctors Read Your Hormone Panel
While each number on your hormone panel offers helpful insight, the real value comes from looking at how the results relate to one another. Here are some of the most common groupings Dr. Hal sees in his clinic and what story they tell:
- Low T, low or normal LH, high estradiol, overweight: “This is the most common guy in my clinic. Visceral fat, insulin resistance, often sleep apnea. Weight loss and sleep matter as much as testosterone.”
- Normal total T, low free T, symptomatic: “Usually an older or lean man with high SHBG. The total looks fine and he still has every symptom. Free T makes the diagnosis.”
- Low total T, normal free T: “Often a heavier man with insulin resistance and low SHBG. The total looks scary and the free T is fine. Fix the metabolic picture before treating the number.”
- Low T, high LH and FSH: “Primary. The testicles aren't responding. TRT.”
- Low T, low LH, high prolactin: “Stop and work up the pituitary.”
In other words, no single number indicates whether you have low T or what treatment you need. Your clinician considers the patterns shown in your lab results alongside your symptoms, health history and other factors to determine the right next step.
Once you start TRT, your hormone panel can help show how your body is responding to treatment. At Gameday, follow-up labs are typically checked at six to eight weeks after starting treatment. Your provider will use those results alongside your symptoms and any side effects to determine whether your treatment needs to be adjusted.
Jillian Gordon, Writer
Jillian Gordon is a Los Angeles-based writer with over a decade of experience covering health and wellness. She has written extensively about longevity science, gut and immune health, nutrition, and emerging wellness trends, with a focus on helping readers make informed decisions about their health.
Dr. Haleem Mohammed, Global Chief Medical Officer
Dr. Haleem Mohammed, MD, MBA, is the Global Chief Medical Officer of Gameday Men’s Health and an award-winning board-certified internal medicine physician specializing in men’s health and performance, including hormone optimization, weight management, erectile performance, peptide and vitamin therapy, musculoskeletal recovery solutions, longevity and precision medicine.
