Your first hormone panel: how to read it in ten minutes
An order-of-operations guide for reading a six-marker hormone panel. What to look at first, which combinations actually matter, and how to spot the patterns that warrant a follow-up.
What to remember before reading on.
- 1Read in this order: SHBG → free testosterone → LH/FSH → prolactin and estradiol. Don't anchor on total testosterone first.
- 2Reference ranges are population-wide. Your number relative to your own baseline is more useful than where it sits in the band.
- 3Three patterns deserve a follow-up: low free T with high SHBG, low T with high LH, low T with low LH. Each points at a different cause.
- 4If everything reads inside the range and you feel fine, that's the test working as intended. The point of a baseline is the next test, in three years.
A hormone panel can look intimidating because it's six numbers all at once. The trick is reading them in the right order. None of the markers mean anything in isolation; they mean different things in combination.
This is how I read mine, and how I'd read yours. I'm a longevity researcher, not a clinician — take this as a navigation guide, not medical interpretation.
Step 1 — Look at SHBG first, not testosterone
Counterintuitive, but it works. SHBG (sex hormone-binding globulin) determines how much of your total testosterone is actually bioavailable. Without it, free testosterone is a guess.
Three quick reads:
- Very low SHBG (under 18 nmol/L) points at insulin resistance, obesity, or hypothyroidism. This is independently useful information about your metabolic health, regardless of testosterone.
- Very high SHBG (above 60 nmol/L) can be driven by hyperthyroidism, ageing, or oestrogen-dominant states. It's the most common reason a "normal-looking" total testosterone leaves a man symptomatic — too much of his T is bound and unavailable.
- Mid-range SHBG (25–45 nmol/L) means total testosterone is roughly trustworthy as a proxy for free.
If your SHBG is at either extreme, the rest of the panel reads differently. That's why it goes first.
Step 2 — Free testosterone, then total
With SHBG read, you can interpret free T. Reference ranges typically put free T at 9–30 ng/dL.
Pair it with total:
- Free T low, total T low, SHBG normal → genuinely low testosterone. Now ask why (Step 3).
- Free T low, total T normal, SHBG high → SHBG is binding too much. The total looks fine but the body is functioning at the free fraction.
- Free T normal, total T low, SHBG low → bioavailable T is fine despite the headline number. Symptoms unlikely from T alone.
- Free T high, total T high → uncommon in non-supplementing men. Worth investigating (exogenous androgens, adrenal pathology, rare tumours).
The free + SHBG pair tells you most of what total testosterone alone can't.
Step 3 — LH and FSH locate the cause
If testosterone reads low (free or total), LH and FSH tell you whether the problem is upstream or downstream:
- Low T, high LH, high FSH → primary hypogonadism. The brain is signalling, the testes aren't responding. Causes include past chemotherapy, varicocele, undescended testes, post-orchitis.
- Low T, low LH, low FSH → secondary hypogonadism. The brain isn't sending the signal. Causes include exogenous testosterone or anabolic use (often un-disclosed in the patient history), opioids, severe under-eating, prolactinoma.
- Low T, mid-range LH and FSH → compensated or transitional. Worth a repeat panel before any decision.
This is the diagnostic information you cannot get from a testosterone-only test. It's also the reason a panel beats a standalone draw for fertility-relevant questions.
If your testosterone is in range, LH and FSH still tell you something. High FSH with normal-looking T is an early signal of testicular stress and is the single most sensitive marker for impaired spermatogenesis.
Step 4 — Prolactin and estradiol catch the things easy to miss
Two markers that GP panels routinely skip and that a complete panel includes for a reason.
Prolactin. Adult male reference is roughly 4–15 ng/mL. Mild elevation (15–25) is often transient — stress, exercise, the draw itself. Persistently above 25 warrants further investigation; above 100 strongly suggests a pituitary adenoma. Either pattern explains low T, low libido, and ED in a way that "just a low T problem" doesn't.
Estradiol. Adult male reference is roughly 11–43 pg/mL. Both extremes are problematic in men:
- Very low E2 (often after aggressive aromatase-inhibitor use) is associated with low libido, joint pain, mood drift.
- Elevated E2 (often in higher body fat or with high-dose exogenous testosterone) is associated with water retention, gynecomastia, mood changes.
The mid-range is where you want to be. Aiming "low" is a common mistake.
Three patterns that warrant a follow-up
If you take nothing else from this, take these three:
- Low free T + high SHBG, with normal-looking total T. The classic "your number is fine but your body says otherwise." Worth a second panel and a clinician conversation.
- Low T + high LH/FSH. Primary hypogonadism. Different conversation than secondary; different intervention.
- Low T + low LH/FSH (especially with elevated prolactin). Possible pituitary cause. Imaging may be warranted; treatment can be specific and effective.
Anything else, in someone without symptoms, is information for tracking — not action.
What "everything in range" actually means
If your panel reads in the reference range across all six markers and you feel fine, the test has done what it's supposed to do. The value isn't in finding a problem — it's in having a baseline.
In three years, when something feels off or the relationship-or-kids conversation accelerates, you'll have your own personal reference to compare against. That's worth a lot more than the comparison to a population mean.
If your panel is one of the three follow-up patterns above, you have data to take to a clinician — and a baseline they can build on.
That's the use case the Hormone Panel 01 is built for. Re-read this post when your result lands.