How to Get Hormone Levels Tested if You Have PCOS

Getting a PCOS diagnosis isn’t always straightforward. For many women, it can take up to 7 years after their first symptoms appear to give this condition a name. Yes, 7 YEARS. That delay often happens for many reasons. Symptoms are brushed off as “normal,” hormonal birth control pills mask underlying issues, and there’s no single test that can definitively diagnose polycystic ovary syndrome (PCOS).

To make things even more confusing, standard bloodwork may come back “normal,” even when you don’t feel normal at all. Broad reference ranges don’t always reflect what’s actually optimal for your body, which leaves many women struggling with symptoms without clear answers.

That’s why hormone testing is such an important step for women with PCOS. A more detailed hormone panel can help you connect the dots between suboptimal hormone levels and the symptoms you’re experiencing. Once you have that clarity, you can work with a doctor (or go at it on your own) to naturally support hormone balance and heal your body. 

In this post, I’ll walk you through how to get your hormone levels tested. I’ll also discuss which labs offer the most helpful, comprehensive insights for PCOS. And if you want to dive even deeper, be sure to listen to the episode of A Cyster and Her Mister called “Navigating PCOS Lab Testing with Dr. Kayla Smith: Key Markers for Diagnosis and Management.”

How to Get Hormone Levels Tested if You Have PCOS

Your hormones can tell you a lot about what’s really going on with your PCOS. But it’s not just about whether your hormone levels fall outside a “normal” range. It’s also about how your body is metabolizing, detoxing, and excreting those hormones—and whether they’re being cleared properly or recirculating and contributing to symptoms. 

Additionally, just because hormone levels are “in range” doesn’t mean they’re not the source of your problem. It’s all a lot more nuanced than that. To help you make sense of it all, here’s what you need to know about PCOS hormone testing:

Can You Have PCOS With “Normal” Hormone Levels?

The short answer: yes. Hormones are tricky. Lab values show what your hormone levels look like at a single point in time. However, they don’t show how those hormones are actually behaving inside your body.

For example, let’s say you’re experiencing symptoms of hyperandrogenism, like irregular periods, acne, or hair thinning. You get your hormones tested, and your androgen levels come back “normal.” So what’s going on?

First, standard hormone tests use very broad reference ranges. Even if your hormones fall within that range, they may still be suboptimal for your body. But let’s say your levels truly are optimal. Symptoms can still happen if androgens are interacting with your body differently. For example, they may be more active at the tissue level, converting into a more potent form. Or maybe the ratio of free testosterone may be off even though total testosterone looks normal. See what I mean?

The same concept applies to A1C, estrogen, and nearly every other hormone. It’s not just about how much of a hormone your adrenal glands or ovaries are producing. Instead, it’s about how your entire endocrine system is regulating, metabolizing, and responding to those hormones. That’s why even “normal” hormone panels can still be associated with health conditions like PCOS.

What Hormone Levels Indicate PCOS

Estradoil

Estrogen (Estradiol E2) levels in women with PCOS are usually normal or high. Even when it’s normal, though, it’s usually functionally dominant. In other words, it’s overactive and causing symptoms like:

• Irregular or heavy periods
• PMS or mood swings
• Difficulty losing weight 
• Breast tenderness
• Bloating

Progesterone

Often, Cysters are low in progesterone because of irregular or absent ovulation. When you have low progesterone, you experience a variety of symptoms, including:

• Irregular or absent periods
• Anxiety 
• Sleep issues
• Infertility 

Testosterone

Most women with PCOS have high levels of testosterone—and free testosterone is especially high. These androgens (aka male hormones) trigger a lot of chronic issues, such as:

• Hormonal acne
• Excess facial or body hair (hirsutism)
• Hair thinning or loss on the scalp
• Irregular menstrual cycles

If you feel like you relate, make sure to check out “Vitamins to Lower Testosterone in Women with PCOS.”

DHEA-S

DHEA-S is a precursor hormone, which means it converts into other hormones—most commonly testosterone and estrogen. Many Cysters have elevated DHEA-S, which can drive androgen excess. The result? Symptoms of high testosterone.

Cortisol

Cortisol is our stress hormone. Women with PCOS can have very high, dysregulated cortisol levels, which can make them experience:

• Fatigue 
• Weight gain 
• Anxiety and irritability
• Sleep issues
• Blood sugar instability 

Want to learn more about this connection (and ways to help it)? Listen to the episode of A Cyster and Her Mister called “High Cortisol Survival Kit.”

Insulin 

Insulin levels are almost always elevated with PCOS. Polycystic ovary syndrome is a hormone disorder, but it’s also a metabolic one. Insulin resistance triggers a chain of problems, including inflammation, high blood pressure, high cholesterol, and other hormonal imbalances. It’s the source of quite a few side effects, including:

• Intense cravings
• Weight gain or inability to lose weight
• Fatigue after meals
• Brain fog
• Acne
• Irregular menstrual cycles

Hemoglobin A1C

Hemoglobin A1C essentially measures your body’s glucose levels. But unlike measuring blood sugar at a single point in time, A1C represents long-term blood sugar levels. Many Cysters have elevated A1C levels, which further contribute to symptoms of insulin resistance.

Thyroid 

The thyroid has three major hormones: TSH, T4, and T3. Thyroid-stimulating hormone (TSH) is usually high while T4 and T3 are low. This is a result of insulin resistance and inflammation, which suppresses the thyroid and causes symptoms like:

• Fatigue
• Cold intolerance
• Hair thinning
• Constipation
• Difficult weight loss

To learn more, check out my post: “PCOS and Thyroid: Symptoms, Connections, and Solutions.”

How to Get Your Hormone Levels Tested with PCOS

Holistic/Functional Practitioners

To get the most comprehensive testing for PCOS, you can work with a holistic practitioner. Common examples include a functional medicine doctor (MD/DO), naturopathic doctor (ND), integrative hormone specialist, or a registered dietitian (if they run labs).

This is often the best approach for diagnosing PCOS, addressing root issues, and finding long-term symptom relief. However, it’s typically not covered by insurance, which means it can be expensive for many Cysters.

Primary Care Doctor 

A primary care doctor can also order basic bloodwork. Since this is normally covered by insurance, it’s often the most affordable option! These labs can be helpful as a starting point and are often used to rule out major issues. However, they only offer a broad overview of what’s going on. They’re not usually detailed enough for targeted healing or symptom management.

OBGYN or Fertility Clinics 

Because PCOS directly impacts the reproductive system, OBGYNs and fertility specialists are another common route for testing. This is where many Cysters first find out they have PCOS!

Testing at OBGYN offices or fertility clinics is usually more comprehensive than what a primary care doctor orders. In addition to basic labs, they often test anti-müllerian hormone (AMH), prolactin, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels. These can be really helpful, especially if improving fertility is your goal. 

These tests are often covered by insurance and provide more insight than standard bloodwork, though still not as in-depth as functional testing.

At-Home Lab Test Companies

You can also order bloodwork from home, depending on where you live. EquiLife even offers lab test kits designed specifically to assess PCOS-related hormone imbalances and nutrient deficiencies. (You can even get it 50% off for being a part of The Cysterhood.) 

These tests are very convenient and often more affordable than lab tests from a functional doctor. (That said, you still have to pay out of pocket.) 

The main downside is that you don’t have a provider to guide you through the results or help you create an informed, personalized action plan. EquiLife and other companies do offer that as an add-on. However, they won’t be long-term providers for you, and it ultimately increases the final cost. 

What Kind of Labs Do You Need for Hormone Testing?

Dried Urine Hormone Test

A dried urine hormone test shows how your body processes and clears hormones, not just how much you have. Instead of a single snapshot, it shows hormone patterns over time. This reveals whether hormones are being properly detoxed or recirculating like they’re supposed to.

Stool Hormone Test

Your gut plays a big role in hormone balance. (Here’s more on PCOS and gut health.) A stool test looks at digestion and the microbiome to see whether hormones (especially estrogen) are being properly eliminated. When gut health is off, hormones can be reabsorbed and worsen PCOS symptoms.

Hair/Tissue Mineral Analysis 

Hair or tissue mineral testing shows your mineral status over time, not just in the moment. Since minerals support hormone production, stress response, and insulin sensitivity, it’s important to know about potential imbalances!

Comprehensive Bloodwork

Comprehensive blood tests provide a baseline look not only at hormones but also at metabolic markers. While these labs don’t tell the full story, they are an essential piece of the puzzle for identifying red flags, supporting diagnosis of PCOS, and tracking progress.

Get your hormone levels tested in multiple ways to help you manage your PCOS symptoms.

PCOS healing is totally possible. Do you need lab work to reverse your condition? No. But it is super helpful for knowing exactly what root issues to target and for mapping your progress. A great first step is learning about PCOS and talking to your doctor about your symptoms. 

From there, we can support you through your healing journey! By downloading The Cysterhood app, you’ll unlock hundreds of PCOS resources like meal plans, exercise routines, educational materials, and an incredibly supportive community. These tools can help you find permanent relief from even your most challenging PCOS symptoms!

If you think you have PCOS and the hormone imbalances that go with it, read (or listen to) these guides next to kickstart your healing journey: