Start with a question
Hormone results are only as useful as their timing. Before you add a test, know what question it answers. If a result won't change your plan, leave that test for now. Write the cycle day and any hormones the client takes on every request, so whoever reads the result can interpret it.
Test timing at a glance
| Area | Marker | When to draw | Watch for |
|---|---|---|---|
| Thyroid | TSH, free T4, free T3 | Morning, same laboratory each time | Thyroxine after the draw. Pause biotin for 3 to 5 days |
| Thyroid | TPO and thyroglobulin antibodies | Any time | Can be positive years before TSH moves |
| Cycle | FSH, LH, oestradiol | Day 2 to 5, ideally Day 3 | Day 1 is the first day of full bleeding. Not interpretable on the combined pill |
| Cycle | Progesterone | 7 days before the next period | Above 30 nmol/L suggests she ovulated. Read it once the period starts |
| Cycle | Testosterone, SHBG, FAI | Day 2 to 5, with the others | Always pair testosterone with SHBG |
| Men | Testosterone, SHBG, LH | Before 10am, fasting | Confirm a low result with a second test |
| Stress | Cortisol (blood) | Around 8am | One snapshot. Saliva across the day shows the rhythm |
| Stress | DHEA-S, prolactin | Any time, ideally morning | Stress, exercise and some medicines raise prolactin |
| Metabolic | Fasting insulin, glucose | After an 8 to 12 hour fast | Same conditions every retest |
This table is also on the one-page Part 2 cheat sheet (PDF), ready to print.
Counting back for progesterone
Progesterone peaks about a week after ovulation, which is about 7 days before the next period. Day 21 only works for a 28-day cycle, so count back from the client's usual cycle length.
| Usual cycle length | Draw progesterone on |
|---|---|
| 24 days | Day 17 |
| 25 days | Day 18 |
| 28 days | Day 21 |
| 30 days | Day 23 |
| 32 days | Day 25 |
| 35 days | Day 28 |
Once the period arrives, check the cycle length was what you expected. If it came earlier or later, read the result against the real timing, and repeat the test if the draw was off.
Reading progesterone
- A laboratory range printed for the whole cycle, such as 0.3 to 90 nmol/L, makes almost any value look normal.
- 7 days before a period, a level above about 30 nmol/L is consistent with ovulation.
- Between about 10 and 30 nmol/L, check the timing and repeat next cycle.
- Vively's optimal mid-luteal range is 40 to 90 nmol/L, against a typical mid-luteal laboratory range of 5 to 90 nmol/L. For a client trying to conceive, aim well above 30.
Ranges only apply at the right time
| Marker | When drawn | Typical lab range | Vively optimal |
|---|---|---|---|
| FSH | Day 2 to 5 | 2 to 10 IU/L | No separate optimal range |
| LH | Day 2 to 5 | 2 to 7 IU/L | No separate optimal range |
| Oestradiol | Day 2 to 5 | About 100 to 400 pmol/L | No separate optimal range |
| Progesterone | 7 days before the period | 5 to 90 nmol/L | 40 to 90 nmol/L |
| Total testosterone, women | Day 2 to 5 | 0.5 to 3.2 nmol/L | 1.5 nmol/L to the top of the lab range |
| Total testosterone, men | Before 10am, fasting | 11 to 40 nmol/L | 12 to 40 nmol/L |
| SHBG | With testosterone | Women 20 to 110, men 11 to 71 nmol/L | No separate optimal range |
Laboratories differ, especially for oestradiol and female testosterone, so read each result against the range printed on the client's report.
Irregular cycles, the pill and HRT
- Irregular cycles: draw on Day 2 to 5 of whichever period comes. For progesterone, aim for 7 days before the next expected period, read it once that period arrives, and repeat if the timing was off.
- No periods: any day will do, but absent periods under 45 are a GP conversation in their own right.
- Combined pill: it switches off her own cycle and raises SHBG, so FSH, LH, oestradiol and progesterone reflect the pill. Thyroid, insulin, iron and vitamin D are still useful.
- HRT: hormone levels rarely guide HRT; symptoms do. Dosing decisions stay with the prescriber.
Perimenopause
Over 45, with symptoms and a changing cycle, perimenopause is a clinical diagnosis. NICE and the Australasian Menopause Society advise against using FSH to diagnose it, because FSH swings from cycle to cycle: a normal result doesn't rule perimenopause out and a high one doesn't confirm it. Under 45, or when the picture is unclear, the GP may use FSH. A timed progesterone shows whether she is still ovulating, and thyroid, iron, insulin and prolactin show what else might be going on.
Testosterone in men
Testosterone is highest in the morning and drops after food, so draw it before 10am, fasting, and confirm a low result with a second morning test before acting on it. Read it with SHBG, free testosterone and LH, and with fasting insulin, weight and sleep. Low testosterone with a normal LH and insulin resistance is often functional and often improves with weight loss. Ask about snoring, because sleep apnoea lowers testosterone too.
Testosterone and SHBG in women
Always order SHBG with testosterone. A total testosterone that looks fine can still mean a high free androgen index (FAI) when SHBG is low, and high insulin lowers SHBG. Draw both on Day 2 to 5 with the other cycle hormones.
Stress hormones
DHEA-S is made by the adrenal glands and is stable through the day, so timing matters less. It falls with age, and a level that is low for age can reflect a long stress load. Cortisol changes hour to hour: a blood draw around 8am is one snapshot, while salivary cortisol across the day shows the rhythm, high on waking and low at night.
Red flags: straight back to the GP
- TSH above 5 or below 1 mIU/L, or free T4 outside the laboratory range.
- Prolactin above the range, especially with headaches, vision changes or nipple discharge.
- Testosterone well above the range in a woman, or rapid new hair growth or a deepening voice.
- Low testosterone in a man, confirmed on a repeat test. The GP confirms it, looks for a cause and decides on treatment.
- Periods stopping before 40, or a raised FSH at that age, to rule out premature ovarian insufficiency.
- Bleeding that doesn't fit: very heavy, between periods, after sex or after menopause.
- Very low morning cortisol with fatigue, weight loss or dizziness.
- No pregnancy after 12 months of trying, or after 6 months if she is 35 or older.
Source: Vively Practitioner Masterclass Part 2 with Dr Michelle Woolhouse, recorded 21 October 2026, and its cheat sheet (PDF). See the full session.
Request practitioner access to refer these markers for your own clients. You need to be a verified practitioner to refer the tests.
Is a Day 21 progesterone always taken on Day 21?
Only in a 28-day cycle. Draw it 7 days before the next expected period: Day 23 of a 30-day cycle, Day 18 of a 25-day cycle, Day 17 of a 24-day cycle.
Which day is Day 1 of the cycle?
The first day of full bleeding. Spotting before the period doesn't count.
Can I test sex hormones while a client is on the pill?
The combined pill switches off her own cycle and raises SHBG, so FSH, LH, oestradiol and progesterone reflect the pill. Thyroid, insulin, iron and vitamin D are still worth testing.
Does a blood test confirm perimenopause?
Not over 45. With symptoms and a changing cycle it is a clinical diagnosis, and FSH swings too much to confirm or rule it out. Under 45, or when the picture is unclear, the GP may use FSH.
When should a man have his testosterone tested?
Before 10am, fasting, and on a second morning if the first result is low. A test after an afternoon gym session or a meal can read falsely low.
Is blood or saliva cortisol better?
They answer different questions. A blood draw around 8am is a single snapshot. Saliva samples across the day show the rhythm, which is more useful for a client who feels wired but tired.
- National Institute for Health and Care Excellence. Menopause: identification and management (NG23).
- Australasian Menopause Society. Perimenopause and diagnosis of menopause.
- American Thyroid Association. Biotin and thyroid function tests.
- British Thyroid Foundation. Thyroid function tests.
- GPnotebook. Progesterone and the luteal phase.
- Yeap BB et al. Endocrine Society of Australia position statement on male hypogonadism. Medical Journal of Australia 2016.
- RANZCOG. Fertility and when to seek help.