Measuring blood levels of the major sex hormones—estrogen and progesterone in women and testosterone in men—can aid in the evaluation of a variety of conditions, including fertility problems and certain cancers with sex-hormone-producing tumors. Because abnormal levels of sex hormones are sometimes associated with dysfunction elsewhere in the endocrine system—primarily the pituitary and adrenal glands—this test may be performed in conjunction with other hormone tests.
Estrogen—predominantly in the form estradiol—is produced by the ovaries in response to signals from the pituitary gland, starting at puberty. The primary function of estradiol is to modulate the course of the menstrual cycle: Its secretion gradually increases over the first 2 weeks, reaches its peak during ovulation, and drops sharply right before the menstrual period. (Another form of estrogen, estriol, is the major estrogen produced during pregnancy.) After the menopause, estrogen levels drop to a consistently low level.
Progesterone, another female hormone produced by the ovaries, causes the lining of the uterus (endometrium) to thicken and develop in preparation for a fertilized egg. Levels begin to rise rapidly after ovulation; if egg implantation fails to occur, progesterone (and estrogen) levels drop sharply and menstruation occurs about 2 days later. In pregnant women, the placenta releases large amounts of progesterone to maintain the pregnancy.
Testosterone is the principal male sex hormone (androgen) secreted by the testes, starting at puberty. (In women, the adrenal glands and ovaries produce small amounts.) Levels begin to plateau at around age 40, and gradually decrease to one-fifth the peak level at age 80.
Purpose of the Sex Hormone Tests
- To evaluate menopausal status
- To aid in the diagnosis of tumors that are known to secrete estrogen, such as certain ovarian tumors
- To evaluate infertility or menstrual problems such as amenorrhea (loss of menstrual periods)
- To monitor fetal health in pregnant women
- To aid in the evaluation of feminization (the development of female characteristics such as enlarged breasts) in men
- To evaluate sexual maturity
- To aid in confirming ovulation and evaluate ovarian function in infertility studies
- To monitor placental health during high-risk pregnancies
- To evaluate male infertility or sexual dysfunction
- To help determine the cause of hypogonadism (decreased testosterone secretion)
- To aid in the evaluation of virilization (the development of male characteristics such as male-type baldness) in women
Who Performs It
- A nurse or technician will draw the blood sample.
- In men, testosterone levels vary slightly with the time of day—highest around 7 AM and lowest at 8 PM. The timing of blood sample collection must be carefully scheduled to coincide with or avoid times of peak secretion.
- Estrogen and progesterone tests may be repeated at specific times to coincide with different phases of the menstrual cycle.
- A recent nuclear scan may affect the results of estrogen and progesterone blood tests, since these hormones are often measured with a laboratory technique that utilizes a radioactive isotope (radioimmunoassay).
- A variety of medications—particularly hormone replacement therapies—can alter levels of estrogen, progesterone, and testosterone and interfere with the results.
Before the Sex Hormone Tests
- Inform your doctor about any medications, herbs, or supplements you are taking. You may be asked to discontinue certain agents before the test.
- Tell your doctor if you’ve recently undergone a nuclear scan.
What You Experience
- A sample of your blood is drawn from a vein, usually in your arm, and sent to a laboratory for analysis.
Risks and Complications
- Bruising of the skin and dizziness can occur.
After the Sex Hormone Tests
- Immediately after blood is drawn, pressure is applied (with cotton or gauze) to the puncture site.
- You may resume any medications withheld before the test.
- Blood may collect and clot under the skin (hematoma) at the puncture site; this is harmless and will resolve on its own. For a large hematoma that causes swelling and discomfort, apply ice initially; after 24 hours, use warm, moist compresses to help dissolve the clotted blood.
- The blood sample is sent to a laboratory for analysis. Your doctor will consider the results in the context of your age, your symptoms and physical exam, and the results of other tests.
- Abnormally high estrogen levels can occur with estrogen-producing tumors or severe liver disease such as cirrhosis. Low levels may indicate ovarian failure, pituitary dysfunction, or menopause. In men, elevated estrogen levels may result from testicular tumors.
- Elevated progesterone levels are associated with ovulation, pregnancy, ovarian cysts, certain adrenal gland disorders, or progesterone-producing tumors. Low levels may indicate dysfunction of the ovaries or pituitary gland or problems with a pregnancy.
- Abnormally high testosterone levels are associated with benign and malignant adrenal gland tumors and hyperthyroidism (overactive thyroid gland). Low levels may result from pituitary gland dysfunction, testicular or prostate cancer, orchiectomy (removal of the testes), estrogen therapy, or cirrhosis of the liver. In women, elevated testosterone levels may be caused by ovarian or adrenal tumors or polycystic ovary syndrome.
- Depending on the suspected problem, additional tests are likely to be necessary in order to establish a diagnosis.
- If a definitive diagnosis can be made, appropriate treatment will be initiated.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media