Men's Hormone Panel: What Testosterone, LH, and FSH Tell Us

Written by Kristy Beard, MSN, APRN, FNP-C — Board-Certified Family Nurse Practitioner and Founder of Elevate Health and Wellness, serving patients across the Gulf Coast in Gautier, MS and Foley, AL.

Why One Number Is Never Enough

When a man comes to Elevate Health and Wellness with symptoms of testosterone deficiency — fatigue, reduced libido, brain fog, loss of muscle mass — one of the most important things Kristy Beard, MSN, APRN, FNP-C communicates is that a single total testosterone reading, while a useful starting point, cannot tell us what we need to know to make sound clinical decisions. Male hormonal health is a system — and understanding the system requires evaluating multiple markers together.

Total Testosterone: The Starting Point

Total testosterone measures the sum of all testosterone in the blood — both the portion bound to carrier proteins (primarily SHBG and albumin) and the small free fraction that is biologically active. The normal reference range in adult men is approximately 300 to 1000 ng/dL, though ranges vary by laboratory. A total testosterone below 300 ng/dL is generally considered low by most clinical guidelines, including those of the American Urological Association. However, a man with a testosterone of 310 ng/dL may have significant symptoms of deficiency while a man with a level of 500 ng/dL may be symptomatic if his SHBG is very high and his free testosterone is consequently low.

Free Testosterone and SHBG: The Bioavailable Fraction

Free testosterone — the unbound fraction that can actually enter cells and exert biological effects — is the most clinically relevant testosterone value. It is calculated based on total testosterone and SHBG (sex hormone-binding globulin). SHBG binds testosterone tightly, rendering it biologically inactive. Men with elevated SHBG — which increases with age, liver disease, hyperthyroidism, and certain medications — may have normal or even high total testosterone but very low free testosterone, producing full clinical symptoms of deficiency despite apparently adequate total levels.

LH and FSH: The Pituitary's Instructions

Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are produced by the pituitary gland to signal the testes to produce testosterone and sperm respectively. Evaluating LH and FSH alongside testosterone allows Kristy to determine the origin of testosterone deficiency. High LH with low testosterone indicates primary hypogonadism — the testes are failing to respond to adequate pituitary stimulation. Low or inappropriately normal LH with low testosterone indicates secondary hypogonadism — the pituitary is not generating the signal the testes need, which may point to a pituitary abnormality, significant obesity, chronic illness, or medication effect.

Estradiol, Prolactin, and the Complete Picture

Estradiol (E2) reflects the conversion of testosterone to estrogen via aromatase — a process that occurs primarily in fat tissue and becomes clinically relevant in men with obesity. Elevated estradiol can suppress LH and testosterone production and contribute to symptoms including breast tissue development, water retention, and reduced libido. Prolactin screens for prolactinoma — a pituitary adenoma that suppresses the entire HPG axis and is a treatable cause of secondary hypogonadism. Together, this complete panel gives Kristy the clinical map she needs to make accurate, individualized treatment recommendations.

Ready for a complete men's hormone evaluation? Visit our Men's Health and Hormones page at Elevate in Gautier, MS and Foley, AL.

Sources: American Urological Association. Testosterone Deficiency Guideline. auanet.org. | Endocrine Society. Male Hypogonadism Clinical Practice Guideline. endocrine.org.

This article is written by Kristy Beard, MSN, APRN, FNP-C, board-certified Family Nurse Practitioner and founder of Elevate Health and Wellness. Information provided is for educational purposes only and does not constitute medical advice. Please consult a licensed healthcare provider for personalized care.